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  • 1. INTELLIGENT DIALOGUE: & CRADLE GRAVE FALL 2008 Many Minds. Singular Results.
  • 2. Cover photo: Creative Commons/pdam2 Many Minds. Singular Results.
  • 3. MESSAGE FROM THE CEO “SOMEONE ALIVE TODAY will live to the ripe old age of 150.” Agree or disagree? Two professors have wagered $150 on this very question. No matter which side you’re on, there’s no arguing that fundamental shifts in health trends have us all rethinking long-held beliefs about life and death. In our latest Intelligent Dialogue white paper, “Cradle & Grave,” Porter Novelli has examined emerging global trends in fertility and birth, health and death that have profound implications for businesses, organizations and consumers far beyond the health care industry. Gaining a better understanding of these complex health issues means getting out of your comfort zone. It means leaving behind preconceived notions of the “right” age for a first-time mother. It means facing your own mortality and examining whether you really want to live to be a centenarian, and then honestly asking yourself, “Am I making the choices today that will allow me to live 100 years?” To prepare this paper, our health care industry specialists joined with our public affairs, corporate affairs and marketing professionals to consider what’s changing across the full arc of life, from conception to death. “Cradle & Grave” identifies key trends in fertility, birth, health care advances, disease prevention and treatment, aging and dying. The paper examines how families (and populations) are changing, and how evolving health challenges like diseases of affluence and the obesity crisis will affect modern society. It raises questions about the advent of personalized drug therapies, the promise of longer life expectancy and the threats posed by swelling ranks of elderly and chronically ill people. While some of the trends discussed in “Cradle & Grave” might not be news, integrating the full scope of them into our lives and businesses is a monumental challenge. This paper is intended to help map out the big picture and prompt discussion. At Porter Novelli, we believe ours is a learning culture, and that ongoing dialogue is key. We challenge assumptions and cultivate creative questions, and we invite you to join the dialogue by checking out our blog, PNIntelligentDialogue.com. It’s your forum for discussing the issues raised in “Cradle & Grave,” and for proposing your own questions. Our goal with the Intelligent Dialogue series is to provide perspective and stimulate conversation. This is an opportunity for individuals and organizations to demonstrate thought leadership on issues that affect all of us. —GARY STOCKMAN
  • 4. TH E PRE S E NT SCREAM S FOR ATTE NTION AN D TH E FUTU RE WH I S PE RS . No wonder more people than ever are falling into the old trap of overestimating Photo: Creative Commons/jonner short-term change and underestimating long-term change. 4 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.
  • 5. INTRODUCTION IN THE CURRENT FRENZY of financial uncertainty, fast- most productive when it’s open and inquisitive. In particular, talking pundits and finger-pointing politicians, can anyone afford this edition is driven by three overarching questions: to think more than a year or so into the future? 1. What about life and death has changed? Nobody knows what may happen between now and next year in the economy, politics or technology, let alone other parts 2. Which long-standing assumptions about life and of life. Thoughts about the longer term are crowded out by death no longer hold true? urgent news of breakthroughs and breakdowns pumped out by the media 24/7. 3. What are the emerging risks and opportunities Businesses and consumers are so busy putting out the fires in for societies, businesses and consumers? front of them, they are unable to focus on what’s further ahead. With our background in social marketing, Porter Novelli The present screams for attention and the future whispers. No believes that now more than ever, when it comes to the life-and- wonder more people than ever are falling into the old trap of death issues covered in this paper, our communities need smart overestimating short-term change and underestimating long-term leadership through Intelligent Influence. During this period of change. This paper is intended to shift the focus and look at Photo: Creative Commons/A.M. Kuchling worldwide financial change, we will be helping our clients take some of the long-term changes slowly but surely reshaping the the long view and keep their sights on these critical health issues most important things in our world: literally the basics of our as they make decisions on how they will move forward. This is life as we know it. They’re gradual changes that we can all see an ideal moment to foster serious consideration of the bigger and feel but are too busy and too distracted to notice; they’re health issues that affect everyone. For smart businesses and eclipsed by breaking news or hot gossip. brands in particular, life and death issues create opportunities to In keeping with our guiding principles, this edition of provide the leadership employees and consumers need— Intelligent Dialogue is driven by observation and open-ended opportunities that enhance both their reputation and their curiosity. It raises a lot of questions, because we find dialogue is bottom line. Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 5
  • 6. BIG QUESTION 1 WHAT’S HAPPENING TO NUCLEAR FAMILIES? TO HAVE KIDS or not? Now or later? and effective contraception make for of 1.5, as do developed countries such as How many? What will it cost? It used to smaller families. Russia (1.4), Japan (1.22) and Singapore Photos (from top): Creative Commons/paristempo, Creative Commons/ShutterCat7 be that babies were the result of “doing (1.08), and newly developing countries In the developed world, births in many what comes naturally.” But now, having like China (1.77), Thailand (1.64) and children isn’t inevitable, it’s a matter of countries are below an average of 2.1 per South Korea (1.29). choice. It’s a complex decision, woman, which is the crucial “replacement and in the 21st century, deciding rate,” or number needed In all sorts of ways, traditional to become a parent involves to maintain a population expectations of childbearing and family considerations unknown to at a stable level. When relationships no longer apply. previous generations. fertility rates are below Though recent figures from 2.1, the population shrinks. This is a radical > WHY ARE WOMEN the U.S. National Center for change from what has WAITING TO HAVE Health Statistics show a record number of babies born in the happened throughout CHILDREN? It used to be that most of history, when people married in their late teens or early U.S. in 2007, birthrates are populations of prosperous 20s, had children and moved into a trending downward worldwide. cultures continually grandparent role by middle age. Now, The more prosperous people become, expanded. Today, with its recent baby growing numbers of people are starting the fewer children they have. More years boomlet, the United States is running at this cycle much later, or they’re skipping of education, higher quality-of-life replacement rate, but the European Union over the marriage step, or they’re expectations, better career opportunities (EU) falls well below that, with a birthrate choosing to become single parents; some 6 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.
  • 7. necessarily mean it’s baby time. Women THE COST OF FERTILITY may still be reluctant to take time out for a child, either because they are unwilling to sacrifice career goals or because they { MILLION don’t feel financially prepared. Or the delay may be beyond their control if they DOLLAR BABY } are having trouble conceiving. The statistics tell the story of delayed motherhood but Hollywood brings it to life, writ large in the personal lives of celebrities: Madonna famously gave birth to her first child at 38 (fathered by a boyfriend); her second at 41 (father was second husband Guy Ritchie); and then adopted a child at 49. “Desperate are starting new families as they move on Housewives” star Marcia Cross celebrated to second marriages, and some are her first marriage at 44, then gave birth marrying relatively late and adopting. to twins less than a year later. Actress The average age for first marriages has Nicole Kidman recently gave birth to her crept up, and it’s not surprising. Younger first child with second husband Keith women are too absorbed in education and Urban at 41, having previously adopted careers to focus on serious dating, and they two children in her 20s with first husband tend to be financially self-sufficient. The Tom Cruise. And several stars chose to women depicted in “Sex and the City” may be adoptive single moms despite their have been TV-land creations but they busy careers—actress Angelina Jolie, In the U.K., child psychiatrist struck a chord all over the world as women singer Sheryl Crow and actress Mary- who enjoyed their independence and were Louise Parker. Patricia Rashbrook made headlines Photos (clockwise from top): Creative Commons/SilentObserver, Creative Commons/Mahalie, Creative Commons/miss pupik taking their time in finding a long-term in 2006 when she gave birth at age partner until well into their late 30s or 40s. Why should women hurry to have > HOW OLD IS 62; she already had three grown children when modern life is giving them TOO OLD TO HAVE A children from a previous marriage. plenty of reasons and ample means to have BABY? Data across the EU and the She and her husband had spent them in their own good time—or not at all? U.S. show the average age of first-time Even settling with a steady partner doesn’t mothers is rising. More women at the $20,000 on fertility treatments with Italian embryologist and fertility specialist Dr. Severino Antinori, who has become a controversial (and wealthy) celebrity in the field. According to the American Society of Reproductive Medicine, the average cost of an IVF cycle in the U.S. is $12,400. Would-be parents may try it two or three times, although IVF is not successful for a significant percentage of women. In Europe the average cost is estimated at $4,000 to $6,000. Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 7
  • 8. IVF TURNS 30 { ONE PLUS ONE EQUALS ME } The world’s first test tube baby, Louise Brown, has just turned 30, and the IVF (in vitro fertilization) technique used to make her birth possible has spawned an industry now worth $3 billion in the United States alone. The process used at the time has been superseded by ICSI (intracytoplasmic sperm injection), where a single sperm is injected directly into an egg. upper range of childbearing ability are Professor Bill Ledger of England’s and “gender bending” (endocrine- becoming mothers. Sheffield University is one of the fertility disrupting) chemicals in the environment. specialists warning that obesity and The average age of EU women giving birth to their first child rose from 23 to 25 sexually transmitted diseases are causing a growing number of fertility problems. > WHAT ARE THE between 1990 and 2002. In the bigger FINANCIAL ISSUES OF Currently, one in seven couples has countries, first-timers were older than that: 28 in France (as of 2001) trouble conceiving naturally, and Ledger OLDER PARENTHOOD? warns this could rise to one in three. First-time parents who are older than the and 29 in Germany (2003). He advises couples to start trying to “traditional” age tend to do a lot of soul- According to the U.K.’s conceive younger than 35. searching. Whether their later parenthood Office for National Statistics, more of Britain’s first-time Older parenthood is not just a is deliberate, or due to circumstances such mothers now fall in the 30 to 34 age female issue; men have their own as marriage or fertility problems, they are group than in the 25 to 29 age group; fertility problems. There is clear more likely to feel the need to rationalize and there has been an almost 50 percent evidence that sperm quality and justify their situation to themselves increase from 10 years ago in women over deteriorates with age and around and/or to others. The Internet is proving 40 having babies. In the U.S., the most a quarter of men of reproductive to be an ideal medium for them to recent census figures show the average age at age are subfertile (they produce compare notes and examine the issues. Photos (clockwise from top): Creative Commons/moyix, Creative Commons/salimfadhley, Creative Commons/paristempo an all-time high of 25.2, with more than sperm but not at maximum One clear advantage of older new 100,000 births in 2003 to women 40 or older. fertility). There are indications that male parents is financial stability—a factor that fertility is decreasing due to several Fertility treatments and improved health seems to be widely accepted and valued in possible causes, notably stress, weight care are certainly pushing up the age at discussions on the issue. Parents in their 30s issues and diabetes. Researchers are which it’s possible to have children. and 40s tend to be educated and established looking into other possible causes such as However, “possible” is not the same as in the workplace. They’re more likely than electromagnetic radiation from cell phones probable, advisable or desirable. younger parents to have achieved a certain standard of living, along with higher expectations of service, comfort and quality. Older prospective parents may have to be prepared to invest significant amounts of money and time in fertility treatments or adoption. On the other hand, these parents may find themselves needing to fund their children’s teenage pursuits and college education at a time when their peers are beginning to draw pensions. As AARP the Magazine put it: “Midlife parents face another challenge: how to stay financially healthy as well [as physically healthy]. Many may find themselves working well beyond the traditional retirement age just so they can send their kids to college.” Current assumptions about maternity- planning patterns and family structures are increasingly out of step with reality. 8 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.
  • 9. TH E MORE PROS PE ROU S PEOPLE B ECOM E, TH E FEWE R CH I LDRE N TH EY HAVE. MORE YEARS OF E DUCATION, higher quality-of-life expectations, better career opportunities and effective contraception make for smaller families. Photo: Creative Commons/jonner Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 9
  • 10. SURROGACY IN INDIA { CARRYING THE WEIGHT OF THE WORLD } Thanks to globalization, India has emerged as an option for surrogacy. Centers are springing up in which local women carry the babies of Westerners who don’t want to pay the high costs generally associated with such a proposition in their home countries. India’s sophisticated medical capabilities and low costs make outsourced surrogacy a viable industry, but one that’s prompting outrage from critics who charge that it exploits poor people and is a crass commercialization of an intimate matter. Dr. Nayna Patel, who works at a surrogacy clinic in Anand, India, defends the practice as a win-win arrangement, telling the Associated Press, “There is a woman who desperately needs a baby and cannot have her own child without the help of a surrogate. At the other end there is a woman who badly wants to help her [own] family. If this female wants to help the other one, why not allow that? It’s not for any bad cause. They’re helping one another to have a new life in this world.” Can employers afford to have valuable, talented staff absorbed in a baby chase? > WHAT’S WRONG frustration through violence, crime and political extremism, and that rising What are the opportunities for businesses WITH GETTING A SNEAK demand for sex workers could fuel the to offer fertility counseling and assistance PEEK? Fertility treatments and practice of human trafficking and the as part of occupational health care, in prenatal screening have given would-be spread of HIV/AIDS. order to attract and retain top-notch mid- parents the option of knowing the sex of Although prenatal gender screening Photos (clockwise from top): Creative Commons/jenaynay, Creative Commons/Michael_Chavarria, Creative Commons/The LeCrones to-senior level professionals? their baby before it’s born. In some involves the relatively simple technology Are employers that foster a maternity- cultures where males have a higher status of ultrasound, its wider social effects are friendly, postpartum-friendly, family- than women (such as India and China), proving to be far-reaching. The effects friendly culture getting ahead of the curve this has resulted in a dangerously skewed of more sophisticated genetic-based in recruitment, retention and reputation? gender balance. prenatal screening are likely to be even Or are they merely picking up the tab for In China, the one-child policy has meant more radical. more ruthless, lean-and-mean competitors? that many parents aren’t willing to let The biological limitations of parenthood nature take its course. China will have 30 have changed, and so have the social million more men of marriageable age limitations. Parents no longer need to be than women in the next decade and a half. in a traditional couple—some are single The ratio for newborn babies in 2005 women, others are same-sex couples. was 118 boys vs. 100 girls, up from 110/100 in 2000. In some regions the There’s a greater willingness to talk ratio is as high as 130/100, compared about fertility problems and options. with an average of between 104 and Still, there’s a risk of social backlash when 107 boys for every 100 girls in people opt for non-traditional choices. industrialized countries. For businesses, how tightly they want to embrace non-traditional choices is not just In 1994, the Indian government banned a matter of inner-focused company policy— medical practitioners from revealing the it’s a part of brand positioning and identity. gender results of fetal scans. Yet the gender imbalance has only further tipped. In 1991 there were 945 women for every 1,000 men, and the gap widened to 927/1,000 by 2001. These unintended consequences of simple screening are likely to be felt for decades to come. There are concerns that millions of restless young men could vent their 10 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.
  • 11. WHY S HOU LD WOM E N H U RRY TO HAVE CH I LDRE N… WH E N MODE RN LI FE is giving them plenty of reasons and Photo: Creative Commons/wilf2 ample means to have them in their own good time—or not at all? Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 11
  • 12. BIG QUESTION 2 WHAT’S THE BEST WAY TO DELIVER BABIES? CHILDBIRTH IS AN EXPERIENCE it happens.” But in fact, it doesn’t happen How much of this is due to the traditionally surrounded by folklore and the same everywhere. precautionary principle, with the fear of mystery. Historically it has been one of the malpractice suits informing medical Now, as in other parts of medicine, riskiest moments in life. It still is. And procedures? How much is due to the globalization has enabled interested parties while medical science has helped alleviate medical profession seeking business to compare practices in terms of medical the risk and pain involved, there are still opportunities? How much is due to the outcome as well as emotional outcome and major open issues. “mission creep” of technology, as implied cost. This has encouraged challenges to the highly medicalized approach to in the polemical 2007 movie “The Business > IS A HOSPITAL pregnancy and childbirth that is at its most of Being Born”? BIRTH THE ONLY SAFE pronounced in the United States. Photo: Creative Commons/premus OPTION? There’s a growing In the U.S., home births account for just > WHO REALLY WANTS tendency for developed countries to treat 1 percent of deliveries, and the American pregnancy and childbirth as medical College of Obstetricians and Gynecologists BIRTH BY CESAREAN issues, requiring highly sophisticated has repeatedly stated its opposition to home SECTION? One of the most hotly medical care and hospitalization. For a births, emphasizing that “the safest setting contested issues is the trend to deliver long time this trend was accepted by for labor, delivery and the immediate babies by cesarean section. Although it’s parents-to-be and the wider society as postpartum period is in the hospital, or a still a serious surgical procedure, it’s no “doctor knows best” and “this is the way birthing center within a hospital complex.” longer a last-resort rarity. 12 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.
  • 14. In the United States, figures for 2007 According to a survey of American As childbirth becomes a less frequent are expected to show around one in three women conducted on behalf of the U.S. occurrence in developed societies, will each births by cesarean, compared with fewer nonprofit Childbirth Connection, 98 pregnancy and birth become more than one in 20 in 1965. Cesareans are percent of women with primary (planned) expensive? Will the medical profession increasingly common in Canada too, even cesareans believed there was a medical become ever-more intensively involved? though the health system is significantly reason for the surgery. The most common Childbirth has become a lot less risky different: 26.3 percent of women concerns cited were fetal distress, position than it used to be in many parts of the delivered by cesarean in 2005–2006, up of baby, size of baby and prolonged labor. world. But is the complete medicalization from 23 percent in 2001–2002. In the However, 42 percent of respondents also of childbirth in the best interest of all U.K., cesarean sections are also felt that due to fear of lawsuits, the concerned? Are health care and insurance increasing and currently stand at around current health care system leads to providers missing an opportunity to offer 20 percent. unnecessary cesareans. alternatives that cost less and satisfy more? IN-HOME DELIVERY { SHOULD WE ALL BE GOING DUTCH? } Among major developed countries, childbirth in the Netherlands is an anomaly. In fact, the attitude of the Dutch toward childbirth has been called medieval. Pain is regarded as a normal part of childbirth, and pain relief is the exception rather than the rule. Indeed, unless there are medical complications, maternity care is a determinedly low- tech affair left in the hands of midwives; a home birth is the default choice. The rate for cesarean sections is less than 10 percent, which is significantly out of line with the modern trend. Likewise, few countries have the Photo: Creative Commons/eyeliam equivalent of the kraamzorg, a program in which a maternity nurse provides after-birth care in the home for a week. It’s standard after all births in the Netherlands and is on the policy list of Britain’s Conservative Party. However, the Dutch example may not be so easy for other countries to emulate. In the small, densely populated Netherlands, most homes are within 10 to 15 minutes of a hospital. If an in-home delivery suddenly turns difficult, medical facilities are within easy reach. 14 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.
  • 15. BIG QUESTION 3 WHAT NEW HEALTH THREATS MUST BE DEFEATED, AND HOW? PEOPLE ARE ALREADY experiencing > ARE THE MAJOR HIV/AIDS and the virulent staph infection MRSA are relatively new to the longer, healthier lives than ever before and there’s the prospect of more good CONTAGIOUS DISEASES roster of communicable diseases. One GONE FOR GOOD? Time Photo: Creative Commons/Andrew Ciscel third of the world’s population is infected news to come. But that doesn’t mean it’s was when contagious diseases were the with the bacteria that causes tuberculosis. all smooth sailing from here on. For one Meningitis continues to lurk and malaria thing, microorganisms (bacteria, viruses, big killers: plague, smallpox, cholera, etc. may yet spread further as global warming etc.) have a way of evolving to exploit Thanks to public sanitation, hygiene, makes temperate zones more congenial for new opportunities, which could trigger a vaccination and antibiotics, their impact mosquitoes. Meanwhile, health authorities major pandemic. For another thing, we has been hugely reduced. But they have are keeping an eye out for the likes of are facing diseases arising from new not been completely eliminated, and they SARS and avian flu, and whatever might lifestyles and from living older. still hold some nasty surprises. yet emerge from tropical jungles. Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 15
  • 16. E A R LY P R E V E N T I O N F O R A H E A LT H Y F U T U R E { WHAT A GIRL WANTS } According to the U.S. Centers for Disease Control and Prevention, the vaccine Gardasil® prevents the types of genital human papillomavirus (HPV) that cause most cases of cervical cancer and genital warts. The vaccine is given in three shots over six months and is routinely recommended for 11- and 12-year-old girls. It is also recommended for girls and women ages 13 through 26 who have not yet been vaccinated or completed the vaccine series. Communicable-disease specialists warn that of Montpellier in France. The systematic there’s a strong chance of more superbugs; monitoring of bush-meat hunters may also microbes and even cancers are developing help prevent future AIDS-like epidemics. immunity to the drugs that have been used against them. Although communicable diseases are not killing huge numbers of people in the old HIV/AIDS is typical of what health familiar ways—sickness, fever, swelling and professionals fear from cunning superbugs. pain within weeks or months—they may be By the time the Centers for Disease Control wreaking havoc over a longer period, and Prevention (CDC) in the U.S. working in the background. Some viruses recognized HIV/AIDS as a distinct can cause changes in cells that may lead to syndrome in 1981, it was already on its cancer. There are clear links between way to becoming a devastating epidemic. cervical cancer and the genital wart virus from behaviors or environments of wealthier According to a 2006 report from the United HPV, between primary liver cancer and societies. This is uncharted territory in Nations Joint Program on HIV/AIDS, over the hepatitis B virus, and between various human history and raises new challenges. the last quarter-century, nearly 65 million cancers and the Epstein-Barr virus. people were infected with HIV and an We are seeking medication to tackle the Photos (clockwise from top): Creative Commons/Mel B., Creative Commons/Jaye_Elle, Creative Commons/Andy McLeod Fortunately medical science evolves fast estimated 25 million have died of AIDS- effects of too little physical activity and too too and a range of new vaccines such as related illnesses. About 33 million—almost much food; we are expecting cures for Gardasil has been introduced in recent half are women—live with HIV today, the diseases that were barely encountered a years that seem to be effective at reducing vast majority unaware of their status. century ago. And they can’t be found soon the incidence of such cancers. enough. By some accounts, half the Scientists are looking for ways to spot Many of the major historical advances American population is living with some other emerging diseases before they in disease control and life expectancy have form of chronic illness. become equally—if not more—devastating. come from preventing diseases rather than About three-quarters of emerging human Diabetes is a case in point. About 124 curing them. Vaccination, sanitation, diseases are “zoonoses,” or pathogens that, million people worldwide had diabetes in education and nutrition have together like HIV/AIDS, originate in animals and 1997, compared with a projected 221 done more to save lives from disease than cross into human populations. A number million by 2010. The rate is rising in have feats of medical wizardry as seen in of projects are focused on gathering front- parallel with obesity, a major cause of type “ER” and “House.” line blood samples across equatorial 2 diabetes; the coupling of a severe weight jungles, watching for changes in behavior The specific illnesses have changed but problem with type 2 diabetes is being and mortality, and coordinating findings the principle holds; cures are needed but referred to as “diabesity.” through specialists such as the CDC and prevention will continue to be the most While death from heart disease in the the virology laboratory at the University effective and the most cost-effective U.S. has fallen by 26 percent and death strategy. from stroke by 24 percent since 1999, they are still the first and third causes of death, > WHAT ARE THE respectively. And the American Heart PROSPECTS FOR Association has warned that the improvement could be short-lived if risk TREATING CHRONIC factors aren’t reduced. AND TERMINAL It’s not just the U.S. that’s grappling CONDITIONS? People in with the big killers. The World Health developed countries are much less apt to Organization reports that cardiovascular die from contagious diseases anymore. disease is the top cause of death globally, Rather, they tend to succumb to old age or and it’s projected to remain so. An to “diseases of affluence”—those stemming estimated 17.5 million people died from 16 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.
  • 17. CH RON IC TH E U PS I DE OF DI S EAS E TREATM E NT I S THAT PEOPLE ARE S U RVIVI NG AN D EVE NTUALLY DYI NG with the disease rather than from it. The downside is that it can be expensive and debilitating to live life on the tightrope of daily disease management. Photo: Creative Commons/Jimee, Jackie, Tom & Asha Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 17
  • 18. through basic research and improvements developing, heavily populated regions such in treatment and care. as China, India and Latin America. The longer people live, the more likely it Like battlefield weapons designed to is they will experience any one of about 80 wound rather than kill, the chronic autoimmune disorders that can make life illnesses of today can be more devastating miserable. These disorders involve the than acute, sudden-death conditions. immune system mistakenly attacking and People suffering from chronic disease over destroying healthy body tissue—“friendly fire,” several years represent major costs, both so to speak. Well-known conditions include: financially and emotionally. type 1 diabetes, thyroiditis, pernicious anemia, The prospect of many millions more rheumatoid arthritis, lupus, multiple sclerosis people suffering from chronic illnesses and and Graves’ disease. According to the millions having to look after them is a real American Autoimmune Related Diseases and unprecedented threat likely to eclipse Association, it’s estimated that the dangers of terrorists and road traffic cardiovascular disease and strokes in 2005, approximately 50 million Americans suffer accidents and violent criminals combined. accounting for 30 percent of global deaths. from an autoimmune disease. How can governments, insurers and In 2003, the World Health Degenerative conditions are another individuals be adequately prepared for it? Organization’s “World Cancer Report” prospect, especially dementia—the umbrella forecast an increase in cancer from 10 name for progressive degenerative brain million new cases globally in 2000 to 15 syndromes that affect memory, thinking, million by 2020, mainly due to steadily behavior and emotion. aging populations in both developed and Alzheimer’s disease is the most common developing countries, as well as rising form of dementia. According to Johns trends in smoking and the growing Hopkins researchers, an estimated 26.6 adoption of unhealthy lifestyles. The million people worldwide suffer from report says cancer poses major challenges Alzheimer’s, a number that’s forecast to for health care systems worldwide, but that rise to more than 106.8 million by 2050. it can be prevented and its impact reduced Much of this increase will be in rapidly Photos (clockwise from top): Creative Commons/Subewl, Creative Commons/Sam Blackman, Creative Commons/brykmantra 18 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.
  • 19. U P TO TH E AG E OF 65, DE M E NTIA DEVE LOPS I N ABOUT ON E PE RSON I N 1,000. Its incidence rises sharply with age to one person in 20 over age 65. The big threat is to people over the age of 80, when the incidence of dementia increases to one in five. That’s riskier than the one in six of Russian roulette. Photo: Creative Commons/lanuiop Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 19
  • 20. > IS OBESITY THE (defined as a body mass index greater than 30) increases the of public and private concerns, ranging NEXT FRONTIER? Obesity risks of developing diabetes, from governments and its complications will cause the high blood pressure, angina, to nonprofits to untimely deaths of hundreds of thousands heart attacks, high the food industry. of people every year for the foreseeable cholesterol, urinary Perhaps a faster, future. In 2006, U.S. Surgeon General incontinence, infertility, fail-safe solution Richard Carmona called obesity “the osteoarthritis, asthma, sleep will come from terror within” and warned that, “Unless apnea and cancer. science. we do something about it, the magnitude of the dilemma will dwarf 9/11 or any These illnesses represent A lot of people other terrorist attempt.” Are such dire huge costs in terms of human are aiming for a proclamations just the nanny state at suffering, not to mention medical “cure” for obesity— work? After all, if obesity is such a big and insurance costs as well as lost miracle foods, pills, productivity and earnings. Obesity is set injections, surgery, gene therapy threat, why are people living longer? to become the most critical health issue and more. Whoever comes up with a safe and There’s no getting around the health shaping life and death in the first half of effective treatment that fulfills the classic implications of extra pounds. According to the 21st century. Turning the tide will marketing imperatives—quick, easy, convenient, U.K. private hospital group BMI, obesity require the commitment and collaboration affordable—will be sitting on a goldmine. Might microbes come to the rescue? THE OBESITY EPIDEMIC Researchers at the EU’s Metagenomics of { NO ROOM TO GROW } the Human Intestinal Tract project (MetaHIT) have found a sharp contrast in the bacteria population in the guts of overweight and thin people. And when heavy people dieted and lost up to a quarter of their body weight, their gut flora changed too, becoming more like those of the lean group. So it may be that certain types of probiotics can help reduce weight. Might genetics solve the problem? In 2007, scientists analyzing a large-scale study of diabetics found a correlation between the FTO gene and obesity. Researchers at Cambridge University in the U.K. have discovered that the gene codes for an enzyme that modifies DNA could be activated or inhibited by pharmaceuticals. This opens the prospect of drug therapies for obesity. For the moment, many people are pinning their hopes on surgery. Restrictive surgery covers procedures that make the stomach smaller, so that the patient eats less. Photo: Creative Commons/gotplaid?. Creative Commons/memekode World Health Organization figures for 2005 show that approximately 1.6 Malabsorptive surgery changes the body’s billion adults worldwide were overweight and 400 million were obese; the ability to absorb calories from food. The two most commonly performed operations WHO forecasts as many as 2.3 billion overweight adults in the world by are laparoscopic adjustable gastric banding 2015, more than 700 million of whom will be obese. (LAGB), also known as lap banding or gastric banding, and gastric bypass. Just how much have our waistlines expanded over the decades? In 1951, Weight problems are no longer simply aesthetic issues; they represent a major a survey found that the average British woman’s waist measured 27.5 threat to public health, although public inches. By contrast, the U.K.’s 2004 National Sizing Survey (SizeUK) found perception of the real threat is far short of reality. that the average waist had increased to 34 inches. While there was no comparative data for men in 1951, the SizeUK data found an average male What will it take for obesity to be treated seriously as a modern medical waist of 37 inches in 2004. condition with major public health 20 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.
  • 21. TH E FOOD AN D DRI N KS I N DU STRI E S HAVEG ROWN TH E I R MARKETS S PECTACU LARLY. While they may not be blamed for consumers’ obesity, they are clearly a crucial part of the problem. How can the health of these industries align more effectively with the interests of public health? Photo: Creative Commons/moyix Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 21
  • 22. ACCORDI NG TO TH E MAYO CLI N IC, EACH YEAR AN E STI MATE D 100,000 AM E RICAN S DI E from adverse reactions to medications and more than 2 million are hospitalized. Photo: Creative Commons/subewl 22 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.
  • 23. implications rather than as a lifestyle issue? before doctors find one that more focused therapy, greater The risk is that the cumulative effects of works. emphasis on preventive obesity will overwhelm the capacity of medicine and cost In the meantime the communities to deal with the financial and reduction. The PMC side effects of this health care consequences. also believes when trial-and-error process used in research, can be distressing for pharmacogenomics patients and risky could reduce the for their health, not length, cost and failure to mention a serious rate of clinical trials, and waste of health care even revive drugs that resources. failed clinical trials or were To reduce the potluck withdrawn from the market. element of drugs, health care A lot depends on technology professionals are looking to being developed to read (or personalized medicine, or “sequence”) genes fast and affordably. In pharmacogenomics. With this approach, > WHEN WILL CURES before medication is prescribed, genetic the U.S., the National Institutes of Health has set a goal for sequencing an entire BECOME LESS LIFE- analysis will be carried out to check for personal genome at a cost of just $1,000 by relevant genetic variations—single THREATENING? For all the nucleotide polymorphisms, or SNPs. This 2014 (currently, one firm is charging amazing progress in pharmaceuticals, $350,000 to anyone who wants a complete will enable doctors to better predict prescribing drugs is still hit-or-miss. Drugs personal genome sequencing). In a parallel whether a drug will provoke an adverse have been developed to deal with initiative, the X Prize Foundation in the reaction or will be likely to do the job. conditions, not individuals; they take a United States has put up a prize of $10 one-size-fits-all approach that can’t account According to the Personalized Medicine million for the first private team that can for individual body chemistry. Patients Coalition, this approach has the potential decode 100 complete human genomes may be subjected to a range of treatments to offer benefits such as early detection, within 10 days for less than $10,000 each. Photos (clockwise from top): Creative Commons/SMercury98, Creative Commons/MASH DnArt, Creative Commons/jurvetson Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 23
  • 24. BIG QUESTION 4 HOW OLD DO WE REALLY WANT TO BE? HOW ABOUT LIVING FOREVER? In most developed countries, life spans that damage and weaken the body. There Mythology, legend, religion and popular have been steadily increasing for a long are fewer accidents and better treatments culture are full of quests to find ways of time and look set to continue upward. for injuries such as fractures and lesions. beating the Grim Reaper: the fountain of Consider that in 1850, life expectancy at Better nutrition is more widely available, youth, the elixir of life, the philosopher’s stone. birth averaged just 38.3 years for helping bodies stay resilient. But the human body hasn’t evolved to live American Caucasian men and 40.5 years The big imponderable is whether the indefinitely; parts of it go wrong (including the for women; by 2004 it was 75.7 for men trend for gradually increasing life spans repair systems), and an accumulation of faults and 80.8 for women. In the U.K., for can be projected indefinitely into the eventually leads to one part of the system every million born alive in the 1880s, just future. What are the limits? Steve Austad, failing, with fatal consequences. 309,020 were still alive at 65 and only a professor of cellular and structural 161,164 at age 75; by the 1990s, a biology at the University of Texas, is majority could expect to reach both 65 > WHAT ARE THE (830,990) and 75 (612,740). convinced that somebody alive today will reach the age of 150. S. Jay Olshansky, an LIMITS OF LIFE People are living longer largely because epidemiology professor at the University EXPECTANCY? Although Photo: Creative Commons/jonner they are staying well longer. They are now of Illinois at Chicago, disagrees strongly. there are a few areas of the world where in better shape as they age—one reason for They each wagered $150 on the question, life expectancy is still poor, in general it proclamations such as “50 is the new 30.” and Olshansky invested the money in a has increased steadily. Globally, life And while it’s true that less healthy fund. If a 150-year-old is alive in the year expectancy at birth was just 30 years in lifestyles and the rise of obesity mean 2150—someone of sound mind and body— 1900; it had more than doubled, to 62, by many people are not in great condition, Austad’s descendants will get the pot; 1985 and currently stands at around 64. they are less beset by infectious diseases otherwise, Olshansky’s offspring will win. 24 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.
  • 25. > WHAT ROLES ELDERS IN FINANCIAL CRISIS CAN PHARMA AND CORPORATIONS { POOR AND PROUD } PLAY IN FOSTERING There’s a significant risk that LONGER LIFE? Many factors people who run out of financial have come together to make longer life resources in old age will be spans possible. As the data accumulate and research goes deeper, we are discovering comparable financially to maturing which other factors can be influenced to teenagers, but in reverse and with extend enjoyable life even further. no “age of majority” in their future: One of the most impactful quick wins on a global level is providing sleeping nets to They’ll have the desire to people at risk of malaria infection by participate in society and a sense mosquitoes. According to the CDC, 41 of entitlement but—unlike teens— percent of the world’s population lives in areas where malaria is transmitted. Each increasingly less prospect of year, 350 to 500 million cases occur independence. worldwide, and more than 1 million people die, most of them young children in sub- Saharan Africa. The big issue: Who pays? Another victory: statins, drugs that According to the Wellness Council of but also a business case. This harks back reduce the amount of cholesterol produced America, the results from effective to the paternalistic business leaders of the in the body, lowering the risk of heart corporate wellness programs are 19th century such as William Hesketh attack. Currently under debate is whether encouraging. At Michigan furniture Lever, founder of Lever Brothers (now statins will become available over the manufacturer Steelcase, the average part of Unilever). Is there a case for counter in the U.S. (an OTC statin is insurance cost for high-risk employees is wellness expertise becoming as much a already available in the U.K.). The FDA 75 percent higher than it is for low-risk core business competence as financial has repeatedly rejected Merck & Co.’s employees; staff that followed the control and stock management? applications to make Mevacor ® available company’s health promotion program and without prescription. Supporters argue that selling statins over the counter could help lowered their risk factors cut their insurance costs by an annual average of > WHAT’S NOT TO millions avoid heart attacks. $618. Other results outlined on the LIKE ABOUT LIVING How about employers encouraging staff Wellness Council’s Web site point in the INTO THE TRIPLE Photos (from top): Creative Commons/Ed Yourdan, Creative Commons/Unhindered by Talent to live more healthfully? Corporate same direction: FIGURES? As conventional wellness has become something of a buzz phrase, but skeptics may see the programs • For DuPont, each dollar invested in workplace health promotion has yielded wisdom has it, getting old is better than the alternative. But up to what age does as a trophy-spend to make big companies $1.42 over two years in lower that adage apply? What tips a long life feel good. Is there any hard evidence that absenteeism costs. from being a blessing to being a burden? investing in wellness benefits the bottom line? The questions are sharpest in the United States, where medical costs can eat • The Travelers Corporation reports a $3.40 return for every dollar invested in As significant numbers of people live to a ripe old age, what will happen to those— health promotion, yielding total the majority—who haven’t had the means up as much as half of a company’s profits. corporate savings of $146 million in or the foresight to make their twilight And the indications are encouraging. benefits costs. Sick leave was reduced by years comfortable? 19 percent during the four-year study. It may well be that technology and • The Stay Alive & Well program at Las Vegas–based Reynolds Electrical & science have once again advanced far faster than our moral and social capacity to deal with the benefits they offer. If the Engineering has cost about $76 per tragedy of times gone by was that too employee during the two years it has many people died of relatively trivial been in operation, while savings have illnesses while they were still quite young, averaged almost $128 per participant. with a lot to live for, it’s likely to be the Increasingly, businesses are seeing not other way around in the future: People will only a moral and reputational imperative for be able to survive serious illness, perhaps fostering better health among employees, long after they’ve lost the things that make Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 25
  • 26. A G ROWI NG N U M B E R OF CHRONICALLY ILL AND VE RY OLD PEOPLE I N WEALTHY COU NTRI E S will need to be looked after at home. It’s projected that by 2011, two thirds of the workforce in developed countries will be caregivers part-time. What are the prospects of full-time salary earners being willing or able to become part-timers, staying home to care for Photo: Creative Commons/Isaac bowen aging relatives? 26 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.
  • 27. PLANNING FOR THE FUTURE { LUST FOR LIFE } Loneliness and the loss of family and friends are part of the cost of living longer. Few people have the financial means or the foresight to plan as carefully as one Swedish advertising executive, who, in his 40s, found a top-quality nursing home overlooking the sea in a beautiful location. He put his name on the long waiting list, set aside money in an investment fund, and invited 100 of his friends to do the same. “I hope I never have to go into a nursing home, but if I do, at least there may be one or two people I know in there with me,“ he explained. life worth living: mobility, mental acuity, that Japan could save $21 billion in elderly spend, or will this group be too cash- social life and family. insurance payments in 2025 by using strapped to comprise a worthwhile market? robots to monitor the health of older Science and technology have given us As the baby boomers move beyond their people rather than human nursing care. the means to extend life, but it’s beyond 60s and start swelling the ranks of the elderly, nursing homes, retirement homes, In theory, the increase in older their scope to provide the reasons or the consumers represents lucrative means to live longer lives. health systems and government assistance programs must be ready to meet the opportunities for astute entrepreneurs: Can businesses and organizations step in challenge of looking after much larger equipment that can be used by less to make those extra years a normal part of numbers of people—especially if many are dexterous hands, stylish apparel that life—a part that’s truly worth living? unable to pay for care. accommodates older body shapes, food Stacking supermarket shelves and acting as and beverages that help older consumers museum guides are a reasonable start but In Japan, where the balance of old to stay nourished and entertainment that let’s hope they’re not the last word in young is shifting faster than in most stimulates them, not to mention all the purposeful activities for older people. countries, people are looking to services they need. The big potential How will business and government technological solutions. The Machine obstacle is their financial resources: Will recognize and meet the exponential needs for Industry Memorial Foundation estimates enough of the elderly have money to affordable, good-quality eldercare options? Photos (clockwise from top): Creative Commons/fredesorensen, Creative Commons/Tim & Selena Middleton Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 27
  • 28. BIG QUESTION 5 HOW IS MODERN DEATH DIFFERENT? Photos (clockwise from top): Creative Commons/tempophage, Creative Commons/orla_keating SO MANY ASPECTS OF LIFE are > WHAT IF WE CAN different from those in previous centuries. It’s inconceivable that death hasn’t PLAN HOW WE’LL changed too. And so it has in many DIE? Society has evolved with some respects. It happens later. It’s more likely basic assumptions about how long people to happen in a hospital or a care facility live, and about work, families and communities. Longer life spans and than at home. It’s more likely to be a growing numbers of older people lonely event. The mortal remains are far challenge those assumptions profoundly. more likely to be hefty than slight. And for most people, death is now a far less visible The biggest thing that will have to part of life. change is the current tendency to put little 28 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.
  • 29. coherent, detailed preparation into the final the other hand, if handled properly, the boomers heading toward their final years of life. After all, who knows when the information may enable people to take curtain? After all, boomers changed end will come and what will cause it? Lack greater control and plan more appropriately. society’s views of youth, of parenthood, of of planning often results in unnecessary middle age; it’s likely they will also change expense, stress and distress for all involved. society’s views of old age and dying. It’s very likely that for most people the According to Hospice Net, an independent, last years of life will now involve more nonprofit organization, death was once an care and more expense than they did for integral part of family life. People died at previous generations. And whatever the home, surrounded by loved ones. Adults individual cases may be, there’s enough and children experienced death together, data to know the final trajectories that mourned together and comforted one most people’s lives will take. Dr. Joanne another. Today death is lonelier. Lynn, a geriatrician at the Hastings Center, Most people die in hospitals or nursing an independent, nonprofit bioethics homes, where they receive the extensive research group, has identified the three medical care they need to give them the most common end-of-life scenarios, based best chance of extending life as long as on extensive numerical data: possible. Their loved ones have less • The quickest is long years of active life > WHY SHOULD opportunity to spend time with them and ending with several months of steep decline DEATH BE A TABOO often miss sharing their last moments. The and death; in the United States this is dying have become isolated from the typical of cancer deaths, which peak at age SUBJECT? The billionaire living; consequently, death has taken on investor and philanthropist George Soros, 65, and is the fate of around 20 percent of added mystery and, for some, added fear. explaining his foundation’s Death in Americans. This scenario typically requires America project, wrote: “In America, the Death has become removed from the hospice support at the end. land of the perpetually young, growing normal experience of people in Western • Those with long-term chronic illnesses such as organ failure go through years of older is an embarrassment, and dying is a failure. Death has replaced sex as the societies. It is denied for as long as possible. It’s assumed that people don’t gradually declining health with occasional taboo subject of our times. Only our want to think about it, so the whole bouts of severe illness and require preoccupation with violence breaks subject becomes more taboo. consistent disease management. Eventually through this shroud of silence.” The risk is that death becomes the one of the bouts of severe illness will cause In a world where so much hope and elephant in the room, causing unnecessary sudden death, which is the case for about effort and ingenuity go into creating life trauma for both the dying and the living. a quarter of Americans. Chronic heart and hanging on to it, dying can seem like Sheer demographics, not to mention good failure and emphysema are the most failure. It means no more second chances, sense, will force more consumers to common illnesses of this scenario, with at least in the prevailing mind-set of the acknowledge the elephant, which will death peaking at around age 75. developed world. Will this mind-set be create opportunities for thought leadership • The third scenario is set to become the most common: gradual long-term altered by the growing number of baby from businesses and organizations. decline and loss of functions, requiring years of personal care. At worst this means a long, frustrating and humiliating decline for the individual and an exhausting and potentially bankrupting ordeal for the family. Approximately 40 percent of Americans, generally past age 85, fall into this category. And the numbers will rise. In the future, a combination of genetic screening, medical examination and actuarial data will make it possible for most people to Photos: Creative Commons/markhillary predict how and when they are likely to die— certainly with far greater chances of accuracy than were previously possible. This could mean a fundamental change in people’s relationship with their own mortality. Knowing about one’s death well in advance is typically perceived as morbid and scary, even a risk to mental health. On Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 29
  • 30. CONCLUSION MANY OF THE ASSUMPTIONS previous generations The issues touched on here are not peripheral or trivial; held about life and death are no longer accurate—but they’re big, and they cry out for coherent, consistent government policies, politicians, organizations, businesses and Intelligent Dialogue. They span the interests of governments, individuals still take them as fact. Outdated assumptions drive corporations, advocacy groups and individuals: They the choices people make: whether and when to marry, have incorporate a need for change in public policy, finance, children, save or consume; how much to invest in family, science, business and behavior. friendships, work, health and hobbies. They remain With our roots in social marketing and our active Photo: Creative Commons/fredesorensen programmed into systems and cultures and mind-sets until they clash with the changes brought about by education, involvement in all these areas, we at Porter Novelli are excited demographics, science, technology and business. by developments in all these fields. We relish the challenge of connecting the dots. And we’re alarmed to see how much People are aware of most of the changes cited here, either discussion around these topics is reactive and partially informed. through the media or direct experience, but awareness is piecemeal; there are lots of little patches of information. And “Cradle & Grave” is intended to prompt discussion and it’s tough to integrate the scope of the changes into a big foster thought leadership across disciplines. We work with picture. The result is that many stumble half confused, half in smart people in great organizations, and we’re looking denial from one predictable crisis to the next. forward to helping them create change and shape the future. 30 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.
  • 31. The Porter Novelli INTELLIGENTDIALOGUE Principle WHAT PORTER NOVELLI UNIQUELY OFFERS can be summed up in two words: Intelligent Influence. The basis for Intelligent Influence is Intelligent Dialogue. As yesterday’s mass media morph into today’s interactive media, people expect to talk back at journalists and opinion leaders. Yesterday’s way was set- piece monologues broadcast to passive audiences by powerful brands and media owners. Today’s way is fluid, evolving dialogues conducted across multiple, linked channels. Ongoing dialogue is now possible and is truly the best basis of dynamic long-term relationships. Easy sound-bite answers are seductive; they give a comforting but illusory sense of resolution. Instead, we need to cultivate open, questioning minds that ask smart, creative questions. Smart questions spark Intelligent Dialogue, open up thinking and tap into the power of many minds. PORTER NOVELLI was founded in Washington, D.C., in 1972 and is a part of Omnicom Group Inc. (NYSE: OMC) (www.omnicomgroup.com). With 100 offices in 60 countries, we take a 360-degree view of clients’ businesses to build powerful communications programs that resonate with critical stakeholders. Our reputation is built on our foundation in strategic planning and insights generation and our ability to adopt a media-neutral approach. We ensure our clients achieve Intelligent Influence, systematically mapping the most effective interactions, making them happen and measuring the outcome. Many minds. Singular results. CONTACT: Marian Salzman, Chief Marketing Officer, Porter Novelli Worldwide, 75 Varick Street, 6th floor, New York, New York 10013; 212.601.8034; marian.salzman@porternovelli.com
  • 32. Porter Novelli Worldwide 75 Varick Street, 6th floor New York, NY 10013 www.porternovelli.com Join the dialogue by visiting www.pnintelligentdialogue.com