INTELLIGENT DIALOGUE:

&
CRADLE
GRAVE

FALL 2008 Many Minds. Singular Results.

Cover photo: Creative Commons/pdam2

Many Minds.
Singular Results.
MESSAGE FROM THE CEO
“SOMEONE ALIVE TODAY will live to the ripe old
age of 150.” Agree or disagree? Two professors have
wagered $150 on this very question. No matter which
side you’re on, there’s no arguing that fundamental
shifts in health trends have us all rethinking long-held
beliefs about life and death. In our latest Intelligent
Dialogue white paper, “Cradle & Grave,” Porter Novelli
has examined emerging global trends in fertility and birth, health and death
that have profound implications for businesses, organizations and consumers
far beyond the health care industry.

Gaining a better understanding of these complex health issues means

getting out of your comfort zone. It means leaving behind preconceived notions
of the “right” age for a first-time mother. It means facing your own mortality
and examining whether you really want to live to be a centenarian, and then
honestly asking yourself, “Am I making the choices today that will allow me to
live 100 years?”

To prepare this paper, our health care industry specialists joined with our
public affairs, corporate affairs and marketing professionals to consider what’s
changing across the full arc of life, from conception to death. “Cradle & Grave”
identifies key trends in fertility, birth, health care advances, disease
prevention and treatment, aging and dying. The paper examines how families
(and populations) are changing, and how evolving health challenges like
diseases of affluence and the obesity crisis will affect modern society. It raises
questions about the advent of personalized drug therapies, the promise of
longer life expectancy and the threats posed by swelling ranks of elderly and
chronically ill people.

While some of the trends discussed in “Cradle & Grave” might not be news,
integrating the full scope of them into our lives and businesses is a
monumental challenge. This paper is intended to help map out the big picture
and prompt discussion.

At Porter Novelli, we believe ours is a learning culture, and that ongoing

dialogue is key. We challenge assumptions and cultivate creative questions,
and we invite you to join the dialogue by checking out our blog,
PNIntelligentDialogue.com. It’s your forum for discussing the issues raised in
“Cradle & Grave,” and for proposing your own questions.
Our goal with the Intelligent Dialogue series is to provide perspective and
stimulate conversation. This is an opportunity for individuals and organizations
to demonstrate thought leadership on issues that affect all of us.

—GARY STOCKMAN
TH E PRE S E NT SCREAM S
FOR ATTE NTION

AN D TH E FUTU RE WH I S PE RS .

No wonder more people than ever are falling

into the old trap of overestimating
Photo: Creative Commons/jonner

short-term change and

underestimating
long-term change.

4 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.

 INTRODUCTION

IN THE CURRENT FRENZY of financial uncertainty, fast- most productive when it’s open and inquisitive. In particular,
talking pundits and finger-pointing politicians, can anyone afford this edition is driven by three overarching questions:
to think more than a year or so into the future?
1. What about life and death has changed?
Nobody knows what may happen between now and next
year in the economy, politics or technology, let alone other parts 2. Which long-standing assumptions about life and
of life. Thoughts about the longer term are crowded out by death no longer hold true?
urgent news of breakthroughs and breakdowns pumped out by
the media 24/7. 3. What are the emerging risks and opportunities
Businesses and consumers are so busy putting out the fires in for societies, businesses and consumers?
front of them, they are unable to focus on what’s further ahead.
With our background in social marketing, Porter Novelli
The present screams for attention and the future whispers. No
believes that now more than ever, when it comes to the life-and-
wonder more people than ever are falling into the old trap of
death issues covered in this paper, our communities need smart
overestimating short-term change and underestimating long-term
leadership through Intelligent Influence. During this period of
change. This paper is intended to shift the focus and look at
Photo: Creative Commons/A.M. Kuchling

worldwide financial change, we will be helping our clients take

some of the long-term changes slowly but surely reshaping the
most important things in our world: literally the basics of our
life as we know it. They’re gradual changes that we can all see
and feel but are too busy and too distracted to notice; they’re
eclipsed by breaking news or hot gossip.
In keeping with our guiding principles, this edition of
Intelligent Dialogue is driven by observation and open-ended
curiosity. It raises a lot of questions, because we find dialogue is
the long view and keep their sights on these critical health issues
as they make decisions on how they will move forward. This is
an ideal moment to foster serious consideration of the bigger
health issues that affect everyone. For smart businesses and
brands in particular, life and death issues create opportunities to
provide the leadership employees and consumers need—
opportunities that enhance both their reputation and their
bottom line.

Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 5

BIG QUESTION 1
WHAT’S HAPPENING
TO NUCLEAR FAMILIES?
TO HAVE KIDS or not? Now or later?
How many? What will it cost? It used to
be that babies were the result of “doing
what comes naturally.” But now, having
children isn’t inevitable, it’s a matter of
choice. It’s a complex decision,
and in the 21st century, deciding
to become a parent involves
considerations unknown to
previous generations.
Though recent figures from
the U.S. National Center for
Health Statistics show a record
number of babies born in the
U.S. in 2007, birthrates are
trending downward worldwide.
The more prosperous people become,
the fewer children they have. More years
of education, higher quality-of-life
expectations, better career opportunities
6 INTELLIGENT DIALOGUE: CRADLE & GRAVE
and effective contraception make for
smaller families.
In the developed world, births in many
countries are below an average of 2.1 per
woman, which is the crucial “replacement
rate,” or number needed
to maintain a population
at a stable level. When
fertility rates are below
2.1, the population
shrinks. This is a radical
change from what has
happened throughout
most of history, when
populations of prosperous
cultures continually
expanded. Today, with its recent baby
boomlet, the United States is running at
replacement rate, but the European Union
(EU) falls well below that, with a birthrate
of 1.5, as do developed countries such as
Russia (1.4), Japan (1.22) and Singapore
Photos (from top): Creative Commons/paristempo, Creative Commons/ShutterCat7
(1.08), and newly developing countries
like China (1.77), Thailand (1.64) and
South Korea (1.29).
In all sorts of ways, traditional
expectations of childbearing and family
relationships no longer apply.
> WHY ARE WOMEN
WAITING TO HAVE
CHILDREN? It used to be that
people married in their late teens or early
20s, had children and moved into a
grandparent role by middle age. Now,
growing numbers of people are starting
this cycle much later, or they’re skipping
over the marriage step, or they’re
choosing to become single parents; some
Many Minds. Singular Results.

are starting new families as they move on
to second marriages, and some are
marrying relatively late and adopting.
The average age for first marriages has
crept up, and it’s not surprising. Younger
women are too absorbed in education and
careers to focus on serious dating, and they
tend to be financially self-sufficient. The
women depicted in “Sex and the City” may
have been TV-land creations but they
struck a chord all over the world as women
who enjoyed their independence and were
Photos (clockwise from top): Creative Commons/SilentObserver, Creative Commons/Mahalie, Creative Commons/miss pupik
necessarily mean it’s baby time. Women THE COST OF FERTILITY
may still be reluctant to take time out for
a child, either because they are unwilling
to sacrifice career goals or because they { MILLION
don’t feel financially prepared. Or the
delay may be beyond their control if they
DOLLAR BABY }
are having trouble conceiving.
The statistics tell the story of delayed
motherhood but Hollywood brings it to
life, writ large in the personal lives of
celebrities: Madonna famously gave birth
to her first child at 38 (fathered by a
boyfriend); her second at 41 (father was
second husband Guy Ritchie); and
then adopted a child at 49. “Desperate
Housewives” star Marcia Cross celebrated
her first marriage at 44, then gave birth
to twins less than a year later. Actress
Nicole Kidman recently gave birth to her
first child with second husband Keith
Urban at 41, having previously adopted
two children in her 20s with first husband
Tom Cruise. And several stars chose to
be adoptive single moms despite their
busy careers—actress Angelina Jolie, In the U.K., child psychiatrist
singer Sheryl Crow and actress Mary-
Louise Parker. Patricia Rashbrook made headlines

taking their time in finding a long-term
partner until well into their late 30s or 40s.
Why should women hurry to have
children when modern life is giving them
plenty of reasons and ample means to have
them in their own good time—or not at all?
Even settling with a steady partner doesn’t
> HOW OLD IS
TOO OLD TO HAVE A
BABY? Data across the EU and the
U.S. show the average age of first-time
mothers is rising. More women at the
in 2006 when she gave birth at age
62; she already had three grown
children from a previous marriage.
She and her husband had spent
$20,000 on fertility treatments with
Italian embryologist and fertility
specialist Dr. Severino Antinori, who
has become a controversial (and
wealthy) celebrity in the field.

According to the American Society

of Reproductive Medicine, the
average cost of an IVF cycle in the
U.S. is $12,400. Would-be parents
may try it two or three times,
although IVF is not successful for a
significant percentage of women. In
Europe the average cost is
estimated at $4,000 to $6,000.

Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 7

 IVF TURNS 30
{ ONE PLUS ONE EQUALS ME
The world’s first test tube baby, Louise Brown, has just turned 30, and the IVF (in
vitro fertilization) technique used to make her birth possible has spawned an industry
now worth $3 billion in the United States alone. The process used at the time has
been superseded by ICSI (intracytoplasmic sperm injection), where a single sperm is
injected directly into an egg.
upper range of childbearing ability are
becoming mothers.
The average age of EU women giving
birth to their first child rose from 23 to 25
between 1990 and 2002. In the bigger
countries, first-timers were older than
that: 28 in France (as of 2001)
and 29 in Germany (2003).
According to the U.K.’s
Office for National Statistics,
more of Britain’s first-time
mothers now fall in the 30 to 34 age
group than in the 25 to 29 age group;
and there has been an almost 50 percent
increase from 10 years ago in women over
40 having babies. In the U.S., the most
recent census figures show the average age at
an all-time high of 25.2, with more than
100,000 births in 2003 to women 40 or older.
Fertility treatments and improved health
care are certainly pushing up the age at
which it’s possible to have children.
However, “possible” is not the same as
probable, advisable or desirable.
8 INTELLIGENT DIALOGUE: CRADLE & GRAVE
}
Professor Bill Ledger of England’s
Sheffield University is one of the fertility
specialists warning that obesity and
sexually transmitted diseases are causing a
growing number of fertility problems.
Currently, one in seven couples has
trouble conceiving naturally, and Ledger
warns this could rise to one in three.
He advises couples to start trying to
conceive younger than 35.
Older parenthood is not just a
female issue; men have their own
fertility problems. There is clear
evidence that sperm quality
deteriorates with age and around
a quarter of men of reproductive
age are subfertile (they produce
sperm but not at maximum
fertility). There are indications that male
fertility is decreasing due to several
possible causes, notably stress, weight
issues and diabetes. Researchers are
looking into other possible causes such as
electromagnetic radiation from cell phones
and “gender bending” (endocrine-
disrupting) chemicals in the environment.
> WHAT ARE THE
FINANCIAL ISSUES OF
OLDER PARENTHOOD?
First-time parents who are older than the
“traditional” age tend to do a lot of soul-
searching. Whether their later parenthood
is deliberate, or due to circumstances such
as marriage or fertility problems, they are
more likely to feel the need to rationalize
and justify their situation to themselves
and/or to others. The Internet is proving
to be an ideal medium for them to
compare notes and examine the issues.
Photos (clockwise from top): Creative Commons/moyix, Creative Commons/salimfadhley, Creative Commons/paristempo
One clear advantage of older new
parents is financial stability—a factor that
seems to be widely accepted and valued in
discussions on the issue. Parents in their 30s
and 40s tend to be educated and established
in the workplace. They’re more likely than
younger parents to have achieved a certain
standard of living, along with higher
expectations of service, comfort and quality.
Older prospective parents may have to
be prepared to invest significant amounts
of money and time in fertility treatments
or adoption.
On the other hand, these parents may
find themselves needing to fund their
children’s teenage pursuits and college
education at a time when their peers are
beginning to draw pensions. As AARP the
Magazine put it: “Midlife parents face
another challenge: how to stay financially
healthy as well [as physically healthy].
Many may find themselves working well
beyond the traditional retirement age just
so they can send their kids to college.”
Current assumptions about maternity-
planning patterns and family structures are
increasingly out of step with reality.
Many Minds. Singular Results.
 TH E MORE PROS PE ROU S
PEOPLE B ECOM E, TH E FEWE R CH I LDRE N

TH EY HAVE. MORE YEARS OF E DUCATION, higher

quality-of-life expectations, better career opportunities and

effective contraception make for smaller families.

Photo: Creative Commons/jonner

Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 9

 SURROGACY IN INDIA

{ CARRYING THE WEIGHT OF THE WORLD }

Thanks to globalization, India has emerged as an option for surrogacy. Centers are
springing up in which local women carry the babies of Westerners who don’t want to pay
the high costs generally associated with such a proposition in their home countries.

India’s sophisticated medical capabilities and low costs make outsourced surrogacy a
viable industry, but one that’s prompting outrage from critics who charge that it exploits
poor people and is a crass commercialization of an intimate matter. Dr. Nayna Patel, who
works at a surrogacy clinic in Anand, India, defends the practice as a win-win
arrangement, telling the Associated Press, “There is a woman who desperately needs a
baby and cannot have her own child without the help of a surrogate. At the other end there is a woman who badly
wants to help her [own] family. If this female wants to help the other one, why not allow that? It’s not for any bad
cause. They’re helping one another to have a new life in this world.”

Can employers afford to have valuable,

talented staff absorbed in a baby chase?
What are the opportunities for businesses
to offer fertility counseling and assistance
as part of occupational health care, in
order to attract and retain top-notch mid-
> WHAT’S WRONG
WITH GETTING A SNEAK
PEEK? Fertility treatments and
prenatal screening have given would-be
parents the option of knowing the sex of
frustration through violence, crime and
political extremism, and that rising
demand for sex workers could fuel the
practice of human trafficking and the
spread of HIV/AIDS.
Although prenatal gender screening

to-senior level professionals?
Are employers that foster a maternity-
friendly, postpartum-friendly, family-
friendly culture getting ahead of the curve
in recruitment, retention and reputation?
Or are they merely picking up the tab for
more ruthless, lean-and-mean competitors?
The biological limitations of parenthood
have changed, and so have the social
limitations. Parents no longer need to be
in a traditional couple—some are single
women, others are same-sex couples.
There’s a greater willingness to talk
about fertility problems and options.
Still, there’s a risk of social backlash when
people opt for non-traditional choices.
For businesses, how tightly they want to
embrace non-traditional choices is not just
a matter of inner-focused company policy—
it’s a part of brand positioning and identity.
Photos (clockwise from top): Creative Commons/jenaynay, Creative Commons/Michael_Chavarria, Creative Commons/The LeCrones
their baby before it’s born. In some involves the relatively simple technology
cultures where males have a higher status of ultrasound, its wider social effects are
than women (such as India and China), proving to be far-reaching. The effects
this has resulted in a dangerously skewed of more sophisticated genetic-based
gender balance. prenatal screening are likely to be even
In China, the one-child policy has meant more radical.
that many parents aren’t willing to let
nature take its course. China will have 30
million more men of marriageable age
than women in the next decade and a half.
The ratio for newborn babies in 2005
was 118 boys vs. 100 girls, up from
110/100 in 2000. In some regions the
ratio is as high as 130/100, compared
with an average of between 104 and
107 boys for every 100 girls in
industrialized countries.
In 1994, the Indian government banned
medical practitioners from revealing the
gender results of fetal scans. Yet the
gender imbalance has only further
tipped. In 1991 there were 945
women for every 1,000 men, and
the gap widened to 927/1,000
by 2001.
These unintended
consequences of simple
screening are likely to be
felt for decades to come.
There are concerns that
millions of restless young
men could vent their

10 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.

 WHY S HOU LD

WOM E N H U RRY TO

HAVE CH I LDRE N…

WH E N MODE RN LI FE is giving them plenty of reasons and

Photo: Creative Commons/wilf2

ample means to have them in their own good time—or not at all?

Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 11

BIG QUESTION 2
WHAT’S THE BEST WAY
TO DELIVER BABIES?
CHILDBIRTH IS AN EXPERIENCE
traditionally surrounded by folklore and
mystery. Historically it has been one of the
riskiest moments in life. It still is. And
while medical science has helped alleviate
the risk and pain involved, there are still
major open issues.
> IS A HOSPITAL
BIRTH THE ONLY SAFE
OPTION? There’s a growing
tendency for developed countries to treat
pregnancy and childbirth as medical
issues, requiring highly sophisticated
medical care and hospitalization. For a
long time this trend was accepted by
parents-to-be and the wider society as
“doctor knows best” and “this is the way
12 INTELLIGENT DIALOGUE: CRADLE & GRAVE
it happens.” But in fact, it doesn’t happen
the same everywhere.
Now, as in other parts of medicine,
globalization has enabled interested parties
to compare practices in terms of medical
outcome as well as emotional outcome and
cost. This has encouraged challenges to
the highly medicalized approach to
pregnancy and childbirth that is at its most
pronounced in the United States.
In the U.S., home births account for just
1 percent of deliveries, and the American
College of Obstetricians and Gynecologists
has repeatedly stated its opposition to home
births, emphasizing that “the safest setting
for labor, delivery and the immediate
postpartum period is in the hospital, or a
birthing center within a hospital complex.”
How much of this is due to the
precautionary principle, with the fear of
malpractice suits informing medical
procedures? How much is due to the
medical profession seeking business
opportunities? How much is due to the
“mission creep” of technology, as implied
in the polemical 2007 movie “The Business
of Being Born”?
Photo: Creative Commons/premus
> WHO REALLY WANTS
BIRTH BY CESAREAN
SECTION? One of the most hotly
contested issues is the trend to deliver
babies by cesarean section. Although it’s
still a serious surgical procedure, it’s no
longer a last-resort rarity.
Many Minds. Singular Results.
 CE SAREAN S ECTION

HAS B ECOM E SO NORMAL

THAT I N SOM E I N STANCE S, IT I S

REGARDE D AS

A WAY OF

S LOTTI NG

CH I LDB I RTH

B U SY SCH E DU LE .
Photo: Creative Commons/wilf2

I NTO A

Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 13

 In the United States, figures for 2007
are expected to show around one in three
births by cesarean, compared with fewer
than one in 20 in 1965. Cesareans are
increasingly common in Canada too, even
though the health system is significantly
different: 26.3 percent of women
delivered by cesarean in 2005–2006, up
from 23 percent in 2001–2002. In the
U.K., cesarean sections are also
increasing and currently stand at around
20 percent.
According to a survey of American
women conducted on behalf of the U.S.
nonprofit Childbirth Connection, 98
percent of women with primary (planned)
cesareans believed there was a medical
reason for the surgery. The most common
concerns cited were fetal distress, position
of baby, size of baby and prolonged labor.
However, 42 percent of respondents also
felt that due to fear of lawsuits, the
current health care system leads to
unnecessary cesareans.
As childbirth becomes a less frequent
occurrence in developed societies, will each
pregnancy and birth become more
expensive? Will the medical profession
become ever-more intensively involved?
Childbirth has become a lot less risky
than it used to be in many parts of the
world. But is the complete medicalization
of childbirth in the best interest of all
concerned? Are health care and insurance
providers missing an opportunity to offer
alternatives that cost less and satisfy more?

IN-HOME DELIVERY

{ SHOULD WE ALL BE GOING DUTCH? }

Among major developed countries, childbirth in the Netherlands is an anomaly. In fact, the attitude of the Dutch
toward childbirth has been called medieval. Pain is regarded as a normal part of childbirth, and pain relief is the
exception rather than the rule. Indeed, unless there are medical complications, maternity care is a determinedly low-
tech affair left in the hands of midwives; a home birth is the default choice. The rate for cesarean sections is less
than 10 percent, which is significantly out of line with the modern trend. Likewise, few countries have the
Photo: Creative Commons/eyeliam

equivalent of the kraamzorg, a program in which a maternity nurse provides after-birth care in the home for a week.
It’s standard after all births in the Netherlands and is on the policy list of Britain’s Conservative Party.
However, the Dutch example may not be so easy for other countries to emulate. In the small, densely populated
Netherlands, most homes are within 10 to 15 minutes of a hospital. If an in-home delivery suddenly turns difficult,
medical facilities are within easy reach.

14 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.

 BIG QUESTION 3
WHAT NEW
HEALTH THREATS
MUST BE DEFEATED,
AND HOW?
PEOPLE ARE ALREADY experiencing
longer, healthier lives than ever before
and there’s the prospect of more good
Photo: Creative Commons/Andrew Ciscel
news to come. But that doesn’t mean it’s
all smooth sailing from here on. For one
thing, microorganisms (bacteria, viruses,
etc.) have a way of evolving to exploit
new opportunities, which could trigger a
major pandemic. For another thing, we
are facing diseases arising from new
lifestyles and from living older.
Many Minds. Singular Results.
> ARE THE MAJOR
CONTAGIOUS DISEASES
GONE FOR GOOD? Time
was when contagious diseases were the
big killers: plague, smallpox, cholera, etc.
Thanks to public sanitation, hygiene,
vaccination and antibiotics, their impact
has been hugely reduced. But they have
not been completely eliminated, and they
still hold some nasty surprises.
INTELLIGENT DIALOGUE: CRADLE & GRAVE 15
HIV/AIDS and the virulent staph
infection MRSA are relatively new to the
roster of communicable diseases. One
third of the world’s population is infected
with the bacteria that causes tuberculosis.
Meningitis continues to lurk and malaria
may yet spread further as global warming
makes temperate zones more congenial for
mosquitoes. Meanwhile, health authorities
are keeping an eye out for the likes of
SARS and avian flu, and whatever might
yet emerge from tropical jungles.
 E A R LY P R E V E N T I O N F O R A H E A LT H Y F U T U R E

{ WHAT A GIRL WANTS }

According to the U.S. Centers for Disease Control and Prevention, the
vaccine Gardasil® prevents
the types of genital human
papillomavirus (HPV) that
cause most cases of cervical cancer and genital warts. The vaccine is given in
three shots over six months and is routinely recommended for 11- and 12-year-old girls. It is also recommended for
girls and women ages 13 through 26 who have not yet been vaccinated or completed the vaccine series.

Communicable-disease specialists warn that of Montpellier in France. The systematic

there’s a strong chance of more superbugs;
microbes and even cancers are developing
immunity to the drugs that have been used
against them.
HIV/AIDS is typical of what health
professionals fear from cunning superbugs.
By the time the Centers for Disease Control
and Prevention (CDC) in the U.S.
recognized HIV/AIDS as a distinct
syndrome in 1981, it was already on its
way to becoming a devastating epidemic.
According to a 2006 report from the United
Nations Joint Program on HIV/AIDS, over
the last quarter-century, nearly 65 million
people were infected with HIV and an
monitoring of bush-meat hunters may also
help prevent future AIDS-like epidemics.
Although communicable diseases are not
killing huge numbers of people in the old
familiar ways—sickness, fever, swelling and
pain within weeks or months—they may be
wreaking havoc over a longer period,
working in the background. Some viruses
can cause changes in cells that may lead to
cancer. There are clear links between
cervical cancer and the genital wart virus from behaviors or environments of wealthier
HPV, between primary liver cancer and societies. This is uncharted territory in
the hepatitis B virus, and between various human history and raises new challenges.
cancers and the Epstein-Barr virus.
We are seeking medication to tackle the

estimated 25 million have died of AIDS-
related illnesses. About 33 million—almost
half are women—live with HIV today, the
vast majority unaware of their status.
Scientists are looking for ways to spot
other emerging diseases before they
become equally—if not more—devastating.
About three-quarters of emerging human
diseases are “zoonoses,” or pathogens that,
like HIV/AIDS, originate in animals and
cross into human populations. A number
of projects are focused on gathering front-
line blood samples across equatorial
jungles, watching for changes in behavior
and mortality, and coordinating findings
through specialists such as the CDC and
the virology laboratory at the University
Fortunately medical science evolves fast
too and a range of new vaccines such as
Gardasil has been introduced in recent
years that seem to be effective at reducing
the incidence of such cancers.
Many of the major historical advances
in disease control and life expectancy have
come from preventing diseases rather than
curing them. Vaccination, sanitation,
education and nutrition have together
done more to save lives from disease than
have feats of medical wizardry as seen in
“ER” and “House.”
The specific illnesses have changed but
the principle holds; cures are needed but
prevention will continue to be the most
effective and the most cost-effective
strategy.
> WHAT ARE THE
PROSPECTS FOR
TREATING CHRONIC
AND TERMINAL
CONDITIONS? People in
developed countries are much less apt to
die from contagious diseases anymore.
Rather, they tend to succumb to old age or
to “diseases of affluence”—those stemming
Photos (clockwise from top): Creative Commons/Mel B., Creative Commons/Jaye_Elle, Creative Commons/Andy McLeod
effects of too little physical activity and too
much food; we are expecting cures for
diseases that were barely encountered a
century ago. And they can’t be found soon
enough. By some accounts, half the
American population is living with some
form of chronic illness.
Diabetes is a case in point. About 124
million people worldwide had diabetes in
1997, compared with a projected 221
million by 2010. The rate is rising in
parallel with obesity, a major cause of type
2 diabetes; the coupling of a severe weight
problem with type 2 diabetes is being
referred to as “diabesity.”
While death from heart disease in the
U.S. has fallen by 26 percent and death
from stroke by 24 percent since 1999, they
are still the first and third causes of death,
respectively. And the American Heart
Association has warned that the
improvement could be short-lived if risk
factors aren’t reduced.
It’s not just the U.S. that’s grappling
with the big killers. The World Health
Organization reports that cardiovascular
disease is the top cause of death globally,
and it’s projected to remain so. An
estimated 17.5 million people died from

16 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.

 CH RON IC
TH E U PS I DE OF
DI S EAS E TREATM E NT
I S THAT PEOPLE ARE S U RVIVI NG
AN D EVE NTUALLY DYI NG
with the disease rather than from it.
The downside is that it can be
expensive and debilitating to live
life on the tightrope of
daily disease management.
Photo: Creative Commons/Jimee, Jackie, Tom & Asha

Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 17


cardiovascular disease and strokes in 2005,
accounting for 30 percent of global deaths.
In 2003, the World Health
Organization’s “World Cancer Report”
forecast an increase in cancer from 10
million new cases globally in 2000 to 15
million by 2020, mainly due to steadily
aging populations in both developed and
developing countries, as well as rising
trends in smoking and the growing
adoption of unhealthy lifestyles. The
report says cancer poses major challenges
for health care systems worldwide, but that
it can be prevented and its impact reduced
18 INTELLIGENT DIALOGUE: CRADLE & GRAVE
through basic research and improvements developing, heavily populated regions such
in treatment and care. as China, India and Latin America.
The longer people live, the more likely it Like battlefield weapons designed to
is they will experience any one of about 80 wound rather than kill, the chronic
autoimmune disorders that can make life illnesses of today can be more devastating
miserable. These disorders involve the than acute, sudden-death conditions.
immune system mistakenly attacking and People suffering from chronic disease over
destroying healthy body tissue—“friendly fire,” several years represent major costs, both
so to speak. Well-known conditions include: financially and emotionally.
type 1 diabetes, thyroiditis, pernicious anemia,
The prospect of many millions more
rheumatoid arthritis, lupus, multiple sclerosis
people suffering from chronic illnesses and
and Graves’ disease. According to the
millions having to look after them is a real
American Autoimmune Related Diseases
and unprecedented threat likely to eclipse
Association, it’s estimated that
the dangers of terrorists and road traffic
approximately 50 million Americans suffer
accidents and violent criminals combined.
from an autoimmune disease.
How can governments, insurers and
Degenerative conditions are another individuals be adequately prepared for it?
prospect, especially dementia—the umbrella
name for progressive degenerative brain
syndromes that affect memory, thinking,
behavior and emotion.
Alzheimer’s disease is the most common
form of dementia. According to Johns
Hopkins researchers, an estimated 26.6
million people worldwide suffer from
Alzheimer’s, a number that’s forecast to
rise to more than 106.8 million by 2050.
Much of this increase will be in rapidly
Photos (clockwise from top): Creative Commons/Subewl, Creative Commons/Sam Blackman, Creative Commons/brykmantra
Many Minds. Singular Results.
 U P TO TH E AG E OF 65,

DE M E NTIA
DEVE LOPS I N ABOUT ON E PE RSON I N 1,000.

Its incidence rises sharply with

age to one person in 20 over age
65. The big threat is to people over
the age of 80, when the incidence of
dementia increases to one in five.
That’s riskier than the one in six of
Russian roulette.
Photo: Creative Commons/lanuiop

Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 19

> IS OBESITY THE
NEXT FRONTIER? Obesity
and its complications will cause the
untimely deaths of hundreds of thousands
of people every year for the foreseeable
future. In 2006, U.S. Surgeon General
Richard Carmona called obesity “the
terror within” and warned that, “Unless
we do something about it, the magnitude
of the dilemma will dwarf 9/11 or any
other terrorist attempt.” Are such dire
proclamations just the nanny state at
work? After all, if obesity is such a big
threat, why are people living longer?
There’s no getting around the health
implications of extra pounds. According to
U.K. private hospital group BMI, obesity
THE OBESITY EPIDEMIC
(defined as a body mass index
greater than 30) increases the
of public and private
concerns, ranging
risks of developing diabetes, from governments
high blood pressure, angina, to nonprofits to
heart attacks, high the food industry.
cholesterol, urinary Perhaps a faster,
incontinence, infertility, fail-safe solution
osteoarthritis, asthma, sleep will come from
apnea and cancer. science.
These illnesses represent A lot of people
huge costs in terms of human are aiming for a
suffering, not to mention medical “cure” for obesity—
and insurance costs as well as lost miracle foods, pills,
productivity and earnings. Obesity is set injections, surgery, gene therapy
to become the most critical health issue and more. Whoever comes up with a safe and
shaping life and death in the first half of effective treatment that fulfills the classic
the 21st century. Turning the tide will marketing imperatives—quick, easy, convenient,
require the commitment and collaboration affordable—will be sitting on a goldmine.
Might microbes come to the rescue?
Researchers at the EU’s Metagenomics of

{ NO ROOM TO GROW } the Human Intestinal Tract project

(MetaHIT) have found a sharp contrast in
the bacteria population in the guts of
overweight and thin people. And when
heavy people dieted and lost up to a
quarter of their body weight, their gut flora
changed too, becoming more like those of
the lean group. So it may be that certain
types of probiotics can help reduce weight.
Might genetics solve the problem? In
2007, scientists analyzing a large-scale
study of diabetics found a correlation
between the FTO gene and obesity.
Researchers at Cambridge University in
the U.K. have discovered that the gene
codes for an enzyme that modifies DNA
could be activated or inhibited by
pharmaceuticals. This opens the prospect
of drug therapies for obesity.
For the moment, many people are pinning
their hopes on surgery. Restrictive surgery
covers procedures that make the stomach
smaller, so that the patient eats less.

Photo: Creative Commons/gotplaid?. Creative Commons/memekode

World Health Organization figures for 2005 show that approximately 1.6 Malabsorptive surgery changes the body’s
billion adults worldwide were overweight and 400 million were obese; the ability to absorb calories from food. The
two most commonly performed operations
WHO forecasts as many as 2.3 billion overweight adults in the world by are laparoscopic adjustable gastric banding
2015, more than 700 million of whom will be obese. (LAGB), also known as lap banding or
gastric banding, and gastric bypass.
Just how much have our waistlines expanded over the decades? In 1951, Weight problems are no longer simply
aesthetic issues; they represent a major
a survey found that the average British woman’s waist measured 27.5
threat to public health, although public
inches. By contrast, the U.K.’s 2004 National Sizing Survey (SizeUK) found perception of the real threat is far short
of reality.
that the average waist had increased to 34 inches. While there was no
comparative data for men in 1951, the SizeUK data found an average male What will it take for obesity to be
treated seriously as a modern medical
waist of 37 inches in 2004. condition with major public health

20 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.

 TH E FOOD AN D DRI N KS
I N DU STRI E S
HAVEG ROWN
TH E I R MARKETS
S PECTACU LARLY.
While they may not be blamed for
consumers’ obesity, they are clearly
a crucial part of the problem.
How can the health of
these industries align more
effectively with the interests
of public health?
Photo: Creative Commons/moyix

Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 21

ACCORDI NG TO TH E
MAYO CLI N IC, EACH YEAR
AN E STI MATE D

100,000
AM E RICAN S DI E
from adverse reactions to medications and
more than 2 million are hospitalized.

Photo: Creative Commons/subewl

22 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.

 implications rather than as a lifestyle issue?
The risk is that the cumulative effects of
obesity will overwhelm the capacity of
communities to deal with the financial and
health care consequences.
> WHEN WILL CURES
BECOME LESS LIFE-
THREATENING? For all the
amazing progress in pharmaceuticals,
prescribing drugs is still hit-or-miss. Drugs
have been developed to deal with
conditions, not individuals; they take a
one-size-fits-all approach that can’t account
for individual body chemistry. Patients
may be subjected to a range of treatments
Photos (clockwise from top): Creative Commons/SMercury98, Creative Commons/MASH DnArt, Creative Commons/jurvetson
Many Minds. Singular Results.
before doctors find one that more focused therapy, greater
works. emphasis on preventive
medicine and cost
In the meantime the
reduction. The PMC
side effects of this
also believes when
trial-and-error process
used in research,
can be distressing for
pharmacogenomics
patients and risky
could reduce the
for their health, not
length, cost and failure
to mention a serious
rate of clinical trials, and
waste of health care
even revive drugs that
resources.
failed clinical trials or were
To reduce the potluck withdrawn from the market.
element of drugs, health care
A lot depends on technology
professionals are looking to
being developed to read (or
personalized medicine, or
“sequence”) genes fast and affordably. In
pharmacogenomics. With this approach,
before medication is prescribed, genetic
the U.S., the National Institutes of Health
has set a goal for sequencing an entire
analysis will be carried out to check for
personal genome at a cost of just $1,000 by
relevant genetic variations—single
nucleotide polymorphisms, or SNPs. This
2014 (currently, one firm is charging
$350,000 to anyone who wants a complete
will enable doctors to better predict
personal genome sequencing). In a parallel
whether a drug will provoke an adverse
initiative, the X Prize Foundation in the
reaction or will be likely to do the job.
United States has put up a prize of $10
According to the Personalized Medicine million for the first private team that can
Coalition, this approach has the potential decode 100 complete human genomes
to offer benefits such as early detection, within 10 days for less than $10,000 each.
INTELLIGENT DIALOGUE: CRADLE & GRAVE 23
BIG QUESTION 4
HOW OLD DO WE
REALLY WANT TO BE?
HOW ABOUT LIVING FOREVER?
Mythology, legend, religion and popular
culture are full of quests to find ways of
beating the Grim Reaper: the fountain of
youth, the elixir of life, the philosopher’s stone.
But the human body hasn’t evolved to live
indefinitely; parts of it go wrong (including the
repair systems), and an accumulation of faults
eventually leads to one part of the system
failing, with fatal consequences.
> WHAT ARE THE
LIMITS OF LIFE
EXPECTANCY? Although
there are a few areas of the world where
life expectancy is still poor, in general it
has increased steadily. Globally, life
expectancy at birth was just 30 years in
1900; it had more than doubled, to 62, by
1985 and currently stands at around 64.
24 INTELLIGENT DIALOGUE: CRADLE & GRAVE
In most developed countries, life spans
have been steadily increasing for a long
time and look set to continue upward.
Consider that in 1850, life expectancy at
birth averaged just 38.3 years for
American Caucasian men and 40.5 years
for women; by 2004 it was 75.7 for men
and 80.8 for women. In the U.K., for
every million born alive in the 1880s, just
309,020 were still alive at 65 and only
161,164 at age 75; by the 1990s, a
majority could expect to reach both 65
(830,990) and 75 (612,740).
People are living longer largely because
they are staying well longer. They are now
in better shape as they age—one reason for
proclamations such as “50 is the new 30.”
And while it’s true that less healthy
lifestyles and the rise of obesity mean
many people are not in great condition,
they are less beset by infectious diseases
that damage and weaken the body. There
are fewer accidents and better treatments
for injuries such as fractures and lesions.
Better nutrition is more widely available,
helping bodies stay resilient.
The big imponderable is whether the
trend for gradually increasing life spans
can be projected indefinitely into the
future. What are the limits? Steve Austad,
a professor of cellular and structural
biology at the University of Texas, is
convinced that somebody alive today will
reach the age of 150. S. Jay Olshansky, an
epidemiology professor at the University
Photo: Creative Commons/jonner
of Illinois at Chicago, disagrees strongly.
They each wagered $150 on the question,
and Olshansky invested the money in a
fund. If a 150-year-old is alive in the year
2150—someone of sound mind and body—
Austad’s descendants will get the pot;
otherwise, Olshansky’s offspring will win.
Many Minds. Singular Results.
 > WHAT ROLES
CAN PHARMA
AND CORPORATIONS
PLAY IN FOSTERING
LONGER LIFE? Many factors
have come together to make longer life
spans possible. As the data accumulate and
research goes deeper, we are discovering
which other factors can be influenced to
extend enjoyable life even further.
One of the most impactful quick wins on
a global level is providing sleeping nets to
people at risk of malaria infection by
mosquitoes. According to the CDC, 41
percent of the world’s population lives in
areas where malaria is transmitted. Each
year, 350 to 500 million cases occur
worldwide, and more than 1 million people
die, most of them young children in sub-
Saharan Africa. The big issue: Who pays?
Another victory: statins, drugs that
reduce the amount of cholesterol produced
in the body, lowering the risk of heart
attack. Currently under debate is whether
statins will become available over the
counter in the U.S. (an OTC statin is
already available in the U.K.). The FDA
has repeatedly rejected Merck & Co.’s
applications to make Mevacor ® available
without prescription. Supporters argue that
selling statins over the counter could help
millions avoid heart attacks.
How about employers encouraging staff
Photos (from top): Creative Commons/Ed Yourdan, Creative Commons/Unhindered by Talent
to live more healthfully? Corporate
wellness has become something of a buzz
phrase, but skeptics may see the programs
as a trophy-spend to make big companies
feel good. Is there any hard evidence that
investing in wellness benefits the bottom
line? The questions are sharpest in the
United States, where medical costs can eat
up as much as half of a company’s profits.
And the indications are encouraging.
Many Minds. Singular Results.
ELDERS IN FINANCIAL CRISIS
{ POOR AND PROUD
According to the Wellness Council of
America, the results from effective
corporate wellness programs are
encouraging. At Michigan furniture
manufacturer Steelcase, the average
insurance cost for high-risk employees is
75 percent higher than it is for low-risk
employees; staff that followed the
company’s health promotion program and
lowered their risk factors cut their
insurance costs by an annual average of
$618. Other results outlined on the
Wellness Council’s Web site point in the
same direction:
• For DuPont, each dollar invested in
workplace health promotion has yielded
$1.42 over two years in lower
absenteeism costs.
• The Travelers Corporation reports a
$3.40 return for every dollar invested in
health promotion, yielding total
corporate savings of $146 million in
benefits costs. Sick leave was reduced by
19 percent during the four-year study.
• The Stay Alive & Well program at Las
Vegas–based Reynolds Electrical &
Engineering has cost about $76 per
employee during the two years it has
been in operation, while savings have
averaged almost $128 per participant.
Increasingly, businesses are seeing not
only a moral and reputational imperative for
fostering better health among employees,
INTELLIGENT DIALOGUE: CRADLE & GRAVE 25
}
There’s a significant risk that
people who run out of financial
resources in old age will be
comparable financially to maturing
teenagers, but in reverse and with
no “age of majority” in their future:
They’ll have the desire to
participate in society and a sense
of entitlement but—unlike teens—
increasingly less prospect of
independence.
but also a business case. This harks back
to the paternalistic business leaders of the
19th century such as William Hesketh
Lever, founder of Lever Brothers (now
part of Unilever). Is there a case for
wellness expertise becoming as much a
core business competence as financial
control and stock management?
> WHAT’S NOT TO
LIKE ABOUT LIVING
INTO THE TRIPLE
FIGURES? As conventional
wisdom has it, getting old is better than
the alternative. But up to what age does
that adage apply? What tips a long life
from being a blessing to being a burden?
As significant numbers of people live to
a ripe old age, what will happen to those—
the majority—who haven’t had the means
or the foresight to make their twilight
years comfortable?
It may well be that technology and
science have once again advanced far
faster than our moral and social capacity
to deal with the benefits they offer. If the
tragedy of times gone by was that too
many people died of relatively trivial
illnesses while they were still quite young,
with a lot to live for, it’s likely to be the
other way around in the future: People will
be able to survive serious illness, perhaps
long after they’ve lost the things that make
 A G ROWI NG N U M B E R OF
CHRONICALLY ILL AND
VE RY OLD
PEOPLE
I N WEALTHY COU NTRI E S
will need to be looked after at
home. It’s projected that by 2011,
two thirds of the workforce in
developed countries will be
caregivers part-time. What are the
prospects of full-time salary earners
being willing or able to become
part-timers, staying home to care for
Photo: Creative Commons/Isaac bowen

aging relatives?

26 INTELLIGENT DIALOGUE: CRADLE & GRAVE Many Minds. Singular Results.

 PLANNING FOR THE FUTURE

{ LUST FOR LIFE }

Loneliness and the loss of family and friends are part of the cost of
living longer. Few people have the financial means or the foresight to
plan as carefully as one Swedish advertising executive, who, in his
40s, found a top-quality nursing home overlooking the sea in a
beautiful location. He put his name on the long waiting list, set aside
money in an investment fund, and invited 100 of his friends to do the
same. “I hope I never have to go into a nursing home, but if I do, at
least there may be one or two people I know in there with me,“ he
explained.

life worth living: mobility, mental acuity,
social life and family.
As the baby boomers move beyond their
60s and start swelling the ranks of the
elderly, nursing homes, retirement homes,
health systems and government assistance
programs must be ready to meet the
challenge of looking after much larger
numbers of people—especially if many are
unable to pay for care.
In Japan, where the balance of old to
young is shifting faster than in most
countries, people are looking to
technological solutions. The Machine
Industry Memorial Foundation estimates
Photos (clockwise from top): Creative Commons/fredesorensen, Creative Commons/Tim & Selena Middleton
that Japan could save $21 billion in elderly
insurance payments in 2025 by using
robots to monitor the health of older
people rather than human nursing care.
In theory, the increase in older
consumers represents lucrative
opportunities for astute entrepreneurs:
equipment that can be used by less
dexterous hands, stylish apparel that
accommodates older body shapes, food
and beverages that help older consumers
stay nourished and entertainment that
stimulates them, not to mention all the
services they need. The big potential
obstacle is their financial resources: Will
enough of the elderly have money to
spend, or will this group be too cash-
strapped to comprise a worthwhile market?
Science and technology have given us
the means to extend life, but it’s beyond
their scope to provide the reasons or the
means to live longer lives.
Can businesses and organizations step in
to make those extra years a normal part of
life—a part that’s truly worth living?
Stacking supermarket shelves and acting as
museum guides are a reasonable start but
let’s hope they’re not the last word in
purposeful activities for older people.
How will business and government
recognize and meet the exponential needs for
affordable, good-quality eldercare options?

Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 27

BIG QUESTION 5
HOW IS MODERN
DEATH DIFFERENT?
SO MANY ASPECTS OF LIFE are
different from those in previous centuries.
It’s inconceivable that death hasn’t
changed too. And so it has in many
respects. It happens later. It’s more likely
to happen in a hospital or a care facility
than at home. It’s more likely to be a
lonely event. The mortal remains are far
more likely to be hefty than slight. And for
most people, death is now a far less visible
part of life.
28 INTELLIGENT DIALOGUE: CRADLE & GRAVE
Photos (clockwise from top): Creative Commons/tempophage, Creative Commons/orla_keating
> WHAT IF WE CAN
PLAN HOW WE’LL
DIE? Society has evolved with some
basic assumptions about how long people
live, and about work, families and
communities. Longer life spans and
growing numbers of older people
challenge those assumptions profoundly.
The biggest thing that will have to
change is the current tendency to put little
Many Minds. Singular Results.
 coherent, detailed preparation into the final
years of life. After all, who knows when the
end will come and what will cause it? Lack
of planning often results in unnecessary
expense, stress and distress for all involved.
It’s very likely that for most people the
last years of life will now involve more
care and more expense than they did for
previous generations. And whatever the
individual cases may be, there’s enough
data to know the final trajectories that
most people’s lives will take. Dr. Joanne
Lynn, a geriatrician at the Hastings Center,
an independent, nonprofit bioethics
research group, has identified the three
most common end-of-life scenarios, based
on extensive numerical data:
• The quickest is long years of active life
ending with several months of steep decline
and death; in the United States this is
typical of cancer deaths, which peak at age
65, and is the fate of around 20 percent of
Americans. This scenario typically requires
hospice support at the end.
• Those with long-term chronic illnesses
such as organ failure go through years of
gradually declining health with occasional
bouts of severe illness and require
consistent disease management. Eventually
one of the bouts of severe illness will cause
sudden death, which is the case for about
a quarter of Americans. Chronic heart
failure and emphysema are the most
common illnesses of this scenario, with
death peaking at around age 75.
• The third scenario is set to become the
most common: gradual long-term
the other hand, if handled properly, the
information may enable people to take
greater control and plan more appropriately.
> WHY SHOULD
DEATH BE A TABOO
SUBJECT? The billionaire
investor and philanthropist George Soros,
explaining his foundation’s Death in
America project, wrote: “In America, the
land of the perpetually young, growing
older is an embarrassment, and dying is a
failure. Death has replaced sex as the
taboo subject of our times. Only our
preoccupation with violence breaks
through this shroud of silence.”
In a world where so much hope and
effort and ingenuity go into creating life
and hanging on to it, dying can seem like
failure. It means no more second chances,
at least in the prevailing mind-set of the
developed world. Will this mind-set be
altered by the growing number of baby
boomers heading toward their final
curtain? After all, boomers changed
society’s views of youth, of parenthood, of
middle age; it’s likely they will also change
society’s views of old age and dying.
According to Hospice Net, an independent,
nonprofit organization, death was once an
integral part of family life. People died at
home, surrounded by loved ones. Adults
and children experienced death together,
mourned together and comforted one
another. Today death is lonelier.
Most people die in hospitals or nursing
homes, where they receive the extensive
medical care they need to give them the
best chance of extending life as long as
possible. Their loved ones have less
opportunity to spend time with them and
often miss sharing their last moments. The
dying have become isolated from the
living; consequently, death has taken on
added mystery and, for some, added fear.
Death has become removed from the
normal experience of people in Western
societies. It is denied for as long as
possible. It’s assumed that people don’t
want to think about it, so the whole
subject becomes more taboo.
The risk is that death becomes the
elephant in the room, causing unnecessary
trauma for both the dying and the living.
Sheer demographics, not to mention good
sense, will force more consumers to
acknowledge the elephant, which will
create opportunities for thought leadership
from businesses and organizations.

decline and loss of functions, requiring

years of personal care. At worst this
means a long, frustrating and
humiliating decline for the individual
and an exhausting and potentially
bankrupting ordeal for the family.
Approximately 40 percent of Americans,
generally past age 85, fall into this
category. And the numbers will rise.
In the future, a combination of genetic
screening, medical examination and actuarial
data will make it possible for most people to
Photos: Creative Commons/markhillary

predict how and when they are likely to die—

certainly with far greater chances of accuracy
than were previously possible. This could
mean a fundamental change in people’s
relationship with their own mortality.
Knowing about one’s death well in
advance is typically perceived as morbid
and scary, even a risk to mental health. On

Many Minds. Singular Results. INTELLIGENT DIALOGUE: CRADLE & GRAVE 29

 CONCLUSION
MANY OF THE ASSUMPTIONS previous generations
held about life and death are no longer accurate—but
government policies, politicians, organizations, businesses and
individuals still take them as fact. Outdated assumptions drive
the choices people make: whether and when to marry, have
children, save or consume; how much to invest in family,
friendships, work, health and hobbies. They remain
programmed into systems and cultures and mind-sets until
they clash with the changes brought about by education,
demographics, science, technology and business.
People are aware of most of the changes cited here, either
through the media or direct experience, but awareness is
piecemeal; there are lots of little patches of information. And
it’s tough to integrate the scope of the changes into a big
picture. The result is that many stumble half confused, half in
denial from one predictable crisis to the next.
30 INTELLIGENT DIALOGUE: CRADLE & GRAVE
The issues touched on here are not peripheral or trivial;
they’re big, and they cry out for coherent, consistent
Intelligent Dialogue. They span the interests of governments,
corporations, advocacy groups and individuals: They
incorporate a need for change in public policy, finance,
science, business and behavior.
With our roots in social marketing and our active
Photo: Creative Commons/fredesorensen
involvement in all these areas, we at Porter Novelli are excited
by developments in all these fields. We relish the challenge of
connecting the dots. And we’re alarmed to see how much
discussion around these topics is reactive and partially informed.
“Cradle & Grave” is intended to prompt discussion and
foster thought leadership across disciplines. We work with
smart people in great organizations, and we’re looking
forward to helping them create change and shape the future.
Many Minds. Singular Results.
The Porter Novelli
INTELLIGENTDIALOGUE
Principle
WHAT PORTER NOVELLI UNIQUELY OFFERS
can be summed up in two words: Intelligent Influence. The basis for
Intelligent Influence is Intelligent Dialogue. As yesterday’s mass
media morph into today’s interactive media, people expect to talk
back at journalists and opinion leaders. Yesterday’s way was set-
piece monologues broadcast to passive audiences by powerful
brands and media owners. Today’s way is fluid, evolving dialogues
conducted across multiple, linked channels. Ongoing dialogue is
now possible and is truly the best basis of dynamic long-term
relationships. Easy sound-bite answers are seductive; they give a
comforting but illusory sense of resolution. Instead, we need to
cultivate open, questioning minds that ask smart, creative
questions. Smart questions spark Intelligent Dialogue, open up
thinking and tap into the power of many minds.

PORTER NOVELLI was founded in Washington, D.C., in 1972 and is a part of

Omnicom Group Inc. (NYSE: OMC) (www.omnicomgroup.com). With 100
offices in 60 countries, we take a 360-degree view of clients’ businesses
to build powerful communications programs that resonate with critical
stakeholders. Our reputation is built on our foundation in strategic planning
and insights generation and our ability to adopt a media-neutral approach.
We ensure our clients achieve Intelligent Influence, systematically mapping
the most effective interactions, making them happen and measuring the
outcome. Many minds. Singular results.

CONTACT: Marian Salzman, Chief Marketing Officer, Porter Novelli

Worldwide, 75 Varick Street, 6th floor, New York, New York 10013; 212.601.8034;
marian.salzman@porternovelli.com
Porter Novelli Worldwide
75 Varick Street, 6th floor
New York, NY 10013
www.porternovelli.com