2015 Global Action Report

A Global Affairs Media Network

2015 GLOBAL ACTION REPORT

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{ Yes, our world

needs your ideas and leadership.} nashville 2015 November 16 & 17, 2015 Music City Center, Nashville, Tennesse USA 2015 Summit Registration: www.globalactionplatform.org Invited guests are top senior level decision makers, leaders and innovators from the corporate, government, academic, media, investment, and NGO communities from around the world.

“The Global Action Platform represents a powerful coalition of cross-sector leaders dedicated to creating abundance through innovation in food, health, and prosperity.”

–

Dr. Fareed Zakaria, CNN

Foreign affairs program “Fareed Zakaria GPS”

and columnist for The Washington Post

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Chairman’s NOTE

WElcome It is our pleasure to share the 2015 Global Action Report with you and to release it at this auspicious time in connection with the launch of the Sustainable Development Goals by the United Nations. With this Report, Global Action Platform joins a broad coalition of corporations, international agencies, NGOs, foundations, and governments around the world in the goal of creating a flourishing human and natural order.

Dr. Scott T. Massey Chairman and CEO

Since 2012, Global Action Platform has worked toward scalable, sustainable solutions for abundant food, health, and prosperity—the same issues targeted now as the top three Sustainable Development Goals. During this time, we have worked collegially to build and convene a growing university-business alliance dedicated to these goals.

We have made investments; we have developed technologies for collaboration; we have convened experts and leaders; and we have communicated our vision and findings annually in the Global Action Report, of which this is the most recent publication.

The launch of the Sustainable Development Goals reminds us that the speed and scale of innovation and knowledge now at hand enable us to tear down the walls of scarcity and create a world of abundance. But this is no simple choice.

To pursue the SDGs as substantive goals will require a new type of wisdom—an abundance intelligence—which is also an ancient form of wisdom that Aristotle called prohairesis. This new and ancient wisdom is one that requires a sustained engagement with the practical problems that train our desires on the flourishing of the human community. This wisdom is more than technical calculation of efficiency in single scope interventions. Instead this intelligence is sustained, systematic, and long term. The SDGs challenge us as agents to be responsible to attain a clarity of purpose and to connect our knowledge and will to strengthen the rational and normative structure of our communities.

As Thomas Pfau has recently written, “ knowledge is inseparable from our commitment to its practical realization.” That is, confronted as we are with grand challenges and great power, we can no longer afford—if we ever could—to live in a world of mere data or information. The SDGs challenge us to transform information into purpose, to incarnate our vast knowledge into scalable, sustainable solutions for a flourishing abundant world.

It is our hope, and our purpose, that this 2015 Global Action Report contributes to that end.

Scott T. Massey, PhD Chairman and CEO Global Action Platform

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the world in 2050

MASTHEAD

Global Action Platform Steeering Committee

Diplomatic Courier

Ted Abernathy, Jr. Economic Leadership LLC Cynthia H. Barbera e-Global Reader LLC Jack Bovender HCA (retired) Phil Bredesen Governor of Tennessee (2003-11) Steve Brophy Dollar General Corp Congressman Jim Cooper U.S. House of Representatives Ryan Doyle oneC1TY Kitty Moon Emery Global Action Platform Beth Fortune Vanderbilt University Darrell S. Freeman Zycron Computer Services Jim Frierson Compass Innovation William H. Frist U.S. Senate Maj. Leader (1995-07) Arlene Garrison Oak Ridge Assoc. Universities Jose Gonzalez Belmont University Cheryl Harrison Global Action Platform Bryan Huddleston Nashville Technology Council John Ingram Ingram Industries Clay Jackson BB&R Insurance Conrad Kiechel Milken Institute Hank Adam Locklin TN Film, Ent., & Music Comm’n L. Randolph Lowry III Lipscomb University Scott T. Massey Global Action Platform Alex McCalla UC Davis Clayton McWhorter Clayton Associates John Morgan TN Board of Regents Jean-Claude Saada Cambridge Holdings, Inc. Howard-Yana Shapiro Mars Incorporated Mike Shmerling XMI Holdings Inc. Thomas J. Sherrard Sherrard & Roe, PLC Remy Szykier Aegis Health Security Steve Turner The Family Office Juergen Voegele The World Bank Group

Editor-in-chief

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GLOBAL ACTION REPORT

A Global Affairs Media Network

Ana C. Rold ACRold@diplomaticourier.org

Editorial Advisors Andrew M. Beato Fumbi Chima Sir Ian Forbes Lisa Gable Mary D. Kane Greg Lebedev Anita McBride

Contributing Editors Alexcia Chambers Michael Kofman Paul Nash

Creative Director Christian Gilliham

UN Correspondent Akshan de Alwis

DC Correspondents Katie Crawford Madeline Bielski Jake Nold

DC Contributors Charles Crawford Justin Goldman Stuart W. Holliday Sarah Jones Oscar Montealegre Arun S. Nair Richard Rousseau Mary Utermohlen

GAR Perspectives Jon Clifton Trevor Davies Gabriel P. Ellsworth Raymond C. Offenheiser Jan W. Rivkin Juergen Voegele

Senior Photographers

Publisher: Medauras Global publishing. The Global Action Report is a product of the Global Action Platform, published in collaboration with Diplomatic Courier, a Global Affairs Media Network. The Diplomatic Courier is produced by Medauras Global, an independent publishing firm based in Washington, DC. The magazine 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. 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 written request. legal. Copyright © 2006-2015 Diplomatic Courier and Medauras Global. 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 Medauras Global and the Diplomatic Courier to provide advertising and/or services.

Every effort has been made to ensure the accuracy of information in this publication, however, Medauras Global and the Diplomatic Courier magazine make no warranties, express or implied in regards to the information, and disclaim all liability for any loss, damages, errors, or omissions. contact. Mailing Address: 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. Digital editions of prior Global Action Reports, Global Action Summit Programs, as well as the 2015 Global Action Report can be downloaded for free on the Diplomatic Courier App on the iStore, Google Play, and Amazon Kindle.

ART/PHOTOGRAPHY/ILLUSTRATIONS. In order of appearance: page 3, photo courtesy of Scott T. Massey; page 5, photo by Joyce Boghosian; pages 10-11, images courtesy of the United Nations, Secretary-General’s office; page 13, photo courtesy of Amina J. Mohammed; page 20, charts courtesy of Gallup; pages108-109, all logomarks are property of the respective companies and have been published with permission.

All other images and photos by Bigstockphotos.com.

Michelle Guillermin Sebastian Rich

Editorial Submissions Letters to the Editors

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2015 GLOBAL ACTION REPORT

Editors@diplomaticourier.org

Press/Media Press@diplomaticourier.org Shared Value

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EDITOR’s NOTE

the world we want

Ana C. Rold Editor-in-Chief

This September the world will reach an important milestone: the deadline of the UN Millennium Development Goals (MDGs). The goals, set 15 years ago by then UN Secretary-General Kofi Annan, aimed at putting the world’s most pressing issues—such as halting maternal and child mortality, eradicating extreme poverty, and achieving universal education—at the top of nations’ foreign policy and development agendas. The goals were hefty and extremely ambitious. Could we see the complete eradication of poverty in our lifetimes?

Last year, UN Secretary-General, Ban Ki-moon, released a synthesis report on the post-2015 MDG agenda titled, “The Road to Dignity by 2030: Ending Poverty, Transforming All Lives and Protecting the Planet.” The report integrated the range of inputs on the post-2015 agenda from global consultations with UN member states, the private sector, non-governmental organizations, and citizens. The document, in essence, framed the sustainable development agenda after the expiration of the MDGs, focusing on prosperity, justice, and partnership.

We too, have been hard at work this past year producing a synthesis report. We are proud to release the 2015 Global Action Report, synthesizing the vision and findings from the Global Action Summit. Since its inception, we have been the official rapporteurs of the Global Action Platform (GAP) and Summit, and we have traced the progress being achieved by GAP leaders in the areas of food, health, and prosperity—all areas, which are critical to several of the SDGs. In addition to this report, this year’s editorial calendar at Diplomatic Courier has focused on the Post-MDG agenda. Since January, we have produced in-depth editions examining the rule of law in helping women and girls rise out of poverty, climate and planet, the future of food and health, and the role of technology in driving more job creation and social good.

The year 2015 and the Sustainable Development Goals offer an unprecedented opportunity to consolidate and galvanize action so that we may see real change in our time. And while the headlines are grim, evidence of abundance is all around us.

We can and should aspire to a future where prosperity is the norm. We are proud to show you what the many thought leaders have accomplished and are aspiring to accomplish vis-à-vis the Global Goals via this report. We believe you will find the writings both practical and inspiring.

Ana C. Rold Editor-in-Chief Diplomatic Courier

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CONTents

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SPECIAL FOCUS: SDGs

PERSPECTIVES

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Sustainable Development: A Universal, Integrated, and Transformative Agenda

A Brighter Outlook: The Global Action Summit

by Amina J. Mohammed

Opening keynote by Fareed Zakaria

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Designing a Post-2015 Global Food System for Food, Health, and Prosperity

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by Juergen Voegele

Interviewed by Fareed Zakaria

A Conversation with Fred Smith

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One Billion Volunteers Can Help Leaders Meet the Post-2015 Sustainable Development Goals

Empowering Young Leaders to Bring Shared Prosperity to America’s Cities

by Jan W. Rivkin and Gabriel P. Ellsworth

by Jon Clifton

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Moving Beyond Aid: How American Public and Private Investment Can Help End Extreme Poverty

by Raymond C. Offenheiser

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Inclusive Economic Growth Is Key to Prosperity

by Trevor Davies

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SECTION

FOOD SESSION 1

SESSION 4

Building an Ecosystem for Abundant Food

Frontiers of Global Food Innovation

Session Panelists: Roger Beachy, PhD, Director,World Food Center, UC Davis (by video) Robert Townsend, PhD, Senior Economist,World Bank M.R.C. Greenwood, PhD, Distinguished Professor Emerita of Nutrition and Internal Medicine, UC Davis Jonathan Wadsworth, PhD, Executive Secretary, CGIAR Fund Council John Ruff, Immediate Past President, Institute of Food Technologists Moderator: J. Bruce German, PhD, Director, Foods for Health Institute, UC Davis

Session Panelists: M.R.C. Greenwood, PhD, Distinguished Professor Emerita, Department of Internal Medicine, UC Davis Sharon Shoemaker, PhD, Director, California Institute of Food and Agricultural Research Pam Marrone, PhD, CEO, Marrone Bio Innovations Gerry Brown, Executive Director, Institute for Economic Stability Moderator: Jonathan Wadsworth, PhD, Executive Secretary, CGIAR Fund Council

SESSION 2

SESSION 5

The Freedom Principle: Stories from Mars

Abundant Food Index: How Do We Measure Success?

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Session Panelists: Harold Schmitz, PhD, CSO, Mars, Incorporated Justin Bakule, Executive Director, Shared Value Initiative Carl Keen, PhD, Professor of Internal Medicine, UC Davis Moderator: Howard Yana-Shapiro, PhD, Chief Agricultural Officer, Mars, Incorporated; Senior Fellow, UC Davis

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Session Panelists: Sanae Iguchi-Ariga, PhD, Faculty of Agriculture, Hokkaido University Jeff Klein, President & CEO, Global FoodBanking Network J. Bruce German, PhD, Director, Foods For Health Institute, UC Davis Nathan Rudgers, Senior Vice President, Farm Credit East Moderator: Audrey Murrell, PhD, Director, David Berg Center for Ethics & Leadership, Katz/CBA School of Business, University of Pittsburgh

SESSION 3

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Big Data and Decision Models for Food, Water, and Climate Session Panelists: Brad Holtz, Chief Strategic Officer, C4UC John Fennebresque, Jr., Managing Director, Fennebresque & Co. Lanny Faleide, President & CEO, Satshot Moderator: Howard Minigh, PhD, President & CEO, CropLife International

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HEALTH SESSION 1

SESSION 4

Frontiers of Health Innovation

Health Ecosystems: Charting a Course for Better Health

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Session Panelists: Dieter Gruenert, PhD, Professor of Otolaryngology, UC San Francisco Scott Mason, Executive Managing Director & Leader, Cushman & Wakefield Healthcare Group, Americas Shaun Lonergan, General Manager & VP, Metabolon, Inc. James E. Crowe, Jr., MD, Director,Vanderbilt Vaccine Center; Director, Vanderbilt Technologies for Advanced Genomics Moderator: Donna Cragle, PhD, SVP & Director, Health, Energy, & Environment, ORAU

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Session Panelists: Melinda B. Buntin, PhD, Professor & Chair, Department of Health Policy, Vanderbilt University School of Medicine The Honorable Carolyn M. Clancy, MD, Interim Under Secretary for Health, U.S. Department of Veterans Affairs Jason Dinger, PhD, CEO, MissionPoint Health Partners Moderator: Jeffrey R. Balser, MD, PhD,Vice Chancellor for Health Affairs, Dean, School of Medicine,Vanderbilt University Medical Center

SESSION 2

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Developing Effective Strategies to Change Behavior to Improve Health Session Panelists: Jean-Claude Saada, Chairman & CEO, Cambridge Holdings Inc. Shari Barkin, MD, Division of Pediatrics,Vanderbilt University Anne Warhover, President & CEO, Colorado Health Foundation John Hoffman, Founder & CEO, The Public Good Projects Moderator: Rick Johnson, President & CEO, Governor’s Foundation for Health and Wellness

SESSION 3

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Big Data and Decision Models for Health Session Panelists: Donna Cragle, PhD, SVP & Director, Health, Energy, and Environment, ORAU Nancy Lorenzi, PhD, Medical Informatics,Vanderbilt University Sten Vermund, MD, PhD, International Medicine,Vanderbilt University School of Medicine Moderator: Matt Koehler, JD, PhD, Principal Artificial Intelligence, The MITRE Corp

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SESSION 5

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Abundance Intelligence: Health Outcomes How Do We Measure Success?

Session Panelists: Mohamed Younis, Senior Analyst, Gallup World Poll Rick Johnson, President, Governor’s Foundation for Health and Wellness R. Lawrence Van Horn, Associate Professor of Management,Vanderbilt University Brian Drozdowicz, Vice President of Population Health, Caradigm Sherri Zink, Vice President Informatics, BlueCross BlueShield of Tennesse Moderator: Ben R. Leedle, Jr, CEO, Healthways

SECTION

prosperity SESSION 1

SESSION 3

Building an Ecosystem for Prosperity

From Creative Class to Workforce Skills: Key Assets for Regional Success

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Session Panelists: Adrian Gheorghe, International Science Director, Center for Understanding Change John Sullivan, Executive Director, Center for International Private Enterprise Jan Rivkin, Harvard Business School, U.S. Competitiveness Project Moderator: Christian Ketels, PhD, Principal Associate, Institute For Strategy and Competitiveness, Harvard Business School

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Session Panelists: Heidi Kleinbach-Sauter, PhD, Senior Vice President, Pepsico Lucian Tarnowski, CEO, BraveNewTalent Lucretia Murphy, JD, PhD, Project Director, Jobs for the Future Balaji Ganapathy, Head,Workforce Effectiveness, Tata Consultancy Moderator: Christian Ketels, PhD, Principal Associate, Institute For Strategy and Competitiveness, Harvard Business School

SESSION 2

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Organizing for Competitiveness: What Regions Do Session Panelists: Ted Abernathy, Managing Partner, Economic Leadership LLC Betsy Biemann, Former President, Maine Technology Institute Matt Erskine, Deputy Assistant Secretary of Commerce for Economic Development & COO, U.S. Department of Commerce Dan Cunningham, CEO, Long-Stanton Group Moderator: Christian Ketels, PhD, Principal Associate, Institute For Strategy and Competitiveness, Harvard Business School

SESSION 4

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Investment Strategy & Prosperity Session Panelists: Mason Kauffman, CEO, US Biologic Ted Abernathy, Managing Partner, Economic Leadership LLP Harry Blount, CFA, CEO, DISCERN Moderator: Christian Ketels, PhD, Principal Associate, Institute For Strategy and Competitiveness, Harvard Business School

SESSION 5

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Social Progress & Economic Development Keynote Speaker: Michael Green, Social Progress Index Session Panelists: Jon Clifton, JD, Managing Director, Gallup World Poll Trevor Davies, Global Head, Center of Excellence International Development, KPMG US Brian Worley, President & CEO, PYA Analytics Moderator: Ted Abernathy, Managing Partner, Economic Leadership LLP

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special focus: Sustainable development goals 2015

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global action platform and the Launch of SDGs 2015

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Sustainable Development: A Universal, Integrated, and Transformative Agenda STORY by Amina J Mohammed

T

he turn of the century marked a major milestone in development, where political leaders revised the terms of development cooperation with the adoption of the UN Millennium Declaration, from which a set of eight Millennium Development Goals (MDGs) emerged. Over the last 15 years, the MDGs have proven to be the most successful anti-poverty campaign in history. Since 2000, extreme poverty has been halved, disparity between boys and girls in primary school enrollment eliminated, maternal and child health improved and significant progress in the fight against AIDS, tuberculosis and malaria made, among other achievements.

The remarkable achievements by the MDGs demonstrate the powerful combination of political will and partnerships between governments, businesses, civil society international institutions, foundations, academia and vested stakeholders. The MDGs gave us the opportunity to use goal-based interventions to address imbalances and gaps. They helped to put people and their immediate needs at the center of national and global public policy. However, we now need go further – much further.

The world has changed radically since the MDGs were adopted and while existing challenges have remained, new complexities have emerged since the turn of the millennium. Pervasive poverty, gross inequalities within and between countries, environmental degradation, joblessness and deprivation, displacement and persecution, violence, migration and abuse, and the global economic, food, energy, and climate crises are all universal challenges we face today. These challenges are increasingly becoming more interconnected and demand collective responses to address them.

Guided by the outcomes of the 2010 MDG Summit and 2012 Rio + 20 Sustainable Development Conference, member states have been deliberating and the UN’s partners have engaged in an unprecedented effort of inclusive consultations at the country, regional and global level, all over the world to inform and help define the post-2015 development agenda. The inclusive process as championed by the SecretaryGeneral Ban Ki-moon has mobilized global leaders, the business, academic, scientific, parliamentarians and civil society communities through its vast networks. An example is the UN’s global

“Guided by the outcomes of the 2010 MDG Summit and 2012 Rio + 20 Sustainable Development Conference, member states have been deliberating and the UN’s partners have engaged in an unprecedented effort of inclusive consultations at the country, regional and global level, all over the world to inform and help define the post-2015 development agenda.”

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MY World Campaign, where over 7 million votes were cast by people from all over the world on the priorities they wanted to see in their lives, with the majority of participants being young people under 30 years of age.

After more than three years of intergovernmental negotiations and unprecedented consultations, world leaders will adopt the Post-2015 sustainable development agenda, including the sustainable development goals (SDGs) in September 2015.

The SDGs are a set of bold, ambitious and truly transformative goals that place people and planet at the center, addressing all forms of inequality, insecurity, and injustice, wherever they occur. The agenda integrates the economic, social and environmental dimensions of sustainable development, recognizing the nexus to peace, and is underpinned by human rights. It also prioritizes the need to sustainably manage natural resources and promote sustainable production and consumption practices.

The sustainable development agenda is grounded in the Charter of the United Nations with “we the peoples” at its heart. Universality is at the core of

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Ms. Amina J. Mohammed was appointed by the UN Secretary-General as Special Adviser on Post-2015 Development Planning in July 2012. Ms. Mohammed has more than 30 years’ experience as a development practitioner in the public and private sectors, as well as civil society. Prior to her UN role, she served as Senior Special Assistant to the President of Nigeria on the MDGs, serving three Presidents over a period of six years.

Ms. Mohammed has served on numerous international advisory panels and boards.

She is a recipient of the Nigerian ‘National Honours Award of the Order of the Federal Republic’ and was inducted in the Nigerian Women’s Hall of Fame in 2007.

sustainable development and translates into leaving no one behind, thus ensuring a life of dignity. Unlike the MDGs, the sustainable development agenda will require all countries to mobilize and contribute. All countries will need to change, in different ways. If we are to eradicate poverty, grow inclusive economies and preserve the environment, both developed and developing countries have to do their part at home. All stakeholders – public and private – have responsibilities and need to be accountable to this universal promise to humankind.

A universal agenda that aims at ending poverty everywhere and irreversibly will require massive transformations.

Transformation means, first and foremost, that poverty is eradicated in all its forms, irreversibly and everywhere; human rights universally fulfilled and prosperity shared globally that is achieved within the world’s planetary boundaries.

Moreover, the sustainable development agenda will change the way we do business and require breaking down silos and delivering in solidarity: it is one set of goals and targets that collectively ➥ SEPTEMBER 2015

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➥ integrate the multifaceted dimensions

of sustainability. All goals must be achieved through combined action in several sectors, with an adequate consideration of cross-sectorial issues.

Interlinkages, synergies and integration are at the core of sustainable development.

All goals integrate, in different ways and depths, the three dimensions. One can no longer be seen without the others. In the final analysis, these goals must be at the core of a country’s vision and plan for its people.

Therefore, business-as-usual will not lead the world to a sustainable development path and it will not allow us to respond properly to new and emerging challenges. As the UN Secretary-General Ban Ki-moon put it, “There can be no Plan B because there is no planet B. Both science and economics tell us that we need to change course – and soon”. A significant paradigm shift must take place – in public and private sector, among governments, parliaments, NGOs, businesses, financial institutions, schools and universities, and media - to bring about a radical change of course and action. This means decoupling economic growth from environmental degradation and human rights abuse. In the absence of inclusive economic growth and environmental stewardship, poverty eradication and social justice will be fragile if not impossible.

As the UN Secretary-General Ban Ki-moon said, “We are the first generation that can end extreme poverty and the last to tackle the worst impacts of climate change.” At the end of this year, we will have seen the adoption of a set of sustainable development goals, a meaningful climate change agenda and a financing framework to provide the resources to achieve this people-centered and planet-sensitive common agenda to safeguard the environment and the future of our children and their children.

This ambitious agenda will be rhetoric if it does not foresee the necessary means to implement this vision into reality. It will only be an aspirational set of goals if it does not mobilize and unlock the means of implementation needed – including sufficient public as well as private finance. Just as important as the availability of the necessary finance, is tackling systemic issues that inhibit the change needed for the future we want.

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“Transformation means, first and foremost, that poverty is eradicated in all its forms, irreversibly and everywhere; human rights universally fulfilled, and prosperity shared globally that is achieved within the world’s planetary boundaries.”

We have to build strong institutions to ensure policy and institutional coherence, build multi-stakeholder partnerships, address governance challenges and ensure data, monitoring and accountability.

It will be crucial to forge principled multi-stakeholder partnerships, at all levels – global, regional, national and local – to carry out this sustainable development agenda. We also need a data revolution for sustainable development, ensuring availability and accessibility of key data everywhere and for everyone, supporting monitoring and accountability of the goals as well as accelerating sustainable innovations and technological advancements for people and planet.

The path to sustainable development is more than a destination, it is a journey and it will have challenges. However, imagine with me a world where all girls and boys in Nigeria have the right to go to school, access basic quality services, enjoy social protection, acquire the requisite resources, knowledge and skills to attain their aspirations and responsibly contribute to the growth of their community and country; a world where forced migration becomes planned, where the humanitarian context is not left behind. A world where all pregnant adolescents and women have access to safe conditions for child birth. A world without child labour and slavery. A world where people with disabilities, the aged and other vulnerable groups have equal opportunities and a life of dignity. This is the world we can achieve – only if we work together in genuine partnership.

The time for global action with local results is now. ■

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Designing a Post-2015 Global Food System for Food, Health and Prosperity STORY by Juergen Voegele

T

he world has made significant progress since setting the Millennium Development Goals to halve poverty and hunger from 1990 to 2015. But with 795 million people still going hungry every day, significant acceleration of progress and support is needed, particularly in low income countries. The new Sustainable Development Goals to permanently end poverty and hunger by 2030 offer an unprecedented opportunity to redouble our efforts.

At the World Bank, we have been calling for a food system that can feed every person, every day, everywhere with a nutritious and affordable diet, delivered in a sustainable way. All of these aspects are closely interlinked, calling for broad partnerships and multi-sectoral approaches for delivering a healthier and more prosperous future.

The three core elements of the action agenda are aligned around: (i) ensuring a more climate-smart agriculture, (ii) improving nutritional outcomes, and (iii) strengthening value chains and improving market access.

Ensuring a More Climate-Smart Agriculture Climate-smart agriculture has three goals: increase agricultural productivity, greater climate resilience, reduce Green House Gas (GHG) emissions for agriculture and related land use change, which is essential to permanently end poverty and hunger.

While past actions to address these three elements have generally been considered independently, a high priority is to increasingly move to actions that

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can deliver all three simultaneously the triple-win.

Ensuring access to existing and new climate-smart technologies by poor farmers will help reduce yield gaps and improve resilience. This includes promoting the adoption of drought and flood tolerant crop varieties. Closing the gender gap will help raise yields, including improving the gender mix in agricultural service providers and tailoring advice to the needs of women farmers.

GHG emissions can be reduced through improved fertilizer use to reduce nitrous oxide emissions; alternate wet and dry irrigation of rice, and improved livestock breeding and waste management to reduce methane emissions; and sustainably raising yields to reduce pressure for agricultural land expansion into forests, or by promoting production expansion in areas with no forests.

Improving Nutritional Outcomes Higher household incomes can allow families to invest in more and higher nutritious food consumption, and improve access to clean water and better hygiene that can help improve

nutritional outcomes. Reducing gender inequality will help raise incomes and strengthen the link between higher household income and nutritional outcomes, as women are generally responsible for most of food production, purchasing, processing, and meal preparation.

Scaling up proven interventions to 90 percent coverage in the 34 countries with the highest child stunting rates could potentially reduce child stunting by 20 percent worldwide and wasting by 60 percent worldwide. The package of interventions includes among other things deworming, growth monitoring and promotion for children under two, and iron and folic acid supplements for pregnant women. Refocused nutritionsensitive investments can further help reduce stunting and underweight.

Nutrition-sensitive investments include focus on female smallholder farmers, technologies to reduce women’s workloads, development and adoption of biofortified crop varieties, and investments related to nutrition education, or micronutrient supplementation, and improved access to clean water and better hygiene. ➥

“Ensuring access to existing and new climate-smart technologies by poor farmers will help reduce yield gaps and improve resilience.

This includes promoting the adoption of drought and flood tolerant crop varieties. Closing the gender gap will help raise yields, including improving the gender mix in agricultural service providers and tailoring advice to the needs of women farmers.”

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“Aligning farmer incentives, through associated policies, to respond to changing market demands can help raise incomes of poor farmers. These include removing price policy biases against production of higher value crops that create disincentives for farmers to respond to market signals and create inefficiencies in value chains.”

➥ Strengthening Value Chains Aligning farmer incentives, through associated policies, to respond to changing market demands can help raise incomes of poor farmers. These include removing price policy biases against production of higher value crops that create disincentives for farmers to respond to market signals and create inefficiencies in value chains. Removing restrictions on using land designated only for specific crops; particularly if these crops also lead to negative environmental outcomes.

Reducing transaction costs, improving the structure of markets, and access to information can increase prices farmers receive for their produce. Reducing food losses can help reduce incomes losses, and together with lower food waste can increase overall food supply without GHG emissions and help preserve food micronutrients. Improving logistics and transportation can help link farmers to growing urban demand.

A Call to Action The historical evolution of the global food system has made possible rapid urbanization and population growth, contributing significantly to welfare improvements in the world. The impacts on poverty and hunger have been positive and significant. Yet we stand at a critical moment in history where we can and must help shape the evolution of the global food system to permanently end poverty and hunger by 2030. The agenda is large and will require focused, multi-sectoral approaches, and stronger partnerships. The World Bank Group will come together on this agenda and work as one Bank to help countries design and implement integrated approaches to end poverty and hunger. With other partners, we can help shape a global food system that will deliver a healthier and more prosperous world now and for generations to come. ■

Juergen Voegele is Senior Director of the Agriculture Global Practice at The World Bank Group.

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1 Billion Volunteers Can Help Leaders Meet the Post-2015 Sustainable Development Goals STORY by By Jon Clifton

B

usinesses, governments, nongovernmental organizations and international organizations need all the help they can get to achieve the ambitious objectives on the post-2015 Sustainable Development Goals (SDGs) agenda. What these organizations may not fully realize is the central importance that larger society— in the form of billions of people inclined to volunteer—can play in virtually every country worldwide. Gallup World Poll surveys in 142 countries in 2014 found that nearly 1.3 billion adults had donated money to charity in the past month, nearly 1 billion had given their time to

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an organization and more than 2 billion had helped a stranger in need.

Even if these organizations realize how invaluable of a resource these potential volunteers are, many lack the ability to identify and quantify who and where these people are. The United Nations Volunteers program rightly notes the need to measure volunteering worldwide: “Volunteerism should be a part of a new measuring framework that goes beyond GDP and demonstrates progress in human well-being and sustainable human development.”

For the past 10 years, Gallup has been monitoring people’s civic engagement in more than 160 countries through a metric

known as the Civic Engagement Index.

The index assesses people’s inclination to volunteer their money, time and assistance to others. It is a barometer of people’s commitment to the communities they live in. This research can help governments, businesses and organizations better understand the population of potential volunteers, and it can be an essential tool for organizations to use to maximize volunteerism to support the SDGs in the areas of food security, health and economic prosperity.

The countries with the most civically engaged populations in the world are not necessarily the richest. While the top 10 list includes wealthy Western countries,

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such as the U.S., New Zealand and Canada, middle-income countries such as Sri Lanka and Malaysia are not far behind. In 2014, Myanmar ranked highest in the world on the Civic Engagement Index, besting the United States. Myanmar’s strong Buddhist traditions, which stress donations to and volunteering at temples, reflect residents’ positive responses to the civic engagement questions.

Despite the amount of volunteerism taking place worldwide, it is not happening to the same degree everywhere.

Perhaps predictably, some of the countries where populations are the least civically inclined are places that have been economically devastated or ridden by internal conflict such as Greece and Yemen. Impoverished countries such as Burundi and Chad might also not be surprising—people are probably focused on meeting their basic needs before thinking about volunteering. However, more surprising is the lack of reported civic engagement in China, which now has the largest economy in the world when adjusting for purchasing power.

A country that has come so far in the past two decades in terms of economics might find that additional efforts in volunteerism would pay off in well-being improvements not just for the recipients of the volunteered time and money but also for the volunteers themselves.

Leaders would be wise to encourage volunteerism in their own countries.

In addition to the obvious benefits associated with volunteerism, such as helping people in need, it also improves the lives of the volunteers themselves.

According to the 2014 Gallup-Healthways State of Global Well-Being report, people who volunteer tend to have higher well-being than those who do not.

Achieving the post-2015 SDGs will not be easy, but it can be done with the help of 1 billion volunteers. To help them attain the SDGs, global leaders need a better understanding of who these volunteers are, where they are and what motivates them. Knowing this will better position global leaders to develop targeted programming aimed at volunteerism to successfully meet the SDGs. ■ Jon Clifton is the Managing Director of the Gallup World Poll.

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A Brighter Outlook opening keynote by Fareed Zakaria

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I

n his keynote speech at the 2014 Global Action Summit, Dr. Fareed Zakaria began by lauding the summit for focusing on problem solving and youth. He argued that it is this kind of thinking that will create positive change in the world.

Zakaria pointed out that the public is often told by the media that the world is in a disastrous state. While he acknowledged that there are a great deal of crises unfolding, Zakaria also highlighted the fact that the world’s

global action platform

markets have not reacted as adversely as we might expect to all this disaster.

“What’s happening in Syria is a tragedy; what’s happening in Ukraine is deeply troubling. But you’ll notice that for all that, the stock markets of the world have not really reacted with the kind of panic that you would expect. If things were going that badly, shouldn’t we be in dire economic times? Shouldn’t this be reflected in some of the economic data, whether it’s the stock market or the bond market? In fact, generally speaking, things have been looking rather good from

that point of view,” Zakaria said.

Zakaria went on to discuss drivers of instability. He focused primarily on the instability we are currently seeing in the Middle East, a region widely recognized for the overturning of dictatorships during the Arab Spring.

Around 25 years ago, the Middle East was a very stable place due to the dominance of repressive dictatorships.

However, beneath these dictatorships there was little structure and in the past ten years we have seen this instability exposed and the old order upended. ➥

“When imperialism came to an end and the USSR dissolved, this external support of the old order in the Middle East ceased to exist, but the internal opposition was still growing.

These issues, combined with factors like demographics, economics, and events like the U.S. invasion of Iraq, led to the Arab Spring.”

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➥ The dictatorships in power were highly secular and would repress opposing religious groups, which increased resistance and anger. The order was also maintained by external support from the U.S. and the USSR during the Cold War, and imperial powers during the Colonial era.

When imperialism came to an end and the USSR dissolved, this external support of the old order in the Middle East ceased to exist, but the internal opposition was still growing. These issues, combined 26

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with factors like demographics, economics, and events like the U.S. invasion of Iraq, led to the Arab Spring.

Countries like Egypt and Libya didn’t have a bureaucracy underlying Gaddafi or Mubarak. So when the regime no longer existed, there wasn’t a state underneath. The civil society in these countries was also exceptionally weak, so a nation wasn’t present either. As a result, the entire system was crumbling.

Zakaria discussed how, when everything is chaotic, people return to older identities

that they find most secure and familiar.

“You know, if you imagine that situation, where all of a sudden you are confronted with total disorder, you’re looking for somebody who is going to keep you safe, is going to protect you; someone you can trust. And it turns out that people turn not to their national identities, but to their much older identities as Shias, or Sunnis, or Kurds, or Arabs, or Persians,” Zakaria said.

It is these older identities that we see becoming increasingly prevalent in the

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“People often look at the rise of ISIS and are confused by the lack of an Iraqi army, but that gap can be explained by this reversion to old identities. Zakaria described that Kurds fight for Kurds, Shias defend Shias, and the Sunnis will not combat ISIS, because it is a Sunni group. “

Middle East. Zakaria explained that the problem with these older identities is that they do not correspond with national boundaries.

People often look at the rise of ISIS and are confused by the lack of an Iraqi army, but that gap can be explained by this reversion to old identities. Zakaria described that Kurds fight for Kurds, Shias defend Shias, and the Sunnis will not combat ISIS, because it is a Sunni group. Since there is no state and the people do not have a sense of

an “Iraqi” nationality these ethnic groups are protecting themselves. Zakaria explained that Lebanon and Syria are experiencing very similar issues related to original identities. The instability in the Middle East has dominated the news for some time now and Zakaria explained that it is important for people to understand why this instability is occurring.

However, from the election of progrowth leaders in Asian nations, to increased democracy in Latin America, as well as an impressive response to Ebola in Africa: drivers of stability are present across the world, Zakaria argued.

Zakaria defined two key drivers of stability: globalization and technology.

Globalization has enabled 500 million people to escape poverty in the past 25 years. If this trend continues, extreme poverty will be ended in 10 to 15 years.

The exchange of knowledge mobilized through globalization has led to rapid improvements in human development across the globe.

Technology is also marked by rapid enhancements. Zakaria referred to the evolution of computer power; computers have now reached a critical mass where they are doubling their productivity in short amounts of time.

Zakaria discussed how smart phones are commonplace, but contain massive

amounts of computing power. Around 650 million people in India will have access to the Internet in the next five years, and a similar trend will occur in Africa. “And we don’t even know what that means, because so far we have not really had this confluence of technologies, of the smartphone, of 4G, of the capacity to get this information out everywhere.

But what we do know is that knowledge can spread, and when it can spread fast, and it can spread seamlessly, it can have transforming effect,” Zakaria said.

Zakaria discussed the impetus to focus on the problems, rather than the solutions.

He argued it is because problems are easily captured and centralized, while there are many solutions that are not as easy to sum up. Specifically, capturing the bottom-up solutions is difficult, despite them being incredibly effective.

He argued that bottom-up energy is largely the reason that the U.S. was able to recover from the great recession, whereas top-down energy often leads to struggle.

Zakaria argued that substantial, effective work is being done at the local government level, rather than in Washington, which is largely seen as broken. In city and state governments, Democrats and Republicans are more likely to be found working together and working towards real change. ■ SEPTEMBER 2015

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A Conversation with Fred Smith and Fareed Zakaria Interview by fareed zakaria

T

he 2014 Global Action Summit featured a special interview between renowned business leader Fred Smith, Founder and CEO of FedEx and Fareed Zakaria.

Smith, who was offered and declined the role of U.S. Secretary of Defense twice, founded FedEx, a $46 billion company that employs more than 300,000 people in 1971. The idea originated from Smith’s college-level paper proposal that, allegedly received a “C”. Smith also co-founded Securing America’s Future Energy, the nonpartisan organization dedicated to reducing America’s dependence on oil.

Smith’s success is remarkable and aligns with recent growth in the United States. Considering that Japan is entering its tenth recession in the last 20 years, Germany is drowning into its third recession in the last five years, and countries around the world are experiencing disappointingly slow growth, the United States’ creation of more jobs than the rest of the industrial world combined—amidst its financial recovery—is incredible.

When asked by Zakaria to explain U.S. growth amidst global failings, Smith responded, “I think we’re doing relatively well for the very simple reason that we are still less statist” than countries enduring economic losses. Because FedEx serves 220 countries around the world, Smith’s assertion is based on personal experience.

Smith related that the United States’ free-market principles enable its growth.

He further advocated privatization by atoning Indian and Brazilian emergence as financial powers to their acceptance of free-market principles.

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Smith noted that the United States imports $200 billion less per year than it did six years ago; that money now contributes to overall U.S. GDP. Furthermore, the United States benefits from technological innovations, developing from communities like the Silicon Valley.

When asked about globalization, Smith revealed that nations are moving away from globalization and towards protectionism. China, a prominent example, is deteriorating since its 10 to 12 percent growth because of its introduction of “Indigenous Innovation,” which Smith said is a euphemism for protectionism, reflecting that China now has excess government regulations and control. Smith remarked, “When you have state-run enterprises and the state in control of virtually everything, you are just inviting corruption.” Proving the rise and faults of protectionism, Smith pointed out the slow growth of countries with increased regulations.

Referring back to some nations’ retreat from globalization, Smith was asked about the growth of regionalism, especially pertaining to regional trading relationships. Smith noted that the EU exemplifies regionalism because it was created to, “reduce barriers to business across borders, have common standards, [and] have a common currency.” And in Asia, China has asserted its goal to become a regional leading power by creating regional trading pacts.

Transitioning back to Chinese influence and more so to Chinese fear of globalization, Smith revealed that in 2005 and 2006 China sent bureaucrats to Japan to study Japan’s mercantilism.

However, China then passed a law ➥

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that hindered the ability of foreign companies—such as FedEx, which is the largest transporter of goods by air to and from China—to conduct domestic business in China. Despite Chinese attempts at localization, FedEx successfully fought to operate domestically in China.

FedEx is also prominent in India, which similar to China, has strong provincial government structures that lead to complicated local regulations.

Unlike China, however, India lacks modern infrastructure. India has benefited from its free market, open borders, and globalization, but suffered from recent attempts to manage the market because of outdated infrastructure.

Brazil is another country that has experienced growth fluctuations. Brazil has transitioned from soaring growth rates and has gained wealth by selling commodities to China. As such, when Chinese growth slowed, Brazilian growth slowed as well. When businesses started practicing protectionism, growth slowed even more. However, Smith said he has faith in upcoming Brazilian growth because the Brazilian government is employing more capable economists who will likely initiate appropriate reforms.

In commenting on European economic strife, Smith quoted and validated Margaret Thatcher’s now famous saying, “the issue with socialism is sooner or later you run out of other people’s money to give away.” He claimed that European countries lack the entrepreneurial spirit prominent in the United States because of immense regulations in European countries. Smith noted, “in northern European countries, you can hardly hire somebody, it’s such an obligation.”

Smith assigned impediments in the United States to three main issues: taxation, “financialization”, and globalization. Regarding taxes, businesses are able to produce goods more profitably outside the U.S than inside the U.S. because “we have the highest industrial tax rate in the world.” Globalization allows businesspeople in the United States to experience more profit outside the United States than in their home country.

In terms of “financialization”, capable individuals focus their energies into consulting or into Wall Street because it’s more profitable than investing in public

➥

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Zakaria and Smith pointed out that while the rest of the world lowered their corporate tax rates to attract capital, the U.S maintained its tax rate. Having stayed the same for 20 years, the U.S. has one of the highest corporate tax rate in the world.

and government centered investments.

Zakaria and Smith pointed out that while the rest of the world lowered their corporate tax rates to attract capital, the U.S maintained its tax rate. Having stayed the same for 20 years, the U.S. has one of the highest corporate tax rates in the world. Smith advocates for lowering the corporate tax rate, allowing investors to invest in equipment and software tax-free in the U.S., and making every financial transaction subject to a 25 percent capital gains tax that decreases each year until it is nonexistent at the end of five years.

According to Smith, investment is not made because of demand; investment creates its own demand. When a product, such as the iPad, comes out and is desirable because it is better than previous offerings, people will buy it.

Referencing the time when oil prices reached $147.00 per barrel in the United States in 2008—the highest in history— Smith discussed recommendations that he and fellow CEOs formulated. Though Smith doesn’t blame rising oil prices for the recession, he believes rising oil prices set off a host of other problems that caused the recession. He recommended that the United States, “maximize U.S. oil and gas production, use less, and develop alternatives.” Smith is confident that North America will be energy sufficient by 2020. ■

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Empowering Young Leaders to Bring Shared Prosperity to America’s Cities STORY by Jan W. Rivkin & Gabriel P. Ellsworth

W

ith American corporate profits at an all-time high, it would be easy to celebrate the success of the U.S. economy. Yet the sad fact is that the American economy is doing only half its job. Yes, large U.S.-based companies are thriving, as are the well-off individuals who run them and invest in them. But working- and middle-class Americans are struggling with stagnant incomes, weak job prospects, and deep economic insecurity. Prosperity in America is not being shared.

This divergence in America’s economy has many causes. Some causes will be hard to reverse. For example, globalization and technological change have put American workers in competition with skilled workers around the world and with automation that can complete routine tasks. Those genies are out of the bottle and are not going back in. But other causes of the divergence are

unnecessary, self-inflicted wounds.

In particular, U.S. society has systematically underinvested in the shared resources that underpin working- and middle-class prosperity: our education system, the skills of our workforce, our infrastructure, our basic R&D and supply networks.

And Washington is too paralyzed by partisanship to do much about it.

The good news is that in cities and towns across the U.S., local policymakers, businesspeople, educators, nonprofit leaders, labor leaders, clergy, and others are coming together across sectors to restore and reinvent these shared resources. To mention just a few examples, we see: ■ community

colleges working with companies to train the graduates that employers want to hire; ■ elected officials and university leaders partnering to get ideas out of laboratories and into startups faster;

■ educators

partnering with businesses and nonprofits to transform school systems; and ■ c oalitions of leaders coming together toupgrade critical infrastructure.

Such efforts share a few traits: they are local, they span sectors, they produce shared prosperity, and they are long-term.

Eager to fan the flames of these local sparks, a faculty team at Harvard Business School has partnered with civic leaders across the country to launch the Young American Leaders Program.

In late 2014 and early 2015, we asked senior champions in each of nine cities to identify ten individuals who they believed would help lead the city in the future. Importantly, each ten-person team reflected the rich diversity of its city: participants came from government, business, educational institutions, nonprofits, the press, and other sectors.

Then in June 2015, we gathered the 90 young leaders on the HBS campus ➥

“In June 2015, we gathered the 90 young leaders on the HBS campus for, in essence, a boot camp in cross-sector collaboration for shared prosperity. For three intense days, the group learned about best and worst practices from across the country and around the globe. They assessed the shared resources in their communities and envisioned collaborations that might improve them. Perhaps most importantly, they connected with one another, shared their experiences, and taught our faculty about the realities of collaboration.”

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“After the immersion on campus, we are encouraging each city team to apply what they have learned to benefit their hometown.

We will keep the young leaders connected to each other, to us, and to future cohorts. Over time, we aim to develop a cadre of young leaders who have the will, the skill, and the connections to work across traditional boundaries to help their communities thrive. This is a model, we believe, that can work in cities across the country and around the world.”

➥ for, in essence, a boot camp in cross-

sector collaboration for shared prosperity.

For three intense days, the group learned about best and worst practices from across the country and around the globe.

They assessed the shared resources in their communities and envisioned collaborations that might improve them. Perhaps most importantly, they connected with one another, shared their experiences, and taught our faculty about the realities of collaboration.

Young leaders hailed from Boston, Massachusetts; Chattanooga, Tennessee; Columbus, Ohio; Detroit, Michigan; Miami, Florida; Minneapolis-Saint Paul, Minnesota; Nashville, Tennessee; Salt Lake City, Utah; and Seattle, Washington.

Why these cities? In each of them, we found senior leaders who are shaping their communities today and who collectively have a broad view of, and credibility with, the next generation. These local champions helped us to identify upand-comers who are energetic, creative, positive, and collaborative, with a track record of civic engagement.

While our program focuses on the United States, the challenges we examine have global relevance. Nearly every

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community in the world is struggling to share prosperity widely. Many of the lessons we have learned apply to cities everywhere; indeed, in some cases they were drawn directly from the experiences of cities outside the United States.

After the immersion on campus, we are encouraging each city team to apply what they have learned to benefit their hometown. We will keep the young leaders connected to each other, to us, and to future cohorts. Over time, we aim to develop a cadre of young leaders who have the will, the skill, and the connections to work across traditional boundaries to help their communities thrive. This is a model, we believe, that can work in cities across the country and around the world. ■

Jan W. Rivkin is the Bruce V. Rauner Professor and Gabriel P. Ellsworth is a Research Associate at Harvard Business School. The authors are grateful to the Young American Leaders Program’s faculty team, including Rebecca Henderson, Rosabeth Moss Kanter, Karen Mills, Gary Pisano, Michael Porter, and Mitch Weiss.

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Moving Beyond Aid: How American Public and Private Investment Can Help End Extreme Poverty STORY by Raymond C. Offenheiser

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his September, the international community is set to adopt the most ambitious goals for global development ever.

Known as the “Sustainable Development Goals,” or SDGs, this effort will have as its headline objective to help one billion people around the world lift their incomes above the line that defines “extreme poverty”—living on less than $1.25 per day.

Foreign assistance is America’s most well-known tool for fighting global poverty. While it accounts for less than 1 percent of the federal budget, the United States is still the world’s largest provider of humanitarian development and relief funding. Americans are rightly proud of leading the world in this category.

But foreign assistance alone will not be enough to help the world reach the goal of ending extreme poverty. To actually escape poverty, people need the opportunity to earn a decent living. They need to work in order to meet the essential needs of their family—health care and food. So when the U.S. focuses too much on giving handouts—like food—we potentially miss the opportunity to help countries and communities build the skills and institutions required to grow more of their own food.

The challenge for developing countries is to create an attractive environment for private investments that leads to job creation. Understandably, companies seek predictability; they look to conduct business in places where public institutions are legitimate and

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accountable; legal frameworks are clear and well-established, and the rule of law prevails.

Many poor countries lack accountable governance. The key to attracting more foreign business is building strong institutions. This is where U.S. foreign aid can play a pivotal role. By supporting improved governance and the rule of law, our country, and others, can contribute to a virtuous cycle where better governance supports more private-sector led growth. Ultimately, this can help countries get to a place where they do not need development assistance to attract foreign capital.

To make this happen, aid needs to help leverage private sector investments in developing countries in four key ways.

First, aid needs to catalyze other development finance, and help sustain it. Aid should be invested in ways that support partner countries to generate and invest more of their own money, so they are less reliant on foreign aid in the future.

Second, aid needs to build the systems and conditions that can ensure that more private investment supports poverty reduction. Attracting more private sector investment is not an end in itself if that investment doesn’t support the creation of decent, secure jobs for people living in poverty. Aid needs to do more to help governments create and enforce fair and effective rules that make sure the poor benefit from growth.

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“The key to attracting more foreign business is building strong institutions. This is where U.S. foreign aid can play a pivotal role.”

Third, aid needs to advance the rights of citizens, particularly poor and marginalized people, to hold government accountable for protecting the rule of law. Aid should support governments to be more responsive to citizens, and support citizens—and civil society—to demand accountability from their governments, and make sure they deliver on their promises.

Fourth, aid needs to do a better job of helping countries and people create lasting development outcomes. Too often, donors program their aid in a way that prioritizes their own needs over the needs of recipients. Citizens in poor countries are not just recipients—they are innovators, investors, and voters.

They hold the key to their own economic futures.

Aid alone cannot create broadbased economic growth. But how aid is delivered can influence how well people and their governments create the conditions that attract investment and create growth. When delivered well, aid can help improve public accountability and the rule of law, and support citizens’ efforts to hold their governments to account. This accountability to citizens is the antidote to corruption and can help disadvantaged people and groups get the policies they need to reduce poverty.

There is major opportunity for the United States, and other nations, to rethink aid policies in a way that can create more opportunities both for poor people and American investors. Members of Congress, like Tennessee’s own Senator Bob Corker, are leading the effort to make U.S. development assistance a catalyst for change, and support the good governance that attracts investments for market-led growth and job creation. ■ SEPTEMBER 2015

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Inclusive Economic Growth Is Key to Prosperity STORY by Trevor Davies

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ccording to recent figures, things are looking very positive for the people of Nigeria. It recently overtook South Africa to become the continent’s largest economy on a GDP basis. New World Bank figures show that poverty in the country has fallen significantly, dropping from a rate of 62% in 2010 to around 33% in 2014. The Presidential elections were regarded as generally fair and open. The country also remains one of the top three destinations for FDI in Africa. While this is great news for Africa’s most populous country, recent shocks reveal that its path to long-term prosperity is more fragile than some of the economic data would suggest.

Recent fuel shortages nearly brought the Nigerian economy to a standstill.

Airlines cancelled flights. Banks closed.

The country’s largest mobile phone operator warned of a possible shutdown to its network. Only two days’ supply of fuel were left throughout the country.

Although Nigeria averted disaster, this shock revealed the gap between the country’s ambitions for long-term prosperity and its current capability to achieve this goal. How can Nigeria,

or any country for that matter, build a framework for achieving long-term prosperity? The answer, by building ‘change readiness’.

Change Readiness Following a discussion on the implications of the Haiti earthquake at the World Economic Forum at Davos in 2010, KPMG International developed the concept of “change readiness” to better understand why some countries, when faced with substantial shocks, are able to bounce back quickly, while others struggle to cope. Change readiness is defined as the capability of a country— its government, private sector and wider civil society—to anticipate, prepare for, manage and respond to a wide range of change drivers, proactively cultivating the resulting opportunities, and mitigating potential negative impact.

Why is the Change Readiness Index (CRI) different?

The Change Readiness Index (CRI), now in its third iteration, is the only index to explicitly measure change readiness.

The index is comprised of a range of indicators structured around three pillars: enterprise, government, and people ➥

“Following a discussion on the implications of the Haiti earthquake at the World Economic Forum at Davos in 2010, KPMG International developed the concept of “change readiness” to better understand why some countries, when faced with substantial shocks, are able to bounce back quickly, while others struggle to cope.”

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➥ and civil society. The CRI uses

published secondary data and primary data gathered through surveys with independent experts. The data is focused on ‘inputs’ which can be actively managed—such as investments into infrastructure or supportive policy environments.

Using the CRI The CRI reveals a number of unique insights that can help Nigeria’s leaders create the necessary policy and business environments to support long-term prosperity. It also provides detailed information for potential investors to feed into risk assessments to inform investment decisions and development agencies and NGO’s looking to focus their economic development, social and advocacy programs.

Economic diversification The oil and gas sector accounts for nearly 35% of Nigeria’s GDP. Dependence on a single commodity is often associated with poor governance, conflict, and an undiversified industrial base. The drop in global oil prices has put tremendous strain on Nigeria’s economy, shrinking government coffers and weakening the country’s currency against the US dollar.

In contrast, South Africa, the continent’s second largest economy, has a more diversified economy across multiple sectors including manufacturing, mining, and business services. This is reflected in CRI scores for diversity of exports.

Nigeria ranks 121, while South Africa stands at 43. Transforming Nigeria’s economy to one that is less reliant on natural resource extraction is an important step towards sustainable prosperity.

Innovation and entrepreneurship Innovation and entrepreneurship are important drivers of economic growth.

They influence a country’s ability to both develop and adopt new technologies that improve efficiency and create new economic sectors. On several key measures, Nigeria ranks towards the bottom in measures of its ‘innovation system’ and expenditure on research and development. Nigeria ranks 77th on this indicator while South Africa ranks 43rd.

The CRI reveals underperformance in these areas, which weakens Nigeria’s ability to develop the STEM (Science,

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Technology, Engineering, and Mathematics) ecosystem required to create jobs in the high-tech, engineering and biotechnology fields.

Fostering innovation will help develop the capacity to onshore high value elements of the economic value chain.

Infrastructure to support economic growth Nigeria currently does not produce enough power to meet demand and needs to improve electricity production and distribution infrastructure to enable economic and social growth. The CRI highlights the need for significant investment in power and other key infrastructure areas to build on existing programs, such as USAID’s Power Africa program which is already investing heavily in Nigeria’s power and electricity sector.

Inclusive growth Perhaps Nigeria’s biggest challenge to sustained prosperity is tackling rising income inequality to ensure that all its citizens benefit from economic growth.

Although poverty figures are promising, a large share of the population still lives just above the poverty line. The CRI suggests that Nigeria should focus on improving the key drivers to its change readiness if it wants to deliver sustainable prosperity for all its citizens. ■

Trevor Davies leads KPMG’s International Development Assistance Services Global Center of Excellence. Trevor leads a global team delivering insight and solutions on complex development issues. Trevor has worked extensively in developing countries in Africa, Asia, Eastern Europe, the Caribbean, and Latin America.

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“Innovation and entrepreneurship are important drivers of economic growth. They influence a country’s ability to both develop and adopt new technologies that improve efficiency and create new economic sectors.”

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FOOD

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FOOD

Session 1: Building an Ecosystem for Abundant Food Session Panelists: Roger Beachy, PhD, Director, World Food Center, UC Davis (by video) Robert Townsend, PhD, Senior Economist, World Bank M.R.C. Greenwood, PhD, Distinguished Professor Emerita of Nutrition and Internal Medicine, UC Davis Jonathan Wadsworth, PhD, Executive Secretary, CGIAR Fund Council John Ruff, Immediate Past President, Institute of Food Technologists Moderator: J. Bruce German, PhD, Director, Foods for Health Institute, UC Davis

SITUATION Agriculture faces the grand challenge of feeding an additional 2-3 billion people safely and sustainably by the century’s end. Much more food with adequate nutritional factors needs to be extracted from the planet’s existing resources, with much less loss and waste than currently occurs.

Success will require a supportive global food ecosystem beyond the technical solutions, tools, and models to optimize crop yields and food supply chain efficiency. The global food ecosystem will be characterized by: ■ A

workable framework that ensures a safe, nutritious, affordable food and feed system.

■ Policies and regulations that encourages innovation and testing of new solutions.

■ Unprecedented levels of global collaboration, cooperation, and coordination.

■ Unprecedented transparency by food technologists, supply chain participants, and policymakers.

■ High levels of trust among stakeholders, particularly consumers.

The challenges these requirements pose are complex and multifaceted.

They are further complicated by the unpredictability of climate change and by rising demands on crops as not only a source of food and feed but also as a source of energy, chemicals and materials.

No single solution will be sufficient to create an ecosystem of food abundance amid such conditions; it will take an integrated, systems approach

and many effective solutions.

There is cause for much optimism since much of the underlying science is already here. The panelists believe in the ingenuity of mankind and that the high stakes will motivate the right behavior.

They also think that assessments of risk/ reward will encourage experimentation and cause innovation to flourish. Now is the time to act since there is much to be done to raise awareness and to engage the many stakeholders.

4. How can we educate, engage, and promote trust among stakeholders in the food supply chain, particularly consumers?

5. How can we address the foodsecurity challenges of developing nations and ensure inclusive participation in the fruits of increasing agribusiness?

6. How we can engage young people in these challenges and inspire them to seek innovative solutions?

KEY QUESTIONS

CHALLENGES

1. What will it take to build a sustainable global food ecosystem that meets the nutritional demands of a world population that is 2-3 billion people larger by the end of the century?

2. How will environmental challenges such as climate change, water scarcity, and increasing demands upon agriculture figure into the picture?

3. How can we achieve the levels of innovation, collaboration, transparency, and global food systems integration that feeding the world will require?

Historically, the world has done an adequate job of feeding its people, even as the global population surged from 1.5 billion a century ago to 7 billion today.

But the United Nations’ Food and Agriculture Organization (FAO) estimates that this century the world will have to increase food production by 70% (grains by 43%, meat by 75%) to meet the food and nutritional demands of a global population that some estimate will be 3 billion people more by the century’s end. This production increase must occur amid negative effects from climate change, less predictable and secure ➥

“If we do nothing, the world will be a hungrier, darker, less healthy place. Nonetheless, the opportunity to make a transformation in the way we produce food, make abundance routine, prosperity a given, and change our trajectory of health . . . making the next generation of people the healthiest . . . generation in history—that’s available.

But we will have to act.”

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➥ supplies of water, and increasing demands on agricultural products for other uses, like biomaterials and biofuels.

Four broad challenges related to global food security, highlighted by Robert Townsend, are: 1. The responsiveness of the food system. This system must be flexible enough to withstand supply shocks (due to weather) or demand shocks (due to increased demand from industrial uses of food, such as biofuels). From 2008 to 2012, there were three major global food price shocks that were not well tolerated by many countries. An integrated global food system is needed that can respond to such shocks by adjusting trade and information flows to minimize the impacts, i.e., moving food from places of surplus to places of deficit and helping hard-hit nations with trade policy.

2. Achieving poverty reduction targets in poor countries. There is twice as much primary agriculture as agribusiness in sub-Saharan Africa. As agribusiness grows there and in other poor countries, a challenge will be to develop inclusive systems that ensure smallholder farmers participate in the benefits of growth.

3. Making agricultural systems sustainable. In many places, agricultural systems result in degradation of resources—land, water, and atmosphere.

Agriculture systems that restore soil nutrients and use water more efficiently are needed, along with policies that support planting crops that use the appropriate amount of water for the climate. Also needed is innovation that makes agriculture not only a huge climate-change contributor but also part of the solution. It is one of the few industries that can actually absorb carbon from the atmosphere. Technologies and metrics to enhance those effects need developing.

4. Having a food system that improves health. Some 800 million to 1 billion people go to bed hungry every night, but that figure is dropping while obesity rates are rising, even in developing countries. As a result, non-communicable diseases (heart disease, diabetes) are rising in these countries, stressing healthcare systems and costs. Building food ecosystems that promote better health outcomes is critical; doing so will mean influencing consumer choice, partly through government policy.

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For poor countries, challenges are to reduce spoilage and post-harvest losses throughout the supply chain, increase yields, and to incorporate sophisticated farming and business practices to smallholder farms. In wealthy countries, a major challenge is changing consumption patterns to encourage better health outcomes. Other challenges include educating consumers and policymakers about food safety, innovative food technologies, addressing food-sufficiency challenges, and attracting and nurturing students to work on the pressing challenges of transforming global food systems via technology and innovation.

OPPORTUNITIES Recent press on global food challenges (including “Leverage Points for Improving Global Food Security and the Environment” in the July 18, 2014 issue of Science) suggests that focusing on improving yields of 17 important grains and vegetables, via use of improved seeds, and taking other targeted measures could go far in building the world’s capacity to feed its people. Roger Beachy identified the following beneficial and critically important steps:

Improving soil health Increasing the efficiency of water and fertilizer use ■ Adapting to climate change ■ Reducing overuse and runoff of fertilizers and agricultural chemicals ■ Improving water quality and safety ■ Reducing greenhouse gas emissions ■ Adapting technologies that allow for better communication with farmers ■ Increasing the public focus on foods that promote health and on food safety ■ Reducing the use of major crops for biofuels ■ Reducing pre-and post-harvest food losses and food waste wherever it occurs ■ Improving food supply-chain management ■ ■

Beachy expressed confidence in the ingenuity of scientists, policymakers, and the public to rise to these challenges so that innovations in agriculture and food science will be allowed to advance. Bruce German also expressed optimism that solutions will be reached, emphasizing the urgent need to act now. However, more is needed than the best scientific solutions and innovative business models. Also critical is building a global ecosystem that supports food abundance by: 1. Cultivating collaboration and trust.

It will take collaboration among many kinds of organizations and people to

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“Over the next 25-30 years, the farmers of the world will need to produce as much food and nutrition as all of the farmers who have existed over the past 8,000-10,000 years. . . . It’s placing and will place tremendous pressure on the resources that we’ve got.”

Jonathan Wadsworth, PhD, Director, Foods for Health Institute, UC Davis

“If we look at this . . . as part of a systems approach to meeting the nutrition and food security needs of the globe, we recognize that all of us can be in this together, whether we are engineers or biologists or medical doctors or nutritionists or marketers or consumers. We’re all in this together and need to find ways to partner to identify solutions.”

Roger Beachy, PhD, Director, World Food Center, UC Davis

“The abilities of technologies to advance our agriculture are there.

They don’t need inventing. . . . The abilities to make food safer for people, make it more abundant, and get it to people are there. The challenge very simply is that we are losing the confidence and trust of people to use these scientific technologies.”

John Ruff, Immediate Past President, Institute of Food Technologists

implement solutions at scale. This includes food technologists and research scientists, academia, governments, NGOs, the private sector, and consumers. As public awareness of the impending food challenges grows, hopefully so will awareness that “we’re all in this together.” M.R.C. Greenwood sees a new potential career path for scientists: as interpreters, working in government, for example, as trusted advisors to scientific legislators. More trust on the part of consumers toward food technologists will need to be cultivated, with more messaging and communication, for example, to convince the public that genetically engineered food is safe under the current regulatory system.

2. Training and motivating the next generation to seek innovative solutions. “We have to inspire the next generation to start innovating in agriculture and food,” said German.

A young agribusiness professional commented on the absence of peers his age at the Summit. He said the way to motivate young people is to give them a seat at the table, putting them on boards of directors and seek their perspectives.

Greenwood believes young people going into agribusiness today are interested not in farming, as it traditionally has been done, but rather in discovering new technology-

enabled models for doing it better, “the farming version of Uber.” However, she says students interested in the field haven’t been given optimal career pathways.

3. C reating forward-thinking organizations that move the ball forward. Beachy’s formula for doing so includes: ■ Framing the questions ■ Engaging stakeholders ■ Identifying partners tasked with solutions ■ Engaging goal-oriented experts ■ Ensuring that policymakers are aware of the needs and supportive of the means for achieving goals, so new technologies can be moved into the marketplace ■ Maintaining transparency throughout these processes Panelists’ organizations are working along these lines, with initiatives to raise awareness, support the discovery of solutions, and advance the agenda of global food security. Various initiatives include: ■ The World Food Center, UC Davis fosters research collaboration across departments. Its thematic pillars include promoting a stable future for agriculture and the consumer, sustainability across the food system, and healthier food outcomes.

UC Davis recognizes its role as a go-to source for information dissemination on

food and agriculture and now houses a multi-campus Institute for Food and Agricultural Literacy to better train graduate students in communicating science to the public. In addition, UC Davis has established the Innovation Institute for Food and Health, with a contribution by Mars Incorporated, to help leverage current capabilities in agriculture and health.

■ CGIAR is a global partnership that unites organizations engaged in research for a food-secure future. Fifteen research centers generate and disseminate knowledge, technologies, and policies for agricultural development.

■ The Global Crop Diversity Trust, a sister organization of CGIAR, has 11 seed banks, with more than a million accessions of crop and forestry species—“the crown jewels of agriculture.” The new crop breeds these seed banks could enable might present solutions to the agricultural challenges of the future.

■ Institute of Food Technologists, with 20,000 members around the world, is using the occasion of its 75th birthday as a platform for advocacy. Associated activities include interviewing 75 thought leaders (more information here) and producing a documentary with award-winning director Scott Hamilton Kennedy, to correct misinformation and educate the public. ■ SEPTEMBER 2015

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Session 2: The Freedom Principle: Stories from Mars Session Panelists: Harold Schmitz, PhD, CSO, Mars, Incorporated Justin Bakule, Executive Director, Shared Value Initiative Carl Keen, PhD, Professor of Internal Medicine, UC Davis Moderator: Howard Yana-Shapiro, PhD, Chief Agricultural Officer, Mars, Incorporated; Senior Fellow, UC Davis

SITUATION Most science doesn’t happen in a vacuum and it doesn’t happen overnight. Given the intensity and intentionality associated with science, collaborations are the key to making a difference in scientific pursuits.

The days of the lone ranger are over. Mars, Incorporated fully subscribes to the need for, and power of, scientific collaboration.

Beyond collaboration, Mars—a company with $30 billion per year in net sales— believes deeply in the idea of freedom. Mars has five core principles that its owners have developed over the decades; one of these key principles is freedom. For Mars, freedom is a financial principle. The company is not burdened with debt and is not beholden to bankers. As a result, its leaders have the freedom to make decisions themselves.

This financial freedom has enabled the company to pursue deep scientific research and uncommon collaborations in a variety of areas.

Mars recognizes that there is a lack of faith about the food industry, companies in the industry, and even nutritionists. The information in the field has credibility

problems. This skepticism exists despite the fact that about 15 years ago, Mars was investing more in human nutrition research than the USDA. And the company continues to invest significantly. Recent research areas for the company have included flavanols, African orphan crops and cacao, and rice cultivation in the United States. Much of this scientific work has been accomplished through the non-obvious (uncommon partnerships)..

KEY QUESTIONS 1. How can grand challenges facing society in the area of nutrition and nutrition security be addressed?

2. How are interactions between corporations and society changing, so both business issues and social issues are resolved?

3. How is the idea of shareholder primacy changing?

4. How can uncommon collaborations between the private sector, governments, universities, and other stakeholders be promoted?

“The ability to tie business issues to social issues is the fundamental underpinning of how we build momentum. At Mars, you see an uncommon culture that places a premium on long-term thinking and long-term investment that can benefit society and the company, and doing it in an unapologetic way that commits to progress on both of those elements.”

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CHALLENGES Society faces many grand challenges, ranging from climate change to loss of biodiversity to health issues like cognitive decline. Preventive health is essential, and nutrition is at the heart of preventive health. Unfortunately, investments in preventive health are not commonly funded by governments or other agencies. More projects and programs are needed where industry does serious research in the areas of food and health with the long view of a 10-15 year vision.

Globally, nutrition security is a serious, important challenge. In Africa, 300 children die every hour due to chronic hunger and malnutrition. Over one third (37%) of children in rural Africa, half of children in rural India, and even 7% of American children are stunted physically and affected neurologically due to poor nutrition. They will never reach their economic potential as adults.

Diets today are not optimized for health or for reducing the risk of chronic disease.

However, this is not widely discussed.

Tomorrow’s medicine will largely be food that industry has manipulated, altered, and improved. Many believe if they ate an all-natural diet, all would be well. However, that’s untrue. For example, if people in the Nashville area ate an all-natural diet, they would likely have mild goiters.

Uncommon partnerships are the key to making progress with nutrition security, but they are unpopular, especially in academia.

One reason is because industry is viewed as evil, self-centered, and interested solely in making money. In the nutrition field, ➥

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The Freedom Principle: Stories from Mars

“It’s one thing to have financial freedom and it’s another to have the courage to leverage that freedom to do something interesting.

The cacao genome sequencing, for example, took courage on the part of the Mars family. It wasn’t possible to even visualize the end point in a concrete way. They had a vision of a sustainable supply chain, but they couldn’t articulate the pathway there. If you look at the story of Mars, it’s the certainty of having financial freedom, but the comfort with uncertainty to pursue something that can ensure freedom in the long term.”

Harold Schmitz, PhD, CSO, Mars, Incorporated

“Mars has invested tens of millions of dollars to upgrade the Greenville, Mississippi facility and to engage the community with better nutrition. The company’s view is that rather than abandoning a community where you’ve been, you go fix the problems.”

Howard Yana-Shapiro, Chief Agricultural Officer, Mars, Incorporated; Senior Fellow, UC Davis

➥ businesses are viewed as trying to sell products, not solve global problems.

OPPORTUNITIES Because Mars has the freedom to invest systematically over the long term in preventive health, it has funded rigorous, gold-standard science related to nutrition and cognitive health. During the last five years, company scientists have published around 155 peer-reviewed publications in the nutrition area. This research is unusual because the company does not use it to protect intellectual property, but chooses to share this information in the public domain.

Mars likes to look at ways to lift parts of the supply chain. The heart of Mars’ business is cacao, the main ingredient in chocolate. A few years ago, the company realized that the entire global supply chain for cacao was unsustainable. Côte d’Ivoire is the leading cacao producing country in the world, but the average yield was 450 kilos per hectare, which meant absolute poverty for small holder farmers. Mars recognized the tie between business and society: cacao is vital to the company, but

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its cultivation wasn’t benefiting the people of Côte d’Ivoire. Work was needed to improve the quality of life for hundreds of thousands of farmers.

In 2008, Mars announced it would sequence the cacao genome to improve the supply chain’s sustainability. Mars scientists asked for $5 million, but the Mars family went further, giving $10 million along with the charge to complete the work in two years. The cacao genome sequencing was completed in September 2010 and immediately placed into the public domain. This allowed the best and the brightest researchers world-wide to use the sequence information as a foundation for further research toward improvement in cacao trees, thereby accelerating the pace of research and development.

Indeed, the moment the sequencing work was done, it was used in an uncommon collaboration. West African researchers that Mars had trained under the Borlaug Fellowship program at the USDA Agricultural Research Service began to apply the information to their projects.

Researchers in Ghana, Cameroon, and Nigeria also are using the cacao genome information. In addition to cacao genome sequencing, Mars participates in

a group called Cocoa Action, which was formed with its supply chain partners.

This is one of the biggest programs ever created to lift rural farmers out of poverty.

Approximately $100 million is collectively directed toward cacao sustainability on an annual basis.

When children are stunted due to diet, the only way to fix the problem is to improve the nutritional content of their diet. Mars decided to sequence all 101 food crops that are consumed regularly in pan-Africa and to place that information in the public domain. This project deals with data on a scale that has never been seen before. Some food crop genomes are three times bigger than the human genome, which cost $10 billion to sequence. The first class of 250 scientists is now being trained in Africa on modern molecular biology so they can breed new, nutritionally rich crops. This work is accomplished through an uncommon collaboration.

Participants include the World Wildlife Foundation, the University of California Davis, the Beijing Genomic Institute, the World Agroforestry Center, and others..

All donations are in-kind. There are no government grants or administration. The group meets twice a year on consensus.

SESSION 2

Flavanols represent another opportunity.

They are potentially a major breakthrough in nutrition, especially Flavan-3-ol. Mars collaborated with several institutions worldwide on research in this area including the University of California Davis, Georgetown Medical School, Harvard University, Brigham & Women’s Hospital, Redding University and Imperial College in the United Kingdom, the University of Düsseldorf, and Australia’s Commonwealth Scientific and Industrial Research Organisation (CSIRO). Mars also recently completed a collaboration funded by the European Union. Mars was the only industry participant among seven universities and one government institution.

Mars also collaborates with Columbia

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University on cognitive health research.

Mars’ work in this area began 12 years ago when the company was approached by the Defense Advanced Research Projects Agency (DARPA). DARPA believed that preventive health and nutrition could be a competitive advantage in the battlefield.

Mars has also worked with Fred Gage at the Salk Institute who discovered neurogenesis.

One of Mars’ most uncommon collaborations is participation in the Lindau Nobel Laureate Meetings. Every three years Nobel Prize winners meet in Lindau, Germany. A group of PhD students and post docs are chosen from tens of thousands of applicants to attend and interact with the Nobel Laureates.

The Nobel Foundation approached Mars

because it wanted a representative from the food sector, since food and agriculture are so essential for the future health of the planet and its citizens. Mars was the only company that this group considered inviting due to the company’s longstanding publication record and focus on long-term issues.

Mars is also the largest branded rice company in the world. Much of its rice is grown in Greenville, Mississippi, one of the poorest regions in the United States.

As one of the last substantial employers in the area, the company has committed to addressing social problems there, rather than abandoning the community. Tens of millions of dollars have been spent to upgrade the Greenville facility and support the community with better health. ■

“There is an evolution in how one does business, but also in how one does science. Mars is at the forefront of it, but other companies are catching up and will be equally engaged. I think it will hold great promise for the future.”

Carl Keen, PhD, Professor of Internal Medicine, UC Davis

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Session 3: Big Data and Decision Models for Food, Water, and Climate Session Panelists: Brad Holtz, Chief Strategic Officer, C4UC John Fennebresque, Jr., Managing Director, Fennebresque & Co. Lanny Faleide, President & CEO, Satshot Moderator: Howard Minigh, PhD, President & CEO, CropLife International

SITUATION The Food and Agriculture Organization (FAO) and other organizations predict that in the next 35 years, the global population will increase by one third, reaching around 9.5 billion people. Much of that growth will occur in geographies already challenged with respect to food and nutrition security.

Climate change will create even more water stress for a larger percentage of the population. The International Food Policy Research Institute (IFPRI) has modeled data and believes that without further intervention, the yields of the three major staple crops—maize, wheat, and rice—will decline between 10% and 25%.

That will be devastating for the poor in less developed countries. IFPRI’s model predicts outcomes down to the local level (60 kilometers by 60 kilometers). A free, online agri-tech tool box is available for anyone, including policy makers, to use for scenario planning.

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The United Nations has proposed a three-pillar approach to addressing these challenges: 1) sustainably increasing agricultural productivity; 2) building resilience to climate change; and 3) reducing greenhouse gas emissions.

Products and technologies already exist that address these three pillars.

Examples include crop protectants and no-till agriculture. By using existing technologies more widely, food security can be increased.

KEY QUESTIONS 1. What new techniques can increase agricultural productivity?

2. How are technology and big data changing farming and benefitting farmers?

3. What are the barriers to more widespread use of agricultural technology domestically and worldwide?

4. What types of business deals are driven by disruptive changes in agriculture?

5. What new technologies will improve water management and deliver the right amount of water to the right place at the right time?

6. What tools can be provided to policy makers to facilitate smarter, datadriven decisions?

7. In terms of the innovation pipeline, what game changers are on the horizon that could make a big difference in agriculture?

CHALLENGES The last 400 years have been stable in terms of temperature and water, but that stability won’t continue. Globally, the absolute amount of water available hasn’t changed. However, water is not located where farmers or the global population need it. Unfortunately, farmers can’t pick up their land and relocate it to places where water is more accessible. Farmers must understand and model water availability, as well as how climate change will affect their area’s soil and potential crops.

Most farmers still have a mentality that unless they keep the water turned on, they will lose their allotment. Many water boards also promote this viewpoint. An open question is how to apply policies, regulation, technology, and common sense so agricultural production can be dramatically more efficient in terms of water usage.

National policies often have a major impact on food security and nutrition.

Regulatory policies restrict access to plant biotechnology, subsidies distort trade, and regulations related to intellectual property distort incentives. Rational conversations are needed about policies that discourage current consumption, in lieu of future consumption. Mechanisms are required that offer incentives for longer-term thinking.

Well-intentioned policies and wellconsidered policies usually aren’t the same. When there is a call for action ➥

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Big Data and Decision Models for Food, Water, and Climate

“Software development isn’t as difficult a puzzle to solve as it once was. The challenge is understanding how to get technology out into the market and getting farmers to embrace it. We’re focused on companies that have technology development, but also understand the realities of the marketplace. They are already significantly up the learning curve in terms of how to deploy technology and have it embraced by the agricultural community.”

John Fennebresque, Jr, Managing Director, Fennebresque & Co.

“On a global level, the real game changer is for the small farm to have access to information that they never did before and to learn from what others have been doing. That will change global agriculture and well-being.”

Brad Holtz, Chief Strategic Officer, C4UC

➥ there seems to be an obvious link

between the desired result and the proposed regulation or policy. However, the world is complex and often regulations don’t affect the intended consequence. The resulting torque causes problems, and policies must be adjusted.

In the less developed world, vast areas of land are under-producing. New technologies could make a big impact in terms of food availability and quality. One barrier to widespread use of technology in agriculture is Internet connectivity and access to information. However, the access to and use of smart phones have become much more prevalent, even in the developing world.

Also, the Internet of Things is gaining traction in the agriculture sector. As sensors are deployed to reinforce decision making, the volume of data is exploding, making sensor overload a real risk. A challenge is how to bring the data together in meaningful ways.

There was significant interest in precision agriculture, and many farmers have begun buying technology to manage their fields better. In fact, a significant amount of venture capital funding is now being directed to precision agriculture startups. However, high-value crops like

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corn have eliminated the incentive among many farmers to implement precision agriculture technology. There are likely to be a massive number of failures among the venture-backed companies in places like Silicon Valley, far from the farm.The issue isn’t software development, which isn’t as difficult as it once was. The challenge is how to get into the market and persuade farmers to embrace technology.

Another challenge is that when systems are designed for the developing world, especially Africa, maintenance is often not fully considered, and proves to be the downfall of most efforts. Engineers must understand how systems will break and how they can be fixed in the market with the materials and resources on hand in any given location.

No one is taking a systemic view and determining how to maintain a

competitive market, while keeping more rewards at the farmers’ level. Also, many farmers have relinquished decision making to third parties. When farmers lose the ability to think for themselves, it jeopardizes food security and our ability to survive globally.

OPPORTUNTIES One way to understand bigger-picture issues is to leverage models created by the private sector, universities, national labs, and others. This enables analysis of the broader context and examination of the long-term implications of actions.

The Center for Understanding Change (C4UC), for example, worked with China and Russia to encourage collaboration on sensitive cross-border water issues.

“We are bringing in information so farmers can manage their fields better. It’s increasing the level of production more efficiently and targeting where fields need input. There are multiple soil types in a field and there are dynamics that change, based on different weather conditions or different applications. By measuring that data on a real-time basis, we can create a precision ag environment.”

Lanny Faleide, President & CEO, Satshot

SESSION 3

C4UC connected each nation’s models in a way that did not expose critical information. Similar work has been done in the power industry, where the implications of big decisions are only understood by studying how component parts are connected.

Satshot uses remote sensing technologies along with satellite and drone imagery to bring the big picture down to the field level for the agricultural community. When this data is tied to the farmer’s knowledge, it enables better decisions about where to target resources.

It is possible to identify good and poor areas in fields based on vegetation biomass signatures. By measuring data on a real-time basis, a precision agriculture environment is created. This data can be used by tractors that are programmed to auto steer, as well as to guide field applications. Although drones are helpful for looking at areas at the micro level, they are not a scalable solution for imaging millions of acres per month or per day.

At this time, they are complementary to satellite imaging.

Major deals like Monsanto’s billion dollar acquisition of The Climate Corporation have stimulated interest in precision agriculture among the

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venture capital community. Although precision agriculture has been focused primarily above ground, there are many opportunities underground in the root system. Another major investment trend is the biological side of agriculture; that is, technologies based on bacterial and fungal microorganisms. Over the last year and a half, there have been several significant transactions in this sector. The largest was Bayer’s acquisition of AgraQuest.

There are a variety of new water management technologies in different stages of development. One company just launched a Kickstarter campaign to fund a product called the Peon. A Peon uses power to pull moisture out of the air for plant irrigation. The technology costs about $20 a year to produce enough water for one plant. Although this is 10 times more expensive than desalinization, it could be useful for sensitive plants. The technology also scales well at the city and regional level for farms.

Another promising water management technology is desalinization. One company is analyzing the problem at the molecular level. At micro-liter quantities, they can achieve 1.35 to 1.38 efficiency.

They create two streams: one more concentrated and one less. The more

concentrated stream can be continually dewatered until almost all the water has been extracted and what remains is a salable brine. The firm plans to use silicon technologies to scale the process and when scaled, the process is massively more efficient than existing desalinization technologies. This innovation won a $100,000 award from Ocean Engineering Oregon.

Global agriculture is extremely diverse in terms of scale, ranging from farmers managing thousands of acres in the US and Brazil to subsistence farmers with small plots in Asia and Africa.

There is also a great diversity of crops and technology. Even for small-scale agriculture, technologies can be beneficial.

For example, small-plot farmers may take a photo of a crop and email it to an expert for advice. On a global level, a game changer is small farms having access to new information about what others are doing.

Another game changer is getting connectivity out in the field in a reliable way that creates confidence among users.

None of the technologies will work unless farmers and advisors are confident they are receiving reliable, consistent data.

Trust is paramount. ■

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Session 4: Frontiers of Global Food Innovation Session Panelists: M.R.C. Greenwood, PhD, Distinguished Professor Emerita, Department of Internal Medicine, UC Davis Sharon Shoemaker, PhD, Director, California Institute of Food and Agricultural Research Pam Marrone, PhD, CEO, Marrone Bio Innovations Gerry Brown, Executive Director, Institute for Economic Stability Moderator: Jonathan Wadsworth, PhD, Executive Secretary, CGIAR Fund Council

SITUATION To address the challenges of global food shortages projected over coming years, and the present-day food insecurity and related problems in struggling developing economies, innovative solutions of multiple types are needed.

How Innovation Happens Scientific research provides a foundation for food-related innovation, but research alone is not sufficient. Findings and discoveries from research need to be leveraged into product or process-related innovations. That often requires public and private sector collaboration.

Most food-related research is funded by the government and takes place in universities. Yet the translation of research findings into practical, usable innovations usually does not occur at universities.

Practical real-world innovation is typically the product of private sector companies (e.g., Apple created today’s most successful innovation, the iPod, but most of the technology used, such as GPS, was created in academic research labs).

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Often potentially important findings from research never leave academia’s “ivory tower.” To accelerate innovation, there needs to be greater alliances and collaboration between academia and industry that facilitate information flow.

Non-profit organizations that focus on problems of food insecurity in developing nations may spearhead innovative solutions on the ground, but their efforts are much more impactful by partnering with big agribusiness companies.

■ Innovative

ways to facilitate knowledge transfer among stakeholders. Stakeholders include everyone focused on issues of the global food supply chain in academia, business, non-profits, and development agencies, who reside in very different worlds and often don’t readily share information.

Kinds of Innovation Necessary The panelists cited several distinct kinds of innovation, all of which are necessary: ■ Technical innovations. Innovations in agricultural technology are necessary to protect crops and increase yields.

These innovations will be important for addressing the challenges of the future, since boosting agricultural productivity will be critical given the widening food supply/demand gap projected as the world’s population rises. There are exciting developments taking place in this arena.

A promising frontier is the utilization of micro-organisms to combat agricultural challenges, including weed control, plant disease, and drought.

■ Systemic process innovations. Also needed will be process-related innovations throughout the food system value chain.

These include making more efficient use of water, energy, and food resources, decreasing waste, and transporting food products in more sustainable ways.

1. What innovations in the global food system can we see coming in the next five or ten years?

2. What kinds of innovations would help us solve some of the world’s serious food and economic development problems?

3. What are desirable goals and outcomes of innovation?

4. What are the barriers impeding needed innovations in the global food value chain?

5. How can alliances among stakeholders—including universities, entrepreneurs, global non-profit agencies, and big business— accelerate innovation?

6. What must happen to facilitate information flow so that research discoveries are leveraged into product and process innovations that address global food challenges and so that the knowledge of advanced economies can be utilized by struggling ones? ➥

KEY QUESTIONS

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Frontiers of Global Food Innovation

“Food demand is growing about 3% a year; the efficiency of productivity in agriculture in Africa is growing at 1% a year. . . .

So innovation, in my view, is all about improving resource use and efficiency. Research lays the groundwork by getting the evidence required to make the best innovative choices. . . . But research and evidence doesn’t mean anything until innovations get into hearts, minds, fields, and plates.”

Jonathan Wadsworth, PhD, Executive Secretary, CGIAR Fund Council

“In California, food waste is a big deal at the farm level and commercial level. . . . We have to rethink the way the process is working to minimize waste as much as possible. That is going on in part, but the adaptation of all the new thinking and change is much slower, frankly, than I would like to see.”

Sharon Shoemaker, PhD, Director, California Institute of Food and Agricultural Research

CHALLENGES

➥ The various innovations needed are

complex and often require collaboration and information sharing among stakeholders operating in different cultures with different processes, rules, and mindsets. The barriers to such collaborations are high.

The pressing problems of food system inefficiencies require process-related innovation, which doesn’t receive nearly

as much funding, research attention, or study as efforts to maximize crop yields through science. However, some think that process innovations are more urgently needed, because if waste continues at current high levels, not nearly as much value results from maximizing agricultural output. Process innovations require coordinated behavior change among parties in the food system value chain, which will be difficult.

Another tough challenge are the academic

institutional reforms that M.R.C. Greenwood advocates. Business often has difficulties working with universities to gain access to research output. The red-tape-laden, protective university institutional model needs to be replaced with one that facilitates information flow beyond institutional borders (which actually would better serve the learning and public good focused missions of universities). More collaboration between business and academia for the public

“I don’t think the issues of waste and loss, the deplorable ways we use water, are technology problems but process problems. We don’t have people in the field [in conflict-ridden countries] figuring out how to make processes economically viable. We have big companies willing to invest [but] the typical development person thinks Cargill is the spawn of the devil. . . . Relationships are adversarial.

Innovating to figure out how we bring the best of American agriculture to conflict-affected countries is a major challenge.”

Gerry Brown, Executive Director, Institute for Economic Stability

“Everybody says you need genetically modified crops to feed the world. Some say you continue to need chemicals. [I say] the third leg is biologicals, micro-organisms. . . . We have a huge, wide world of micro-organisms out there that hasn’t been exploited [to] increase yields, control pests and diseases. . . . We have a micro-organism that reduces drought stress; we can stop watering for six weeks. . . .

Real innovation.”

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SESSION 4

good would accelerate much-needed global food system innovation.

Similarly, workers in big agribusiness corporations and development agencies should figure out how to work together more effectively to alleviate food insecurity in struggling, war-torn countries, believes Gerry Brown. Global agribusiness companies are willing to invest in these countries and can play important roles in the solutions they need for food security and economic

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development. But the people who work in development agencies on the ground often hold strong anti-business sentiments that impede collaboration; they perpetuate adversarial relationships with the companies. Also, these development workers often know little about agriculture (despite trying to effect change in communities where people have close ties to the land), so they don’t represent the kind of partners that agribusiness companies want.

OPPORTUNITES The way forward will involve more “value chain thinking,” which is starting to happen, said Brown, and more investment by global agribusiness companies in emerging markets, given the maturing of their advanced economy markets. These multinationals “bring a tremendous amount to the party in terms of technology, brand, and convincing local populations that things are getting better,” Brown said.

There must also be discussion of “who would have to be in the room” to maximize the value of the knowledge that universities are generating, said Greenwood. Parties need to work out fair and agreed-upon ways to bring innovations to market; i.e., “moving knowledge out of the ivory tower and into the public domain.” More academia-to-business deals and alliances are needed, like Sharon Shoemaker’s agri-food technology network, CIFAR, which fosters collaboration among member

organizations.

Opportunities also exist for greater exploitation of microorganisms to tackle agricultural challenges like controlling weeds in organic crops, fighting pests and disease, and decreasing salt stress and drought stress. There is enormous untapped potential in using microorganisms for crop protection, according to Pam Marrone. More than half of all human drugs are derived from natural sources, yet only 11% of crop protection products are, so far. “You can find a microbe to do just about anything you want it to,” she said.

Other ideas and innovations that excite panelists include: ■ Bio Innovations’ discovery of a microorganism that kills weeds, holding the potential to transform organic production.

■ A newly discovered bacterium that stops sucking insects from reproducing and repels them from plants (licensed to Bio Innovations by the US Department of Agriculture).

■ A microorganism that Bio Innovations and others discovered that reduces drought stress, allowing plants to thrive for six weeks without water.

■ The use of analytics to figure out what to plant in various markets around the world.

■ Development of healthier foods with “natural complexity,” achieved through fermentation and other means.

■ Discovery of new protein sources.

■ The rethinking of food processing to eliminate waste; for example, utilizing all parts of a grape plant, thereby producing varietal wines, oils, flours, and biochars. ■ SEPTEMBER 2015

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Session 5: Abundant Food Index: How Do We Measure Success?

Session Panelists: Sanae Iguchi-Ariga, PhD, Faculty of Agriculture, Hokkaido University Jeff Klein, President & CEO, Global FoodBanking Network J. Bruce German, PhD, Director, Foods For Health Institute, UC Davis Nathan Rudgers, Senior Vice President, Farm Credit East Moderator: Audrey Murrell, PhD, Director, David Berg Center for Ethics & Leadership, Katz/CBA School of Business, University of Pittsburgh

SITUATION Efforts to alleviate food insecurity and promote abundance are being aided by multiple game-changers at various points along the food value chain.

These innovations have been enabled by technology, leveraging of “big data” analytics, and application of business methodologies in non-profit operations.

Game-changers include: ■ The creation of a metrics-based system, the Food Abundance Index, to assess the adequacy of food supplies in specific local communities. This newly launched tool is the first of its kind, establishing common definitions and standards of measurement as well as prescribing effective solutions for the factors that contribute to suboptimal food supply conditions. The tool empowers communities with measurement capabilities and recommendations to improve conditions, track progress, and build upon successes.

■ Business

approaches applied to global food bank operations to promote distribution efficiencies and financial sustainability.

This is exemplified by the Global Food Banking Network, a highly successful collaboration of large multinational corporate partners and 25,500 service agencies operating around the globe. In 2013, this network distributed 1.1 billion pounds of food otherwise destined for landfills, accomplishing the dual goals of alleviating hunger and stemming global warming (by producing methane, as food in landfills contributes twice as heavily to global warming as does air traffic).

■ Scientific

research identifying how to create sustainably nourishing food that prevents disease. Researchers at UCDavis’ Foods for Health Institute have been looking at abundance broadly, focused not on food quantity but quality.

For example, researchers are studying lactation in efforts to enhance the diseasepreventing properties of food. They are also establishing metrics by which to measure foods’ effectiveness in preventing disease.

■ The

application of big data/analytics and mobile technologies in farming, to increase yields and improve the efficiency of farm operations. In the US, this technological capability is precipitating institutional change, usurping roles that the cooperative exchange system historically has played.

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■ The

creation of new kinds of graduate education programs in global food studies.

Japan’s Hokkaido University is applying an integrated, multi-disciplinary, and globally focused approach to graduate education to produce leaders who are well equipped to make the complex decisions that the future will require for the optimal use of our global food resources.

KEY QUESTIONS 1. What game-changers are emerging to address the problems of inadequate food supplies and promote abundance? At the level of farms? Local communities?

Globally?

2. How can access to data empower people in the food value chain to make better decisions—including farmers wanting to maximize crop yields, social entrepreneurs addressing communities’ food system challenges, and individuals interested in managing their health through diet?

3. How are strategies and best practices from the business world being used to reduce food waste and promote more sustainable food bank operations?

4. What is happing in education to prepare future leaders for the challenges of optimizing water and food supplies in a resourceconstrained world? ➥

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Abundant Food Index: How Do We Measure Success?

“We think of ourselves as a business, competing for resources, whose clients are the 800 million hungry people who walk the Earth, one out of seven. That dynamic is opposed against the fact that a third of all food grown is wasted. For various reasons, it doesn’t find a hungry stomach. We’re the traffic cop in the middle of that action, born out of the US food banking system.”

Jeff Klein, President & CEO, Global FoodBanking Network

“Big data stands to absolutely enhance what farmers already understand about their operation. Being able to address productivity issues in an efficient manner— farmers will absolutely use that, because they’re universally focused on improving their position. . . .

That’s a game-changer. The only fear a lot of producers have is: Who else has access to my information and how might they use it for me or against me?”

Nathan Rudgers, Senior Vice President, Farm Credit East

CHALLENGES

➥ An estimated $750 billion in food is

wasted each year, six times the amount spent on development aid. To grow from a 7 billion to a 9 billion-person world, it will be necessary to alleviate this massive waste problem. In developing countries particularly, a tremendous amount of food is wasted because of the lack of infrastructure needed to transport food products quickly and store them safely (particularly lacking is sufficient cold storage). Retaining and training food bank volunteers is another challenge of these organizations. So is how to scale up successful models among grassroots entrepreneurial operations.While farmers are embracing the application of big data to improve their operations, many have privacy concerns, wary of how their

data might be used for or against them.

Regarding concerns (expressed earlier in the Summit) that there may be inadequate numbers of next-generation farmers in the United States, Nathan Rudgers reports that is not so. The reason for rising ages among principal operators is not a lack of younger farmers willing to take over but simply later retirement, a phenomenon in many industries.

A challenge that Foods for Health Institute faces in working to improve foods’ disease-preventing capabilities is measuring the effects of food on health.

Evidence of causality will be necessary for a viable economic model. People won’t pay for disease-fighting capabilities in food if they are not demonstrated. Daily health monitoring devices, with data linked to diet, may be part of the solution.

“Hokkaido University’s Graduate School of Global Food Resources, which will start in 2017, is a five-year Ph.D. program. . . . Our goal is to provide integrated education for the pursuit of high-quality human life through optimization of global resources. Through comprehensive trans-disciplinary learning, featuring conservation of water and land . . . and innovation in food sciences technologies, we will foster leaders who can solve problems and facilitate dialogue.”

Sanae Iguchi-Ariga, PhD, Faculty of Agriculture, Hokkaido University

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SESSION 5

OPPORTUNITIES Social entrepreneurs addressing food supply inadequacies in local communities now have the benefit of common standards, metrics to measure progress, and prescriptive recommendations thanks to the Food Abundance Index tool. The University of Pittsburgh’s Ethics and Leadership Center spent the last three years creating this tool after realizing that no common definitions existed to discuss issues of food abundance/scarcity; without a way to compare communities, how could poor conditions be recognized and ameliorated? What tools there were lacked usability, being complex, difficult to adapt, and expensive. And no tool was able to measure change over time, so progress made couldn’t be documented or tracked.

The Food Abundance Index is portable,

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adaptable, free, and freely available online.

It uses a scorecard methodology similar to the LEED green building system.

Importantly, the index puts the power of data into the hands of community leaders and social entrepreneurs, providing a way to document that their efforts are making a difference. The next step is to train communities to use it.

(More information and a link to training resources are available here.)

Another positive development is the explosion of grassroots, entrepreneurial ventures around the world devoted to curbing food waste and rerouting useable food.

Increasingly, business strategies are being employed to help food banks remain viable while minimizing their dependence on altruism. A better understanding of market economics at the

“We’re looking at abundance broadly. It’s not enough to deliver abundance if it simply represents calories or relief from essential nutrient deficient diseases. What we need is a food supply that is simultaneously safe and stable, nourishing in the broad sense, and sustainable. Nourishing health means delivering on prevention—we need a food supply that acts preemptively to prevent disease. What we’re doing is establishing long-term principles and strategies to deliver on that bold promise.”

“low end of the pyramid” could help organizations see ways to recoup some of their expenses; e.g., charging beneficiaries token amounts. One highly successful UK operation is charging companies for money-saving services it performs; for example, relieving them of food rejected by distribution centers (but still perfectly safe).

The complexities of food abundance/ scarcity issues call for integrated solutions and partnerships among different players along the food system value chain. Yet Dr. Murrell sees two camps that don’t typically communicate: Agriculture players who source food, and “everyone else upstream.” That is a challenge being addressed by innovative graduate education programs such as Hokkaido’s Graduate School of Global Food Resources, with a curriculum designed to promote communication and collaboration across silos and geographies.

The New York Farm Viability Institute is another venture that promotes cross-silo collaboration for the common good: It funds university research identifying ways to improve farm profitability; researchers work closely with farmers in the process. ■

J. Bruce German, PhD, Director, Foods for Health Institute, UC Davis SEPTEMBER 2015

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HEALTH

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HEALTH

Session 1: Frontiers of Health Innovation Session Panelists: Dieter Gruenert, PhD, Professor of Otolaryngology, UC San Francisco Scott Mason, Executive Managing Director & Leader, Cushman & Wakefield Healthcare Group, Americas Shaun Lonergan, General Manager & VP, Metabolon, Inc. James E. Crowe, Jr., MD, Director, Vanderbilt Vaccine Center; Director, Vanderbilt Technologies for Advanced Genomics Moderator: Donna Cragle, PhD, SVP & Director, Health, Energy, & Environment, ORAU

SITUATION

KEY QUESTIONS

The US healthcare system leaves much to be desired. It’s too costly; it’s inefficient; it’s inadequate for the enormous demand expected as baby boomers age; and there is much room for improved health outcomes. But improvements in all of these areas are on the way in the form of innovations in healthcare delivery.

Multiple aspects of care delivery are being rethought and better solutions are being found.

Promising innovations are occurring in healthcare delivery. Much of what hospitals provide can be provided in more cost-efficient, accessible, and patientfriendly retail settings. Scott Mason foresees major changes in how the industry utilizes real estate, revolutionizing healthcare delivery and allowing the system to accommodate the growing needs of the healthcare system over the next 10-20 years driven by aging baby boomers.

Innovation is also occurring in diagnosis and treatment. Research scientists in academia and business are learning more about how the body works on cellular and molecular levels and are leveraging this understanding into new technologies and tools. These include advances in our understanding of stem cells’ capabilities, viral antibody production, and the whole spectrum of metabolic processes. Work being done in each of these areas appears poised to revolutionize how clinicians diagnose and treat, leading to better health outcomes.

1. How can a restructuring of the healthcare industry’s real estate usage be part of the solution to the cost, efficiency, and access challenges of the US healthcare delivery system?

2. How can a partnering of the healthcare and retail industries help advance this solution?

3. How are recent innovations in healthcare leveraging medical discoveries to improve diagnosis and treatment of disease? Contain pandemics and epidemics?

4. What are some of the challenges faced by medical researchers? The companies that commercialize their discoveries?

CHALLENGES The US healthcare industry needs to embrace a “triple aim,” said Mason, addressing three important challenges:

■ Reducing

costs. Hospitals are the costliest place to receive care; less costly alternatives are needed for situations that don’t require sophisticated technology.

These alternative settings include community-based ambulatory care centers and health clinics within retail stores such as Walgreens, CVS, and Walmart (“retail medicine”), staffed by nurse practitioners.

■ Improving the health of the population, especially disenfranchised segments.

Elderly, poor, and immigrant segments of the population need better access to efficiently delivered care in lower-cost facilities, reducing these groups’ overuse of hospital emergency rooms which strains costs for the entire system.

■ Improving patient experiences.

Care delivered in smaller, more personal facilities than hospitals often means better patient experiences.

The degree to which the healthcare and retail industries collaborate to deliver healthcare services at lower cost and with greater efficiency is a key ➥

“Healthcare in the United States is truly a mess. It costs way too much. . . . [I]t’s not very efficient. . . . It’s going to get better, and real estate is going to play a big part of that. . . . The healthcare experience must become more of a retail experience if it’s going to meet our needs better.”

Scott Mason, Executive Managing Director & Leader, Cushman & Wakefield Healthcare Group, Americas SEPTEMBER 2015

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Frontiers of Health Innovation

“Just a small amount of blood, and we’re able to look at your entire metabolic system. . . . That’s important to your clinicians, not only so that they can determine what’s wrong with you but also so they can improve those results—so you look normal again from a metabolic standpoint. It’s a very innovative way of looking at the foundation of all biological systems.”

Shaun Lonergan, General Manager & VP, Metabolon, Inc.

“Effectively, we can take cells from any individual and . . . make it like an embryonic cell. Then we can take those cells and push them forward in any direction we want, making them into tissue-specific cells. . . . That’s a very powerful contribution to our toolkit for fixing organs.”

Dieter Gruenert, PhD, Professor of Otolaryngology, UC San Francisco

➥ determinant of how bright the future of healthcare in America will be, Mason believes. The most realistic scenario is probably somewhere in between the most optimistic one, characterized by much collaboration and a rich array of services offered in a wide range of settings, and the most pessimistic one, where retail and healthcare fail to partner effectively.

Unless culture change is part of the solution, the retail/healthcare idea might not really take off. But surveys have shown that patients are receptive to accessing care in a variety of locations, including retail malls. Needed are traditional providers who support the idea, even though it would cannibalize existing emergency room business; getting these players more involved in educating patients about healthcare options would help. That is happening, but too slowly.

Another, more global challenge: the fast exchange of people and goods across the world increases the likelihood of

epidemics and pandemics. The global spread of viruses will become increasingly commonplace, says James Crowe.

Scientific discoveries and innovations in vaccine technology that help combat this have been rapid, but funding limitations are constraining the pace. The National Institutes of Health’s (NIH) annual budget has remained at roughly $30 billion for the past decade. NIH Director Francis Collins has stated that there would probably already be an Ebola vaccine if the NIH had had more money.

Public perception of the companies that commercialize research breakthroughs is another challenge; they are often demonized as profiteers, when they should be seen as valued partners of academics, enabling discoveries to be used broadly for good. That is a problem cited by both Dieter Gruenert in respect to stem cell technology and Crowe in respect to vaccine technology. “The public needs to get their minds around [the fact that]

these are not the bad guys,” said Crowe, “these are the people who take [scientific innovations] over the bar.”

Companies provide an invaluable service, and assume a great deal of risk to do so. Novartis offers a case in point: after two decades of work to develop a meningitis vaccine at an expense of $1.5 billion, Novartis discontinued its efforts in this area because European public health officials decided not to recommend its usage. When children subsequently died from meningitis, parents were outraged to learn that a vaccine had existed. That story also speaks to the challenge of the copious public misinformation about the risk/benefit of vaccines. Better education of the public is required.

OPPORTUNITIES Scott Mason says of the pressing need to transform healthcare delivery in America,

“One of the technologies we’ve been working on is making antibodies. We start with someone who has survived an infection. . . . So we get cells out [of the infection survivor] and basically turn them into factories in the lab. . . . We not only can make drugs that kill viruses but once we see where they bind on the virus, we can use that part of the virus as a vaccine.”

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session 1

“Out of chaos comes opportunity.”

He sees great opportunity for people working in healthcare real estate to “make a difference” by promoting retail medicine. Gruenert, Shaun Lonergan, and Crowe all work with exciting healthcare innovations poised to revolutionize diagnoses and treatment.

Gruenert’s work in regenerative medicine suggests an optimistic future for cellular therapies. In particular, a recently identified category of stem cells, “induced pluripotent” stem cells, provides a means for reprogramming any mature cell in the body, remaking it into any kind of tissue-specific cell desired. This pluripotent ability to become any type of cell is shared by embryonic stem cells, but this newly discovered kind avoids the controversy and ethical issues associated with embryonic stem cells. “Effectively, we can take cells from any individual and turn back the clock, making it like an embryonic cell,” he said. That capability holds powerful promise for organ repair.

Lonergan’s company Metabolon is taking personalized healthcare beyond the genomic revolution with a blood analysis technology that provides a snapshot of an individual’s entire metabolic health. Each aspect that deviates from what is normal is flagged. This allows clinicians to see precisely the effects that medicines and other treatments are having on a person’s metabolism, and therefore to adjust treatments by their effectiveness in a specific individual. Whereas genomics

health

reveals only the likelihood of a condition becoming manifest, a metabolic snapshot shows whether the condition actually exists. This allows nascent conditions to be treated before symptoms appear.

Moreover, this metabolic analysis is more efficient than traditional blood testing, in which each test yields only the narrow information targeted and requires a vial of blood. With the metabolic snapshot, a small amount of blood yields data on every metabolic process going on in the body. “We can take a look at your entire metabolic system,” said. Lonergan.

There are exciting applications for personalized medicine, next-generation sequencing (NGS) monitoring technology, and diagnostic and biomarker discovery.

Crowe’s work leverages the fact that immune systems that have produced antibodies through exposure to a virus “never forget.” Those antibodies can be extracted, reproduced, and used to make either virus-killing drugs or vaccines.

Vanderbilt Vaccine Center has antibodies for many types of viruses collected from the blood of survivors, even from 100-year-old survivors of the 1918 flu.

Moreover, immune systems hold multiple antibodies for each virus survived, providing “a rich library of how to kill a virus.” Vanderbilt Vaccine Center has over 100 antibodies that were isolated from a healthcare worker who survived dengue fever; each binds to different places on the dengue virus, providing a wealth of information on how to fight dengue. ■ SEPTEMBER 2015

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Session 2: Developing Effective Strategies to Change Behavior to Improve Health Session Panelists: Jean-Claude Saada, Chairman & CEO, Cambridge Holdings Inc. Shari Barkin, MD, Division of Pediatrics, Vanderbilt University Anne Warhover, President & CEO, Colorado Health Foundation John Hoffman, Founder & CEO, The Public Good Projects Moderator: Rick Johnson, President & CEO, Governor’s Foundation for Health and Wellness

SITUATION

KEY QUESTIONS

The United States spends more than 90% of healthcare dollars on treatments and cures, and less than 10% on prevention. Yet, 70% of diseases and health conditions are behavior and environmentally driven. Today, healthcare expenditures have reached $3 trillion.

The tidal wave of medical costs facing the country is unsustainable.

The United States spends twice as much on healthcare as Great Britain and has poorer health outcomes. In fact, the United States ranks 17th out of the 17 wealthiest nations in the world in terms of health outcomes. Healthcare expenditures account for 18% of U.S. GDP. The country with the next highest level of healthcare expenses is Great Britain at 10% of GDP. The situation in Tennessee is particularly dire. Tennessee is one of the least healthy states in the country and has consistently ranked in the bottom 10 states for the last 20 years. The rate of growth for obesity is 2.5 times the national growth rate. One in four adults and one in five teenagers report that they smoke. More than 12% of the adult population has been diagnosed with Type 2 diabetes and one-third of the population is totally sedentary.

1. What approaches can be used to affect health-related behaviors?

2. How can the built environment influence health-related behaviors?

Can real estate development be reengineered in ways so mindful, healthy living is easier to achieve?

Can community centers be used as a hub for healthier living?

3. How can health issues be addressed early in children’s lives? Can media and programming influence more healthy behaviors?

4. How can media be used to elevate the public’s understanding of critical issues and point to solutions?

5. Is it possible for media to create an environment in which people better understand the personal consequences and risks associated with their behaviors, as well as what they need to do to lead a healthier life?

6. With regard to wide-scale, healthrelated behaviors, how much should initiatives be based on education and how much should they be based on motivation?

CHALLENGES The built environment is a contributor to many health problems in the United States.

When babies are born today, the Centers for Disease Control and Prevention

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(CDC) has found that they already have 278 building toxins in their blood streams.

Last year, there were 13 million absent kids from school due to upper respiratory problems. A challenge is how to design buildings to be toxin free. It is important to create social environments where people can collaborate, work together, and have easier access to healthy food. Although it is more difficult to reengineer existing cities with legacy problems, it’s possible to do so.

Health happens in context, not in the doctor’s office. Context must be integrated with health. Health outcomes researchers need to ask the right questions and look at the context in which those questions are being asked. This leads to iterative ways of asking questions that include families and communities where health advancements are needed.

The goals for a healthy America are audacious, but we have to try. A child born today has a chance of a shorter life expectancy than his or her parents. That is unacceptable in a nation as wealthy as the United States. Preventable chronic diseases haven’t been the country’s highest priority and now efforts are underway to make them one.

Negative behaviors and societal changes are often unintended consequences of progress. If the nation has engineered its way into health problems, then it has to engineer its way out. This will take a massive retooling of the country’s economic engines, food supply, public policies, and educational systems. ➥

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Developing Effective Strategies to Change Behavior to Improve Health

“If we can get more and more Tennesseans changing their healthrelated behaviors, we’ll change chronic diseases and make this a healthier state. In so doing, we will also have a huge economic impact on the state. We’ll reduce healthcare costs over time, improve productivity, and decrease absenteeism. Most important of all, we’ll reduce human suffering and improve the quality of life.”

Rick Johnson, President & CEO, Governor’s Foundation for Health and Wellness

“We have obesity and . . . we’re breathing air in the built environment that is toxic. How do we fix that? We need to use real estate development to reengineer the way we live, shop, eat, and breathe, so that mindful, healthy living is made easier.”

Jean-Claude Saada, Chairman & CEO, Cambridge Holdings Inc.

➥ All the responsibility for health-related behaviors can’t be put on the individual.

Humans are biologically programmed not to move and to conserve energy when possible. Also if people don’t have access to healthy food or venues for exercise, behaviors won’t change. Many live in unsafe neighborhoods with no sidewalks and inadequate lighting. Part of the problem is poverty and part of the problem is public policies that govern how neighborhoods are built. Strong advocates are needed to effect change.

In the rhetoric of health-related behaviors, people overlook how painful a life of disability is. It’s not just that children will have shorter lives, they will have sicker lives. In Sneedville, Tennessee, for example, children as young as five are being

diagnosed with diabetes. Positive behaviors must be started early. If a child is overweight by age six, there is a very high likelihood that he or she will be an obese adult.

However, early childhood settings are hard to change because they are fragmented.

A big contributor to obesity is portion and pack sizes of food. We need, as a society, to rid ourselves of processed foods and move toward a more natural diet. In many cities, there is a proliferation of healthier foods and restaurants. Even fast food chains are selling more healthy foods. Unfortunately, there seems to be a nearly universally held belief that it is more expensive to eat healthy food, which is not true. It can be more time consuming, but it doesn’t have to be. In two generations, Americans have lost a huge amount of

understanding about how to buy and prepare healthy foods. Some believe home economics should be brought back into the education system.

OPPORTUNITIES To change behaviors to improve health, Tennessee has united a broad coalition of stakeholders, including the private sector. The initiative focuses on three key behavior changes: increasing physical activity, eating healthier foods in controlled portions, and stopping tobacco use. If these behaviors can be changed, it will have a huge positive economic impact. Healthcare costs will be reduced over time, productivity will increase,

“Chronic disease has become a phrase we don’t hear. Heart disease, stroke, diabetes don’t carry a lot of weight as language.

The rhetoric for some reason washes over us and we don’t really think about the painful life of disability. It’s not just that a child will have a shorter life; they will have a sicker life.”

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SESSION 2

absenteeism will decrease, and quality of life will increase.

Tennessee’s program has a “ground game” and an “air game.” The ground game involves implementation partners in communities statewide. These partners include employers, chambers of commerce, United Way chapters, faith-based organizations, and local health groups. The air game consists of messaging delivered through television and digital media. Web-based tools have been created to promote incremental behavior changes that lead to longterm habitual change and better health outcomes. People are more likely to adopt incremental behavior changes than dramatic changes. The program also includes monitoring and measurement of progress.

Addressing preventable chronic diseases has not been a high priority for the country; the media may be able to help. It is known that media can change the culture, as evidenced through media campaigns targeting decreased tobacco usage. The rate of cigarette smoking nationwide has decreased significantly.

The Division of Pediatrics at Vanderbilt University partners with families and communities for its research. The research agenda has four themes: it is family based, community centered, measurable, and has sustainability built in at the front end. The research work translates into better health, if it can be sustained.

Researchers work with advisory boards, communities, and stakeholders to

health

analyze existing infrastructures.

One of the Colorado Health Foundation’s key beliefs is that philanthropy is not sustainable unless the private sector is willing to take good ideas to scale. The Foundation partnered with the Urban Land Institute to develop principles of building healthy places and the Institute has adopted those principles as a key objective.

The built environment has a clear connection with everyday physical activity and health outcomes. If people live within a 10-minute walk of a park, for example, they are 50% more likely to get the physical activity required for a healthy lifestyle. Transit users are also healthier than non-transit users because they walk more. Cambridge Holdings Inc. recently

revamped its office space and found that the design encourages people to collaborate more, as well as go outside and take walks.

The company’s One City initiative in Nashville is intended to redesign spaces to create movement as part of the natural habitat. The goal is mindful, healthy living made easier.

Education is necessary, but not sufficient to encourage health-related behavior changes.

Extrinsic motivation is good for shortterm outcomes; however, motivation in general is an intrinsic phenomenon. The majority of daily decisions are automatic and reactive. It takes more activation energy to be intentional. Experience has shown that the involvement of social networks is the key to effective, sustained behavior change. ■

“I don’t think you can be an expert in improving health, unless you’ve walked in the community’s shoes and experienced what life is like through their eyes. We partner with families and communities. Everything we do in our research has four themes— it’s always family based, community centered, measurable, and we build sustainability in at the front end.”

Shari Barkin, MD, Department of Pediatrics, Vanderbilt University SEPTEMBER 2015

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Session 3: Big Data & Decision Models for Health Session Panelists: Donna Cragle, PhD, SVP & Director, Health, Energy, and Environment, ORAU Nancy Lorenzi, PhD, Medical Informatics, Vanderbilt University Sten Vermund, MD, PhD, International Medicine, Vanderbilt University School of Medicine Moderator: Matt Koehler, JD, PhD, Principal Artificial Intelligence, The MITRE Corp

SITUATION In a sense, big data has been with us since the days of cave men who left data on cave walls. But, until the 1970s, when labs started computerizing their reports, healthcare data wasn’t digitized. Once it was, this data could be leveraged in many more ways. In the decades since, advances in technology have given industry participants more and more ideas about how to use computerization and data to enhance the effectiveness and efficiency of care delivery. However, the age of big data has not yet really caused any explosive paradigm shift in healthcare. Thus far, leveraging data for improved healthcare decision-making has been an incremental process. Ways in which leveraging data has been improving healthcare include: ■ Empowering

patients and providers via health informatics. People interested in health informatics talk about “BD2K,” or transforming “big data to knowledge.” (The Fitbit wearable device is an example of informatics transforming health data to knowledge.) With the knowledge that big data facilitates, patients can be empowered to take greater control of their own wellness, making healthier datainformed lifestyle choices. Providers make better diagnoses and treatment decisions with the benefit of patients’ customized health data, but much of this promise has yet to be realized.

■ Simplifying complex health-related program execution. Donna Cragle 70

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spearheaded a program for the US Department of Energy (DOE) to examine any health-related outcomes experienced by employees as a result of having worked at DOE facilities.Vast amounts of data had to be collected in physicals, on people spread across the nation. Implementing such a complicated program would have been much more difficult without IT systems integrating and coordinating its many aspects (such as triggering the right medical and laboratory testing to be ordered based on patients’ survey responses, and generating the letters informing people of results).

■ Guiding public health policy. Big data can be a powerful tool for promoting public health. Analytics-based decision modeling can forecast future disease patterns, assess rates of infectiousness of populations so disease spread can be curtailed, and improve clinical outcomes.

For example: Analytics can predict disease patterns: Since malaria thrives where humidity and temperature allow mosquitos to live long life spans, data on the weather changes that are anticipated as global warming progresses can predict regions

where malaria can be expected in the future.With this information, governments can take action preemptively to minimize the disease’s toll.

Analytics can curtail the spread of disease: Well-known co-morbidity factors influence whether patients infected with HIV will be prescribed and stick with the antiretroviral regimes needed to make them non-infectious. In the United States, 72% of HIV-infected patients are infectious compared with only 28% in Great Britain.

The data exists to better manage comorbidity factors in the United States, but it is not being done nearly as effectively as in Great Britain.

Analytics can improve clinical outcomes: Clinic-level data in four African countries are spurring changes at the local clinic level that are reducing the incidence of babies acquiring HIV from infected mothers.

The insights yielded from health analytics decision modeling can be used to direct governments’ investments in public health and in improving the efficiency of healthcare delivery. ➥

“Big data and decision analysis models do have a role in infection control. They can help in the prevention and control of infectious diseases. . . . Big data can help guide policy.”

Sten Vermund, MD, PhD, International Medicine, Vanderbilt University School of Medicine

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Big Data & Decision Models for Health

“The future is that every single one of us will have our own DNA profile. Lots of data. We’re going to have healthcare that meets our particular needs. We’ll have wearable computers.”

Nancy Lorenzi, PhD, Medical Informatics, Vanderbilt University

KEY QUESTIONS

CHALLENGES

OPPORTUNITES

1. What are some of the ways in which healthcare has been leveraging the power of big data?

2. How is data improving the efficiency of healthcare program delivery?

3. How is health data improving decision making at the individual level? The provider level? The public policy level?

4. What opportunities does big data present to improve the delivery of healthcare in the future?

5. What challenges are presented by the vision of integrated personal health records given America’s disjointed healthcare delivery system?

6. Who “owns” a patient’s personal health data, and what does “ownership” in this context mean?

The American healthcare system is undergoing a massive consolidation. In the future, 90% of the tens of thousands of delivery systems may be absorbed by 150 networks (some say just 30). If a health system’s data communicates seamlessly, that interoperability will be a big competitive advantage. Creating interoperability among the different systems remains a huge challenge for American healthcare (except the VA system, which has a unified patient data platform). It is necessary not only to overcome this challenge because system consolidation is coming, but also to realize the widely shared vision of electronic personal health records that go where patients do.

Possibly, a solution to the interoperability challenge will emerge from machine learning or other data techniques that bypass incompatibility blockages, but currently the issue is a looming, unsolved challenge.

Data health scientists are developing many future innovations that will personally customize healthcare delivery, making it more efficient and effective.

Institutions are bound to change in response, reshaping themselves in ways that improve care delivery. Some of the visions that will leverage analytics-based decision systems include: ■ We will all have wearable health-focused computers collecting diverse health-related personal data, as well as informing and advising us and our providers based upon that data.

■ Everyone’s DNA will be mapped, and providers will customize treatment informed by the DNA profile.

■ We all will have an electronic patient health record, which we will own, and be able to input data directly into. But what exactly “owning” one’s data means still must be determined. ■

“As data sets become mind-bogglingly vast, we’re going to be able to do a couple of things: we can very specifically tailor treatment to a particular patient, and we can also tailor the institution’s design around the treatment.”

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“A program we run for the Department of Energy gives occupational physicals to individuals. . . . It’s a nationwide program involving a lot of data, so we married ourselves to the computer. . . . We designed an algorithm.”

Donna Cragle, PhD, SVP & Director, Health, Energy, and Environment, ORAU SEPTEMBER 2015

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Session 4: Health Ecosystems: Charting a Course for Better Health Session Panelists: Melinda B. Buntin, PhD, Professor & Chair, Department of Health Policy, Vanderbilt University School of Medicine The Honorable Carolyn M. Clancy, M.D., Interim Under Secretary for Health, US Department of Veterans Affairs Jason Dinger, PhD, CEO, MissionPoint Health Partners Moderator: Jeffrey R. Balser, MD, PhD, Vice Chancellor for Health Affairs, Dean, School of Medicine, Vanderbilt University Medical Center

SITUATION The Affordable Care Act and public discourse have catalyzed new approaches to healthcare delivery in America. A new paradigm that has generated much excitement is the “triple aim” of better health, better healthcare, and better value.

The “better value” aspect is leading more people into high-deductible plans, where patients have more financial stake in the healthcare services they consume. The pursuit of “better health” and “better value” is prompting much experimentation to learn the lifestyle correlates and causes of better health.

Data emerging from these inquiries strongly suggests that better health may not be as much a function of better healthcare as historically assumed.

MissionPoint Health, an accountable care organization (ACO), has found that spending time and effort to understand individual patients’ situational health risks and intervening to mitigate them is a cost-effective way to both improve health outcomes and reduce expenditures on care. Non-clinical health coordinators visit patients in their homes to assess barriers to health and create health improvement plans.

Thinking about health less as a function of the quality of clinical care and more as a function of everyday life circumstances and behaviors isn’t new to the VA healthcare system. Over the past 20-25 years, the VA has developed a strong appreciation for the incredible 74

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importance of health behaviors through insights gleaned from analysis of data on its veteran patient population (9 million of the nation’s 22 million veterans are enrolled in the VA system; 6 million are frequent users). Through a vast array of interventions to influence health behaviors, including apps and social media, the VA has positively impacted health determinants. Efforts to ensure that health intervention efforts are practical, achievable, and cost effective are ongoing.

Both the VA and MissionPoint Health view patient engagement as critical to promoting health behaviors and lifestyle changes. About one-third of VA system users are enrolled in the VA’s online patient portal, My Healthy Vet, which educates and engages by emphasizing that daily choices make a big difference to overall health.

Melinda Buntin summed up the “sea change” in healthcare since the Affordable Care Act as “a fundamental change in our ability to pay for what we want in

American medicine.” It is a change she sees as precipitated by the convergence of multiple forces: ■ Better healthcare data and a better ability to use it, thanks to “big data” analytics programs.

■ Better quality measurements and more effective efforts to manage health, thanks to a body of research showing where to focus interventions to improve health and prevent disease. This represents a break with the historical focus on delivering services and treating disease.

■ The patient engagement movement and greater ability to engage patients in improving their own health, thanks to modern IT—the Internet, social media, mobile apps, etc.—putting more information at everyone’s fingertips.

■ Reforming how we pay for healthcare, driven by the desire to curtail what America spends on healthcare and the unsustainable rate at which it is increasing.

■ A desire to have more Americans covered by healthcare insurance. ➥

“Moving information availability back out to the patient and letting them make decisions . . . we resist that in clinical medicine. We want to take in information, filter it, and decide what patients should hear or see or think. . . . That model might have worked in 1965, but it’s not going to work for today.”

Jeffrey R. Balser, MD, PhD, Vice Chancellor for Health Affairs, Dean, School of Medicine, Vanderbilt University Medical Center

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“We have better data than ever and a better ability to use it.

We have better quality measurements . . . and a body of research showing us where we need to focus to improve health. . . .

And we have . . . greater ability to engage patients, with more information at our fingertips.”

Melinda B. Buntin, PhD, Professor & Chair, Department of Health Policy, Vanderbilt University School of Medicine

“Historically we have always presumed that better care led to better health. . . . It was just a given, we didn’t even really think about it.

In fact, over the past 20-25 years, we’ve come to appreciate the incredible importance of health behaviors.”

The Honorable Carolyn M. Clancy, MD, Interim Under Secretary for Health, US Department of Veterans Affairs

KEY QUESTIONS

CHALLENGES

1. How has the new “triple aim of healthcare” changed how some large healthcare systems think about what they do?

2. What new approaches are healthcare systems employing to pursue the aims of “better health” and “better value” simultaneously?

3. Why is patient engagement critical to the success of these new approaches? What techniques are being employed to better engage patients?

4. What cultural challenges are healthcare systems encountering, for example in terms of physician engagement? How are these being addressed?

5. How are forward-thinking healthcare systems mining big data for insights as to where to focus preventative initiatives?

6. How are they using predictive analytics to pinpoint at-risk patients?

MissionPoint Health is encountering cultural challenges as it pursues new, patient-empowering approaches. In particular, the paradigm under which physicians have historically operated-— where they dictate unilaterally to patients what should be done—is less viable today. “It’s very hard for a lot of our traditional folks to get out of the mindset that I’m going to make this better by telling you what you need to know,” said Jason Dinger.” So how do we leverage the expertise but not the expert in the conversation?”

This is a big problem because the traditional model governing patient/ doctor relationships is on the way out.

Younger patients don’t put blind trust in physicians. Patients now have the means and desire to educate themselves about their conditions online (and studies show that their self-diagnoses are usually correct). Moreover, patients with high-deductible plans are cost-

conscious consumers, often very frugal in their healthcare spending as they save up for the prospect of costly future hospital stays. They may be less willing to comply with doctors’ orders for dubiously necessary but nice-to-have tests and procedures.

Another cultural challenge is that physicians aren’t accustomed to receiving care-related information from non-clinical personnel, such as the health coordinators that are critical to MissionPoint Health’s efforts to manage patient health.

OPPORTUNITIES One way to address the challenges of physician engagement is to experiment with various compensation schemes and financial incentives; these can be levers to influence physician behavior. For instance, MissionPoint Health pays bonuses to physicians to keep their offices open on weekends or to use email with patients.

However, research on the effectiveness of different compensation approaches in

“On average, we’ve lowered the cost of claims more than 10% just in the first year, which is saving folks millions of dollars in material ways. Member satisfaction is going up statistically significant amounts because we’re lowering costs measurably. . . . But it is early. There’s so much that we can learn [by] listening in different ways than we have historically, and we’re excited to be a part of that journey.”

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affecting doctors’ behavior is still lacking.

More generally, Buntin sees great opportunity in the ways that healthcare is evolving in America. She believes it is critical that the industry “stay the course” while continuing to experiment with incentives and delivery models that align the interests of diverse stakeholders, including patients, providers, government payers, and employers. There needs to be a willingness to cast aside models that don’t work to align interests and promote the triple aims, as well as an ability to grow the systems that work well, such as MissionPoint Health and similar ACOs. Predictive analytics is a new frontier of opportunity and an area of experimentation for the VA. The VA is mining data to find clues that will help identify the sickest, most at-risk patients; not just those at the early stages of disease but also those with possible psychological problems. For example, missed appointments and decreased activity are viewed as possible signs of suicide risk and trigger interventions as deemed necessary. ■

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Session 5: Abundance Intelligence: Health Outcomes, How Do We Measure Success?

Session Panelists: Mohamed Younis, Senior Analyst, Gallup World Poll Rick Johnson, President, Governor’s Foundation for Health and Wellness R. Lawrence Van Horn, Associate Professor of Management, Vanderbilt University Brian Drozdowicz, Vice President of Population Health, Caradigm Sherri Zink, Vice President Informatics, BlueCross BlueShield of Tennessee Moderator: Ben R. Leedle, Jr., CEO, Healthways

SITUATION

KEY QUESTIONS

CHALLENGES

Most Americans view medical care as a solution to their health problems and are active consumers of it. They don’t understand that medical care accounts for only 10% of variations in health. The primary determinants of health are behavior, lifestyle, genetics, and environment. Even incremental behavior changes can help individuals become more healthy; research has found that surprisingly small amounts of weight loss or small increases in physical activity can reap important dividends.

Unfortunately healthcare in America is costly. Tennessee alone spends about $6 billion a year in direct costs to treat preventable behavior-related disease.

That does not count the secondary costs of absenteeism, lower productivity, and the other economic, cultural, and societal effects of preventable behavior-related diseases.

Today, the government and employerbased insurance pays for most of the costs of healthcare in the United States.

However, employers realize that they can no longer pay for healthcare as they have in the past; it will put them out of business.

Data and analytics may be a way to drive greater consumer engagement in healthcare. However, managing technology challenges may be easier than changing behaviors.

1. With the Affordable Care Act, many new people are entering the health insurance system who have never had insurance before. How can these people be guided to make better healthcare decisions from a financial standpoint?

2. People in Tennessee have many negative health outcomes and poor health-related behaviors. How can the status quo be changed?

3. How do we educate American consumers and make them knowledgeable enough to make informed healthcare choices?

4. What role should the government play in providing access to healthcare coverage?

5. How can data and analytics help promote better healthcare decisions?

For the last 30 years, the healthcare marketplace has not been consumer driven. This is changing, however, since high-deductible health plans where consumers pay out of pocket for routine care have become more prevalent. As individuals become healthcare consumers, it is important to understand what they value and what drives their decision making. The healthcare system must find efficient, low-cost ways to create products and services to meet their needs.

The current healthcare system absolves people of any accountability and they have no financial stake in the game.

Americans think that free or low-cost medical care is owed to them. The existing healthcare system was compared to this analogy: You have a car and are told you can wreck it as often as you want and never have to maintain it. If anything ➥

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“At the end of the day, you can have all the data, analytics, and scoring in the world. But if you don’t have a way to operationalize that within your organization, it’s very difficult to act on analytics.

As a result, we’ve also invested in a campaign management engine to promote multi-channel delivery.”

Sherri Zink, Vice President Informatics, BlueCross BlueShield of Tennessee

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Abundance Intelligence: Health Outcomes, How Do We Measure Success?

“When it comes to healthcare, I’m not individually accountable or individually underwritten. Yet, in every other market I am.

My employer and insurer should individually underwrite me and charge me for my bad decisions. They should make me feel like I have some ownership and responsibility.”

R. Lawrence Van Horn, Associate Professor of Management, Vanderbilt University

“We live in a society where more than 90% of our dollars are spent on treatment and attempted cure, and less than 10% is spent on anything related to prevention. We have to change a lot about how it works. It’s not sustainable economically. At the heart of it is what induces, incents, and enables individual behavior change.”

Rick Johnson, President, Governor’s Foundation for Health and Wellness

➥ goes wrong with it, you pay someone $10 or $20 to fix it and then you go back and keep doing the same thing.

Further, the United States is at the precipice of unraveling the employeremployee relationship in healthcare.

However, no one is comfortable having that conversation.

There is a great deal of information with top-down prognoses, but there aren’t many bottom-up inputs which illuminate what is happening at the individual, community, or neighborhood levels and how that information connects to topdown assessments.

Assembling data to support healthcare decision-making is challenging due to the

variation in technologies. For example, the University of Washington formed an affiliation with 40 other healthcare providers, but all are using different electronic medical record (EMR) systems. Data, analytics, and scoring are not enough. If there is no way to operationalize that information within the organization, it is difficult to act on the data. With real-time engagement opportunities, applying traditional analytic techniques to data usually isn’t highly effective.

More information is needed than what is available on a traditional claim.

Measuring outcomes relates to test results; not just doing the tests. That requires

pulling additional data into the EMR, such as purchasing patterns. For example, if it is known that an individual goes to a fast food restaurant every day, but also exercises every day, the system might inform them about how much physical activity they need daily to offset their fast food visits. If external data is pulled into the EMR, however, there are HIPAA compliance concerns.

OPPORTUNITIES About six years ago, Gallup and Healthways started a partnership, which has involved developing a Well-Being

“We have a lot of information on top-down prognoses that describe the problem. We don’t have a lot of bottom-up inputs that help us understand what’s happening on the individual, community, or neighborhood level. We don’t know how that connects to the top-down assessments.”

Mohamed Younis, Senior Analyst, Gallup World Poll

“Providers today are focused on accountable care, bundled payments, forming clinically integrated networks, self-insuring their own employees, and more. With all these different flavors of risk that providers are starting to get into, they need a broader view of the data for patients.”

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Index. This takes a holistic approach to understanding well-being. In creating and updating the Well-Being Index, over two million individuals in the United States have been interviewed about 50 different health-related items. These items cover everything from eating habits to chronic illnesses. These interviews also captured attitudes about purpose in life, financial well-being, and the impact these factors can have on overall well-being.

Caradigm is a joint venture between GE and Microsoft. The company focuses on delivering technology solutions to address problems related to data aggregation and population health. The basis of the company’s work is a robust data management platform that pools data from many disparate sources. This platform is useful for providers as they seek a broader view of patients they care for. Predictive algorithms look at patient risk and suggest where limited resources should be focused. Caradigm has also partnered with Geisinger, a leading healthcare provider prominent in the adoption of population health management techniques. Geisinger’s outpatient care managers use a Caradigm technology environment on a day-to-day basis to drive outcomes that reduce costs and improve clinical outcomes.

BlueCross BlueShield of Tennessee has focused over the last several years on leveraging data and analytics to drive consumer engagement. It has created a big data and analytics platform that pulls

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in different information from across the organization as well as from outside the organization.

An additional opportunity is understanding how people make decisions outside the healthcare arena from a socioeconomic standpoint.

As with the retail sector, healthcare needs to understand consumers and better engage them. Robust predictive analytics and predictive models have the potential to help.

To transition from claims payment to consumer enablement, BlueCross BlueShield of Tennessee has invested in a campaign engine. This promotes multichannel delivery of messages to members using text messages, emails, postcards, and interactive voice response. The goal is to identify each individual’s contact preferences and move to an omnichannel environment that provides a personalized experience and delivers information that is appropriate and meaningful to members.

Tennessee has started an initiative focused on three fundamental behavior changes that can reduce chronic disease rates and poor health conditions. These are: 1) increasing physical activity; 2) eating healthier foods and reducing portion sizes; and 3) stopping tobacco use. The project is rigorous about monitoring, measurement, and reporting, so it will be clear whether the programs are successful. The goal is to determine if healthcare costs are reduced and

measure the returns. This initiative has engaged more than 100 nongovernment coalition partners. Webbased tools have been released to help people make behavior changes in incremental ways with the expectation of positive outcomes.

Technology and data problems are easier to solve than change management and incentive challenges. However, device integration is a key component from a big data perspective. Multiple device integrations are essential to meet people where they are and accommodate their device preferences.

Looking ahead, it is likely that employers will allow employees to put money in a tax-deferred account and use those funds to buy health insurance on a private exchange. When this occurs, people will need a company like Fidelity or Vanguard with whom they can establish a relationship. That company will serve as a health advisor over the course of a person’s life, which is likely to span multiple markets and geographies.

The experiments that have been started in healthcare today will help change awareness, engagement, and behaviors. Although momentum will build, it is unlikely that in five years there will be a marked difference in how things are managed on a day-to-day basis.

However, there will be a larger share of individual consumers who are engaged in decision-making processes around healthcare. ■

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Session 1: Building an Ecosystem for Prosperity Session Panelists: Adrian Gheorghe, International Science Director, Center for Understanding Change John Sullivan, Executive Director, Center for International Private Enterprise Jan Rivkin, Harvard Business School, US Competitiveness Project Moderator: Christian Ketels, PhD, Principal Associate, Institute For Strategy and Competitiveness, Harvard Business School

SITUATION Harvard Business School’s U.S. Competitiveness Project, co-chaired by Jan Rivkin, has explored three questions in depth, arriving at the following conclusions: Does the United States have a competitiveness problem Yes. An appropriate definition of “competitiveness” does not just include success for businesses competing in global markets, but requires simultaneously improving living standards for Americans.

It incorporates the notion of “shared prosperity.” By that definition, the United States is an economy doing just half its job.

The corporate sector and shareholders are thriving, as the stock market and corporate profits are at record highs, and US GDP growth is outpacing that of the Eurozone or Japan. But middle-class living standards in America are not improving. Real household income has been stagnant for decades.

Labor force participation is down to levels not seen since 1981.

If current trends continue long term, negative consequences are likely to include: 1) declining consumption by the middle class; 2) less productivity among economically hard-pressed workers; and 3) pro-business policies that won’t be politically sustainable, as the economy won’t be lifting living conditions for Americans broadly. All three will hurt the corporate sector.

How did we get here?

The United States has seen systematic under-investment in “the commons” over recent decades; i.e., the shared resources that allow businesses and individuals to prosper, such as education system infrastructure. This was not historically the case. “The great thing about America,” said Jan Rivkin, “is that historically government and business and education and nonprofits all collaborated to build a very rich commons.”

Beginning in the 1980s, changes in governance, geopolitics, and technology opened the world for business. Globalization and technological advances, which have been great for US companies, have had three negative consequences: 1) as companies became more mobile and more globally focused, their connections to their local communities deteriorated; 2) middle-class workers were pitted in competition against ambitious, skilled workers from around the world; and 3) highly skilled workers entered a “golden age,” as technology allowed their talents to be sold on a global scale, exacerbating inequality.

Society’s response to a general and prolonged middle-class economic malaise

has been a series of empty promises that created an illusion of middle-class prosperity even as living conditions got tougher. For example, credit was promised, encouraging people to consume with abandon, particularly the promise of low-cost and easily accessible mortgages, a promise that helped precipitate the financial crisis.

There have also been unfulfilled promises made about employment, healthcare costs, retirement, and taxes. Now after a great recession, a lackluster recovery, and two wars, society is left with a politically divided federal government that can’t manage its financial obligations and a corporate sector that doesn’t invest in the commons as it once did.

How might we as a society respond to the intense economic pressure on the middle class?

Society’s best response would be to invest heavily to make the middle class skilled and productive enough to compete effectively in labor markets with anyone in the world.

This would involve cross-sector collaborations among business, government, education, and nonprofits. ➥

“People seem to be concluding that deep structural questions cannot be answered by old ideology—more government or less government, higher taxes to redistribute or lower taxes to increase business dynamics. Much of it is about how we create . . . the instruments, the institutions, the right individual actions for a context of shared prosperity.”

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Building an Ecosystem for Prosperity

“We’re seeing around the country tremendous creative action at the local level. We’re seeing mayors, governors, and local business leaders partnering with educational institutions and non-profits to restore the commons. . . . It will come back in part because business leaders say, ‘We’ve got to step up and do this, not because it’s an ethical obligation but because it’s a business imperative.”

Jan Rivkin, Harvard Business School, US Competitiveness Project

“First, we figure out why things work the way they do. Then, we use a variety of tools to say, ‘What do we need to do to reduce the transaction cost to create the kind of exchange society that rewards initiative, provides secure property rights, and deals with the other basics?’ If you do those things, you could begin to build strong economic growth.”

John Sullivan, Executive Director, Center for International Private Enterprise

➥ Other nations face different and highly

unique challenges to shared prosperity, says John Sullivan. He runs the Center for International Private Enterprise, an affiliate of the US Chamber of Commerce created during the Reagan administration to help democracies around the world develop their private sectors. This Center helps governments make economic reforms that will promote business growth and create ecosystems for prosperity.

KEY QUESTIONS 1. What definition of “competitiveness” incorporates the notion of “shared prosperity”?

By this measure of competitiveness, how is America doing?

2. What are the stakes if American society allows “the commons” to continue to deteriorate?

3. What is America’s best hope for building an “ecosystem for shared prosperity”?

4. How can the private sector “invest in the commons?”Why is doing so a business opportunity?

4. What are examples of ways some companies have pursued their business interests while also investing in the commons?

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5. What challenges to shared prosperity do other countries face?

What are some countries whose economic reforms have led to increased prosperity?

CHALLENGES A conclusion of the US Competitiveness Project is that American business leaders have an obligation—not a moral obligation, but a business imperative—to invest in the commons in their local communities.

In that way, they will be improving US competitiveness and positioning their own companies for success. The researchers urge business leaders to protect and build the commons in three ways: 1. Run their own businesses vigorously. This comes naturally to business leaders; they do this well already.

2. Make sure not to undermine the commons in the pursuit of profitability. Small companies rarely undermine the commons. But as companies get larger and gain political clout, they often secure beneficial tax and regulatory treatment from legislators that benefits their company but does not serve the rest of society (which is how America got such a convoluted and dysfunctional tax code).

3. Find ways to grow business while building the commons, collaborating with other sectors to do so. Find ways to grow business while building the commons, collaborating with other sectors to do so. Many companies have found that doing so has opened the door to new business opportunities.

Regarding the diminished responsibilities that US-based multinationals feel toward American communities and workforces, companies with many years of global experience seem to be coming around to the view that chasing low wages and supplier pricing around the world isn’t worth the resources spent, said Christian Ketels.

Learning the environmental particularities that affect operational success in each location is a time-consuming but imperative undertaking. One can’t simply supplant American solutions to business problems elsewhere, pointed out Sullivan.

Regarding the challenges that other countries face, they differ greatly, though have some commonalities. A big challenge in many developing nations, for example, is their large, informal economies, with participants who are disenfranchised from the broader economy.

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Finding solutions to boost shared prosperity in such countries is quite complex. Often one can’t even refer to a “business community” in the singular; there are several: 1) the crony sector; 2) the small business sector; 3) the informal sector; 4) the state-owned enterprise sector, which often opposes economic reforms; and 5) leading-edge companies that see opportunity in adhering to international business standards of governance.

OPPORTUNITIES The ultimate message of the US Competitiveness Project is an optimistic one. The researchers have found many examples of local cross-sector partnerships springing up in cities across America, dedicated to revitalizing business environments, creating opportunities for the middle class, and building ecosystems for shared prosperity.

Siemens in North Carolina and IBM in New York City, facing skilled worker shortages, have partnered with educational institutions to educate students to be workers they would want to hire. Georgia-based Southwire hired local at-risk high school students to work in a

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new factory; the company found that they were 40% more productive than adults. Moreover, the kids defied the odds ascribed to them, remaining in school and going on to college.

Some initiatives involve investing in the capacity of small suppliers, which builds up local supply chains, as Harley Davidson, John Deere, and Caterpillar have done.

Intel encourages entrepreneurship among local college students in areas where it operates, holding business plan contests and other campus activities.

Success stories of cities revitalized via partnerships among local government and business leaders include Pittsburgh; the Twin Cities in Minnesota (The Itasca Project); and in Europe the city of Vienna, Austria.

When Sullivan’s team comes in to help a country make economic reforms, the first question they ask is, “Why do things work the way they do?” Using various tools, they figure out how to reduce transaction costs and create a society that rewards entrepreneurial initiative, offers secure property rights, and provides basic rights. Facilitating public-sector/private-sector dialogue has proven fruitful; a recent conference exploring Afghanistan’s infrastructure challenges was attended by 450 Afghan

entrepreneurs. Sullivan points to three countries as holding lessons for others: ■ Poland’s many reforms sprang from asking, “Why do things work the way they do?” One of its first changes was to declare that “Everything not illegal shall be legal.” Previously, the society had functioned under the opposite understanding: that everything not explicitly declared legal was illegal.

That had the undesirable effect of squelching initiative.

■ Peru is one of the few countries that peacefully has quelled a violent Marxist insurgency. Its economic reforms have revitalized GDP growth, now growing at a 6%-7% clip.

■ The Philippines has built a consolidated democracy with strong institutions and an environment that rewards growth and entrepreneurship.

Separately, those working on the complex problems of prosperity, health, and food may be aided by systems dynamics models such as those being pioneered by the Center for Understanding Change. Interconnected system dynamics models are used to explore how impacts in one area of critical infrastructure affect other, seemingly unrelated areas. ■ SEPTEMBER 2015

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Session 2: Organizing for Competitiveness: What Regions Do Session Panelists: Ted Abernathy, Managing Partner, Economic Leadership LLC Betsy Biemann, former President, Maine Technology Institute Matt Erskine, Deputy Assistant Secretary of Commerce for Economic Development & COO, U.S. Department of Commerce Dan Cunningham, CEO, Long-Stanton Group Moderator: Christian Ketels, PhD, Principal Associate, Institute For Strategy and Competitiveness, Harvard Business School

SITUATION This is a pivotal moment for America economically. On the one hand, the United States is in a comparatively strong economic position. Numerous national advantages bode well for innovation and business growth, including stable capital markets, continued increases in productivity, strength in R&D investment, strong rule of law and intellectual property protections, reliable supply and service chains, and new business opportunities created by the expansion of domestic energy resources.

On the other hand, many regional economies are not prepared to fully seize this economic opportunity. While state and local governments are better positioned financially today than they were four years ago, many still face tremendous budgetary constraints, making it tough to create business environments conducive to growth.

“Businesses cannot succeed for long while their communities languish,” wrote Harvard Business School professors Michael Porter and Jan Rivkin in their September 2014 report, An Economy Doing Half its Job. Exacerbating the situation, private investment capital remains highly risk averse; companies are not investing in the R&D they need to innovate or the infrastructure they need to expand.

Brookings Institution researchers found that the rate of new company formation has declined over the past three decades in every state (see Brookings’ May 2014 report, Declining Business Dynamism in the United States).

The Obama administration recognizes a role for the federal government in removing barriers to America’s economic competitiveness by fostering business growth and innovation. Innovation drives regional and global competitiveness, creating jobs and resilient economies, and helping attain national goals. The US Economic Development Administration (EDA) and the US Commerce Department’s “Open for Business” initiative are using a regional economic development model to support innovation among American businesses as a key to economic prosperity. By focusing federal resources on the development of highgrowth, globally competitive regional economies across the country, the goal is to help communities become agile and resilient in the face of changing economic forces.

The federal government’s specific objectives include: 1) improving the conditions for economic growth by

expanding the capacity of individuals, businesses, and communities to support innovation and commerce; 2) making communities more attractive to companies by reducing private investment risk and improving business environments; 3) transforming regional economies by promoting productive use of local resources; and 4) improving economic development policy at all government levels.

EDA’s regional innovation ecosystem model is advanced through tools it develops and disseminates to help economic development practitioners and government policymakers make more informed economic decisions; for example, the US Cluster Mapping and Registry Tool. Other program initiatives include the National Advisory Council on Innovation and Entrepreneurship (NACIE), a regional innovation strategies program competition, and designated manufacturing communities (more information is available at www.EDA.gov). ➥

“There is no one model such that you can easily say, ‘Okay, here’s the folder. Follow exactly this list; this is how you set up these new structures.’ You need to understand the location-specific context, the culture, the way decisions work, the interests, and so on, and [you need to] experiment. Then you use data to see what’s really working, what’s not working, and how to adjust over time.”

Christian Ketels, PhD, Principal Associate, Institute For Strategy and Competitiveness, Harvard Business School

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Organizing for Competitiveness: What Regions Do

“You have to find what works in an individual community, and there’s no magic bullet. You do need leadership. That leadership needs to have certain rules; it needs to be looking out for a broader part of the community. So a stewardship model is a way to look at it.”

Ted Abernathy, Managing Partner, Economic Leadership LLC

“We created the Maine Technology Institute to fund and support Maine companies that had new product ideas they wanted to bring to the market. We required, importantly, that those companies had skin in the game and were investing $1 for every $1 that the state put in.”

Betsy Biemann, former President, Maine Technology Institute

➥Multi-sector partnership is a must for successful regional economic development.

All of the panelists’ work highlights the power of collaboration: ■ A

premise underlying EDA’s efforts is that success requires robust partnerships among multiple parties, said Matt Erskine, including: government at all levels, private-sector stakeholders, community leaders, nonprofit organizations, and higher education. Federal government collaboration with local stakeholders is critical because regions’ economic development needs differ and are best understood by local players. There is no cookie-cutter model that would work in all instances.

■ Under Ted Abernathy, Research

Triangle received one of the EDA’s first grants to promote regional economic development. The organization went into urban communities in the South, meeting with business leaders, chambers of commerce representatives, and university administrators to create economic development partnerships. The conversations that occurred focused on identifying the right structures to address the interests of the many stakeholders.

The models that emerged differed, reflecting each community’s unique needs.

If there was a unifying theme, it was “stewardship”—the models prioritized taking care of the community.

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KEY QUESTIONS

CHALLENGES

1. How can grand challenges facing society in the area of nutrition and nutrition security be addressed?

2. How are interactions between corporations and society changing, so both business issues and social issues are resolved?

3. How is the idea of shareholder primacy changing?

4. How can uncommon collaborations between the private sector, governments, universities, and other stakeholders be promoted?

There is no one model for regional economic development that works in all situations. A region can’t simply follow a list of steps to get to the ideal of shared prosperity. As Christian Ketels pointed out, “You need to understand the locationspecific context, the culture, the way decisions work, the interests, and so on.”

Multi-sector stakeholders need to be at the table and actively participating, as multiple sectors have different roles to play. In a risk-averse investment environment, for example, the private

“To do what I’m talking about, you need a clear call to action.

That’s why we talk about raising prosperity—having Ohio become number one. People respond to that. You have to include business, government, and universities.”

Dan Cunningham, CEO, Long-Stanton Group

“[EDA] will continue to push forward in partnership with you all— pushing evidence-based policy; focusing on specific place-based [strategies]; making things less cumbersome, more streamlined; and focusing on supporting. Because while the federal investment is relatively small, the leverage power is extremely, extremely significant.”

Matt Erskine, Deputy Assistant Secretary of Commerce for Economic Development & COO, U.S. Department of Commerce

SESSION 2

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represent opportunities that can be replicated, include: ■ Forging

sector won’t readily jump in to fill the training infrastructure void; companies look to education. Financially, the government doesn’t have the means to do it all, but as Abernathy said, “Building collaborative capacity takes resources. If the federal government can put little bits of money in place to allow that to happen, it has a huge impact.”

State and local policymakers also have a policy role to play, encouraging privatesector investment in under-invested areas (as MTI did in Maine) and creating regulatory environments that aren’t unduly onerous so as to impede companies’ growth.

However, forging collaboration among multiple sectors with different interests is difficult. Solutions need to reflect

both economic and political logic, observed Ketels, which can be elusive.

OPPORTUNITIES With recognition of the challenges, with a collaborative model that leverages government financial resources and involves private-sector capital investment, and with the buy-in of the necessary parties, regional economic development programs can work. They can be an effective way to “invest in the commons”— filling infrastructure gaps and promoting the business innovation needed to create shared prosperity and build a more economically competitive nation. Best practices from the panelists’ work, which

strong multi-sector partnerships focused on community stewardship. Through exploring the interests of all parties, win/win/win solutions often can be found that meet all interests and promote shared prosperity and good stewardship of the community.

■ Articulating a clear call to action to motivate the right people to get involved.Cunningham has rallied support for his proposal in Ohio by painting a clear picture of the benefits for individuals, government, universities, and businesses.

■ Breaking down silos that impede collaboration. EDA has been breaking down Washington silos to achieve efficiencies. Since fiscal 2010, EDA has led interagency efforts that invested in more than 100 collaborative regional innovation initiatives.

■ Enabling evidence-based policy with good data. It is important to use good, evidence-based data to test what is working and not working, adjusting solutions as necessary. The EDA has developed concrete metrics to assess their various programs and optimize programs’ impacts.

■ Building accountability into the solution’s processes. Cunningham emphasizes the importance of holding work groups and state agencies accountable for results. Accountability lends strength to initiatives. ■ SEPTEMBER 2015

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Session 3: From Creative Class to Workforce Skills: Key Assets for Regional Success Session Panelists: Heidi Kleinbach-Sauter, PhD, Senior Vice President, Pepsico Lucian Tarnowski, CEO, BraveNewTalent Lucretia Murphy, JD, PhD, Project Director, Jobs for the Future Balaji Ganapathy, Head, Workforce Effectiveness, Tata Consultancy Moderator: Christian Ketels, PhD, Principal Associate, Institute For Strategy and Competitiveness, Harvard Business School

SITUATION

KEY QUESTIONS

CHALLENGES

Skills are absolutely essential. If you look at the performance of regions, the skill base is closely tied with the region’s economic performance. The same is true of individuals. Looking at the US economy over the last 20 to 30 years, the level of education people have received is one of the most critical markers of economic success. Educational status is the dividing line between those who have been able to take advantage of globalization and those who have not.

The best way to make the United States more prosperous is to focus on talent.

Talent must be given the same attention that is given to other critical national resources. The average investment for higher education in the United States is around $100,000. Yet, about half of adults with an undergraduate degree (48%) earn less than half the national median.

An issue is the pace and scale at which skills and talent are created. Too few people graduate from higher education on time.

At flagship universities, the four-year graduation rate is 36%. It is 22% at land grant universities and 19% at non-flagship universities. Unfortunately, the true nature of globalization in the post-recession economy means that companies don’t have extra money to dedicate to developing employee skills in-house. This is especially true in small and medium-sized businesses, which is where the majority of new jobs are being created. The education system must produce higher-skilled talent more consistently.

1. What skills are critical for the performance of regions in a modern, knowledge-driven economy?

2. Is the current education system broken and if so, what is needed to fix it?

3. How does the educational experience need to be rethought?

4. Can the “professor on the stage” model be innovated?

5. How should the US deal with the high dropout rates for higher education programs?

6. How can STEM skills be turned into value creation?

7. Can technologies be applied to better utilize human capital?

8. How can we efficiently add the key capabilities that future talent needs across all industries?

The perception exists that the current education system in the United States isn’t delivering the skills needed for economic prosperity. There is a lack of understanding about what level of education is needed to succeed in the workplace.

To engage in the modern economy, science, technology, engineering, and math (STEM) skills are essential. Even for “middle skill” jobs like mechanics, employees need high levels of technical skills, including math as well as digital fluency. Unfortunately, those skills aren’t developed at many schools, certainly not at the lower-end schools that students in high-poverty areas attend.

The education system is the world’s largest middleman, but it is getting worse at delivering qualified people ➥

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“STEM and technology are opportunities for populations that are falling out of the four-year college system, the K-12 system, and the community college system. The work we’re doing at Jobs for the Future and with many partners across the country is to build the first rung where individuals get basic employability skills.”

Lucretia Murphy, JD, PhD, Project Director, Jobs for the Future

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From Creative Class to Workforce Skills: Key Assets for Regional Success

“I think as a nation what we need to provide access to where opportunities to prosper are higher, focus on driving persistence and achievement from K-12 to college and career and . . . including those who don’t have the opportunity to participate in number one and number two.”

Balaji Ganapathy, Head, Workforce Effectiveness, Tata Consultancy

“I think if we step back, we’d probably all agree that all of the world’s resources, human capital is the most underutilized. There’s a great opportunity to better utilize human capital with technology.

The question is how and where does that innovation sit? Is it going to be the education system or the employers or some technology companies connecting the two?”

Lucian Tarnowski, CEO, BraveNewTalent

➥ to match the supply of jobs. The education system isn’t talking to employers and employers aren’t giving clear guidance to educators about what skills they need. Human capital can be better utilized through the use of technology. However, an open question is whether this innovation should reside with the education system, employers, or technology companies that connect the two. The best solutions to the talent challenges that are faced are all multistakeholder approaches, but silos are a major contributor to the underlying problems.

In many countries, scale in terms of producing employable people often happens outside the formal educational system. Unfortunately models that have worked well in one location or context, such as the German vocational educational apprentice method, haven’t been successfully transferred to other locations. Regardless of what model is used, it is essential to give people access to real-world problems and industry context and then enable them to learn how to succeed (and fail) in that environment.

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OPPORTUNTIES Some have suggested that four key capability platforms that should be taught from kindergarten to workforce: digital fluency, innovation excellence, employability skills, and industry-specific new skills.

No matter where people work, digital fluency is critical for success and prosperity. Innovation excellence is more than creativity—it is the key to helping employers and the economy drive growth.

In terms of employability skills, there are many leadership skills needed to manage in highly matrixed, global organizations, such as working in multi-functional teams.

Every industry, such as automotive or IT, has skills that are unique to that business.

The most efficient way to bridge young talent into great careers is to offer access to experiential learning.

For many years, businesses have been opening their labs and inviting high school students, teachers, parents, and other key stakeholders into the real world setting of industry. Job fairs and other events have become widespread and showcase the types of jobs that are available, what skills are needed, and how much money can be made in those positions. Putting skills in a real-life context accelerates the learning curve. Schools today have access to many

types of experiential learning models that have been shown to be effective.

Solutions to the human capital supply and demand problem include peer-topeer learning and online communities.

Although the Internet is the world’s classroom, it lacks context. In addition, massive open online courses (MOOCs) are basically a recorded lecture, which is an old educational model rather than a disruptive innovation. BraveNewTalent believes that communities provide the necessary layer of context to online learning. They offer a peer-to-peer environment where people can be recognized for what they are learning and make it possible to validate what they are learning. It is essential to move to a model where everyone is a teacher and a learner at the same time.

Opportunity youth are a demographic group that needs to be addressed. These individuals are ages 16 to 24, don’t have a high school diploma, and aren’t working.

They are technologically proficient in some ways. For example, they know how to use smartphones and social media. Yet, they have huge deficits when it comes to other technologies. One strategy that has been powerful for this population is to meet them where they are skill-wise. An organization in the South Bronx has been training opportunity youth to be beta

SESSION 3

testers for technology applications. The organizations started training these young people on their cell phones, which was in the participants’ comfort zone. Next, the team moved to laptops. The key is starting where the competencies are and

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then showing how those skills are directly applicable in other contexts.

Although the problems associated with skill development are national and global, the solutions are local. Implementing local solutions requires a sandbox

and experimentation with coalitions.

Communities must share what works and what doesn’t. There are some common assets that all communities must invest in and then there are unique features that will work for individual communities. â–

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Session 4: Investment Strategy and Prosperity Session Panelists: Mason Kauffman, CEO, US Biologic Ted Abernathy, Managing Partner, Economic Leadership LLP Harry Blount, CFA, CEO, DISCERN Moderator: Christian Ketels, PhD, Principal Associate, Institute For Strategy and Competitiveness, Harvard Business School

SITUATION

KEY QUESTIONS

We have come through the biggest bull market the world has ever seen. In the 1980s, interest rates were high, baby boomers were entering their peak earning years, and amounts of debt were very low.

All of that has changed. The elements that created tremendous wealth over the last 30 years are no longer in place. Looking ahead, the value of innovation will be higher than ever before, as will the need for financial innovations that can help entrepreneurs create product innovations.

The reasons why businesses fail are varied. They usually boil down to access to capital, access to talent, and execution by the management team. Depending on the business, capital is often fungible; if a firm has a good idea, capital will find it.

However, the talent side of the equation is critical and can be more difficult than capital.

A critical element to sustained innovation success is an ecosystem where there is not fear of failure. In many organizations experimentation and “failing fast” is encouraged, though rarely in the public sector.

1. What sources of capital do companies want to tap into?

2. What sources of capital are available to research-intensive companies?

3. Is there enough capital available?

4. What types of investments is capital available for?

5. How do regions attract investment and how do they support access to capital for small and mediumsize companies?

6. What makes certain locations a good host for certain types of business activities? Where do companies actually grow?

7. Is crowdfunding a community discussion? Is it separate from traditional economic development or is it fully embedded in what is happening across regions?

CHALLENGES Numerous challenges exist related to investments that can help create greater prosperity. Portfolio managers face four main challenges that prevent them from

“There are many different investment models out there. It’s important to know the people in the network and what they’re bringing to the table. It’s hard getting capital, but anybody can do it sooner or later. Who you get the capital from is worth so much more than the dollars that you get.”

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achieving attractive financial returns that beat the market. First, they don’t have all the relevant information in one place at the right time. When decisions are based on partial information, the probability of making wrong decisions is high.

Unifying relevant data from thousands of commercial data vendors requires a complex database schema, which is a difficult problem to solve. Second, persistence is needed. What if the right question were asked, but at the wrong time? It is necessary to create a set of questions and then persistently scan the data. Third, how do organizations know that their insights are unique relative to the landscape at large? If a team has the same idea at the same time as everyone else, it won’t have good returns. Fourth, not enough time is spent managing and optimizing capital on an ongoing basis.

A further challenge is that the technology used by mode investors for capital allocation is outmoded. Even today, capital allocation is done primarily through spreadsheets, a 30-year-old, pre-Internet innovation. Spreadsheets are commonplace in Wall Street, corporations, governments, and nonprofits. ➥

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Investment Strategy and Prosperity

“This is an opportunity to democratize business decision making. The thing about most companies, whether it’s Google or Bloomberg, is that they look at aggregating data for the most common denominator. They don’t know how to personalize it.

I believe if you can deliver personalized information, people will be much more efficient running their businesses and have a much higher probability of success.”

Harry Blount, CFA, CEO, DISCERN

“We are a commercialization company, which is important. If we were just an R&D company, we wouldn’t be allowed investment money. If I can say, however, here’s a pathway to turn really good technology into a strong revenue stream, that’s a role we play.”

Mason Kauffman, CEO, US Biologic

➥A challenge facing economic

developers is knowing how to satisfy local and regional business needs. Those responsible for economic development have been taught to ask the business community what business needs in order to grow. The belief is that once economic developers know what is needed they can respond accordingly. However, for years the business community has been saying the same things: they want regulatory barriers removed, more qualified employees, and better access to capital.

Different regions have different ways of getting money into their communities.

If a regional group has found something that works, they are unlikely to talk about it because they don’t want others to steal it.

A surprising challenge is that the amount of capital needed for start-ups is going down. Yet this is contrary to what venture capitalists want, which is bigger pools of money, as more capital means bigger management fees.

Another challenge is that the track record for public sector–funded venture capital is dismal. One academic has suggested that the public sector

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isn’t tough enough and doesn’t push entrepreneurs enough. As an alternative form of investing, several states have passed crowdfunding legislation, but not many have yet succeeded with this form of financing. States are realizing that they don’t understand the issues related to risk, reward, and reasonability. A diligence process is needed that represents the fiduciary responsibility to evaluate investments.

OPPORTUNITES In the 1990s, it was easy to get money.

Today the environment has changed and the opportunities to secure capital are different. But there is still a great deal of money available, especially if organizations know how to work with various state and federal government agencies. US Biologic, for example, has two or three Small Business Innovation Research (SBIR) grants or Small Business Technology Transfer (STTR) grants in process at all times. These are great mechanisms for obtaining non-diluted funding for research and development.

US Biologic sees opportunity as a commercialization company. It identifies pathways for turning promising technologies into significant revenue streams. One focus area is preventing Lyme disease. This is the largest animalborne disease in the United States and is growing at an alarming rate, with 300,000 new cases each year. The technologies for eradicating the disease are proven, but the disease’s “supply chain” (or the infection chain) is extremely complex. This chain starts with a mouse. Ticks feed on mice, become infected, and then bite humans. A researcher believed that if the disease cycle could be broken at the source (i.e., the mouse), it could be eradicated.

Based on that theory, US Biologic developed a product called Lyme Shield.

It is a food pellet coated with a vaccine.

In trials, in fields that were treated the prevalence of infected ticks decreased by 76%. Lyme Shield is initially being purchased by local governments for public parks. The company needs to develop a distribution network for private properties and residences. In 2013, US Biologic won the Global Food and Innovation Challenge for this innovation.

SESSION 4

An opportunity identified by DISCERN is to replace the spreadsheets used by investors with a more integrated platform that aggregates data from 7,000 sources and continually scans the data for insights.

The firm can be described as a big data filtering company. DISCERN’s platform pulls all of the necessary data into one place. The result is more efficient capital allocation. DISCERN’S initial target market is Wall Street, and it hopes to expand to corporations and nonprofits.

The company recently received its first funding from external investors. Selling this big, complex, abstract idea to investors was challenging. Investors wanted to know about the speed and acceleration of the investment cycle, customer acquisition, product manufacturing, sustainability, recurring revenue, and defensibility.

An age-old challenge for economic developers is how to get more money into the community. Ted Abernathy does not try to recruit venture capital funds from outside the community. Instead, he focuses on raising money locally.

In general, traditional venture capital funding is waning. Over the last 15 years, however, a major trend has been angel investing in small and mid-size companies.

Most communities have angel investor funds and many research universities have chancellor’s funds used to invest in promising business ideas. Some angel investor groups are very sophisticated.

They often put their own money into investments and then amplify them via crowdsourcing. Another emerging trend

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is for businesses to do crowdfunding for mezzanine financing. In addition, traditional federal government funding sources like SBIR grants are very popular.

In Tennessee, the state has partnered with a venture capital firm, XMi. The TNInvestco program matches 25% of investments made by XMi. This increases the success of investments because all the key stakeholders have skin in the game.

Kitchen Budapest in Hungary is a phenomenal incubator for innovation. A group of entrepreneurs work in a shared space. To participate in the group, one must interview with all the entrepreneurs.

If accepted, an entrepreneur must devote 30% of his or her time to helping the other innovators. That is important because 90% of all major disruptions come from cross pollination across vertical markets. ■ SEPTEMBER 2015

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Session 5: Social Progress and Economic Development Session Panelists: Keynote Speaker: Michael Green, Social Progress Index Jon Clifton, JD, Managing Director, Gallup World Poll Trevor Davies, Global Head, Center of Excellence International Development, KPMG US Brian Worley, President & CEO, PYA Analytics Moderator: Ted Abernathy, Managing Partner, Economic Leadership LLP

SITUATION

■ “Social

Countries of similar wealth may differ dramatically on measures of social progress. Some countries use their economic resources to create better lives for their people more effectively than others. Success in creating better lives is important to measure so that government policymakers, advisers, and other stakeholders know what works best.

However, until the creation of The Social Progress Index (SPI) it has been virtually impossible to assess how effectively countries improve their societies and the lives of their people.

That is because all other such indexes, such as the UN’s Human Development Index and the OECD’s Better Life Index, are composed of both economic and social indicators.

The Social Progress Imperative, chaired by Harvard Business School’s Michael Porter, recognized that only by creating an index composed entirely of social environmental indicators and by comparing the results of countries at similar wealth levels would the effectiveness of governments’ efforts to improve the lives of their citizens be revealed. Comparing the social progress of countries generally, without reference to their economic means, wouldn’t be a fair assessment or yield meaningful insights. Key aspects of the SPI include:

“In Brazil, they’ve taken [the Social Progress Index] and drilled the methodology down to a regional level. I don’t think there are many composite indexes you can do that with . . . I’m going to be really interested to see the results that come out of that: Does the government of Brazil on a national and regional level actually use the data? [After] a time series of five years or so, is there evidence that decisions based on that data have had a measurable impact on people’s lives?”

progress” is defined as “the capacity of a society to meet the basic human needs of its citizens, establish the building blocks that allow citizens and communities to enhance and sustain the quality of their lives, and create the conditions for all individuals to reach their full potential.” Those three components and four elements under each compose the model’s 12-part (equally weighted) framework. Each of the 12 parts includes several indicators, for a total of 54.

■ Important design features, besides the exclusion of economic data, are the measurement outcomes, not inputs such as expenditures; relevance for countries at all levels of development; and actionability.

■ Only indicators from reliable, global sources are used (e.g. the United Nations and the World Bank). This is to ensure

comparable data among countries.

Where globally comparable data is lacking, proxies are used; for example, suicide rates as a proxy for mental health.

■ SPI scorecards have been created for 132 countries. On each indicator, a country might come in above, below, or on par with its economic peers.

■ The relationships between GDP per capita and SPI performance for all of the countries have been charted (Figure 1).

The chart shows that “GDP is not destiny”: at any given GDP-per-capita level, there is variation in social progress levels. That suggests non-economic factors impact social progress. Thus, government strategies that rely solely on economic development to improve citizens’ lives may prove to be less effective than expected. ➥

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Social Progress and Economic Development

“One of the reasons GDP has been so successful as a statistical tool is that it’s wonderfully simple. . . . It distills [how the economy works] to a single number. What we wanted to do with Social Progress Index is one aggregate score, a simple score that can reframe the conversation. . . . [T]hen we can have different political debates and make different choices about our futures.”

Michael Green, Social Progress Index

“There are two things to [question] when consuming indexes: Does it make sense? Does it have face validity? . . . The second thing: Is the index useful?”

Jon Clifton, JD, Deputy Director, Gallup World Poll

KEY QUESTIONS

CHALLENGES

1. How is the design of the Social Progress Index (SPI) revolutionary among indexes measuring societal conditions?

2. What can the SPI measure more effectively than other indexes?

Why is that important?

3. How can the SPI aid understanding of the mechanisms of social progress?

4. In what ways can the SPI be used as an actionable tool to drive social progress?

5. How have governments begun to use the SPI? What future uses do the index creators foresee?

The world is “over-indexed,” with around 20,000 indexes out there. Consumers of indexes therefore need to be discerning.

Index consumers need to keep in mind that an index should make statistical sense, combining elements that have a high “Cronbach’s alpha,” or statistical correlation. It should have high “face validity,” making sense in the context of real-world trends. Arab Spring revealed flaws in the UN’s Human Development Index, as it had been registering years of perfect social progress in Egypt before the unrest.

An index should also be useful. Some indexes combine such disparate elements

that the aggregate number is almost irrelevant because it can’t speak to any coherent narrative offering insights or guiding actions.

OPPORTUNITIES Increasingly, policymakers are looking for ways to improve their decision making through data. They want evidence to show constituents that their policies are working; they also want advance warning regarding where policies might have unintended consequences. PYA Analytics uses computational social models to anticipate how groups of individuals might react under various scenarios, so that policies can be adjusted to

“What we’re interested in is collecting data that’s characteristic of an individual’s response to a policy. You look at all the political scenarios that could come out of policy change from an individual standpoint, collect data against those, and get early indications of how policies are working [and of] adverse effects. . . . We can see unanticipated effects [and ask], what’s the cause? Could we tweak policy to get rid of them?”

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SESSION 5

minimize unintended consequences.

The SPI is an actionable tool that can be used for making data-based policy decisions, because it can show where improvements are needed, where solutions are working, and how policy measures are affecting various indicators of social progress.

More specifically, country rankings on social progress indicators highlight where shortfalls need to be addressed.

The United States scores poorly on health and wellness, for example, and more surprisingly, despite being the home of Silicon Valley, has a weak score on access to information and communications. The SPI can also reveal where solutions are working well and should be scaled up.

With changes in SPI indicators tracked over time, one can see the social impacts of policy actions, to better understand which approaches work and don’t. Also, by examining correlations among the various SPI component indicators as well as their relationships to GDP, the mechanisms of social progress can be better understood.

Some ways the index is being employed to drive social progress include: ■ Measuring and improving national performance on social indicators.

Paraguay is the first country to adopt the SPI as a national performance measure.

The Paraguayan National Development Plan has both GDP and SPI targets.

The SPI model has helped country policymakers set budgetary targets around an initiative to eliminate malnutrition.

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■ Assessing

and improving the social progress of states or municipalities. Brazil has begun to develop SPI indexes for the nine states in its Amazon region. Increasingly, the Social Progress Initiative has been working on developing indexes for cities around the world.

■ Finding solutions to the world’s social development challenges.

The Social Progress Imperative is looking to create partnerships among governments, businesses, and civil society that will use the SPI to drive social change and find solutions to the world’s increasingly urgent challenges of sustainable prosperity. ■

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GLOBAL ACTION PLATFORM

Global Action Platform: A Global Agenda for Abundance Food + Health + Prosperity

The Global Action Platform convenes, aligns, and mobilizes global corporations, universities, investors, government agencies, and NGOs to create abundance through innovation in food, heath, and prosperity. The Platform

■ Advances a social leadership movement, ■ Invests in innovation and new businesses, ■ Deploys online work groups and global communications to accelerate action, and ■ Focuses on the intersection of food, health, and prosperity.

Specific program initiatives include the annual Global Action Summit; forums at the World Bank Group, the National Press Club, and Meridian International Center; multi-million dollar impact investments and awards; online services; a global Summit Fellows program for young leaders; publications and annual reports; content sharing with the G7, G20, APEC, and BRIC Summit publications; and a global corporate award program for shared value.

The Global Action Platform is an open, neutral, nonpartisan, and collaborative platform to convene leaders, make investments, align collaborations, and share ideas and strategies through global communications to create sustainable abundance in food, health, and prosperity.

The Platform aims to identify and invest in sustainable, scalable innovations that offer the promise of transformative impact in the intersection of food, health, and prosperity.

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With input from an international steering committee and national expert advisors, the Global Action Platform was designed in 2013 around four program activities: Convene, Challenge, Connect, and Communicate. These integrated programs facilitate action through dynamic leadership events, investments, ongoing working groups, and global communications. In 2014, a five-year roadmap was initiated to inform decisionmaking among cross-sector leaders and scientists.

Specific programs of the Global Action Platform include: Convene ■ Global Action Summit ■ Global Action Fellows ■ Global Corporate Awards Dinner ■ World Bank Group Forum ■ National Press Club Forum ■ Meridian International Center Forum Challenge Million Challenge Fund ■ Early Stage Challenge Funds ■ Social Enterprise Funds (Under development)

Connect ■ Fellows Social Enterprise Work Groups ■ Online Collaborations and Work Groups

Communicate ■ Global Summit Program ■ Global Action Report ■ Global Action Platform Website ■ $1

■ Video ■ Social

Library Media

Convene: Building a social leadership movement for abundance through innovation The Global Action Platform is building a growing social leadership movement to create abundance through innovation in food, health, and prosperity. To build this network and shared understanding, we conduct the following programs and events: Global Action Summit The Global Action Summit is the most dynamic, agile, innovative, and fastest growing forum for today’s global leaders in food, health, and prosperity. The invitation-only summit is the anchorconvening event of the Global Action Platform and is hosted annually in Nashville, Tennessee in November.

The Summit convenes top senior level decision makers from the corporate, government, academic, media, investment, and NGO communities from around the world with a distinct focus on creating abundance through innovation in food, health and prosperity.

The Summit is guided by a distinguished international steering committee and informed by extraordinary partners that include the World Bank Group, The Institute for Strategy and Competitiveness—Harvard Business School, Vanderbilt Medical Center

GLOBAL ACTION PLATFORM

(CRC), UC Davis, the Diplomatic Courier, and the UN Foundation and +SocialGood, among many others.

Global Action Fellows The Global Action Fellows Program enables outstanding students and young professionals to participate in a life-changing educational leadership experience. Fellows are top undergraduate and graduate students from universities and partner organization networks around the world who are selected by their participating institutions to attend the annual Global Action Summit. At the Summit, Fellows learn and practice 21st Century skills that prepare them to address critical issues in the creation of abundance through innovation in food, health, and prosperity.

Global Shared Value Dinner The Global Shared Value Dinner serves as the annual closing ceremony for the Global Action Summit. The event is a celebration of innovation, entrepreneurship, and the impact of the private sector in helping solve the grand challenges facing the world. The cocktail reception and dinner are followed by an awards program moderated by Dr. Fareed Zakaria, CNN and TIME Magazine contributor. The event includes a major keynote address, as well as announcements of new Challenge investments and the presentation of a distinguished global award to a corporation dedicated to “shared value” corporate strategy–i.e., to solving global grand challenges through new enterprise and innovation.

World Bank Group Forum Each year, the World Bank Group and Global Action Platform collaborate in presenting a leadership forum for banking, investment, and business leaders at the World Bank Group headquarters in Washington, DC. The Forum presents findings and strategies from the Global Action Summit relevant to economic and business development in creating abundance through innovation in food, health, and prosperity.

National Press Club Forum In partnership with the Diplomatic Courier, we present a Forum for journalists and media leaders at the National Press Club. The Forum is

scheduled to take place immediately prior to the release of the Global Action Report, an annual report published by the Global Action Platform in collaboration with Diplomatic Courier magazine and distributed to key global leaders. The Global Action Report features long range editorials by leading research institutions and business leaders in food, health, and economics; summaries of major ideas and recommendations from the Global Action Summit, and progress reports on a five year roadmap toward abundance in food, health, and prosperity.

Meridian International Center Forum To convene leaders of key government agencies and leaders in the Diplomatic Corps, the Meridian International Center and Global Action Platform collaborate in conducting an annual Forum at the historic headquarters, the Meridian House in Washington, DC. The forum provides an opportunity to share copies of the annual Global Action Report and to discuss policy implications of the ideas and recommendations from the Report. ➥

“The Global Action Challenge is a pool of investment funds and an international business competition designed to stimulate global innovation and to invest in innovations and businesses that can have a transformative impact on food, health, and prosperity.”

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➥ Challenge: Investing in innovation and transformative new enterprises In order to accelerate innovation, the emergence of transformative businesses, and the disruptive market changes that can lead to abundance, the Global Action Platform created the Global Action Challenge.

The Global Action Challenge is a pool of investment funds and an international business competition designed to stimulate global innovation and to invest in innovations and businesses that can have a transformative impact on food, health, and prosperity. The Global Action Challenge is based on the understanding that business solutions are the foundation for effectively solving the global grand challenges facing the world.

Through the Challenge, the Global Action Platform helps to launch solutions to issues discussed at its annual Summit and Forums. Challenge funds represent a spectrum of investments; from early stage to late stage venture funds, grants, and social enterprise funds.

Submissions for the Challenge follow published guidelines for each distinct fund and are reviewed by independent experts and investors.

Finalists from the competition make live presentations at the Global Action Summit, where investment decisions are announced at the closing Summit dinner, moderated by Fareed Zakaria, CNN and Time Magazine contributor.

The Global Action Platform works in partnership with Diplomatic Courier, oneC1TY, the World Bank Group, SHOUTAmerica, Oakridge Associated Universities, Wells Fargo Bank, DevDigital, global university networks, and several other constituencies.

Million Dollar Challenge The $1 Million Challenge is a competitive investment opportunity to identify breakthrough prototypes, technologies, or early-stage ventures that hold promise for transformative impact on health and food and are scalable business enterprises. The Global Action Challenge is open to food and/or healthcare innovators and entrepreneurs from around the world. The recipient(s) and top finalists will be recognized at the Global Action Summit scheduled for November 17-18, 2014 in Nashville, TN. The $1M Challenge was founded in 104 GLOBAL ACTION REPORT

In addition, the Global Action Platform provides concierge enterprise services designed to help organizations, membership groups, and companies developing shared value strategies and innovations that align with the mission and programs of the Global Action Platform.

Communicate: Sharing ideas though global reports and communications to build consensus and informed action The Global Action Platform works to share ideas and innovative solutions globally to key leadership audiences and to the general public. Through our global reports and communications, we seek to contribute to a global knowledge base for food, health, and prosperity and to create a growing global consensus for action.

2013, in partnership with XMI Holdings, Inc. and the Nashville Entrepreneur Center, which provides independent administration of the $1 Million Challenge, including inquiries, review, and ranking of submissions.

Early Stage Challenge Funds The Global Action Challenge offers early stage investment opportunities at the $50K and $100K levels for innovations and early business development for enterprises that can have a transformative impact on food, health, and prosperity.

The competitive submission is open to researchers, entrepreneurs, and innovators from around the world. Finalists are recognized at the Global Action Summit and investment decisions are announced at the closing dinner of the Summit, moderated by Fareed Zakaria, CNN and Time Magazine contributor.

Connect: Initiating self-organizing working groups, partnerships, and collaborations across sectors The Global Action Platform actively seeks partnerships, alliances, and promotes collaboration and alignment among existing initiatives in the food, health, and economic sectors. Through its Connect programs, the Platform provides an online service to support self-organizing work groups and online tools to further collaborations among Fellows, universities, entrepreneurs, investors, and other leaders.

Global Action Report The Global Action Report documents proceedings of the annual Global Action Summit, providing summaries of major ideas, recommendations for action, longrange vision frameworks, and exemplary stories and analysis relevant to creating abundance through innovation in food, health, and prosperity. The Report is published and distributed worldwide in partnership with the Diplomatic Courier. Distribution includes mailings to 25,000 top global decision makers in the corporate, government, university, investment, media, and NGO sectors, and online readership of 2.4 million.

The Report is released annually as a series in a five-year roadmap toward abundance.

Social Media In partnership with the UN Foundation’s +SocialGood network of social media influencers in 145 countries, the Global Action Platform shares ideas and presentations for a global audience through live stream broadcast of major events and a broad set of social media communications, blogs, and sharing through other media platforms in order to reach a large audience around the world.

Video Library The Global Action Platform is building a library of video presentations from its Summit and other events, featuring leading global experts addressing critical issues facing the world in food, health, and prosperity. ■

AcknowledgmentS

We gratefully acknowledge the dedication and work of over 250 partners and colleagues throughout the world who have generously assisted to create the growth and opportunities for of the Global Action Platform over the past four years.

We look forward to your continued involvement and support in 2015 and beyond.

If you or your organization would like to become involved in any of our initiatives in food, health, and prosperity, and the roadmap to create abundance through innovation, we welcome you to contact us.

The Global Action Platform presents opportunities for global brand placement and leadership participation, reaching elite target markets and audiences through an integrated series of annual programs and sponsorship opportunities: ■ ■ ■ ■ ■ ■

Global Action Summit – Nashville Summit Fellows Program Global Action Report Global Food and Health Innovation Challenge Media Outreach – publications, videos, and social media Premium Events throughout the year

Contact: CumberlandCenter GLOBAL ACTION PLATFORM Mailing Address: oneC1TY 6 City Boulevard Nashville, TN 37209 +1(877) 300-5806 (main) www.GlobalActionPlatform.org

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SPONSORS Thank you! lead institutional Partner

DIAMOND SponsorS

GOLD SponsorS

SILVER SponsorS

BRONZE SPONSORS

GLOBAL media partner

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social media partner

We thank our sponsors for their generous support of the Global Action Summit and the Global Action Platform:

GOLD SponsorS

SILVER SponsorS

BRONZE SPONSORS

Business media partner

TECHNOLOGY PARTNER

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collaboration | innovation | technology | you

nashville

a Cambridge mindful living community

oneC1TY is a collection of diverse places designed as a catalyst for mindful, healthy living and a fully integrated extension of Nashville’s urban fabric.

1

The WATERSHED Water quality gardens double as a series of outdoor rooms for great minds to steep and chance meetings to change our world.

2

The LOOP The urban, modern lane brings together office + residential uses to create, collaborate and cohabitate.

3

The YARD A community lawn and stage anchor this multipurpose gathering place surrounded by Nashville’s finest outdoor dinning experience.

oneC1TY captures advancements in the human experience that result from collaborations in healthcare, information technology, scientific research, entrepreneurship and a mindful development philosophy. These synergies are woven into the public spaces and the built environment that comprise oneC1TY.

GLOBAL THOUGHT driving innovation through collaboration

LOCAL IMPACT reflecting Nashville’s investments in health, culture and our unique urban fabric

PERSONAL HEALTH leveraging the opportunity to be students of mindful living and improve human performance

4

COMMUNITY TABLE Anchored by healthy eating, local food is the main focus for this teaching and dinning experience. Nothing brings a community together like food (and music).

5

C1TY AVENUE oneC1TY’s high touch pedestrian shopping experience brings together the best local + national retailers that embody our quest for a high quality of life.

6

C1TY BLVD This lush boulevard is not only the collector for everyday traffic, but also the poster child for sustainable living.

THE GLOBAL ACTION PLATFORM IS PROUD TO SUPPORT THE LAUNCH OF THE 2015 SUSTAINABLE DEVELOPMENT GOALS