Interview with Dr. George Mensah: Role of industry in promoting heart health

Dr. George A. Mensah, an internationally recognized expert in cardiovascular disease prevention, recently joined the Global Research and Development unit at PepsiCo as Director for Heart Health and Global Health Policy after having held several senior leadership positions in heart disease, stroke, and other chronic disease prevention with the US Centers for Disease Control and Prevention for the past nine years. ProCor had the opportunity to interview Dr. Mensah about his new position and the role of industry in promoting global heart health. - Catherine Coleman, Editor in Chief, ProCor

ProCor: What prompted your move from the CDC to PepsiCo?

Dr. Mensah: Nutrition and dietary practices play fundamental roles in the development of chronic diseases as well as their prevention and control. The food industry is now seen as an important stakeholder in addressing nutrition-related chronic diseases, especially heart disease and stroke. The enormous global reach that PepsiCo has, its record of corporate responsibility in addressing social issues, and the changes it is putting in place presents a unique opportunity for a heart specialist to make a significant and positive contribution to global health. These are the factors that prompted my move to PepsiCo. 

My longstanding commitment to promoting heart health and passion for prevention will never change. Throughout my career with CDC as well as in academia prior to joining CDC, I had unique opportunities to be involved in multi-sectoral partnerships and to collaborate with other health professionals to contribute to the science of public health and medical practice. I am proud to have had those opportunities to learn and grow in my understanding of the potential for changing people's lives through public policy and prevention programs. The food industry presents an exciting venue and new opportunities for me to contribute to global health.

As the general public continues to become more knowledgeable about the impact of their dietary practices on their overall health--particularly their cardiovascular health--the food industry will have new and expanding opportunities. Working within the industry to bring the best science in cardiovascular medicine--basic, clinical, and population science--to inform the development of products that provide healthy options for consumers across the life span represents a real excitement for me. Expanding the availability of healthy options makes it a little easier for consumers to make the choices that reduce their risk for cardiovascular diseases. I look forward to continuing to seek guidance from, and collaborate with colleagues from all sectors as well as develop new relationships with key stakeholders interested in global health policy related to diet and nutrition issues that fall within the parameters of my new role.

ProCor: What is the role of industry in preventing cardiovascular disease? The food industry is perceived by some as a major contributor to the global cardiovascular disease epidemic but you are describing the opposite.

Dr. Mensah: PepsiCo has a strong commitment to being socially responsible as do many of the other major corporations in the food industry. We know that we can be fiscally successful and have a constructive social purpose. At PepsiCo, this is called Performance with Purpose.

For example, expanding offerings of products that contribute to reducing cardiovascular risk, such as providing low-sodium options, reduced portion size, and no-calorie beverages--all guided by the best available scientific evidence--are just a few of the ways that the food industry is being socially responsible. Not just PepsiCo, but all of industry can contribute to developing these options to assist consumers reduce their risk of cardiovascular and other chronic diseases.

ProCor: Workplace wellness was the theme of this year's World Heart Day.  What are the opportunities and challenges of promoting heart health in the workplace?

Dr. Mensah: Globally, almost half of all deaths from chronic disease occur in people in the workforce, and this is especially true in low- and middle-income countries where the median age at which cardiovascular disease develops is significantly lower than seen in high-income countries. Industry has an opportunity, through worksite health initiatives, to raise awareness beyond what it has already done and to provide supportive policies and environments that facilitate healthier choices at the workplace. At the basic level, these can include heart-healthy food options, tobacco-free environment, and facilities and policies that support physical activity at the workplace.

One of my goals is to advocate for supportive policy changes in workplaces. It is one thing to make individuals aware of health risks or advise individuals to make changes in their lifestyles, but it's completely different when you implement a supportive policy at the workplace, especially policies that take advantage of emerging science of behavioral economics and choice architecture. Such policies, when well implemented can help make the healthier choices the easier choices. In fact, worksite policy and environmental changes make it easier for all workers to benefit--whether it's through smoking bans or providing facilities for physical activity, or making healthier, less expensive food choices available.

The developing world poses a unique portfolio of challenges with regard to the workplace. Having grown up in Ghana, in sub-Saharan West Africa, I'm familiar with the needs of the informal workforce sector. An enormous number of workers do not have an "employer." They are vendors and merchants who sell or offer services in markets or on the street; thus impacting not only their own nutritional health, but having the ability to influence tens of thousands of others based on the wares and products that they sell. Not only is this informal workforce sector difficult to reach and inform, it is equally difficult to collect health impact data about this sector. There is a wide spectrum of settings in which the informal workforce is found, and this calls for carefully designed interventions that suit different sub-sectors in each specific area. As well, due consideration must be given to how to effectively work within the government and health structures and with the media in developing countries to promote intervention approaches and policy changes. Peri-urban areas would have quite different needs than those appropriate for a rural setting. Reaching the informal workforces that dominate much of the globe is a challenge that deserves increased attention, perhaps beginning with a partnership between the food industry, international organizations and government entities such as Ministries of Health.

ProCor:  How can we overcome the barriers to promoting global heart health?

Dr. Mensah: There are a number of challenges to be addressed in promoting global heart health. First and foremost, we must acknowledge, engage, and rely on the researchers, clinicians, nurses, and other health professionals living and working within the developing world to help guide us in our approaches. Accessing their vast pool of country-specific knowledge can provide immeasurable understanding of the current state of the burden of chronic diseases related to diet and nutrition and potential for policy implementation and introduction of new interventions. Additionally, we must find ways to support, sustain, and invest in the talent among these professionals in low- and middle-income countries.

We should also focus on the need for public education to address misconceptions about chronic disease and risk factors and the social and environmental determinants that increase vulnerabilities.

Government, businesses, industry, and the private sector will need to partner to increase and expand the ways in which the public is provided health educational information (that is appropriate for the differing cultural and religious populations) that raises awareness about prevention of noncommunicable diseases in low- and middle-income countries.

There's still a widespread misperception that chronic diseases are diseases of affluence. Developing countries still have huge burdens of communicable diseases which co-exist with the increasing burden of chronic disease. Often the important interaction between communicable and noncommunicable diseases is ignored. For example, chronic diseases such as heart disease, stroke, and diabetes complicate the prevention and control of infectious diseases such as tuberculosis. In fact, diabetes has been known to cause a three-fold increased risk of new cases of tuberculosis and similarly, TB can also increase the risk of developing diabetes. Addressing these chronic diseases should not be considered as an approach that diverts resources from communicable diseases--instead we should argue for increased public and private resources to address both.

Historically, the thinking has been that industry's only interest is in making a profit, and this thinking, has in the past, created a barrier that discouraged academic centers and government agencies from working productively with industry. However, because responsible corporations and industry sectors are demonstrating that they can in fact address issues of social importance and still be profitable, their ability to work with these entities is changing. Examples of appropriate industry actions include supporting heart health by expanding the portfolio of offerings to help reduce cardiovascular risk, and through advertising and marketing practices that encourage balanced nutrition and physical activity.

An additional barrier that must be addressed is the high cost of industry research and development to support needed changes. Incentives such as those created for pharmaceutical companies to encourage new knowledge in drug and device development should also be created for industry to stimulate creative research and product reduce their risks for heart disease as well as other chronic diseases. Inroads are being made, but continuing success will require commitment from industry, philanthropies, governments, and academic centers. Sustainable business models will be crucial to on-going success.

Advocacy & Policy
Date Posted: 23 November 2009