A hearty hello from Day #1 of the Partnership for a Healthier America’s Building a Healthier Future Summit, PHA’s first-ever conference that brings together 800 stakeholders to strategize in the war against childhood obesity. Day #1 was fantastic – the mix of stirring keynotes and major announcements made for lots of excitement. Although this is not the typical diabetes or obesity scientific meeting that we cover, we believe it is very important to track changes on the obesity front that start with children – the main focus of PHA. We are also increasingly watching wellness trends, as we believe they are central to considering likely changes in the diabetes population over time.
Yesterday, we heard inspiring keynote addresses from Honorary Vice Chair Dr. William Frist (Former US Senator, Tennessee) and Honorary Vice Chair Cory Booker (Mayor, Newark, NJ), as well as new PHA-sanctioned commitments from Hyatt Hotels (improving the nutritional content of its children’s and full menus – some big changes from a low base), Kaiser Permanente (to promote breastfeeding for its patients and its employees), and the Philadelphia-area chain Fresh Grocer (to build five new stores in areas with low access to healthy and affordable food). ChildObesity180, a network of leaders from the public and private sector, also announced its first initiative, which we also found quite striking – Healthy Kids Out of School – a collaboration between the 4-H, YMCA, Boy Scouts of America, Girl Scouts of America, and others that will work to foster better nutrition and more physical activity for nine million children by 2012. We applaud PHA for welcoming other organizations to announce commitments at the summit, even if these commitments don’t specifically pass through PHA’s rigorous partnership process. Indeed, Dr. Gavin, Dr. Frist, and Mayor Booker implied that PHA’s goal is to use its initial industry partnerships as a model for system-wide change, as other companies realize that “making the healthy choice the easy choice” is good for their bottom lines. We hope that these non-PHA- sanctioned commitments will have “teeth” and transparency, following the model of Walmart and other early PHA partners, so that the media and the marketplace reward only companies making real changes. (In our view, the Healthy Kids Out of School plan sounds like a good start but is too vaguely for us to understand its real impact – on the other hand, we really like the mantra that all the organizations will communicate to children “Drink right, move more, snack smart.) We think that major health and wellness institutions, many of which were well-represented at the summit (notably, healthcare industry represented a minority), will be important in driving demand for healthier options (and in educating people about which options are actually healthier).
One major, welcome theme of the day was that now is the time for action, not rhetoric. And while all conferences inevitably involve at least a tiny share of rhetoric, the evening closed with an action-packed and apropos dinner challenge – this is as differentiated and meaningful as conference dinners get! Two teams of gourmet chefs (Ming Tsai and Holly Smith vs. Tom Colicchio, Maria Hines, and ten-year-old crowd favorite Haile Thomas, a web-show host who had spoken earlier about how kids can be part of the solution) competed to cook a meal for four on a total budget of $10, the average received through the federal Supplemental Nutrition Assistance Program (SNAP). While each team made a three-course meal that seemed delectable to our San Francisco palates, the real challenge was pleasing the judges – especially a finicky six-year-old named Austin, who rated five of the six dishes at zero out of 10. Austin’s spit-the-salad-into-the-napkin maneuver reminded us that for real change to happen, demand must shift in lockstep with incremental changes in the food industry. Still, progress so far is encouraging, and as PHA Board Chair Dr. James Gavin (Emory University, Atlanta, GA) reminded us, the 6th-century BC philosopher Lao Tze said, “A journey of 1,000 miles begins with a single step.” Or, playing on a Steve Jobs quote, he noted that as we scale up to “go thermonuclear” on childhood obesity, political and economic considerations might make drastic changes difficult in the short term. Until then, Dr. Gavin said that if the only way to hit the target is with “arrows, stones, and spears, then…that is what we are going to throw.” A modest characterization, we think: if these multimillion-dollar, far-reaching partnerships are rocks and sticks, we can’t wait to see the heavy artillery.
- Executive Highlights
- Detailed Discussion and Commentary
Detailed Discussion and Commentary
BUILDING A HEALTHIER FUTURE
Cory Booker (Honorary Vice Chair, Partnership for a Healthier America; Mayor, Newark, NJ)
In the hands-down most engaging speech of the day, Mayor Booker called the audience to stand up for childhood health and education, which he believes to be the most important issues facing America. His address included a personal anecdote that included wisdom from his family, a catalogue of past US generations, and an update on progress he has witnessed in his home city of Newark. As big fans of Mayor Booker and proud members of his 1.1-million-strong Twitter following (@corybooker), we had been deeply excited to see him in person. Having now done so, we believe even more strongly that his passionate, dynamic, tech-savvy, and laugh-out-loud-funny leadership is one of PHA’s most valuable assets.
- Mayor Booker insisted that Americans cannot consider ourselves a “first-class” nation as long as we are headed in the wrong direction on childhood obesity – a point that he illustrated with a metaphorical (and funny) anecdote. He told a story from early in his career that involved realizing he was late for a flight, rushing through the airport, debating or cajoling every person who told him that it was “impossible” for him to get there in time (“My momma told me ain’t no such thing as impossible”), finally making it on board just before the plane took off, and even being bumped to a first-class seat, since all the others had been taken. The only problem, which he realized shortly after takeoff, was that the plane was headed to the wrong city, making his “first-class” seat beside the point. Analogously, he implied that the US cannot long consider itself the number-one democracy or number-one economy when it is also the number-one nation for obesity and healthcare costs associated with preventable disease.
- Every generation of Americans has been defined by its greatest challenge, said Mayor Booker, and ours is childhood obesity. He recounted major accomplishments of our forebears (with an emphasis on the role played by his hometown of Newark): theRevolutionary War, the Underground Railroad, World War II, and the civil rights movement. Today, more so than terrorism or the unemployment rate, Mayor Booker asserted (very convincingly) that the greatest challenge to our nation involves the health and education of the country’s children.
- “We must not let our inability to do everything undermine our commitment to do something […] this conference can be the catalytic agent to transformative change.” Mayor Booker called on the audience to stand against childhood obesity, transcending the “savagely sardonic cynicism” that too often permeates discussion in Washington DC. He noted that in Newark, a collaboration involving businesses and philanthropists recently created the largest parks expansion in the past century of the previously “under-parked” city; he said that companies such as General Mills, Nestle, and J&J have also led valuable city-level changes.
- Perhaps most compellingly, Mayor Booker reminded his listeners how much has been passed down by past generations and how much we owe the youth in our country – with a food-appropriate metaphor, to boot. “As people in this room,” he said, “We drink deeply from wells of freedom, liberty, and justice that we did not dig. We eat lavishly from banquet tables prepared by our ancestors. Will we be the first generation that does not nothing but consume? Or will we metabolize our blessings and let them burn a fire within us to continue the progress of our generation? We cannot be the first generation with children who are less educated, less healthy, and less productive. It’s time for us as individuals to say, with a chorus of conviction, ‘Not on my watch!’ I’m a prisoner of hope because I’ve seen what committed Americans can do in my city.”
- During a smaller conversation with media that included many questions about federal policy, Mayor Booker emphasized the importance of spending time and energy on problems that can be addressed immediately. He said that while he is among the first to argue that the farm bill needs reform and that “pizza is not a vegetable”, his constituents in Newark need healthy food as soon as possible (“My kids don’t have time to wait”). Moreover, he argued that the best place to make changes in America is at the community level, as seen in historical movements for civil rights and workers’ rights. Mayor Booker warned that we must not fall into a state of “sedentary agitation.” On the Partnership for a Healthier America, he said, “I celebrate this coalition because it is getting things done right here, right now.” While we had known that PHA was not policy-driven, we also hadn’t quite understood before this meeting how contentious many aspects of policy are in Washington; not only is PHA not pursuing change at the policy level, it sounds like most aspects of food related to policy (corn bill, subsidizing “real” fruits and vegetables, soda tax) are too controversial for most lawmakers and nonprofit organizations to even touch.
- Also during the time with media, Mayor Booker likened PHA’s work to that of the green movement. He noted that corporations have seen bottom-line gains if they advertise that products are “green,” and he expressed his hopes that similar benefits will accrue to companies that work to offer healthier food products. We agree that demand is starting to increase – and hope that companies can offer such “premium” healthier food products without a premium. We hope that PHA continues to enforce industry commitments and that consumers recognize which ‘better-for-you’ boasts are legitimate, so that the anti-childhood-obesity movement retains credibility in the years to come. (Many would argue that the green movement, by contrast, has been weakened by supposedly “green” products that are inherently excessive, like single-use water bottles, etc.)
William Frist, MD (Honorary Vice Chair of the Partnership for a Healthier America; Former Senate Majority Leader)
After Dr. Frist described the potential consequences of the current childhood obesity epidemic if left unaddressed, he optimistically expressed confidence that public-private partnerships which demonstrate that healthier choices can improve the bottom line for companies will be integral to reversing the epidemic at hand. While we agree with Dr. Frist that the federal government in its current state will not provide a solution to childhood obesity given partisanship and gridlock, we nonetheless hope that members of Congress will eventually transcend party lines and industry ties to act in the best interest of our nation’s health on the policy front – changing agricultural subsidies, and nutritional standards for school meals could have a profound impact on reducing childhood obesity. We also don’t believe that without policy changes to go alongside the work that PHA is making happen, that childhood obesity can end in a generation. By contrast, in the last generation, we look at what has happened with type 2 diabetes globally – the number of people with type 2 has increased from approximately 35 million in 1985 to 366 million in 2011. With this as a backdrop, we think the “ending” childhood obesity is an incredibly ambitious goal that will require work from all sides.
- Dr. Frist emphasized the urgency with which childhood obesity must be addressed, citing numbers and statistics on the prevalence, costs, and consequences of the epidemic. He noted that obese children are at higher risk of developing chronic diseases, including asthma, cancer, and diabetes; one third of all American children (half of all Hispanic children1) born in 2000 will develop diabetes during their lifetime. The costs of obesity are staggering – Dr. Frist stated that $73 billion in annual productivity losses are attributable to obesity. In addition, he suggested that the childhood obesity epidemic poses a threat to our national security – between 1995 and 2008, 140,000 individuals failed entrance exams for enlistment because they were too heavy.
- He expressed confidence that the solution to our current childhood obesity epidemic lays in public-private partnerships (involving businesses, foundations, philanthropists, etc.), not in government. Fundamentally, Dr. Frist believes that these partnerships need to make the healthy choice the easy choice, and show competitors that doing so can actually help to improve the bottom line. He stated that when companies are able to show their investors that they are able to improve their bottom lines by making healthier foods more accessible in underserved communities, the market would follow. Dr. Frist emphasized that companies can be financially strong while helping to end childhood obesity, that these two strategies are not mutually exclusive. In a study conducted by the Hudson Institute, it was determined that ‘better-for-you’ products account for just under 40% of groceries, while accounting for more growth in sales and 2.5 times the operating profit growth of other product lines. Dr. Frist believes that the consumer demand for healthier products already exists, and that the private sector merely needs to take advantage of that demand. Instead of “marketing gimmicks” such as writing checks to entities companies think customers will identify with, Dr. Frist proposed for companies to make meaningful commitments, such as those made by partners of the Partnership for a Healthier America.
COMMITITING TO A HEALTHIER FUTURE
A number of PHA and other announcements were made yesterday that contributed to an exciting first day of the meeting.
- Hyatt announced its commitment to improve the nutrition of its offerings for kids and adults. Senior Vice President of Operations Mr. Pete Sears noted that the hotel chain has committed to offer a fruit or vegetable as the standard side dish, and offer milk (eight ounces, with free refills) and water as the default beverage choices on their children’s menus by the end of November 2012. We felt this represented “real” change although it also shows the fairly low base for children’s meals at hotels now. Hyatt will also offer at least one item on its children’s menus that meets the MyPlate guidelines, featured as the first item on the menu – we like that this will receive more visibility though the fact that only one will meet the MyPlate guidelines was a little depressing overall. But as Dr. Gavin says – we must start somewhere! In addition, Hyatt has committed to reduce calories, sodium, and added sugar on its general menus by 2016, with at least 50% of these goals meeting these standards within three years. By 2016, Hyatt will offer at least two healthy meal options on their menus equal to or lower in price than less healthy options on the menu. We think this is terrific as long as they also work to make the meals appealing! Hyatt certainly has scale and for the hotel to be the first to take the step to improve wellness in families was terrific to see - annually, Hyatt serves over 24 million meals to people in the US, including over three million meals served to children. We wonder about the hotel’s international guidelines and what will happen as a result of changes in the US over time.
- Although not an official partner of Partnership for a Healthier America (PHA), ChildObesity180 announced that it has engaged with a number of the nation’s leading out-of-school-time programs to develop the Healthy Kids Out of School Initiative – a set of three unified principles that the organizations will adopt: These principals recall Michael Pollen’s “eat right, not too much, mostly plants” mantra. The principles are: 1) drink right – choose water instead of sugar-sweetened beverages; 2) move more – boost movement and physical activity in all programs; and 3) snack smart – fuel up on fruits and vegetables. Nine organizations have committed to the Healthy Kids Out of School Initiative – 4- H, the Boy Scouts of America, the Girl Scouts of the USA, the National Council of Youth Sports, US Youth Soccer, the YMCA, the National Council of La Raza, the National Urban League, and Pop Warner. Collectively, of course, these organizations have a reach in the tens of millions. Mr. Peter Dolan, Chairman of ChildObesity180, emphasized that the simple, unified message spread by these nine organizations could have a powerful effect, since kids would hear the same messages from staff and volunteers in multiple settings, thereby promoting and reinforcing healthy lifestyle behaviors. According to Mr. Dolan, this groundbreaking collaboration is a historic first, but only marks the beginning – ChildObesity180 is in the process of developing several other initiatives to address childhood obesity. We aren’t sure exactly how each organization will educate children on this front. For example, will Girl Scouts still sell cookies while trying to educate their girls to “snack smart”?
- Kaiser Permanente will introduce initiatives to promote breastfeeding in its hospitals that offer maternal and child health services. Dr. Edward Ellison, Executive Medical Director elect of Kaiser Permanente Southern California, explained that Kaiser is placing such a heavy emphasis on breastfeeding going forward, since it has been shown to lower the riskof overweight and obesity by 10-20% for infants, compared to those who are formula fed; breastfed babies also have reduced risk of diabetes, asthma, allergies, and a number of other health conditions. Kaiser will establish a system-wide program for the development and implementation of evidence-based hospital breastfeeding practices. By January 1, 2013, all 29 of Kaiser’s hospitals that offer maternal and child health services will report rates of exclusive breastfeeding at discharge – we liked this as it may prompt competition on this front, which should be a positive. In addition, Kaiser will develop and make a breastfeeding best practices guide (lessons learned, and an operational guide) publicly available to other hospitals such that they can improve care – we thought this was a terrific, collaborative move. All this said, we also think it would be terrific for Kaiser to have other initiatives that have “headline value” such as programs that motivate children (and adults) for results on the weight front, etc.
- Philadelphia-based The Fresh Grocer will open five grocery stores in or near food deserts in the mid-Atlantic region by 2016. An estimated 800,000 people are expected to gain access to healthy and affordable foods as a result. As a reminder, 23 million people live in areas in the US without access to healthy and affordable food.
- PHA Chairman Dr. James Gavin III reviewed other recent commitments, including ones with Darden (to improve the nutrition of its offerings on its children’s menus as well as its general menus; see http://www.ahealthieramerica.org/news-and-information/darden-commits), Walmart (to make packaged food products healthier, healthy groceries more available, and educate consumers with front-of-package labeling; see June 22, 2011 Closer Look at https://closeconcerns.box.com/s/as4v4t69xxypi7ncxynx), Walgreens (to convert at least 1,000 stores by 2016 into food oasis stores where people can access healthy, affordable foods), SuperValu (to open 250 Save-A-Lot stores in food deserts by 2016), Alabama-based Calhoun Grocer (to open 10 stores to serve individuals in low access areas by 2016), Brown’s Super Store (to build one store and expand one store [reopening December 14] in food deserts near Philadelphia), Klein’s Family Markets (to build one store in a low-access area in Baltimore), and Bright Horizons (to improve nutrition and physical activity at its childcare facilities; see June 22, 2011 Closer Look at https://closeconcerns.box.com/s/as4v4t69xxypi7ncxynx). In addition, he noted that the California Endowment, one of the founders of PHA, has pledged $200 million in financing and grants to new individual retail channels and innovative food distribution programs in California.
-- by Joseph Shivers, Vincent Wu, and Kelly Close
1 This is one half of Hispanic girls, actually – the reference is a little exaggerated (from JAMA 2003, Narayan KM). The full free text is online.