Fumbi Chima,
WalMart Executive
Leader, Women’s
Resource Council

2013 Global AConvene
ction Report
Food, Health, and Prosp...
Food, Health and Prosperity

GLOBAL ACTION PLATFORM

Global South Summit– Nashville

DIPLOMATIC COURIER | A Global Affairs...
2013 Global action RepoRt
Food, Health and Prosperity
Food, Health, and prosperity
Food, HealtH and ProsPerit y
Global Sou...
Founding Leadership
and governance
Honorary Chairs
Jack O. Bovender, Jr. | Retired Chairman
and CEO, Hospital Corporation ...
Announcing the 2nd Annual Global Summit:

Global South Summit - Nashville
November 11 & 12, 2013

Keynote Speakers:
Peter ...
contents

013

re convening and collaborating to
Platform in 2013.

The Global Food and Health Innovation
Challenge was an...
34

SECTION II: Abundant Health

35 THE FUTURE OF HEALTH
Editorial by Senator William H. Frist, M.D.

37 Transforming Heal...
contents
48

SECTION III:Abundant Prosperity
Building Global Innovation Hubs for Food and Health

49 THE FUTURE OF PROSPER...
62

SECTION IV: Perspectives

63 A Vision for Abundance:
Research and the Future
By Francis Collins
Director, National Ins...
INTRODUCTION

2013 Global
Action Report
Building a Global Action
Platform: Food, Health,
and Prosperity
by Dr. Scott T. Ma...
INTRODUCTION

I

n November 2012,
four hundred leaders from ten nations, representing
the corporate, research,
government,...
INTRODUCTION

Integrated themes:
Food, Health and
Prosperity
As this vision was explored, it
became clear that key conditi...
INTRODUCTION

capacity and promise to create
abundant food, health, and
prosperity for everyone on
the planet. Our approac...
nashville
collaboration | innovation | technology | you

Tennessee
Global Health.

driving innovation through colaboration...
56

more thaN

250

healthcare companies
have operations in

Nashville ranks as the

17th C i t y

GreeNest

in the Us

he...
REET

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NORTH
NASHVILLE

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DOWNTOWN
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0

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28TH AVE.

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WEST
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1

3

2
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6

5
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Avenue 31

2

C1TY Boulevard

high touch, pedestrian scaled
shopping and dining street.
lush, ped-fr...
Section I

Abundant Food
Feeding the Planet
As the world approaches a population of 9 billion,
we face an unprecedented ch...
Abundant Food

The Future
of Food

Editorial by Juergen Voegele, Director, Agriculture and Rural
Development, Sustainable ...
Abundant Food

Juergen Voegele,
Director, Agriculture
and Rural Development,
Sustainable Development
Network, The World Ba...
Abundant Food

Feeding the Planet
Where Do We Stand Today?
“We can do this! We can harness the power of agriculture to ach...
Abundant Food

We will need to leverage uncommon collaborations and build bridges with other “tribes” with
expertise in he...
Abundant Food

and livelihood. Poor families pull their children
out of school so they might be another source
of income f...
Abundant Food

seeds, training and credit. If women had same
access as men, their farm yields would increase
by 20-30%.
“F...
Abundant Food

7. Work collaboratively across disciplines
Sustainable change can happen. Sustainable
change can be scaled ...
Abundant Food

Faced with a growing world population, we
must move toward “sustainable intensification”–
increasing produc...
Abundant Food

1. Ownership of seeds. Only seven or eight
companies essentially own all the seeds in the
world. While most...
Abundant Food

more creative ways to produce food with less
regulation, especially by people who have never
farmed before....
Abundant Food

SITUATION
We understand one thing: with more people,
more health and more wealth, we will need to
move more...
Abundant Food

this should be provided for through industry
and not through government subsidies.
The reality is that we h...
Abundant Food

3. Promote technology.
Even relatively simple technologies can help
quite a bit. While many farmers are ill...
Abundant Food

At the table
Nutrition and Health

“I can envision future menus and food choices that can help to reverse o...
Abundant Food

munity is, in fact, partially responsible. For
example our restaurants tend to equate calories
as a functio...
Section Ii

Abundant Health
Healthcare Solutions
Practical innovations in patient care, advanced
technologies, and a new f...
Abundant health

The Future
of Health
Editorial by Senator William H. Frist, M.D.

I

t’s a common refrain that America ha...
Abundant Health

Senator, William H. Frist, M.D, former US Senate
Majority Leader, Clinical Professor of Surgery, heart
an...
Abundant Health

Transforming Healthcare
How Collaboration and IT Create
Game-Changing Innovation
SUMMIT PRESENTERS
• Keit...
Abundant Health

• Much of the population doesn’t have access
to primary care, causing them to go to the
emergency room fo...
Abundant Health

THE NEW MEDICINE
SUMMIT PRESENTERS
• Roy Elam, Instructional Systems Specialist, Directorate of Training ...
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
2013 Global Action Report: Food, Health, and Prosperity
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2013 Global Action Report: Food, Health, and Prosperity

  1. 1. Fumbi Chima, WalMart Executive Leader, Women’s Resource Council 2013 Global AConvene ction Report Food, Health, and Prosperity CumberlandCenter GLOBAL ACTION PLATFORM GLOB AL ACTION PLATFORM Global South Summit– Nashville Global South Summit– Nashville Challenge Heidi Kleinbach-Sauter, Senior Vice President PepsiCo Global Foods 2013 Jeanne McCaherty, Vice-President and Regional Director, Cargill Diplomatic Courier Food, Health A GlobalProsperity and Affairs Magazine Special Edition global Action Report | 1
  2. 2. Food, Health and Prosperity GLOBAL ACTION PLATFORM Global South Summit– Nashville DIPLOMATIC COURIER | A Global Affairs Magazine PUBLISHER | Medauras Global Editor-in-chief | Ana C. Rold Executive Editor, GAP | Cynthia H. Barbera Managing EDITOR, DC | Chrisella Herzog Managing EDITOR, GAP | Cheryl Harrison Assistant Editor | Calie Hill ADVISORY BOARD | Andrew M. Beato; Sir Ian Forbes; Lisa Gable; Kirk L. Jowers; Greg Lebedev; Anita McBride; Erik Peterson; Lisa Sutherland CONTRIBUTING EDITORS | Kathryn Floyd; Kaeleigh Forsyth; Whitney Grespin; Paul Nadeau; Paul Nash Art Director | Christian Gilliham Technology Officer | Kyle Herzog DC CONTRIBUTORS | Michele Acuto; Whitney Grespin; Steve Lutes; Boris Maguire; Oscar Montealegre; Paul Nadeau; Paul Nash; Rebecca Park; Richard Rousseau Photography/Design | Sebastian Rich; Naomi Slack; Doriano Strologo VIDEO Correspondent | Monica Gray VIDEO ASSISTANT| Jared Angle Editorial Interns | Ryan Burkhart; Bryce Bytheway; Akela Lacy; Madeleine Terry Mailing address | Diplomatic Courier 1660 L Street, NW, Suite 501 | Washington, DC 20036 publishing. The Global Action Report is a product of the Global Action Platform and the CumberlandCenter, published in concert with Diplomatic Courier magazine, a product of Medauras Global LLC. The Diplomatic Courier is printed six times a year and publishes a blog and online commentary weekly at www.diplomaticourier.com. editorial. The articles in this report both in print and online represent the views of their authors and do not reflect those of the editors and the publishers. The authors are responsible for the facts and interpretations. permissions. Authors and the Cumberland Center retain all copyrights to their articles. None of the articles can be reproduced without their permission and that of the publishers. For permissions please email the editors at: info@medauras.com with your request. ISSN. The Library of Congress has assigned: ISSN 2161-7260 (Print); ISSN 2161-7287 (Online). legal. Copyright © 2006-2013 CumberlandCenter and Global South Summit. All rights reserved. No part of this publication can be reproduced without written consent of the publishers. All trademarks that appear in this publication are the property of the respective owners. Any and all companies featured in this publication are contacted by CumberlandCenter and the Global South Summit to provide advertising and/or services. Every effort has been made to ensure the accuracy of information in this publication, however, the publishers and editors make no warranties, express or implied in regards to the information, and disclaim all liability for any loss, damages, errors, or ommissions. contact. For all editorial and/or publishing inquiries please contact: The Diplomatic Courier, 1660 L Street, NW, Suite 501, Washington, DC 20036, U.S. Fax: 202-659-5234. E-mail: info@diplomaticourier.org and editors@diplomaticourier.org. DIGITAL EDITION. To access this report in digital edition format, on your iPad, iPhone, or Android device, please visit www.diplomaticourier.com and enter this free token for password: 13361-1521-61147. 2 | WWW.GLOBALACTIONPLATFORM.ORG Leaders and innovators from Accenture, Chic Group Global - China, University of Florida and Sysco are exploring challenges of the food supply chain. Nashville welcomes global leaders, experts and entrepreneurs in food and health to attend its Global Summit in November. Leaders from UCSD Connect, Vanderbilt, Johns Hopkins, Maryland Industrial Partnerships and UC Davis explored topics on building life sciences clusters for innovation. Plenary Speaker, Dr. Francis Collins, Director of the National Institutes for Health, addresses an audience of over 400 leaders and Summit Fellows in Nashville, setting a new course for the future of health. Keynote speaker, Thomas Friedman, New York Times Pulitzer Prize-winning journalist spoke to audiences of 600 about the pressing need for innovation at the Global Summit, November 2012.
  3. 3. 2013 Global action RepoRt Food, Health and Prosperity Food, Health, and prosperity Food, HealtH and ProsPerit y Global South Summit– Nashville CumberlandCenter PLATFORM GLOBAL ACTION GLOBAL 2013 ACTION PLATFORM Global South Summit– Nashville Diplomatic courier A Global Affairs Magazine Special edition Global South Summit–four hundred leaders from five continents convened in In November 2012, Nashville Nashville for launch of the Global GLOBAL ACTIONthePLATFORM South Summit. Today, these leaders and our partners are working actively on issues critical to our world’s future: food, health, and prosperit y. In the Global Action Report that follows, we are pleased to share their ideas and recommended actions. The vision inspiring our work is abundance through innovation. Our goal is expanding opportunit y for all, so what is emerging is an entirely new platform for enhancing local, regional, and global economies through uncommon collaborations and investments that reward scalable and sustainable solutions. As we look to 2050 and an anticipated population of nine billion, creating smart strategies is of paramount importance. The next three to five years are critical. Many effective approaches have already been identified. Our growing cross-sector network of international partners from universities, business, government, foundations, media and committed individuals are working together to share solutions and advance new ideas. We stand at the threshold of new opportunit y and invite you to join us. Dr. Scott T. Massey Chairman and CEO Dr. Massey leads the CumberlandCenter, a university business alliance to transform innovation into prosperity. He serves as Founding Chairman of the Global South Summit, an annual global event focused on creating abundance through innovation in food, health, and prosperity. CumberlandCenter GLOBAL ACTION PLATFORM GLOBAL ACTION PLATFORM Global South Summit– Nashville Global South Summit– Nashville global Action Report | 3
  4. 4. Founding Leadership and governance Honorary Chairs Jack O. Bovender, Jr. | Retired Chairman and CEO, Hospital Corporation for America Arlene Garrison | VP, University Partnerships, Oak Ridge Associated Universities Phil Bredesen | Former Tennessee Governor Steve Brophy | VP, Government Affairs, Dollar General Corporation Ernesto Brovelli | President, Sustainable Agriculture Initiative; Senior Manager, Sustainable Agriculture, The Coca-Cola Company Congressman Jim Cooper Ryan Doyle | President, oneC1TY Harvill Eaton | President, Cumberland University Kitty Moon Emery | President and CEO, KittyMoon Enterprises; Senior Strategist, CumberlandCenter Beth Fortune | Vice Chancellor for Public Affairs, Vanderbilt University Darrell S. Freeman | Chairman, Zycron, Inc. Jim Frierson | President, Compass Innovation Senator Bill Frist | Former Majority Leader, U.S. Senate Jose Gonzalez | Co-Founder, Conexión Americas; Instructor of Management & Entrepreneurship, Belmont University Keith Gregg | Chairman and CEO, JRG Ventures; Entrepreneur-in-Residence for Health Technology, Nashville Entrepreneur Center Cynthia H. Barbera | Executive Editor, Global South Summit; Founder, e-Global Reader LLC Cheryl Harrison | President, Harrison Design Group; UC Davis Trustee Emeritus & Advisor, UC Davis College of Agriculture & Environmental Sciences Ralph Hexter | Provost, University of California, Davis Carol Hudler | President and Publisher, The Tennessean John Ingram | Chairman, Ingram Industries Inc.; Chairman and CEO Ingram Content Group Clay Jackson | SVP, Regional Agency Manager, BB&T, Tennessee Conrad Kiechel | Director of Communications, Milken Institute Rev. Timothy Kimbrough | Dean and Rector, Christ Church Cathedral L. Randolph Lowry | President, Lipscomb University Scott T. Massey | Chaiman and CEO, CumberlandCenter; Chairman, Global South Summit Alex McCalla | World Bank (retired); Professor Emeritus Agricultural and Resource Economics, UC Davis Paul McElearney | Membership Development, Clinton Global Initiative April McMillan | Manager, Secure Biosystems Integration, Oak Ridge National Laboratory Clayton McWhorter | Founder, Clayton Associates John Morgan | Chancellor, Tennessee Board of Regents Trent Nichols | CMO, Secure Biosystems Integration, Oak Ridge National Laboratory Brad Perkins | SVP, Strategy and Innovation, Vanguard Health Mike Shmerling | Chairman and CEO, Choice Food Group; Managing Partner, XMi High Growth Development Fund Howard Shapiro | Chief Agronomist, Mars Incorporated Thomas J. Sherrard | Founding Partner and Member, Sherrard & Roe, PLC Deborah Wince Smith | President and CEO, Council on Competitiveness Remy Szykier | Co-Founder, Aegis Health Security Steve Turner | Principal, Market Street Enterprises Juergen Voegele | Director, Agriculture and Rural Development Department, Sustainable Development Network, The World Bank 4 | WWW.GLOBALACTIONPLATFORM.ORG 2013 Cross-sector task forces are convening and collaborating to create the Global Action Platform in 2013. The Global Food and Health Innovation Challenge was announced on March 26, 2013 with a starting $1 million award for transformative solutions. (From L to R): Dr. Scott Massey, Chairman, joins Mark Cackler of the World Bank, Mike Shermling, CEO, Choice Foods Group and Sam Lingo, COO, Entrepreneur Center. Mars Incorporated, Chief Science Officer, Harold Schmitz lead a discussion on a collaborative approach to sustainable food and the role of private sector business.
  5. 5. Announcing the 2nd Annual Global Summit: Global South Summit - Nashville November 11 & 12, 2013 Keynote Speakers: Peter Diamandis Fareed Zakaria Peter Diamandis is an engineer and Intel entrepreneur, founder and chairman of the X PRIZE Foundation. He is also the co-founder and chairman of Singularity University and the co-author of the New York Times bestseller book, Abundance. Fareed Zakaria is a columnist and editor of Newsweek International. In 2010 he became editor-at-large of Time. He is the host of CNN’s Fareed Zakaria GPS. He is also a frequent commentator and author about issues related to international relations, trade, and American foreign policy. Communicate Convene CumberlandCenter GLOBAL ACTION PLATFORM GLOBAL ACTION PLATFORM Global South Summit– Nashville Global South Summit– Nashville Connect Fumbi Chima, WalMart Executive Leader, Women’s Resource Council Michael Norris, Chief Operating Officer, Sodexo North America Challenge Heidi Kleinbach-Sauter, Senior Vice President PepsiCo Global Foods 2013 Jeanne McCaherty, Vice-President and Regional Director, Cargill Food, Health and Prosperity global Action Report | 5
  6. 6. contents 013 re convening and collaborating to Platform in 2013. The Global Food and Health Innovation Challenge was announced on March 26, 2013 with a starting $1 million award for transformative solutions. (From L to R): Dr. Scott Massey, Chairman, joins Mark Cackler of the World Bank, Mike Shermling, CEO, Choice Foods Group and Sam Lingo, COO, Entrepreneur Center. 10 INTRODUCTION Building a Global Action Platform for Food, Health and Prosperity By Scott T. Massey Chairman and CEO, CumberlandCenter chairman, Global South Summit Annual Announcing the 2nd 18 Global Summit: SECTION I:Global South Summit - Nashv Abundant Food November 11 & 12, 2013 19 The Future of Food Editorial by Juergen Voegele Director, Agriculture and Rural Development Sustainable Development Network, the World Bank Keynote Speakers: 21 Feeding the Planet: Where Do We Stand Today? Peter Diamandis Fareed Manager, Agriculture and Environmental Services Mark Cackler, SectorZakaria The World Bank Group Role of Business: Harold Schmitz, Mars Inc. Role of Government: Bill Lacy, UC Davis Role of Foundations and NGOs: Prabhu Pingali, Bill and Melinda Gates Foundation Role of Research: April McMillan, Oak Ridge National Laboratory Peter Diamandis is an engineer and Fareed Rosenzweig, and Role of Finance: William Zakaria is a columnistPhysic Ventures Intel entrepreneur, founder and chaireditor of Newsweek International. In 2010 he became editor-at-large of man of the X PRIZE Foundation. He is also the co-founder and chairman of Singularity University and the co-author of the New York Times bestseller book, Abundance. 25 Growing Abundantthe host of CNN’s Fareed Time. He is Food: Zakaria GPS. He is Global Trends in Food Securityalso a frequent Frederick Vossenaar, commentator and author about issuesAffairs, Ministry of Economic related to international relations, Agriculture & Innovation, Royal Netherlands trade, and American foreign policy. Kent Bradford, Seed Biotechnology Center, UC Davis Michael (Mike) Dimock, Roots of Change Sylvia Ganier, Green Door Gourmet 28 From Harvest to Table: Preservation, Logistics and Distribution Rob Howell, Sysco Systems Jeffrey K. Brecht, University of Florida Rich Kottmeyer, Accenture Edward Zhu, CHIC Group Global Communicate Mars Incorporated, Chief Science Officer, Harold Schmitz lead a discussion on a collaborative approach to sustainable food and the role of private sector business. Convene Connect Fumbi Chima, WalMart Executive Leader, Women’s Resource Council 32 At the Table: Nutrition and Health Roy Elam, Vanderbilt Center for Integrative Health Greg Drescher, Culinary Institute of America David Schmidt, International Food Information Council (IFIC) CumberlandCenter GLOBAL ACTION PLATFORM GLOBAL ACTION PLATFORM Global South Summit– Nashville Global South Summit– Nashville 6 | WWW.GLOBALACTIONPLATFORM.ORG Mic Chi Offi No Challe He Sen Pep 2013 Jeanne McCaherty, Vice-President and Regional Director, Cargill Food, Health and Prosp
  7. 7. 34 SECTION II: Abundant Health 35 THE FUTURE OF HEALTH Editorial by Senator William H. Frist, M.D. 37 Transforming Healthcare: How Collaboration and IT Create Game-Changing Innovation Keith Gregg, Chairman and CEO, JRG Ventures James Lakes, Director US Health and Life Sciences, Microsoft Douglas Wenners, SVP, Provider Engagement and Contracting, Wellpoint-Anthem Jordan Shlain, Commissioner, San Francisco Health Service Systems; Founder, HealthLoop, & practicing physician at Private Medical Services 39 The New Medicine Roy Elam, Medical Director, Vanderbilt Center for Integrative Health Steven Burd, President and CEO, Safeway, Inc. Brent Parton, Program Director, Shout America Wayne Riley, President, Meharry Medical College 41 The Future of Hospitals and Hospital Management Jordan Asher, CMO and CIO, Mission Point Health Partners Martin Rash,Chairman and CEO, RegionalCare Hospital Partners Trent Nichols, Senior Research Staff, Chief Medical Officer, Secure Biosystems Integration, Oak Ridge National Laboratory Landon Gibbs, Director of Healthcare Initiatives of Clayton & Associates 44 Personalized Medicine: Treating the Unique Jeff Balser, Vice Chancellor, Vanderbilt Medical Center Raymond DuBois, Jr., Provost and Executive Vice President, The University of Texas MD Anderson Cancer Center Dan M. Roden, Assistant Vice Chancellor for Personalized Medicine, Vanderbilt University School of Medicine global Action Report | 7
  8. 8. contents 48 SECTION III:Abundant Prosperity Building Global Innovation Hubs for Food and Health 49 THE FUTURE OF PROSPERITY Editorial by Christian Ketels Director, The Competitiveness Institute (TCI) Institute for Strategy and Competitiveness, Harvard Business School 51 the Future of American Research Francis Collins, Director, National Institutes of Health Ted Abernathy Jr., President and CEO, Southern Growth Policies Board Arlene Garrison, Vice President of University Partnerships, Oak Ridge Associated Universities Nickolas S. Zeppos, Chancellor, Vanderbilt University 54 International Perspectives on Health, Food and Sustainability David Schmidt, President and CEO, International Food Information Council (IFIC) Anne-Christine Langselius, Founder of Nuwa, CEO, My Global Enterprise Solutions 56 Building Life Science Clusters of Innovation Mary Walshok, Vice Chancellor, UCSDConnect Alan Bentley, Associate Vice Chancellor, OTTC, Vanderbilt University Thomas Cebula, John Hopkins, CTO CosmosID; Former FDA Director, Office of Research and Food Safety Martha Connolly, Director, Maryland Industrial Partnerships Steven Currall, Dean, UC Davis Graduate School of Management 59 Designing a Research Innovation Model Editorial by Cheryl E. Harrison President, Harrison Design Group; UC Davis Trustee Emeritus and Advisor, College of Agriculture and Environmental Sciences, Founding Leadership Committee, Global Action Platform 8 | WWW.GLOBALACTIONPLATFORM.ORG
  9. 9. 62 SECTION IV: Perspectives 63 A Vision for Abundance: Research and the Future By Francis Collins Director, National Institutes of Health (NIH) 65 The World at the Crossroad: Where Do We Go From Here? A Call to Action By Thomas Friedman Columnist, The New York Times 68 Partner Viewpoints International Food Information Council (IFIC) Global Harvest Initiative STEMconnector 74 SECTION V: Building a Global Action Platform 75 Inspiring Leadership Editorial by Linda Peek Schacht Executive Director Nelson and Sue Andrews Institute for Civic Leadership 76 Recommendations for Action Editorial by Cynthia H. Barbera Executive Editor, Global Action Report, Founding Leadership Committee, Co-Founder, eGlobal Reader 80 About the Cumberland Center Transforming Innovation into Prosperity global Action Report | 9
  10. 10. INTRODUCTION 2013 Global Action Report Building a Global Action Platform: Food, Health, and Prosperity by Dr. Scott T. Massey 10 | WWW.GLOBALACTIONPLATFORM.ORG
  11. 11. INTRODUCTION I n November 2012, four hundred leaders from ten nations, representing the corporate, research, government, media, foundation, and NGO sectors convened at the Global South Summit in Nashville, Tennessee. The goal of this international gathering was to begin framing an agenda for abundance with a focus on three interconnected, issues—food, health, and prosperity. Founding Mission and Objectives The mission of the Global South Summit is to convene leaders from around the world to define solutions that create abundance through innovation. At the conclusion of the Summit in 2012, an integrated approach to Food, Health and Prosperity were defined as the most critical national and global priorities over the next three to five years. Similar to Davos, the Clinton Global Initiative and the Milken Global Conference, the annual Global South Summit Series is designed to create a singular opportunity to convene top state, national and international C-Level decisionmakers. The Global South Summit uniquely integrated the varied perspectives from across key sectors, including corporations, global NGO’s, research universities and nonprofit organizations. Nashville was selected as the “hub” for these discussions due to its outstanding geographical location, connecting wide cross-sector expertise in the food and health industries, with direct access to emerging scientific research and leading investments in regional, national and global initiatives. The Cumberland Center, headquartered in Nashville, is Dr. Francis Collins, Director, National Institutes of Health the organizer and host for the Global South Summit.  With its expanding collaborative networks and long-standing relationships among major research universities, thought leaders and institutions in the United States and throughout the world, CumberlandCenter is the ideal convener of the ongoing annual Summit and Global Action Platform.   Why Food, Health and Prosperity? Founding Leaders creating the project started with an economic concern--how to advance sustainable economic growth and prosperity for a growing world population. The organizers found strong interest in mobilizing cross sector leadership to find new paths and models for economic development aimed at sustainable prosperity. It became clear that models could be focused on strategies to meet the growing global challenges of food and health with an eye toward expanding, shared prosperity. This vision of an economic future of growth, sustainability, and expanding opportunity for everyone required a special lens. To balance growth, sustainability, and opportunity leaders needed an adaptable model named the “Global Action Platform”, a nimble, neu- tral infrastructure well-suited for the fast-emerging, complex conditions of the 21st century. The elements of this model include industry clusters, regional economies, and strategy for competitiveness, which are of central importance. New technologies, the internet, and innovation are also key to the mix. A Vision of Abundance Instead of a focus on scarcity and conflict, Summit founders and participant leaders wanted to look toward the creation of abundance, as a central organizing idea. How can we focus economic activity in regional innovation hubs to expand opportunity and unleash innovation? How can the whole human population flourish--while also allowing the environmental and ecosystems that make life possible also flourish? Initial research and broad conversations with global leaders, major research institutions and thought leaders led to a converging focus and integration on issues in food, health, and prosperity. The interconnections were intriguing and compelling--as well as surprising. global Action Report | 11
  12. 12. INTRODUCTION Integrated themes: Food, Health and Prosperity As this vision was explored, it became clear that key conditions for innovation and prosperity are food and health. If economic growth requires a broad base of talented, innovative people working together, then the health and nutrition of society is paramount in determining the prosperity of the future. In fact, food and health are baseline measures of the asset strength of the major economic driver of today’s economy-human capital. Food and nutrition are widely discussed as integral to the future of human health and healthcare. The path through healthcare transformation thus led us to conversations on food, food security, food productivity, distribution and safety. Interestingly, food and agriculture are also key foundations for economic growth and stability. So, food, health, and prosperity proved to be linked in strategic ways. Health and Healthcare: An urgent need for new solutions In each area of our Summit program, clear challenges exist. How to stimulate economic growth through innovation, how to transform healthcare, how to feed the planet—these were framing questions for our work. Dean Steven Currall, UC Davis, with Summit co-founders Cheryl Harrison, Scott T. Massey, Chairman, and Cynthia Barbera at the Plenary Luncheon Session, Nashville Experts in the health field offered a wide range of options to change healthcare, from proposing a model for a “new medicine” to applying advanced genetic research. Between the current state of affairs and a major transformation lay thorny issues of realigning financial incentives while managing the demographic shifts toward an older population with greater health needs. It was clear from our research and from presentations at the Summit that time is running out and that there is a growing sense of urgency to find transformative healthcare solutions. the world currently produces enough food to feed everyone alive, but we lack the logistics and political consensus to distribute efficiently and safely what we produce. We have seriously depleted food reserves, which had not been replenished since the 2010 drought, putting the world on the edge of major food shortages. Disputes are raging over the role of genetically modified foods, the composition of a healthy, nutritious diet, and the role of government to enforce diet, food policies, food safety, and its role in funding research and food relief efforts. Food: A compelling concern for feeding our planet In the area of food, we found a state of crisis, economic challenge and conflict over the future similar to the parallel challenge in economics and healthcare. We learned that Our advisors pointed toward a need for a trusted convener to bring the sectors and key institutions together to build trust and create consensus; they asked us to help serve that role. Nashville Symphony Orchestra Brass Quintet performing at the 2012 Global South Summit 12 | WWW.GLOBALACTIONPLATFORM.ORG As organizing plans for the 2012 Summit began, plans were also emerging for the next Universal World Expo in Milan, Italy in 2015 to focus on its theme, “Feeding the Planet –Energy for Life.” As the world now begins to prepare for this Expo, we were asked to help launch the global discussion on food among cross-sector leaders and participants. Building a Global Action Plan The challenge we face now is to frame long term solutions and innovations that have the
  13. 13. INTRODUCTION capacity and promise to create abundant food, health, and prosperity for everyone on the planet. Our approach is local, regional and global. In short, we are bringing together cross-sector leaders to imagine, to explore—and to specify— how innovation can create abundance, and how we can efficiently and much more effectively connect and network invested leaders, research institutions and innovators to collaborate in fulfilling the promise of abundance. The programs, events and initiatives of the Global South Summit are being planned over the next five years, as a way to convene the key leaders who will build a coherent set of ideas and recommendations that culminate in a comprehensive set of high profile reports into a “Global Action Platform.” Innovation as a Human Resource Simply put, the future welfare of both human beings and the planet depend on a distinctly human resource—innovation. Our emerging economies demand more timely solutions, access to innovation, improved efficiencies and high impact results. On this there is broad consensus. In order for societies be innovative, people in these societies must be able to thrive; they need food, health, and the tools and systems of innovation that produce sustainable prosperity. As we strive to achieve positive change in our complex world, leaders and innovators will need to collaborate together to create a shared platform for clear, more efficient decisionmaking and informed actions to guide our future. The Global Action Reports Reports following the Summit(s) will be published as a series, used to inform and engage leaders in food, health, and economic strategy/innova- tion, disseminated through partnerships with the Diplomatic Courier, The World Bank, CGIAR, USAID, National Press Club, and a growing network of organizations, agencies, research universities and business partners around the world. The following report is the first in a series offering three powerful framing essays on the future of food, healthcare, and prosperity by three profound thinkers in these fields. This report summarizes and shares the wide array of innovations and ideas for how to move out of the current crises in these areas to abundant food, health, and prosperity. The report offers initial recommendations for action, distilled from the inaugural Global South Summit in November 2012. Editorials and essays from industry experts add perspective and depth to the findings presented. This Report is the first in a series that will continue to promote innovation and action for abundance. Report Content and Editorials The Global Report features four major editorial works on three topics of food, health, and prosperity, as noted below: • “The Future of Healthcare”, Dr. William Frist (former Senate Majority Leader, surgeon, and HCA founding family member). • “The Future of Food,” Juergen Voegele, Director, Agriculture and Rural Development Division, The World Bank. • “The Future of Prosperity”, Dr. Christian Ketels, MOC Director, Institute for Strategy and Competitiveness, Harvard Business School. The Report also features editorial contributions from the Keynote speaker, Thomas Friedman, New York Times Pulitzer Prize-winning journalist International Food Information Council (IFIC), Global Harvest Initiative, STEMconnector and others. Global Distribution to Leaders and Major Institutions The 2013 Global Action Report will be previewed with lead editorials distributed in the G8 Summit materials in London, followed by distribution in the G20 materials in St. Petersburg, and a World Bank event in Washington DC. Later in June 2013, 25,000 copies of the published report will be mailed to a target list of tier-one global corporate executives, heads of state, policy makers, foundation leaders, media leaders, and leaders of major international agencies and foundations. Further, an electronic version of the Report will be published on the Diplomatic Courier website and the website of the Global South Summit, reaching a global online audience of 1.5 million readers. The 2012 Global South Summit and this Report are our first steps along this path to create the Global Action Platform for the next five years. We invite you to join us. global Action Report | 13
  14. 14. nashville collaboration | innovation | technology | you Tennessee Global Health. driving innovation through colaboration Local Impact. reflecting our City’s investments in health, culture and unmatched urban fabric Personal Health. leveraging the opportunity to be students of mindful living and improve human performance 14 | WWW.GLOBALACTIONPLATFORM.ORG
  15. 15. 56 more thaN 250 healthcare companies have operations in Nashville ranks as the 17th C i t y GreeNest in the Us healthcare company headquarters ranked 13th “america’s Best Cities” Nashville global Action Report | 15
  16. 16. REET N ST ERSO JEFF NORTH NASHVILLE J H I DOWNTOWN G P 0 I–4 28TH AVE. Q LOTTE CHAR WEST NASHVILLE UE C OPTION 1a 505DESIGN | 25 FEB 2011 | 1 OPTION 1a 505DESIGN | 25 FEB 2011 | 1 F E D B A E AVENU EST VEN DA EN W I–440 K ST 31 E. AV GREEN HILLS - MIDTOWN L M N “Build a new era of innovation and collaboration between education and healthcare.” A. B. C. D. E. F. G. H. I. O oneC1TY HCA Healthcare Centennial Park Centennial Medical Center Red Cross Baptist Hospital Nashville General Hospital at Meharry 16 | WWW.GLOBALACTIONPLATFORM.ORG Fisk University Meharry Medical College Tennessee State University J. K. Vanderbilt University L. VA Medical Center M. Vanderbilt University Medical Center N. Monroe Carrell Jr. Children’s Hospital at Vanderbilt O. Belmont University OPTION 1b P. Downtown Nashville 505DESIGN | 25 FEB 2011 | 2 Q. Entrepreneur Center
  17. 17. 1 3 2 4 6 5 7 1 Avenue 31 2 C1TY Boulevard high touch, pedestrian scaled shopping and dining street. lush, ped-friendly streetscape with landscaped median is the collector for everyday traffic. 3 The LOOP expressive canopy and a modern, sophisticated landscape provide a big sense of arrival. 4 Community Table anchored by healthy eating, local food is the main focus for this teaching and dining experience. 5 The Yard a terraced lawn and community orchard anchor this multipurpose gathering place. 6 The WATERSHED water quality gardens double as a series of outdoor rooms for great minds to steep. 7 The Climbing Gardens the terraced gardens link 28th Avenue to the Yard and back to Centennial Park. global Action Report | 17
  18. 18. Section I Abundant Food Feeding the Planet As the world approaches a population of 9 billion, we face an unprecedented challenge: how will we feed our planet while also preserving our environment and the fragile ecosystems that make life possible? It is not just about food. Solutions must also include nutrition and healthy diets as fundamental considerations to our global well-being. Leading experts in food, health and nutrition explore the interrelated challenges of sustainably growing abundant food, safely transporting and storing food, transforming food into a nutritious diet, and the cultural experience and values surrounding food and food policies. 18 | WWW.GLOBALACTIONPLATFORM.ORG
  19. 19. Abundant Food The Future of Food Editorial by Juergen Voegele, Director, Agriculture and Rural Development, Sustainable Development Network, The World Bank Agriculture must urgently address three sets of issues: • Reduce the hunger and malnutrition affecting 870 million people. We must address the fact that 165 million children under five years of age are stunted, and the number of stunted children is rising in sub-Saharan Africa, with 52 million children suffering from wasting, and with little improvement globally since 1990. For most of these children, the damage to their growth and development is irreversible and will impact the world for generations. • Provide sustainable solutions to extensive rural poverty on a large scale. Three-quarters of the world’s very poor people (incomes <US$1.25/day in 2005 $) live in rural areas, and most get their main livelihoods from farming. • Mitigate 30% GHG which is leading factor in the expected 4 degree Celsius increase in temperature...which could wreak havoc on global agriculture. Producing more food will not solve hunger and malnutrition problems on its own; food security requires ensuring access to sufficient nutritious food every day to every person, which goes beyond what agriculture can do on its own. However, failing to produce at least 60% more food by 2050 will ensure that there will not be enough to go around, with truly catastrophic effects. The way we increase production has a lot to do with the distribution of its benefits for food security. So, we also need to worry about the resilience of production systems, nutritional implications of production systems, and how to reduce waste. For success in both production growth and ensuring that food gets to those who need it most, small farmers will have to be a big part of the solution. Today roughly 83% of the world’s population lives in developing and emerging countries. There are roughly 400-500 million small farmers in the world, heavily concentrated in developing countries. Globally, the average farm size (scale of production) declined from 2.1 hectares in 1980-1985 to 1.9 hectares in 20062010, with large regional variations. Resource depletion is beginning to set in. By 2025, nearly two-thirds of all countries in the world will be water-stressed and 2.4 billion people will face absolute water scarcity. Since about 70% of freshwater use is for agriculture, such countries will depend on imports to meet their food needs. Worldwide, about 18% of cropland is irrigated, producing 40% of all crops and 60% of all cereals. Large parts of the world are already living beyond their water means by supporting agriculture based on unsustainable use of groundwater. In addition, about 25% of the world’s crop land is degraded; a further 35% of present African cropland is likely to be unsuitable for cultivation by 2100 due to climate change. And, just between 2000 and 2010, we lost on average 5.2 million hectares of forest every year. We also face the prospect of as much as 4 degree Celsius warmer world. If this happens, food staple production could decline by 10-15% over current levels, rather than increase as is needed, leading to greatly expanded hardship, conflict, and even mass starvation within the span of one lifetime. We not only need to increase production under conditions that are harder than when the world was responding to a big food crisis in the 1970s, but we also need to pay specific attention to how production occurs to create the benefits of improved livelihoods and better nutrition. Fortunately, agriculture is in a unique position to help on all these issues. Only agriculture at scale (including forestry) can take carbon out of the atmosphere. Forests cover 25-30% of the earth’s land surface and absorb about 15% of the planet’s GHG emissions, and crops can potentially absorb more. In-depth work in 2008 also showed that agricultural growth is very effective (2 to 4 times more than other sectors) global Action Report | 19
  20. 20. Abundant Food Juergen Voegele, Director, Agriculture and Rural Development, Sustainable Development Network, The World Bank at reducing poverty. And agricultural growth at the smallholder level can be managed to provide more beneficial nutritional outcomes. It takes proactive investment and policy changes to achieve these outcomes at scale. The climate-smart agriculture of the future requires that we think in terms of an integrated approach to landscapes. A “landscape approach” means taking both a geographical and socioeconomic approach to managing the land, water and forest resources. The World Bank Group is increasingly using landscape approaches to implement strategies that integrate management of land, water, and living resources, and that promote sustainable use and conservation in an equitable manner. The precedents for this were a few large-scale but highly successful projects in what would now be called emerging countries such as China, India and Brazil. Here, the landscape approach combined with other methods of conservation and development can increase personal income while protecting local landscape. Examples are now found in Africa as well. In Ethiopia’s Great Rift Valley, the landscape approach has included establishing forest cooperatives that sustainably manage and reforest the surrounding land using Farmer-Managed Natural Forest Regeneration techniques, thus addressing deforestation that threatens groundwater reserves that provide 65,000 people with potable water. In Rwanda, a landscape approach is being scaled-up to a large area of steep hillsides by providing infrastructure for land husbandry (for example, terracing and downstream reservoir protection), water harvesting and hillside irrigation. Training is provided for farmers, farmer organizations are supported, and marketing and financing activities are enhanced. As a result, productivity in rain fed areas has tripled, more land is protected against soil erosion, and the share of commercialized agricultural products has increased. In Western Kenya, some 60,000 farmers on 45,000 hectares of land are now combating erosion using sustainable land management practices to enrich degraded soil. In Niger, new farming systems now include trees that capture nitrogen. 20 | WWW.GLOBALACTIONPLATFORM.ORG For a landscape approach to work, we need secure land tenure rights, so that individual farmers, especially women, as well as communities have an incentive to invest in improved land and water management and to protect trees and forests. In Indonesia, for example, research by the CGIAR on Forests, Trees and Agroforestry shows that community management and village forest permits not only lessen deforestation and forest degradation, but also reduce risks for smallholder farmers and improve the well-being of forest-dependent communities. Appropriate pricing regimes are needed to encourage rational use of scarce resources. Regulations backed by strong legitimacy at the local level are needed to control pollution run-off or to avoid free-grazing of animals, while appropriate incentives are in place for private farmers to invest in “public good” activities. An environment conducive to behavioral change is fundamental. Transparent and accountable institutions are critical. And if people do not have access to information they can understand, they do not have an incentive to change behavior. The ICT revolution is now widely spread, including in many parts of Africa. This serves to impart information, provide interactive information exchange, and to collect data. In summary, agriculture is the “essential sector” for reducing poverty, creating shared prosperity and promoting environmental sustainability. Together, we can harness the power of agriculture to meet the world’s challenges. Juergen Voegele, is the Director of the Agriculture and Rural Development Department, Sustainable Development at The World Bank. He oversees World Bank global programs for rural poverty alleviation, agriculture and natural resources management. Prior to his current appointment, Mr. Voegele worked in agriculture and natural resources divisions in the Europe and Central Asia Region and in the East Asia and Pacific Region. He also led various assignments for the East Asia and Pacific Region and transferred to the World Bank’s Beijing, ChinaOffice to lead the World Bank’s Agriculture Unit.
  21. 21. Abundant Food Feeding the Planet Where Do We Stand Today? “We can do this! We can harness the power of agriculture to achieve abundant, sustainable safe and nutritious, food for all. We just have to have the will to make it work. Nine billion people are counting on us.” -Mark Cackler, World Bank, Manager of the Agriculture and Rural Development Department “Food will not represent sustainable breakthrough abundance if it is comprised of hollow calories”. -Harold Schmitz, CSO, Mars Inc. “I believe that sustainable change can happen. But we alone cannot achieve this change. In order for this change to take place at scale and for it to be sustainable, it requires an enormous number of partners to be working together.” -Prabhu Pingali, Deputy Director, Agriculture, Bill and Melinda Gates Foundation “Dance with entrepreneurs. Invite entrepreneurs to the table.” -Will Rosensweig, Co-Founder and Managing Partner, Physic Ventures SUMMIT PRESENTERS • Mark Cackler, Sector Manager, Agriculture and Environmental Services, The World Bank Group • Harold Schmitz, CSO, Mars Inc. • Bill Lacy, Vice Chancellor, UC Davis • April McMillian, Manager, Secure Biosystems Integration, Oak Ridge National Laboratory • Prabhu Pingale, Director, Tata-Cornell Initiative, Former Deputy Director, Agriculture, Bill and Melinda Gates Foundation • William Rosenzweig, Co-Founder and Managing Partner, Physic Ventures global Action Report | 21
  22. 22. Abundant Food We will need to leverage uncommon collaborations and build bridges with other “tribes” with expertise in health, energy, transportation, and the environment. It is time to connect the scattered global food initiatives and fuel the cycles of innovation in order to achieve our shared goal of feeding the planet. CHALLENGES 1. Price Volatility High and volatile food prices are the new normal. Food prices are becoming more volatile while food stocks in US and around the world are at the lowest level in a generation. • World grain consumption in last five years has increased 2.3 percent per year while production has only increased 1.8 percent per year. “I believe that sustainable change can happen. But we alone cannot achieve this change. In order for this change to take place at scale and for it to be sustainable, it requires an enormous number of partners to be working together.” -Prabhu Pingali, Deputy Director, Agriculture Bill and Melinda Gates Foundation SITUATION In 2050, we will need to feed nine billion people and increase food production by 70 percent worldwide. Tonight and every other night, one out of eight people in the world–870 million people–will go to bed hungry. From an evidence-based perspective, we know that food and agriculture comprise a dominant if not the dominant influence on the footprint of the planet when it comes to our health and our environment. We will need to figure out how to feed nine billion people in way that embraces environmental and ecological sustainability, addresses complex social and cultural issues as well as strengthens the relationship of food and nutrition with public health. The next three-to-five years presents a critical window to make a difference for the long term. We can provide sustainable, nutritious, abundant food for everyone. But this goal will require trust, innovation, and collaboration among farmers, businesses, governments, research institutions, foundations/NGOs, and finance. 22 | WWW.GLOBALACTIONPLATFORM.ORG • Food stocks have been coming down around 20 percent of annual consumption; • Since June 2011, corn prices are up 45 percent, wheat prices have risen 50 percent. • US corn stocks are down to 7 percent, making us more vulnerable to volatile prices. There is an absolute correlation between food stocks and price volatility. The drivers of price volatility are not going away: • Increased grain exports from areas such as the Black Sea and Latin America, which have higher weather volatility, are contributing significantly to price volatility. Exports of wheat in the 1990’s from those areas were 11 percent; today they are 28 percent. • Biofuel mandates have added constraints and rigidity to the system. • Policies such as trade restrictions by countries like Russia, India, Vietnam, and Ukraine who limit their exports, are making a bad problem worse. All of these have repercussions throughout the world. The Arab Spring was in large part a reaction against volatility in food prices. This situation cannot be fixed overnight and will require long-term solutions. 2. Poverty The poor suffer most from food price volatility with consequences that include long-term social and economic disruptions stemming from a lack of nutrition. Sudden rises in food prices can cause a harmful chain reaction in terms of personal health
  23. 23. Abundant Food and livelihood. Poor families pull their children out of school so they might be another source of income for the family. They will eat cheaper, and less nutritious food. And for those who cannot afford food at all, their children might suffer from malnutrition, which, if untreated in the first two years poses a major threat to brain development and can result in permanent brain damage. Thus, short-term hunger has catastrophic long-term effects on the health of these citizens, threatening economic growth as well as social stability. 5. Food waste • 20-30,000 children born in India today will suffer from life-long stunting. Food will not represent sustainable breakthrough abundance if it is comprised of hollow calories that contribute to stunting and other issues. No country has been able to achieve sustainable reductions and poverty without massive investments in agricultural development. Finally, we waste a lot of food. Depending on the crop, in poor countries between 15-40% of food is lost. The food waste in rich countries each year is equal to all of the annual food produced by Sub-Sahara Africa. RECOMMENDATIONS 1. Invest in agricultural development in developing countries. 3. Climate Change Climate change is undeniably altering the landscape for food production. Extreme weather is becoming more common causing more flooding, heat, and droughts. We will need more aggressive agricultural research to prepare for climate change such as developing more crops that are tolerant tolerate to extremes in temperature as well as resistant to diseases and pests. Given that agriculture contributes to 30% of greenhouse gasses, it is time to have agriculture included in discussions surrounding solutions to climate change rather than just be viewed as “part of the problem”. 4. Bad policies Much of the global food system is dependent on the government policies and regulations that affect trade issues, safety issues, and equity. Many of these policies, such as protectionism and bans on exports hinder access of farm products from poor countries to rich countries and are self-defeating. Many governmental policies also discriminate against the poor and most vulnerable. These include trade policies, protectionism, and laws that discriminate against women when it comes to land tenure. Land grabbing is an increasingly visible issue around the world as the wealthy buy up land in an unjust way from poor farmers. Another issue is that oceans are being depleted of fish. We must figure out how work together to improve our policies and get long-term agreements on the high seas to assure sustainable fisheries. We also need to change unwise policies that divert food to other uses. Because most of the world’s poor people are farmers, enhancing productivity of small farms is the best way for poor people around the world to grow their way out of poverty. We need to make investments in smallholder agriculture especially in Sub Sahara Africa and South Asia. Every solution doesn’t have to scale or be optimized. Even small efforts, like teaching farmers how to rotate crops, better soil management, even waste management (ie: composting) can make a big difference. Gradually higher and more stable food prices, could actually be a good thing, because higher prices can help farmers rise out of poverty. 2. Empower women. Women farmers may be the single most important development priority. • While women make up 43% of agriculture labor force in developing countries, women farmers are less productive than men due to the fact that they have less access to land, water, global Action Report | 23
  24. 24. Abundant Food seeds, training and credit. If women had same access as men, their farm yields would increase by 20-30%. “Feed the Future” which grew out of 2009 G8 Summit, is rooted in partnerships with local governments, donor organizations and civil society. All of us, including the business sector, would benefit by joining forces with this coordinated effort. 3. Make better use of technology. We need to do a better job of harnessing the power of technology to help farmers. In 2002, half the people in the world had never made a phone call. Today, people have mobile phones, in the most isolated areas. It is time to make better use of new technologies, such as mobile devices, videos and other modern ways of disseminating and extending knowledge to help farmers. EXAMPLE: Using GPS technology, we can put sensors on top of a tractor that can help farmers determine what kinds of fertilizers and how much to use to increase the yields on their crops. They can do this on the fly, saving much time with greater efficiency. EXAMPLE: The Oakridge National Laboratory is monitoring a wide range of data from around the globe through a number of uncommon collaborations–gathering biological, chemical, transportation, economic, and climate information among other data. The hope is that the combined data will reveal new information to guide planning on future food production and food systems. 4. Invest in infrastructure. To make a difference in global agricultural development over the long term, the US and other nations will need to work more closely with governments around the world on investments in infrastructure such as roads, ports, irrigation systems and agricultural innovation. The US itself is a demonstration model of successful long-term government investments in agriculture. Since 1862, the US federal and state governments played a key role in providing funding backed by local resources to support domestic agricultural development across America through the land grant university system and agricultural extension. This investment has been a fundamental contributor to America’s abundant food supply and economic success. 5. Connect food issues more closely with health 24 | WWW.GLOBALACTIONPLATFORM.ORG UN Photo/BZ We need to focus much more on policies in rich and poor countries alike that link food production to nutrition and health outcomes. The FDA, for example could take a much more active role in allowing food-based health ingredients to be protected and marketed so that they can make legitimate claims based on clinical science. EXAMPLE: Mars, a company that depends very much on cacao for its products, has been researching the health benefits from a natural product that comes from Theobroma cacao. This cacao product has demonstrated to have both cognitive benefits as well as its ability to lower blood pressure. 6. Develop business incentives and invite in entrepreneurs. It’s time to dance with entrepreneurs. We know the magnitude of the problems, but solutions are moving too slowly. One of the biggest impediments to change is that the basic food business model works so historically there has been no imperative to raise the game. However, the private sector can be tremendously helpful in introducing new input supply systems, new seed systems, new market systems, and other related systems especially to rural communities where the needs are highest. Private sector research and development can also bring real advances to poor farmers. To reach our goal of abundant, nutritious food for everyone, we will need to work with the very large food corporations who are doing everything possible to optimize their production and, at same time, engage entrepreneurs and venture capital to find innovations that can disrupt current models in order to make them better. The solution is full of paradoxes, full of tension, but leaders will have to embrace both.
  25. 25. Abundant Food 7. Work collaboratively across disciplines Sustainable change can happen. Sustainable change can be scaled up. But by working alone we cannot achieve this change. In order for this change to take place at scale, and for it to be sustainable, requires an enormous number of partners to be working together. EXAMPLE: The CIFAR program at UC Davis is one of the successful programs that includes all the cross-disciplinary collaboration elements needed to make a difference. This outstanding collaborative model grew out of academia and engages business to embrace all inputs. Perhaps what is needed is the food equivalent of Sputnik–a global strategic imperative that everyone can agree with. Once we establish the strategic imperative, we can work together on the long-term strategy with inputs from business, science and technology along with academia, NGO’s, and government. We can do this! We can harness the power of agriculture to achieve abundant, sustainable safe and nutritious, food for all. We just have to have the will to make it work. We have technologies for today. We have a way to develop the technologies for tomorrow. Nine billion people are counting on us. UN Photo/BZ Growing Abundant Food Global Trends in Food Security SUMMIT PRESENTERS • Frederick Vossenaar, Program Manager, Climate-Smart Agriculture, Ministry of Economic Affairs, Agriculture and Innovation, The Netherlands • Kent Bradford, Director, Seed Biology Center, UC Davis • Michael Dimock, President, Roots Of Change Fund SITUATION What we’re doing as human beings to feed ourselves has the largest impact on the natural world–greater than any other activity. We face huge challenges: climate change, hunger, environmental degradation, degradation of human communities, and challenges to human health. This tells us that the system isn’t totally working. Recently, we’ve moved from a period of commodity abundance, (i.e. more corn, more wheat, etc,) to a period of relative commodity scarcity. The number in terms of productivity and consumption are very close: any shock to the system and we will be negative.* global Action Report | 25
  26. 26. Abundant Food Faced with a growing world population, we must move toward “sustainable intensification”– increasing productivity per unit area–in order to protect our wild lands, preserve biodiversity and reduce the environmental impacts while also providing the food that is needed by our growing population. produced each year. Significant other issues surround the appropriate use of biotechnology. To move forward with a clear vision, trust between all parties including producers and consumers alike, becomes a critical priority. CHALLENGES In 1960, there were 1 billion hungry people but we were feeding 2 billion. Today, we still have about 1 billion hungry people, but we’re feeding 6 billion. We’re actually feeding 3 times as many people while still experiencing persistent hunger among the world’s poorest people. A new problem is coming soon. In 2050 China and India will have 40 percent of world’s population with only 15 percent of arable land. By some estimates, we will need another 50-70 percent increase in food production to meet the anticipated global food demand in 2050. “I am advocating for biotechnology for sustainability. Let’s stop marginalizing this technology–let’s think serious about how we should be using it specifically to enhance sustainability.” –Kent Bradford, Director, Seed Biology Center, University of California Davis Advances of the “green revolution” including genetically engineered crops, improved food varieties, fertilizers, pest control, all allowed us over the last 50 years to triple agricultural yields around the world with only a 10 percent increase in overall area cultivated for agriculture. Directly due to innovations in biotechnology, between 1987-2007, there has been a 41 percent increase in yield/acre and we have done better on every index in terms of sustainability: energy use, soil loss, irrigation, climate impact and land use. If we attempt to meet this demand by expanding land area used for production, we will face enormous problems, including considerable carbon loss. Burning rain forests for new land, plowing the land and aerating new lands all release carbon. The data show that innovations in seed biotechnology have allowed us to have higher productivity and tackle sustainability issues simultaneously. With seed biotechnology, we can use fewer pesticides, less fuel, and lower the impact on environment. For example, we can control weeds through new crops varieties so that we don’t need to plow, reducing carbon release and reducing energy use in the process. Most agree that the key to meeting increased global demand for food is to continue to maximize crop yields per acre rather than increase land used for production. To accomplish this for our future, many scientists believe the only way is to stop marginalizing biotechnology and think seriously about how we should be using it responsibly to enhance sustainability. However, there are many complex issues we still need to grapple with to get to a world of abundance. We need a robust debate to reconcile the competing views about how our world will need to evolve. Unfortunately, in food biotechnology, we’re seeing a suppression of entrepreneurship by regulatory and market-based push-back. While locally-sourced food is worth promoting, it represents less than 3 percent of food we eat in the US. We will need all the technologies we have to solve the significant problems ahead of us. There is no reason the two can’t work together. Some question, for example, the need to increase food production so dramatically when we already waste between 40-45 percent of food Nevertheless, significant issues associated with biotechnology merit public debate. These include: 26 | WWW.GLOBALACTIONPLATFORM.ORG
  27. 27. Abundant Food 1. Ownership of seeds. Only seven or eight companies essentially own all the seeds in the world. While most agree that companies who invest in biotechnology should be able to have a return on their investment, better systems need to be in place to assure more access to these beneficial technologies–especially among the world’s poorest populations. 2. Who funds the research. If biotechnology research is mostly paid for by the large seed companies, the scientific debate can be easily impeded. 3. Regulation. When those who have been working in the industry become the regulators, trust is compromised. We need to assure transparency throughout the system so that the science and its products can be trusted. RECOMMENDATIONS It’s not about the developed world saving food scraps and shipping them to Africa. The solution is that Africa needs to feed itself. If we empower women, for example, we would see a 20-40 percent increase in food production. The food waste problem is very different for US than in other places. In America, a lot of food is wasted because people don’t know how to understand the expiration date and good food just gets tossed. In Kenya, on the other hand, half of grain may be wasted due to spoilage after harvest. 3. Recognize the value of food. There are a lot of external impacts that are not included in the price of food. It’s very hard to get to sustainability if we don’t have the right pricing structure that reflects the true costs. Typically, we create taxes to deal with these impacts, but we’re struggling with that now. 1. Continue to innovate in order to optimize our food systems through biotechnology and other means. Some of the proposed biotechnology innovations with the greatest promise include: Nitrogen and phosphorus use efficiency. We don’t have enough phosphorus to maintain our productivity. Nitrogen can be made from the air, but there are consequences to doing this. We need to find ways to optimize the production and use of nitrogen and phosphorus in our crops. Fertilizers. About half the fertilizers we use goes somewhere, but not into the plants. We need to find ways to make the application of fertilizers more efficient. Nitrogen fixation. Certain plants that can actually fix their own nitrogen. We need to get this into more crops. With biotechnology, this is very doable. Photosynthesis in wheat and rice. If we could get wheat and rice to do photosynthesis as efficiently as corn does we would save water, increase productivity and have the next quantum leap we need in productivity. Improving stress tolerance. We know that climate change will increase the variability of global temperatures and other conditions. Crop losses due to drought, salinity, and temperature extremes present critical challenges. We need to embrace the successful strategies that already exist to help farmers withstand these situations. 2. Reduce food waste. Food waste is a huge problem…and opportunity. If we could stop waste, we might not need a 70 percent increase in production, we might only need 20 percent. UN Photo/BZ 4. Involve the public in more science-based discussions about food to build trust and move appropriate technology innovations forward. Transparency is critical. In our discussions, we need to be “technically correct”, not “politically correct”. Three “E’s” merit focus “Eatable” food. The entire premise of the food system should be about better nutrition, not just more food. We must more actively support health through food. Education. It’s amazing how many people don’t know where their food actually comes from. We need to find ways to educate the public more so that they are more connected to food. Farmers don’t have the time to do this. global Action Report | 27
  28. 28. Abundant Food more creative ways to produce food with less regulation, especially by people who have never farmed before. 5. Engage the private sector in playing a bigger role in agricultural innovation and encourage them to make long-term commitments. EXAMPLE: Several Dutch seed companies are investing in Sub Sahara Africa knowing they will lose money for the next decade, but confident that in the future they will be successful. They are working to develop markets in countries that many would consider too difficult or too poor to generate results. UN Photo/Eskinder Debebe Entrepreneurship. Unleashing the inventive human spirit can lead the way to solving a lot of agricultural problems. Support both the small farmer as well as the large farmer find better and We need to make strategic investments in processes and people that will accelerate pressures on food producers and governments to change the system to make it better. It is time to think strategically about what we all need to do to sustainably and positively impact agriculture, and then let’s do it! * Global Harvest GAP Report. UN Photo/Forte From Harvest to table Preservation, Logistics, and Distribution SUMMIT PRESENTERS • Rob Howell, VP, Sourcing and Supply Chain Services, Sysco Systems • Jeffrey Brecht, Director, UF/IFAS Center for Food Distribution & Retailing, University of Florida • Rich Kottmeyer, Senior Executive and Global Agriculture & Food Production Leader, Accenture • Edward Zhu, CEO, CHIC Group Global 28 | WWW.GLOBALACTIONPLATFORM.ORG
  29. 29. Abundant Food SITUATION We understand one thing: with more people, more health and more wealth, we will need to move more food. While a lot of people think this is a problem, it is also an opportunity. As three billion people become middle class by United Nations standards, the economy will grow by $1.5 trillion. That gives us a reason for everyone to get aligned. A major obstacle to providing food for everyone is the loss of food through waste, spoilage, disease, pests or the lack of adequate logistics for transportation and distribution. According to Rabobank, we already produce enough food to feed every person on earth a diet of 8,000 calories per day–clearly more than we need. However, after we harvest the food, approximately 60 percent is lost from spoilage or failure to be delivered to where the food is needed. Sometimes politics blocks the movement of food; other times it is lack of airports, roads, technology or other infrastructure. Improper handling, storage or poor regulation also contributes to contamination and loss. In developing countries, food safety is especially challenging because the agricultural system is tied to individual small farms that have little or no technology in place to capture or report any data. It is nearly impossible for the government to effectively track food safety issues or put the necessary inspections in place at the central, provincial and local levels. EXAMPLE: In China, there are 229 million farmers, most with farms that are less than 1 acre. These farmers are largely illiterate and lack the ability to understand the complex, sometimes conflicting agricultural regulations. In India, there are 630 million farmers with similar concerns. “Higher performance at scale is good for everyone.” –Rich Kottmeyer Senior Executive and Global Agriculture and Food Production Leader, Accenture It is not enough to focus solely on producing and harvesting enough food. We also must take thoughtful steps to assure that the right systems are in place to keep food safely moving through the food chain including efficient, cost effective distribution from point of harvest to point of consumption. CHALLENGES 1. Growing populations and a growing middle class will require more food. Food distribution is like a pipe: as our global populations grow and as they become more middle class, we’re going to need to put twice as much through the pipe. There are three ways to accomplish this: 1. Improve the pipe: This is what companies such as Sysco and others are doing to assure food is distributed efficiently and safely throughout the food chain. 2. Optimize the pipe: Improve the velocity of food through the pipe. This is what Accenture and other consulting companies are working on. 3. Fix the leaks: Prevent waste and loss of food that has already been produced. 2. Food safety is a global concern with large variations between countries. UN Photo/James Bu 3. Regulatory issues are too complex and not globally compatible. To optimize global and local food distribution, we will need to address the myriad of national systems and standards that are not compatible– some mandatory and some recommended. For example, in China there are approximately eight overlapping and contradictory domestic pesticide standards. Adding to the complexities are large variations in each country’s diet, crops, maximum residue limits for pesticides among other factors that make trade compliance between countries highly challenging. Recent global efforts to standardize terminology and cooperate more on food safety such as GFSI* are making a difference, but agriculture remains an area that needs much more focused attention. global Action Report | 29
  30. 30. Abundant Food this should be provided for through industry and not through government subsidies. The reality is that we have to improve the performance of small-holder farmers especially in China, India, SE Asia and Sub Sahara Africa because we are going to be working with these small farmers for an indeterminable and probably longer time than we anticipate. Global agricultural industrial leaders have an opportunity to work with entrepreneurs in China and in other developing countries to help the food chain to improve. By investing in these countries, they not only open new markets, they become new places to source safe products from. UN Photo/John Isaac [*Global Food Safety Initiative a business-driven safety initiative managed by The Consumer Goods Forum, the only independent global network for consumer goods retailers and manufacturers worldwide, serving CEOs and senior management of nearly 400 members, in over 150 countries.] 4. Too much food is wasted or lost. Loss and waste are different issues requiring different solutions. Loss, which refers to food being destroyed by environmental conditions, eaten in storage by pests or destroyed through decay by microorganisms, tends to be more problematic in developing countries. Waste is more of an issue in developed countries where a lot of good food is discarded due to expiration dates or because it is not cosmetically perfect. 2. Celebrate size and scale. Large size and scale in agriculture brings something to celebrate. If you look at how we got the incredible increases in crop yields over the past half-century, it was because of consolidated power of seed companies and consolidated action. Scale issues also refer to supply chains. Across the world, we don’t have to go from really bad practices to instilling modern supply chains overnight. It’s all about getting modest, incremental gains, but doing it at scale. At the same time we’re working to be scalable, we have to be flexible. For example, can we predict what the Chinese middle class will want to eat in 2040 or how that’s going to impact world food? Anticipating and then planning for these major trends is where technology will play a big role. The goal should not be to deliver barely eatable food to consumers. Food must be palatable and nutritionally valuable. RECOMMENDATIONS 1. Support small-holder farmers to improve food safety. A short-term solution to food safety in developing countries is to install electronic traceability systems such as barcodes that traces food safety issues from food cultivation to harvesting to post harvesting through processing and distribution– all the way to the table. To accomplish this, the larger agriculture companies will need to take a leadership role in helping small-holder farmers. In long run, the only way to assure food safety is to slowly reduce the number of poor, small-holder farmers in order to have technology-based large-scale farming. It will be essential to provide a safety net to ease this transition. Optimally 30 | WWW.GLOBALACTIONPLATFORM.ORG UN Photo/James Bu
  31. 31. Abundant Food 3. Promote technology. Even relatively simple technologies can help quite a bit. While many farmers are illiterate, almost all now have a phone and many have cameras. We can analyze a picture and call farmers back to help them understand what’s going on with their crops. In a lot of cases, especially in the developing world, significant gains can come from a shift from virtually no agricultural practice to modest agricultural practice. EXAMPLE: In India, Monsanto has demonstrated that a little technology can have considerable impact. By providing just a little bit of help to farmers over a simple voice-based system the farm yields improved dramatically. EXAMPLE: In China, the CHIC Group is working to optimize the supply chain and improve safety by giving a scanner free of charge to thousands of farmers they work with. Farmers scan every product they are harvesting. Whatever the farmer puts into the system, such as the source or amount of pesticides, fertilizers, etc, can all be traced. Information on the barcode is further linked with the transporting truck, the shifts of the manufacturing plant, the pallet, and the shipping container, thereby connecting information about that food product all the way from the farm to the marketplace. 4. Use more data and analytics. We can look at data as a way to be more responsive to the demand forecast in the marketplace. Data and analytics now allow you understand what is being grown as it is being grown as well as what the quality is going to be. We can aggregate all this data and make more sensible supply chain decisions. We will need to become more granular about the data we collect because food companies and food retailers are saying, “I want to connect people back to the products, the farmer and the ingredients.” The more efficiently we can aggregate data working with manufacturing partners, the more effectively it can be moved through the supply chain. The biggest challenge is the “cold chain.” We’ve got to be sure we protect the environment of the product from the day it is farmed to the day it reaches the table. This means we have to take the data not only forward in aggregation but take it back granular. But this is a big challenge, but it has been done in many other industries due to the fact that we can process so many more data and run so many more analytics on it than ever before. 5. Scale up and be flexible. To meet our food needs in the future, we’ve got to either scale or be able to scale up. We don’t need to necessarily need to consolidate farms, but farms will have to act bigger than they are. We’ll have to be more flexible, and that means we’ll have to optimize. It will no longer be acceptable to have plants that have 40 percent operational efficiency because that means we’ll have to build another plant. It is much better to use the plant we already have and get it to 60 percent efficiency. And, prevent waste by fixing the leaks. UN Photo/Kibae Park global Action Report | 31
  32. 32. Abundant Food At the table Nutrition and Health “I can envision future menus and food choices that can help to reverse obesity, and chronic disease trends, lighten the impact on our environment and still yield delicious flavors that delight our customers”. -Greg Drescher, Culinary Institute of America “If there were a dream to aspire to, it is that the family comes together again around a table–without the TV–to the eat food that they have prepared together.” -Dr. Roy Elam, Medical Director, Vanderbilt Center for Integrative Health SUMMIT PRESENTERS • Roy Elam, Medical Director, Vanderbilt Center for Integrative Health, Discussion Leader • Greg Drescher, VP, Strategic Initiatives and Industry Leadership, Culinary Institute of America • David Schmidt, President and CEO, International Food and Information Council SITUATION We can envision a future where menus and food choices can help to reverse obesity, and chronic disease trends, lighten the impact on our environment and still yield delicious flavors that delight our customers. It comes down to the average consumer: what’s on the plate? When we consider what is optimal nutrition, we need to look at intersection of sustainable, social and equitable food in addition to what foods are delicious and have cultural appeal. “If there were a dream to aspire to, it is that the family comes together again around a table– without the TV–to eat the food that they have prepared together.” -Dr. Roy Elam, Medical Director, Vanderbilt Center for Integrative Health 32 | WWW.GLOBALACTIONPLATFORM.ORG Research shows that the future of health and medicine will focus more and more on human behavior. The focus will shift from intervening in a health crisis with massive resources, to behavior that promotes health over a lifetime. While several factors do promote health, perhaps the most central factor is food--a healthy, nutritious diet. As the world moves toward the goal of sustainable, abundant food for everyone, the nutrition of that food is critical. It isn’t enough just to produce enough food and distribute it; the food manufactured, cooked, and served also needs to be nutritious and to promote good health and happiness. Food is deeply cultural, and in almost all human societies, food is deeply connected with religious and spiritual values. Diverse cultural and religious perspectives on food are critical issues to engage and integrate into plans for attaining sustainable abundant food for everyone. CHALLENGES Obesity is a big challenge. The culinary com-
  33. 33. Abundant Food munity is, in fact, partially responsible. For example our restaurants tend to equate calories as a function of value. We have the idea that if they serve us more, we are getting more value. This is a perception that may be difficult to change, but should be addressed so that people feel that value comes with nutrition and other positive impacts, not calories. Other factors that contribute to obesity are environmental. According to Lee Kaplan, an obesity expert from Massachusetts General at Harvard, four major environmental factors determine the “set-point” for body fat, many caused by advances of the industrial revolution. These factors have literally altered the set point for obesity, a situation that costs our country $200 billion in healthcare costs each year. 1. Stress is the biggest factor that has changed our body fat set-point. All the technology that allows us to move faster in our daily lives, also drives the fight or flight hormones faster and faster into our bodies which changes the setpoint for body fat. 2. Food and nutrition–energy intake - changed when processed food was introduced because it became much easier to consume a lot more calories in a meal than previously possible. 3. Burning energy, through exercise, muscle movement matters a great deal. The brain manages this set point in a very complex way: it is not just about calories in, calories out. 4. Medications given to patients, such as antidepression, pain medications and even diabetes medications will change the set-point for fat and often cause more obesity. RECOMMENDATIONS There is a huge potential for the culinary community to serve as a positive change agent in guiding the food we purchase and eat by helping to reshape consumer preferences toward foods that improve health and nutrition and support sustainability. More and more Americans are preparing fewer meals at home and asking culinary chefs to make their food choices for them. Americans currently spend almost half (48 percent) of their consumer food dollars on restaurant food. The food service industry–a $630 billion industry–has many different facets and therefore numerous avenues to affect consumer change. For example, the industry has an opportunity to build excitement about new foods prepared with plant-based protein rather than animal-based protein which doesn’t support optimal nutrition and is unsustainably resource intensive. As we move now to more plant–based diets, the Culinary Institute of America, is looking for inspiration and guidance from other parts of the world that rely more on plants for their diet. In rural Thailand, for instance, you will find largely-plant-based meals that are delicious because Thai home cooks have been working away at this diet for generations with the local foods that were available. There is enormous cultural genius all around the world that can help us make the transitions to a more nutritious, plant-based diet. U.S. consumer data points 76% strongly or somewhat agree that changing information on food makes it hard to know what to believe. Consumers are saying “I’m bombarded with information so I’m going to make my own decisions.” Half of all consumers believe it is easier to do their own taxes than to figure out how to eat healthfully. Only about 15% of consumers actually know how many calories they should be eating. Taste and price drive food and beverage choices more often than healthfulness. Nearly 66% of consumers are favorable or neutral toward the use of biotechnology in food production. Two-thirds of consumers say they have thought about the sustainability of their foods and beverages. People in developing countries are more willing to see the need for adequate nutrition and in many cases more willing to support biotechnology. The issue of transparency regarding information about the food we purchase and consume will also become a larger factor in affecting consumer demand. A huge accelerator will be information about food that will include not only what’s in the product, but also social responsibility, sustainability and ethical issues such as how workers are treated. It is not only the food we eat, but it’s the context within which we eat. If there were a dream to aspire to, it is that the family comes together again around a table–without the TV–to the eat food that they have prepared together. Food choice really comes down to people’s imagination. Our goal should be to provide enough inspiration so that consumers do things that are going to support a more rational, sustainable, healthier future in terms of diet and health for the planet. global Action Report | 33
  34. 34. Section Ii Abundant Health Healthcare Solutions Practical innovations in patient care, advanced technologies, and a new focus on wellness have the potential to transform our approach to healthcare for the better. How can healthcare providers offer more personalized solutions, preventive care, nutritional guidance, and improve patient outcomes in a more cost-effective way? A healthier world that includes access to quality healthcare for all citizens is critical to our economic future and social vitality. Leading industry experts discuss the challenges and outline priorities for a “new medicine.” 34 | WWW.GLOBALACTIONPLATFORM.ORG
  35. 35. Abundant health The Future of Health Editorial by Senator William H. Frist, M.D. I t’s a common refrain that America has the best health care in the world but our people are far from the healthiest. We spend twice as much as any other nation on health services yet rank dismally, behind more than twenty other countries in basic health metrics like infant mortality and life expectancy. We have more MRI machines, heart transplants, new drug patents, Nobel prize winners than any country in the world and yet people in Greece, Israel and Jordan live longer. How can this be? The New York Times will tell you that the lack of a true healthcare system, preferably a nationalized and universal system, causes these failures. If only we had a true, equitable and universal system, such as Britain’s or France’s, we could skyrocket up the rankings. This is simply not true. Data have shown that when all factors are taken into account health services only account for roughly 10% of determining how long we live. The two major factors are personal behavior, accounting for 40%, and genetics, accounting for 30% (social circumstances and environmental exposure round out the rest at 15% and 5%, respectively). So how do we harness the true drivers of mortality? How do we live healthier, create a more targeted and personalized approach to medicine all while simultaneously cutting costs and eliminating waste? The answer lies in what I call “New Medicine.” I believe that we are currently at an inflection point in medicine. We are poised to capitalize on decades of innovation, tying together disparate fields including genetics, social networks, supercomputing, the internet, stem cells, cutting edge imaging and sensors, and pharmaceuticals. These forces, unleashed in a dynamic, coordinated fashion can usher in this era of “New Medicine” that treats each patient as an individual, not the average, eliminates waste, adverse side effects and maximizes the outcome of diagnosis and treatment for you specifically, not just for most people or the population in general. We have been building towards this inflection point for decades with seemingly unrelated advances such as the advent of cell phones in the 1970’s, the discovery of the double helix model of DNA in 1953, or the first MRI on a human being in 1977. I have written in several forums about some of these advances, most notably pharmacogenomics and the rise of consumerism in healthcare, but today I focus on one breakthrough of incredible potential. Stem cells hold the power to be a major pillar of the “New Medicine.” Scientists have speculated for years about the awesome potential of stem cells. Conditions as wide ranging as diabetes, spinal cord injuries, burns, limb amputations, heart disease and neurological disorders can all likely be treated by stem cells. But what makes embryonic stem cells so special? Embryonic stem cells are special for two reasons; first they produce exact copies forever and second they can grow into specialized tissue, which fully formed (or “adult embryonic stem cells” human cells cannot, or at least were not thought able to. Embryonic stem cells are harvested from a five day old embryo, taking the inner cell mass of the blastocyst, generating pluripotent embryonic stem cells. These cells can be differentiated into heart cells, brain cells, basically any cell in the human body. But there are two problems with embryonic stem cells. First is the ethical issue. It requires the destruction of embryos, the destruction of something that, left to nature, would become human life. Second, it is “non-self.” Even though these cells can become specialized into any type of cell, they do not come from you and your body knows this. But this approach has yielded remarkable scientific breakthroughs. We have cloned frogs and sheep. I had the great pleasure of visiting Dolly in Scotland, the first cloned sheep, which many may not know was actually named after Dolly Parton, the famous Tennessean entertainer. However, for reasons we don’t fully understand, humans cannot be cloned using this same method. Thus, the real breakthrough came using a radically different approach. In 2012, the Nobel Prize global Action Report | 35
  36. 36. Abundant Health Senator, William H. Frist, M.D, former US Senate Majority Leader, Clinical Professor of Surgery, heart and lung transplant surgeon. for Medicine and Physiology went to Dr. Shinya Yamanaka (along with Sir John B. Gurdon). Yamanaka induced skin cells to become “Pluripotent Stem Cells” (iPS). These “iPS cells” have all the special properties of the magical stem cells. In the simplest terms, Yamanaka was able to take normal, adult skin cells and transform them, using four master genes, into pluripotent stem cells, just as capable of transforming into any cell type, but without the use, and consequent destruction of an embryo. Not only does this solve an incredibly complex moral issue, it also bypasses the issue of embryonic stem cells being foreign or “non-self” to the eventual patient or user. Doctors can simply use the patient’s own skin cells to create the iPS cells needed to treat him. The first real application of this breakthrough is in the form of regenerative medicine. As a transplant surgeon, I have performed hundreds of operations to extend the life of patients by giving them a new heart or lung. This complex procedure meant that I would get on a plane, fly to the organ donor, remove the donor heart and fly back, transplanting it into my patient, all in a matter of hours. The patient receives years, even decades, of life with family and friends. I have many patients who I transplanted more than 25 years ago. But the heart transplant patient has traded a fatal disease for a chronic disease, which requires daily management. The heart a surgeon transplants is “non-self” and thus the body continually attempts to reject it. On top of having just undergone one of the most traumatic operations a human body can endure, the patient must then take multiple immunosuppressant medicines to keep his own body from killing his new heart. Consequently, pneumonia, or even a common cold, becomes deadly. But this operation may well become a thing of the past, like the iron lung. In the not too distant future, we will take a patient who needs a heart transplant, perform a skin biopsy, create patient-specific iPS cells, grow them into healthy heart cells and then transplant, not a separate heart, but merely the genetically matched healthy heart cells. The body, recognizing its own genetic material, would find no cause for rejection and this operation can be done with a needle, not a bonesaw. There 36 | WWW.GLOBALACTIONPLATFORM.ORG is also no shortage of organ donors or patients dying while waiting for just the right match. This example represents just one of hundreds of applications. In fact, the first clinical trials for macular degeneration (blindness) will occur this year. The second application of Yamanaka’s breakthrough is the huge potential for drug discovery. Let’s take Alzheimer’s Disease for an example. Up to now, all drugs have failed. But what if we could test a new drug specifically on your brain cells to see if it works. Using this technology we can. We simply take adult skin cells, revert them to iPS cells in a test tube and then again into brain cells and then test their response to a potential drug in a dish. Now we can literally conduct “clinical trials in a dish.” It’s a new world. The Gladstone Institute, where Dr. Yamanaka works, has already made cells for Alzheimer’s, Parkinson’s, Huntington’s and cardiac disorders. With the ability to test drugs on actual cells of a specific patient, we can take the guesswork out of efficacy and toxicity of drugs. This should, and will, lead to a major rejuvenation of the pharmaceutical industry and more targeted, specific and effective care for patients. “New Medicine” is coming. Don’t be left behind. William H. Frist, M.D., is a nationally recognized heart and lung transplant surgeon, former U.S. Senate Majority Leader, and partner with the private equity firm Cressey and Company. Senator Frist represented Tennessee in the U.S. Senate for 12 years where he served on both Health and Finance committees. He was elected Majority Leader of the Senate having served fewer total years in Congress than anyone in history. His leadership was instrumental to the passage of the 2003 Medicare Prescription Drug, Improvement and Modernization Act and unprecedented funding to fight HIV/AIDS. He is currently an Adjunct Professor of Surgery at Vanderbilt University and a Clinical Professor of Surgery at Meharry Medical College. He is also a Senior Fellow and Co-Chair of the Health Project at the Bipartisan Policy Center. His board service includes the Robert Wood Johnson Foundation, the Kaiser Family Foundation, and the Center for Strategic and International Studies.
  37. 37. Abundant Health Transforming Healthcare How Collaboration and IT Create Game-Changing Innovation SUMMIT PRESENTERS • Keith Gregg, Chairman and CEO, JRG Ventures • James Lakes, Director US Health and Life Sciences, Microsoft • Douglas Wenners, SVP for Provider Engagement, Wellpoint • Jordan Shlain, Commissioner SF Health Service Systems, Founder Healthloop SITUATION A yawning disconnect exists between patient needs and the ability of America’s healthcare system to deliver timely and cost-effective services to all populations. This is causing a new face of healthcare to emerge. Practical innovations that include better use of technology, new uses of big data, collaborative teams and a focus on wellness and preventative care rather than sickness, have the potential to transform health care delivery, improve patient outcomes, save money, and promise all populations a healthier life in the future. CHALLENGES 1. The cost of healthcare in America has escalated beyond its value to consumers: • In last 10 years (between 2001 and 2011), there has been a 119% increase in the cost of healthcare insurance premiums. • Average cost for insurance/person - $450/ month ; for family of 4 this is $1,600/month. 2. An aging population that is also less healthy: • The senior age group is now, for the first time, the largest in terms of size and percent of the population in the US. • 63 percent of all Americans are either obese or overweight. 3. A massive primary care shortage, combined with a high degree of variation in cost and quality of care: • Today there is an average 20 days wait for non-emergency visit. This results in patients either going to the emergency room for immediate treatment or to specialists who may prescribe the wrong treatment. Both approaches result in higher expenses and reduced overall care for the patient. global Action Report | 37
  38. 38. Abundant Health • Much of the population doesn’t have access to primary care, causing them to go to the emergency room for care or to no one at all. 4. A failure to use technology to manage patient data across care providers and/or bridge communication between the physician and patient: • Most of the healthcare technology was developed for doctors primarily for billing purposes. It is time to refocus technology to support the patient. Today, for example, a doctor might not know that their patient went to the emergency room five times in a month because either s/he couldn’t get an appointment or had to wait 28 days, or didn’t comply with a medication triggering an emergency room visit. • The Electronic Medical Record does not fulfill the data reporting needs that are required to be successful in a modern world. The Electronic Medical Record and the Physician’s Health Record tell you about what happened yesterday; what is really valuable is what is happening today. • A focus on “big data” ignores the importance of the individual. In the end, a doctor manages one person at a time. We need to use data to support each individual’s health, not aggregated populations. RECOMMENDATIONS 1. Innovations must support doctors helping patients while involving all parties. Our overall approach to healthcare needs to be: “You are the patient, I’m the doctor, together we develop a roadmap. I can invite your family member(s) in on the plan.” EXAMPLE: At “Healthloop”, it’s all about feedback and involving everyone. If you’re not in the “loop”, you can’t make a decision. At Healthloop, the doctor gets reimbursed for the patient’s participation, not on the diagnosis. When the patient participates, that’s when the doctor gets paid. 2. Provide incentives for physicians to maintain contact with patients, while also focusing on wellness and preventive care. We need to take more advantage of the funda- 38 | WWW.GLOBALACTIONPLATFORM.ORG mental trust people have with their doctors. An e-mail message from the doctor has the potential to have a huge impact. Doctors can personalize messages because they know who their patients are. EXAMPLE: Wellpoint is experimenting with a $6-8/month fee per patient to physicians to compensate them for personalized care and care coordination. 3. Technology solutions need to be directed to the patient’s needs. Use technology to take the predictive information that is already available and get it to the patient in a way that is both accessible and useful. It’s the little data that matters; there is no need to invent complex, expensive solutions. We need our systems to recognize that our professional life and personal life are closely related. A solution would include offering consumers more seamless communication connections to health care providers with the capability to communicate across all platforms. IBM is one company that is working on building platforms to facilitate this. Use technology to communicate frequently and involve family members. If patients know they are being observed, they will be more likely to be motivated to do better. Family and friends typically want to help but they frequently don’t know how nor do they have the right information. Look at developing technologies that can reach into an HMR (Health Medical Record), extract out pertinent clinical data and marry this with pertinent financial data to provide meaningful information to physicians. So far, no company is doing this adequately. 4. Encourage consumers to be more engaged partners in health. To involve patients more, we need to change some of our language. For example, rather than say “You must take your pill...” suggest: “How can I help you take your pill?” We all have the same problems, but as individuals we need to own our problems. Personalized medicine is what happens to you.
  39. 39. Abundant Health THE NEW MEDICINE SUMMIT PRESENTERS • Roy Elam, Instructional Systems Specialist, Directorate of Training and Doctrine MCOE, Fort Benning • Steve Burd, President and CEO, Safeway, Inc. • Brent Parton, Program Director, Shout America • Wayne Riley, President, Meharry Medical College SITUATION CHALLENGES The “New Medicine” is about emerging, disruptive innovations that are likely to cause significant changes in how we approach healthcare. Large and small providers are already beginning to transform our system from one that focused on consumption of disease-based health care services to one based on the consumption of prevention and wellness. 1. There is a deep disconnect in our healthcare delivery system. Our entire system is set up for patients to be dependent on physicians for prescriptions, for procedures, and treatments; there is no model for self-care. Historically, our healthcare system has worked to solve targeted health emergencies through massive intervention: in the early 20th century, we focused on infectious disease; in the mid 20th century, the focus was on cardiovascular and strokes; and in the latter part of the 20th century, the focus shifted to cures for cancer. It is time now to focus on health. A healthier world for all citizens–especially those who have been underserved–is tied to economic vitality. We must invest earlier and work together more strategically across teams to promote healthy lifestyles. This is the “New Medicine.” EXAMPLE: In Nashville, the capital of healthcare with over 300 Healthcare companies, the obesity rate is over 30%; Tennessee has a 10% rate of diabetes. Clearly, the amount of healthcare available in the city and state is not helping the local population. 2. We must shore up primary care to assure all populations are provided for–especially the underserved. Primary care is cost effective and more efficient. Currently we do not do an equitable job of serving all populations: • Both racial and ethnic minorities experience higher rates of illness and death than nonminorities.” • Hispanics are less likely to receive major proce- global Action Report | 39

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