Long, healthy lives cost more?

Did anyone else come across this bizarre news:

Actually, a long, healthy life costs more

The sub-headline proclaims that “treating obesity and smoking is cheaper than keeping folks fit.” According to the article, a recent Dutch study found that thin, healthy adults cost the health system more because they live longer. I find myself baffled - did the authors not think to include lifetime earning capacity into the equation? Surely productivity of healthier individuals - which translates into profits - counters the “excessive” healthcare costs they rack up during their long lifetimes, as Bloom/Canning and others (and logic) have pointed out. And what about quality of life for healthy vs unhealthy individuals? Would it not have made more sense to compare ANNUAL healthcare costs, rather than lifetime healthcare costs? Or to compare these figures to lifetime earnings/productivity? What was the point of this study? Were the authors trying to prove that, contrary to popular belief, turning the entire population into obese smokers will make the world a better place and save governments and health systems millions?

Good grief.

Oxford Health Alliance Launches World’s Most Comprehensive Chronic Disease Prevention Research Programme

The Oxford Health Alliance (OxHA), a global coalition with the aim of preventing the epidemic of chronic disease, is launching a groundbreaking public health research programme to enhance scientific knowledge about the effectiveness of community interventions in reducing the prevalence of chronic diseases. This programme, Community Interventions for Health, will determine what can be done in communities to prevent the further spread of obesity, tobacco use and related illnesses. The research will be conducted in China, England, India and Mexico, and PepsiCo Foundation is funding OxHA with a $5.2 million grant to support the three-year research project.

The research and intervention programme will directly impact more than two million people across the four sites and is expected to affect more than 16 million people in surrounding areas through regional policy changes. It is the first time such comprehensive community-based interventions will be undertaken and then evaluated across a number of different countries.

Beginning in Spring 2008, the CIH programme will use proven, sustainable strategies, such as coalition-building and education to target schools, workplaces, health centers and community centres. The study will also employ economic and policy changes, including increased access to nutritional information and healthy food choices as well as physical activity to improve health and reduce chronic disease. It will focus on three areas: nutrition, physical activity and reduction in tobacco use.

Professor Stig Pramming, Executive Director of the Oxford Health Alliance, says, “Despite the fact that chronic diseases are by far the world’s biggest killers, they are largely overlooked by governments and donor institutions alike, which is why the CIH programme is long overdue. The real tragedy is that heart disease, diabetes, lung disease and many cancers are almost entirely preventable through lifestyle changes alone, yet they are currently pushing healthcare systems to the brink, not to mention the impact they’re having on national economies.

“In fact, the World Health Organisation predicts that in the next 10 years, China, India and the UK will lose $558 billion, $237 billion and $33 billion, respectively, in foregone national income due to heart disease, stroke and diabetes.”

In each of the four intervention communities, to be specified at a later date, a number of policy changes will be implemented including:

• Smoke-free hospitals with healthy food options;
• Incentives and training for providers to screen for and prevent chronic disease;
• Affordable healthy food and drink in cafeteria and vending machines;
• Advertisement-free schools;
• 30 minutes of physical activity a day, three times per week for students;
• Affordable and accessible fruit carts or farmers markets in the local community;
• Healthy food choices at local establishments and at events;
• Safe routes for walking and bicycling;
• Health risk assessments and smoking-cessation programmes at work;
• Incentives for employees to participate in on-site and off-site physical activity.

The CIH programme will evaluate the health impacts of these interventions on 5,000 people in each community (which will be compared to a similar community), thereby providing a best practice road-map, which can be replicated in other sites around the world.

For more information about the CIH programme, visit the Oxford Health Alliance website at www.oxha.org/initiatives/cih.

Oxford Health Alliance launches redesigned 3four50 site

The Oxford Health Alliance (OxHA) recently launched a redesigned 3four50.com.

In November 2006, the OxHA first launched this new online ‘open space for health’, with an aim of harnessing the social networking power of the internet in order to promote chronic disease prevention. The name of the website reflects OxHA’s message of three risk factors leading to four chronic diseases contributing to more than 50% of deaths worldwide.

All of the content on the site is user-generated, and includes stories, blogs and vlogs (reflecting different cultural perspectives on health and comments/ideas from those wishing to share their views), high-profile guest interviews, photos, and full coverage of the 2006 Annual Summit, held in Cape Town, South Africa. Through these channels, 3four50 aims to facilitate communication of health messages in an innovative and compelling ways. For example, the website facilitates youth perspectives via personal stories and photography, and also hosts a world-wide campaign to attract personal stories and photography on health.

The new design for the site is based on feedback from delegates at the Cape Town summit and member input since then. The new site includes a networking facility, through which members can contact one another through the website. Other new features will include:

• The option to create a ‘private space’ where members can collaborate together on global chronic disease prevention projects
• A ‘Soapbox’ section that builds on the success of the ‘soapbox session’ at the Cape Town summit – this encourages the posting of short videos and other information about successful chronic disease prevention efforts from around the world.

Want to get involved? Here’s how:

Sign up for the 3four50 Network (including your photograph and biography) – to do so, register online, and add a photo and a short biography to the ‘profile’ that is created for you. From here, you can access the site’s new networking features described above.

P.E. Classes Turn to Video Game that Works Legs

The Dance Dance Revolution video game, popular among youth, is being increasingly used to get schoolchildren to exercise, and to be enthusiastic about it. Researchers have shown that regular users of the game can improve their fitness levels and markers of heart health.

Read the full article: http://www.nytimes.com/2007/04/30/health/30exer.html

Ovations launches global partnership to address chronic disease

Ovations, a UnitedHealth Group company, today announced a global partnership to address the growing epidemic of chronic disease, which today is responsible for sixty percent of all deaths worldwide. Ovations is partnering with the National Institutes of Health (NIH), the Oxford Health Alliance, and health care experts from around the world to develop specific strategies to address this critical public health issue in concert with governments, non-governmental organizations and the private sector globally.

The focus of the initiative will include:

• Raising awareness of chronic disease and the potential global impact
• Developing, implementing and sharing best practices on preventing and managing chronic illnesses at the local level
• Building systems and infrastructure to address chronic disease that could also be used to manage other diseases more effectively and sustainably.

“The dramatic rise in chronic disease, if left unaddressed, will have severe human consequences,” said Simon Stevens, Chief Executive Officer of Ovations, the UnitedHealth Group company dedicated to improving the health and well-being of Americans ages 50 or older. “The global economic impact of chronic disease is equally alarming - costing trillions of dollars, reducing worker productivity, keeping millions of people in hardship, and straining government budgets at all levels. Tackling chronic conditions effectively is key to improving the equity and sustainability of health care systems in the US and internationally,” said Stevens.

The Ovations Approach

In addition to raising awareness of chronic diseases, Ovations and its partners will focus on creating an effective infrastructure for sharing the knowledge and skills necessary to prevent, manage and treat chronic illnesses in developed and developing countries. This will include improving the cost-effective deployment of human, technology and financial resources within the national health care systems.

Ovations will work with governments, non-governmental organizations, non-profit groups, individuals and private companies to expand and accelerate effective and practical programs that support the initiative’s goals. As part of UnitedHealth Group’s Corporate Social Responsibility program, Ovations is committing up to $15 million in financial, managerial and in-kind resources over the next five years in support of the program, which is being developed in conjunction with the Clinton Global Initiative.

Global Advisory Board Formed

The Company has assembled a Global Advisory Board of leading health care experts to provide strategic direction and guidance for the program. Chaired by Dr. Richard Smith, Chief Executive Officer of UnitedHealth Europe and former editor of the British Medical Journal, the Advisory Board includes:

• Sir George A.O. Alleyne, Pan American Health Organization - Regional Office of the WHO
• Dr. Julio Frenk, The Gates Foundation
• Dr. Roger I. Glass, Director of the NIH’s Fogarty International Center and Associate Director for the organization’s international programs
• Dr. Lauren Leroy, Grantmakers in Health
• Dr. Liming Li, Vice President, Chinese Academy of Medical Science/Peking Union Medical College
• Dr. John Mach, Chief Executive Officer, Evercare Health Care
• Dr. Stephen MacMahon, Principal Director, University of Sydney, George Institute
• Dr. Victor Matsudo, President, Physical Fitness Research Center of Sao Caetano do Sul - CELAFISCS, and the founder of Agita Mundo, an international organization dedicated to the promotion of physical activity
• Dr. Bongani Mayosi, University of Cape Town
• Dr. K. Srinath Reddy, All India Institute of Medical Sciences
• Dr. Nizal Sarrafzadegan, Director, Isfahan Cardiovascular Research Center
• Marcia Smith, former Chief Executive Officer, Evercare Health Care
• Dr. Derek Yach, member of the board of the Oxford Health Alliance, an international partnership of governments, NGOs and corporations, which is confronting the epidemic of chronic diseases; Director, Global Health Policy for PepsiCo; Advisor to the Clinton Global Initiative; and former Executive Director of Non-communicable Diseases at the World Health Organization.

“We need to apply what we know about managing, treating and preventing chronic disease at the local level around the world,” said Dr. Smith. “This type of public-private partnership is the best way to identify, implement and share practical solutions for preventing and managing chronic disease globally. This approach is informed by the resources, expertise, commitment, knowledge and understanding of the local circumstances in countries around the world.”

“Already, the rising incidence of chronic illnesses is having an especially negative impact in the developing world - but if they are left unaddressed, the consequences could be catastrophic,” said Dr. Glass of the NIH. “There are many research questions that need to be answered. We’re proud to be part of this initiative, and expect that it will play an instrumental role in addressing this pressing public health challenge.”

Spring Summit to Launch and Coordinate Global Efforts

There will be a Spring Summit at the National Institutes of Health’s campus in Bethesda, MD on May 7 and 8. Co-hosted by the NIH, the event will bring together more than 20 experts on chronic disease from around the world to define global priorities, identify the most effective practical measures for preventing and managing chronic disease, and begin to organize collective efforts to fight the growth of chronic disease. Thomas Gaziano, MD, a member of the Harvard University faculty and an expert on cardiovascular disease in developing countries, has written a position paper that will form the basis of the discussion at the Spring Summit.

The Impact of Chronic Diseases

In 2005, chronic diseases - including cardiovascular disease, diabetes, cancers, and chronic respiratory disease - claimed nearly 35 million lives worldwide, a number that is expected to rise by more than 40% by 2020. These diseases are an interconnected epidemic often driven by urbanization, rapid industrialization and the resulting impact on lifestyle - poor diet, lack of physical activity, environmental strains, and the use of tobacco and alcohol cause most chronic diseases.

These long-term illnesses are not primarily diseases of the well-to-do, a common misperception. In fact, nearly 80% of those suffering from chronic disease are among poor populations in the developing world, where few nations are adequately prepared to handle the health care burden of both acute infectious diseases and chronic illnesses. Developing countries bear the greatest burden of this growing public health crisis, further impeding their economic growth. In just four countries - China, India, Brazil and Russia - it is estimated that the loss of national income from heart disease, stroke and diabetes totals more than $1.1 trillion.

About Ovations and UnitedHealth Group

Ovations, a subsidiary of UnitedHealth Group, is the largest company in the U.S. dedicated to meeting the health and well-being needs of people age 50 and older. It provides chronic disease management services, health insurance, Medicare-managed care and related services, access to prescription and non-prescription medications, and other healthy living products. It has a long track record of innovative partnerships with governments and not-for-profit organizations.

UnitedHealth Group is a diversified health and well-being company dedicated to making health care work better. The company directs its resources into designing products, providing services and applying technologies that improve access to health and well-being services, simplify the health care experience, promote quality, and make health care more affordable.

Headquartered in Minneapolis, Minn., UnitedHealth Group offers a broad spectrum of products and services through six operating businesses: UnitedHealthcare, Ovations, AmeriChoice, Uniprise, Specialized Care Services and Ingenix. Through its family of businesses, UnitedHealth Group serves approximately 70 million individuals nationwide. Learn more about UnitedHealth Group at www.unitedhealthgroup.com.

The Human Toll of Chronic Disease

Chronic disease - cardiovascular disease, long-term respiratory disease, cancer and diabetes - are the leading cause of death in the world, killing more than 35 million people in 2005 alone, a number that is expected to rise by more than 40% by 2020, six times more than the number of people who died from all communicable diseases such as TB, malaria and HIV/AIDS combined. These diseases also have a profoundly negative impact on the quality of life of those who suffer from them.

• Sixty percent of deaths around the world, encompassing both developed and developing nations, are the result of chronic disease.(1)
• Chronic disease is the leading cause of death and disability in the United States(2)
• More than 90 million Americans live with long-term illnesses.
• Heart disease and stroke, the most common cardiovascular diseases, and the #1 and #3 causes of death for both men and women in the United States, account for nearly 40% of all annual deaths.
• Today there are one billion people in the world who are overweight or obese - 200 million in China alone.
• In 1991, only four U.S. states had obesity prevalence rates of 15-19% and no states had rates at or above 20%. In 2004, seven states had obesity prevalence rates of 15-19%, and 42 states had rates at or above 20%, including nine with rates over 25%.
• Chronic diseases are a far more significant - and growing - problem in the developing world.3
• Eighty percent of long-term disease deaths are in low and middle-income countries. In China and India, long-term diseases account for 70% to 80% of deaths.
• Cardiovascular disease is now the leading cause of death in developing countries.
• The number of individuals with diabetes is estimated to increase from 171 million to 366 million by 2030 - or more than 19,000 new patients every day for the next 20 years.(4)
• Developing countries will bear the greatest burden, with 81% of global diabetes cases by 2030.
• Four of the five largest diabetes populations in the world are in Asia - India, China, Pakistan and Japan(5).
• Cancer incidence increased 19% between 1990 and 2000, mainly in developing countries.(6)

The Economic Impact

The economic impact of chronic disease is dramatic - costing trillions of dollars, reducing worker productivity, straining government budgets at all levels and keeping millions of people in poverty. Nearly 80% of those suffering from chronic disease are among the poor populations in the developing world, where few nations are adequately prepared to handle the health care burden of both infectious diseases and chronic illnesses.

• The medical care costs of Americans with chronic diseases account for more than 75% of the nation’s $1.4 trillion medical care costs.
• The United States cannot effectively address escalating health care costs without addressing the problem of chronic diseases.(7)
• The direct and indirect costs of diabetes are nearly $132 billion a year.
• The estimated direct and indirect costs associated with smoking exceed $75 billion annually.
• In 2001, approximately $300 billion was spent on all cardiovascular diseases. Over $129 in lost productivity was due to cardiovascular disease.
• The direct medical costs associated with physical inactivity were nearly $76.6 billion in 2000.
• It is estimated that the loss of national income in just four nations - China, India, Russia and Brazil - from heart disease, stroke and diabetes totals more than $1.1 trillion.(
• WHO estimates that the costs of treating diabetes may reach 25% of the total budget of Pacific Islands and Caribbean states.(9)
• It is estimated that one out of every three hospital bed-days in Latin America are occupied for diabetes-related causes, with average costs for a year of diabetes care at roughly $550 per person, exceeding most per capita gross domestic product health expenditures.(10)
• Thirty percent of poor Chinese households in 2005 attributed their poverty to health care costs.(11)
• In India, payroll losses from cardiovascular disease in a single year (2000) were estimated at $198 million.(12)

(1) World Health Organization
(2) Centers for Disease Control and Prevention
(3) World Health Organization
(4) Ibid
(5) BBC, 02/22/06
(6) World Health Organization
(7) Centers for Disease Control and Prevention
( World Health Organization
(9) Ibid
(10) Nature Medicine, (January 2006)
(11) Ibid
(12) World Health Organization

Robert Wood Johnson Foundation commits $500 million to reverse childhood obesity epidemic in U.S.

The Robert Wood Johnson Foundation (RWJF) today announced it will commit at least $500 million over the next five years to tackle one of the most urgent public health threats facing our nation: childhood obesity. This is the largest commitment by any foundation to this issue. The Foundation’s goal is to reverse the epidemic of childhood obesity in the United States by 2015.During the past four decades, obesity rates have soared among all age groups, more than quadrupling among children ages 6 to 11. Today, more than 33 percent of children and adolescents—approximately 25 million kids—are overweight or obese.

Preventing obesity during childhood is critical, because habits that last into adulthood frequently are formed during youth. Research shows that overweight adolescents have up to an 80 percent chance of becoming overweight or obese adults. Earlier onset of obesity leads to the earlier onset of related illnesses, such as type 2 diabetes, heart disease, stroke, and certain types of cancer.

In addition to the toll on our nation’s health, obesity also poses a tremendous financial threat to our economy and our health care system. It’s estimated that the obesity epidemic costs our nation $117 billion per year in direct health care costs and lost productivity. Childhood obesity alone carries a huge price tag-up to $14 billion per year in direct health care costs to treat kids.

“This is an all-American crisis,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of RWJF. “It affects all Americans, and it will require all of America working together to turn it around. Our commitment is a call to action for families, schools, government, industry, health care and philanthropy. To reverse the obesity epidemic and create a culture of health, we must provide families with better access to healthy choices.”

The Foundation will focus on improving access to affordable healthy foods and opportunities for safe physical activity in schools and communities. It will place special emphasis on reaching children at greatest risk for obesity and related health problems: African-American, Latino, Native American, Asian American and Pacific Islander children living in low-income communities.

“Individual choice and behavior are important, but the world we live in plays a big role, too. We have to make it easier for kids to eat well and move more,” said Lavizzo-Mourey. “That means more parks and safe places for kids to play, more grocery stores that stock affordable fresh produce, and improved school policies on nutrition and physical education. With this new commitment, we hope to foster more of these changes that will make it easier for families to raise healthy kids.”

For the past several years, RWJF has supported programs to address childhood obesity that offer potential for wide-scale change in communities and schools. These include efforts to bring supermarkets back to underserved communities and programs to improve nutrition, physical activity and staff wellness in schools nationwide. The Foundation also invests in research to determine which changes to school and community environments are most effective in increasing physical activity and improving nutrition for kids. The $500 million commitment will build on RWJF’s current work and foster the movement to reverse the childhood obesity epidemic.

“It’s impressive to see the Robert Wood Johnson Foundation make this commitment,” said former U.S. Surgeon General David Satcher. “The leadership statement this makes is tremendous. With so many serious problems in health and health care, RWJF’s investment highlights just how critical this problem has become and is a call to all the nation that past efforts have been too small, too slow and too fragmented. The childhood obesity epidemic already is affecting millions of young lives, and we know enough now to foresee the future harm it will impose-not only on our children’s health and quality of life, but also on our economy and health care system.”

With this investment, RWJF will expand school-based programs; help states and communities coordinate their efforts, advocate for change, and evaluate impact; and encourage food and beverage companies to offer healthier products and change their marketing practices.

(This is the press release posted on RWJF’s website. For more information, visit www.rwjf.org.)

Global Changing Diabetes Leadership Forum: Youth Report from Anja Nielson

Anja Nielsen is a 22 year-old Danish student of Molecular Biomedicine at the University of Copenhagen. A long time diabetes advocate, Anja was diagnosed with type 1 diabetes at the age of 14, in June 1999. Anja considers herself lucky to live with diabetes in Denmark, which provides easy access to free healthcare. Since January 2003 Anja has been a member of the Youth Council of the Danish Diabetes Association. Her areas of responsibility have been media and cooperation with Youth Councils in Sweden and Norway. Currently, she serves as the Vice President of the Youth Council. Anja is also a member of the Novo Nordisk Youth Panel and is an IDF Youth Ambassador. She is especially concerned with making it easier for everyone to lead a healthy lifestyle, as well as improving the psychological well-being and quality of life of those living with chronic diseases such as diabetes.

Here is her report from Novo Nordisk’s Global Changing Diabetes Leadership Forum.

On March 12-14, 160 delegates from 18 countries gathered in New York City to discuss the future of diabetes. A variety of different stakeholders were present, including industry, government officials, media, patient organizations and people with diabetes. When attending such meetings, I always wonder what the outcome will be. It’s great to put a lot of clever people with extensive networks in the same room and all agree that diabetes is a big problem.

But where do we go from there? The problem and urgency of the issue have been identified, now should be the time to implement some concrete initiatives for action.

Bill Clinton’s speech, as well as a Socratic Dialogue involving 12 panelists, provided a framework and overview of problems and the future we would like to see for diabetes. Then it was time to come up with ideas for solutions. The participants were grouped according to countries to determine which issues should have the highest priority and therefore be addressed first. Then actions and barriers to those actions were identified. For the group representing Denmark and Sweden, it was quickly decided that focusing on secondary prevention - that is, prevention of long term complications in those already diagnosed with diabetes - would have the greatest impact. This may be achieved through a greater focus on quality assurance and quality cycles in the care of patients. Also, education of general physicians caring for people with diabetes should be enhanced.

Dan Jørgensen, Member of the European Parliament, stressed the importance of working together with other interest groups to make a greater impact on politicians. When considering diabetes prevention, the goal is a healthier population overall. Therefore, it does make a lot of sense to collaborate with other organizations, working towards the same target.

The last day of the meeting was concentrated around sharing commitments for changing diabetes. The International Diabetes Federation (IDF) and Novo Nordisk committed to publishing documents that will complement each other. IDF will continue updating the Diabetes Atlas, which documents the problem of diabetes worldwide. Novo Nordisk will start publishing an annual Diabetes Barometer, which states the state of diabetes in countries all over the world. Is there a national diabetes plan? Is the plan followed up by political action and resources? Is it working? Are we breaking the curve of increasing incidence of people with diabetes? Novo Nordisk also acknowledges the need for transparency, measurability and driving change through being an example.

In Australia, an Obesity Declaration has been made. The mission is to reverse the rates of obesity and overweight, since Australia ranks high as being one of the fattest nations of the world. The goal is to prevent the rise in obesity by 2010 and reduce the number of obese and overweight children by 50% in 2015. This is being done by engaging key stakeholders because the current numbers regarding obesity and overweight in Australia are a cause for alarm and needs urgent action.

Martin Salkow, a 23 year old South African living with type 1 diabetes, made commitments on behalf of youth and as an IDF Youth Ambassador. We as young people have unique skills to contribute with, as young people are much more likely to listen to other young people than to the older generation. We can make changes because we have the passion it takes.

As a person living with diabetes who is very passionate about improving the lives of people with diabetes, looking back on the Leadership Forum gives me mixed feelings. I saw lots of commitment and passion but I would like to see some action. The example of the Obesity Declaration from Australia and the idea of a Diabetes Barometer from Novo Nordisk seem great, I look forward to following the progress of these initiatives and the ideas suggested for implementation back in Denmark.

For more information about the Forum, click here.

Break the silence

Break the Silence is a short film about diabetes seen from the perspectives of 25 IDF Youth Ambassadors from around the globe.

The video was filmed in December 2006 during the IDF Diabetes Congress in Cape Town, South Africa. The 25 Youth Ambassadors were gathered for a workshop to create an action plan for how they as young people living with diabetes can support the UN resolution on diabetes and contribute to ensure that the resolution is implemented in their home countries.

 

World’s Fattest Countries

Forbes recently published a list of the fattest countries around the globe. Here are some snippets from that article:

“No matter how you tip the scales, Americans are getter wider every year. What’s worse is that many nations are following suit.

In a list of the countries with the greatest percentage of overweight people, Nauru tops a list of countries with the greatest percentage of overweight people, with an alarming 94.5% of its adult population (ages 15+) classified as such, based on the most recent estimates by the World Health Organization (WHO). The Federated States of Micronesia, Cook Islands, Niue and Tonga round out the top five, all with a portly population of over 90%.

The U.S. weighs in at No. 9, with 74.1% of those over 15 years old considered overweight. But given that its population is nearly 20,000 times that of Nauru, clearly the U.S.’s size belies it rank.

Experts say it is not surprising that people across the globe are increasingly becoming overweight. They blame urbanization and the influx of Western ways of life including myriad fast food choices, little exercise and stressful jobs.”

The article also highlights the South Pacific, a region where changes in lifestyle, and its consequences, are evident.

Read the full article: Forbes.com

A Recipe for Success

The HEAL Partnership, part of the Prince of Wales’ International Business Leaders Forum, recently published a report on how the private sector can engage to promote health. A Recipe for Success: how food companies can profit from consumer health makes a series of recommendations as to how companies should address consumer health and obesity issues, from strategy and governance to reformulating products and funding consumer and employee health programmes. This final version of the report reflects the comments received from a wide range of stakeholders consulted between July and October 2006.

Recently, a growing trend shows that the private sector can, and should, engage in health issues. In so doing they will:

• Protect revenues, market share and profits, or open up new market opportunities, thereby retaining the confidence of shareholders.
• Maintain and enhance consumer trust and corporate and brand reputation - a highly valuable asset in consumer sectors.
• Demonstrate their ability to effectively respond to consumer health concerns through voluntary means, rather than being forced to do so through regulation.
• Avoid costly and brand-damaging future litigation, should further law suits arise.

The findings of the report can be summarized as follows:

1. Food manufacturers seem to be more engaged and more advanced than food service companies or retailers, and listed companies had more fully developed responses than private companies.

2. No one company has yet adopted and fully communicated publicly a comprehensive response, applied in all markets, for all products and divisions.

3. None of the 25 companies assessed for this report has yet conveyed a clear set of objectives applicable across the whole business to respond to consumer health and obesity issues worldwide, or a strategy to deliver on these objectives.

4. Few companies have set targets or adopted KPIs - this report provides recommendations on what such KPIs might be. Companies are encouraged to adopt these KPIs, as appropriate to their businesses.

5. Reporting mechanisms, governance structures, measurable targets and responsibility and accountability for consumer health and obesity issues all need to be more fully integrated into core business activities and reporting strategies. It is especially important for companies to put in place, and explain, how they ensure that policies adopted centrally by group boards are communicated and acted on by all divisions in all markets.

6. It is essential that companies demonstrate their genuine commitment to addressing consumer health issues by developing responses in countries and regions where changing trends in diet and lifestyle are emerging as serious public health issues, although they may not yet be as serious as in Western Europe and North America.

7. The paucity of examples in several sections of the report, including action on affordability and accessibility, portion size and calorie control, suggests that there is an opportunity for further corporate action.

8. Responsible marketing, advertising and promotion of food products, with particular reference to children, remains a key issue for the food industry. Further thinking and action in this area is essential. Responsible companies need to ensure that they develop acceptable new approaches to promoting healthy, balanced lifestyles and diets in the rapidly expanding opportunities in non-broadcast media.

9. Companies need to better articulate and report on their responses to consumer heath and obesity in their annual report and accounts, corporate responsibility reports and on their websites. It seems companies are doing themselves a disservice by not pulling together and disclosing more about their work and progress in this area.

10. Companies need to engage more effectively with their critics, both by inviting them onto formal advisory panels, as well as engaging with them directly or working with them in partnership to find practical solutions to the global overweight, obesity and related chronic disease crisis.

11. Food companies should also seek opportunities at local, national and international levels to work in partnership with other sectors with coincident interests, such as the sports and fitness sector, medical, insurance, TV, advertising and education sectors.

12. Companies need to do more to promote a balance of healthy eating and active living initiatives, especially through sport and physical activity programmes, and these should be set within a wider strategy. Designing such programmes to achieve specific health outcomes is also important, but currently does not seem to be done.

Go to the full report: http://www.iblf.org/docs/RecipeforSuccess.pdf