On May 5th, Cornerstone Capital hosted a webinar about Covid-19 and its disproportionate impact on some communities. Race, income, ZIP Code – all are factors that influence one’s chances of making it through the crisis personally and financially. In New York City, black and Hispanic/Latinx residents are twice as likely as white residents to die from the disease caused by the novel coronavirus. This fact is directly related to the lack of economic opportunity in some communities, especially communities of color anywhere in the US, as well as other structural issues including who has access to investment capital.
How can investors address the inequitable impact of COVID-19?
Katherine Pease, Managing Director, Head of Impact Investing at Cornerstone moderated our call with three investors and entrepreneurs with expertise in venture capital and investing for impact for women, communities of color and social justice:
NATHALIE MOLINA NIÑO is an entrepreneur, an investor (at O cubed) and tech globalization veteran focused on high-growth businesses that benefit women and the planet. She is the author of LEAPFROG, The New Revolution for Women Entrepreneurs (Penguin Random House, Tarcher Perigee) and serves as a Venture Partner at Connectivity Capital Partners. Molina Niño launched her first tech startup at the age of twenty and is the co-founder of Entrepreneurs@Athena at the Athena Center for Leadership Studies of Barnard College at Columbia University.
PRIYA PARRISH is the Managing Partner of Private Equity at Impact Engine. Prior to joining Impact Engine, she served as Chief Investment Officer at Schwartz Capital Group, a single-family office investing across global markets. Priya currently serves as Adjunct Assistant Professor of Strategy and Impact Investor in Residence at the University of Chicago Booth School of Business.
MORGAN SIMON is co-founder of Candide Group. She has close to two decades of experience making finance a tool for social justice. Morgan has influenced over $150B in investments and is a regularly sought out expert on impact investing. Her first book, Real Impact: The New Economics of Social Change, has been featured widely. Prior to Candide Group, Morgan was the founding CEO of Toniic, a global impact investment network.
The link between health and the economy
Nathalie began the webinar by noting that the existential danger facing black and brown businesses is directly correlated to their communities’ economy and health. She noted that banks have a long history of rejecting people of color for loans. They are often asked for more qualifying material compared to white borrowers. If loans are received, they are typically issued at higher interest rates that whites obtain. As a result, Nathalie was not surprised that $559 billion in PPP (paycheck protection program) loan money which was deployed through banks went to borrowers with whom the banks already had existing relationships vs. black and brown business owners. As a further barrier, the program excluded people with prison records, which disproportionately impacts entrepreneurs of color.
Morgan noted that $30 billion of the PPP has been designated to be disseminated through Community Development Financial Institutions (CDFIs) and smaller community banks (under $10 billion in asset size). She is angry that this relatively small amount is dwarfed by the $500 billion-plus being targeted at large companies, including $17 billion to Boeing. She believes that this policy failure should be addressed by investors and noted that her organization, Candide, publicly makes political contributions to advocate for broader access to capital for all. Candide has 75 women-owned companies in its portfolio, of which 18 successfully applied and were approved for PPP, in part because they had investors that advocated for them. Candide leveraged its financial connections to help business owners, including some who are not in their portfolio, to gain access to funds.
Priya voiced a somewhat optimistic outlook on the economy. She noted that PPP is not an economic stimulus plan per se but rather a relief package. She sees a long road ahead with actual fiscal stimulus and investor tax incentives. She expects a larger amount of capital to be deployed going forward.
Access to capital a challenge to black and brown communities
But with regards to access to capital, networks or key. Those who have access to a managing director at a venture capital (VC) firm are typically people from privilege, not just a particular race or gender. Priya noted that VC is a high risk/reward asset class and most who invest in venture can afford to take those risks. If you do not come from money, you’re an outsider. The VC firms tend to look for larger, high tech firms that can have big returns. Those firms’ founders/owners tend to be white and male (as are most VC partners).
Priya also noted that venture firms with female and diverse partners may be open to a variety of investments, not just the high-risk, high-reward kind. As an example, the firm invests in a telemedicine company that provides mental health services to 50% of the counties in the U.S. that do not have access to a mental facility. That is impact, in Priya’s estimation.
Nathalie said it’s likely that half of businesses owned by people of color will be gone soon. She believes there must be policy solutions at the municipal and state level. She hopes some policies will be initiated quickly by both the public and private sectors to try to save some of these businesses. Nathalie notes that the needs of both black and brown main street and high-growth companies should be addressed. With people of color a growing US demographic, the needs of main street companies need to be addressed to support near term and future economic health of the US. High growth companies with Black and Brown founders also need access to capital. The challenge is that there are few asset managers of color running funds. Nathalie proposed that governments, corporations and limited partnerships should allocate 30% of money to managers who are people of color to address the growing need for capital by companies run by people of color. Priya agreed but went further by suggesting that managers and investors need to look at who the company is serving and to invest in companies whose products and services support underserved communities.
Finally, during the discussion, both panelists and attendees shared a variety of articles and links to additional resources regarding small business relief, impacts on communities of color, and philanthropic opportunities:
The COVID-19 pandemic and the corresponding uncertainty in the financial markets necessitate a different approach to our Quarterly Market Update and Outlook. Importantly, COVID-19 is a health issue first and an economic issue second. In this report we highlight:
- Financial markets dislike uncertainty. We believe volatility will persist until the virus is contained globally or a medical solution (e.g., a vaccine) is developed.
- We recommend investors take a long-term view of the markets, and not focus on day-to-day volatility. This is a short-term shock to the system, not a structural issue as occurred in 2008. With a long-term view in mind, we are not changing our recommended asset allocation.
- The COVID-19 crisis and its disruption to our society and our prevailing modes of individual behaviors help to underscore the core tenets of impact investing:
- A consideration of our collective environmental and social well-being;
- a deep understanding of an investment’s positive or negative impacts;
- and sound corporate governance and transparency.
In Cornerstone’s view, following these principles will reward the long-term investor.
While we expect more evidence to emerge, we cite a few examples here that underscore the importance of investing with an impact lens:
- Governance in the public arena and private sector — in the form of leadership, planning, disciplined execution and adherence to safety protocols — is on full display as a differentiator in the consequences of the health crisis and its economic fallout.
- The underperformance of the fossil fuel sector, which predated this crisis, will likely continue. We can expect more investors will seek to reduce risk in their portfolios by implementing carbon-free investment strategies.
- People of color are being disproportionately impacted, both physically and economically, by the pandemic. Disproportionate impacts have also been recorded among poor and/or rural populations regardless of ethnicity. Demand for investments to promote greater social justice and reliable access to basic health care, nutrition and other basic services have already been heightened at the national and local levels.
As a firm dedicated to a vision of a more inclusive and regenerative world, we at Cornerstone wonder, will humanity look back at this season of fear and be proud of how we responded? Will we appreciate those who gave more than their fair share to fight the pandemic? Will we recognize the synchronicity in which much of humanity comes together to observe traditions marking rebirth, recommitment to faith, family and community, and humble recognition of our role in healing the world?
As we observe the holidays of Passover, Easter, and Ramadan this month, there is another notable eternal connection between us. Abraham Lincoln’s death, marked in the Hebrew calendar, coincides with Passover every year. And Lincoln said, as if to us today, that “My great concern is not whether you have failed, but whether you are content with your failure.” Have we learned the lessons from past disasters? Have we mitigated the destruction that this virus without borders has caused? Have we eased the spiritual and financial hardship descending upon so many people around the world? Can we move forward?
I am not content with failure. While we know we are in a global health crisis, and we are certainly in an economic crisis, we are also in a crisis of confidence … confidence in our governmental institutions, confidence in our financial institutions, confidence in our capitalist institutions. I am not content to stand by in this very special season and allow confidence to be forever lost. So, right now we need to use our traditions to begin to heal ourselves and our institutions, and to move forward.
So much of the symbolism and tradition across the three major religions describes the same events, just from different points of view. Passover is the story of freedom. It is the story of the liberation of body and spirit. With the storytelling come lessons of humility — the belief in something larger than ourselves. Passover marks our move from slavery to liberation. We commemorate the hardships and the miracles, and we move forward, celebrating our freedom with family and food.
Easter is closely linked to Passover, of course, not just by the (presumed) historical concurrence of the Last Supper with a Passover seder, by also by ancient symbols. As the Seder plate holds an egg to symbolize the cycle of life, rebirth, and renewal, in Christianity the egg became associated with the resurrection. And across the centuries, these stories have never lost the power to inspire the imagination of generations of humankind as we move forward.
And with Ramadan, we have another holy time for families. Ramadan is a time of rededication to core values. It balances the deep introspection of the long day’s fast with gatherings to strengthen the bonds of family and friendship. And what could society need more right now than the pillars of Islam, among them charity and philanthropy, tolerance, justice and honesty?
So, in this very important season, in these very dark days, we move forward. And to Cornerstone Capital Group, moving forward means maintaining our belief that confidence in the capital markets can be restored. That good governance is a proxy for quality. That a long-term commitment to sustainable and impact investing can provide positive social impact as well as strong returns over time. And most importantly, that investments must create solutions to the world’s greatest challenges, must drive innovative, resilient and inclusive growth. And we move forward.
On behalf of the Cornerstone family I wish you peace, health and a renewed sense of hope and determination,
Erika Karp, Founder and CEO, Cornerstone Capital Group
On March 19, 2020, Cornerstone Capital Group held a conference call addressing concerns about the current coronavirus pandemic and its impact on the markets, the economy, and importantly, the changes in how we think about the infrastructure of our society over the longer term. Cornerstone’s Erika Karp, Craig Metrick and Michael Geraghty were joined by two equity managers on the Cornerstone platform: Cathie Wood of Ark Investment Management, and Garvin Jabusch of Green Alpha Advisors. The full call replay can be accessed here.
Managing Portfolio Risk Through Integrated Analysis
The participants on the call focused on the benefits of integrating environmental, social and governance (ESG) factors into the investment process in an effort to de-risk long term portfolios and identify critical growth opportunities. Both Ark and Green Alpha look at multiple risk factors at a systemic level to minimize exposure to threats such as climate change. This extends to investing in methods to address risk — such as pandemic crisis. In their view, by focusing on innovation and the future while considering all stakeholders instead of only shareholders, investors may experience better long-term returns with lower volatility.
Kicking off the discussion, Erika highlighted that “sustainable investing is a proxy for quality. It’s a proxy for innovation and a proxy for resilience. And that is precisely what we need right now.” She asked whether, when we emerge from this current crisis, we would be forever changed:
“We have to think about issues like distance learning, telecommuting, distributed health systems. We have to think about supply chain logistics. We have to think about surge capacity. We have to think about virtual entertainment, emergency service centralization, obviously food safety, water quality, hygiene standards. We have to think about mental health provision. We have to think more proactively and in an innovative way about investing. Going forward to attack these challenges, we remind everyone that impact and sustainable investing is just investing. But a more conscious, predictive way to invest. Impact investing is the new cornerstone of capitalism.”
Michael Geraghty, Cornerstone’s market strategist, discussed the volatility of the markets under the current coronavirus situation. He doesn’t believe the markets will stabilize until the virus is either contained or a vaccination is developed and made available to the public. Michael notes, however, that this is a short-term shock to the system and not a structural one. That’s not to say that this pandemic won’t have a profound effect on the economy or the markets near term. The consumer accounts for 70% of U.S. Gross Domestic Product (GDP). If consumers are staying home and hunkering down, a cut in rates by the Federal Reserve and a payroll tax cut by the Federal government won’t have a strong impact on consumer behavior.
Craig Metrick noted that Cornerstone focuses on long term investment objectives while creating an investment plan which is designed to achieve social and environmental impact. He then interviewed Cathie and Garvin as to their views on the longer-term implications of the current crisis.
Investing in Disruptive Innovation and Strong Governance
Ark Investment Management focuses on investing in disruptive innovation over a five-year time frame. Its five core themes are: DNA sequencing, robotics, artificial intelligence, energy storage and blockchain technologies. Cathie Wood noted that the companies her firm invest in are not typically in any indices. Other managers are selling these names while buying names in the indices, such as the S&P 500, giving firms like hers an opportunity to buy these innovative company stocks at lower valuations. Over the long haul, she believes these investments should outperform older economy names that still dominate the indices.
Garvin Jabusch noted that a recession is already priced into the markets and his firm is looking for companies that will perform well out of the downturn. Bottom-up analysis is key, in his view. He looks for companies that are good stewards of capital, are innovative and create solutions that will make the economy more productive. Green Alpha is a long term buy and hold manager. The firm focuses on innovative companies that can help de-risk the economy such as those engaged in decarbonization, biotech and electrification.
Summing up the discussion, which included a very lively Q&A, Erika noted: “When it comes to ESG analysis, the “G,” governance, is first among equals. Because if we’re talking about a well-governed company, then by definition it is looking at environmental and social issues. And if a company is not looking at environmental and social issues, it is by definition not well-governed. It’s tautological.”
Ark Investment Management and Green Alpha are two of the strategies included in the Cornerstone Capital Access Impact Fund. Click the link to view standardized performance and the Fund’s top ten holdings: https://cornerstonecapitalfunds.com/quarterly-commentary
You should carefully consider the investment objectives, risks, and charges and expenses of the Fund before investing. The prospectus contains this and other information about the Fund, and it should be read carefully before investing. You may obtain a copy of the prospectus by calling 800.986.6187. The Fund is distributed by Ultimus Fund Distributors, LLC. Cornerstone Capital Group is the adviser to the Fund. Investing involves risk, including loss of principal. Applying ESG and sustainability criteria to the investment process may exclude securities of certain issuers for both investment and non-investment reasons and therefore the Fund may forgo some market opportunities available to funds that do not use ESG or sustainability criteria. Securities of companies with certain focused ESG practices may shift into and out of favor depending on market and economic conditions, and the Fund’s performance may at times be better or worse than the performance of funds that do not use ESG or sustainability criteria.
COVID-19, more commonly known as the coronavirus, emerged in late 2019. It was first identified in Wuhan, the capital of Hubei, China. Infection is primarily through human-to-human transmission via exhalation, such as sneezing or coughing. Symptoms may include flu-like symptoms, such as fever, coughing, breathing difficulties, fatigue, and muscle pain. No vaccine currently exists. Thus far, the fatality rate has been estimated at around 2–3% of cases, with older people particularly vulnerable.
In this note we assess the coronavirus in terms of its impact on humans, economic activity, corporations, and financial markets.
Coronavirus: The Human Impact
Thus far there have been close to 3,000 deaths caused by the coronavirus — the majority of those in China — in addition to around 80,000 officially recorded cases globally. Worryingly, pockets of the virus have popped up in a range of geographically dispersed countries, most notably Japan, Italy, Iran and South Korea. As of now, some of the infections in those countries have no known connection to China. The World Health Organization (WHO) has said the increase in the number of cases in Italy, Iran and South Korea is “deeply concerning.” However, the WHO has not yet declared the spread of the virus to be a pandemic, which is defined as an uncontrollable geographical spread.
Restriction of movement is the primary method authorities are using to control the spread of the virus. In China, tens of millions of people are under some form of quarantine, curfew, or lockdown. Italy’s government recently imposed a lockdown on an area of 50,000 people near Milan, which is the epicenter of the virus in Italy. It has been reported that South Korean officials are drawing up plans for a quarantine in affected areas.
Coronavirus: The Economic Impact
Quarantines, curfews, and lockdowns don’t just impact day-to-day activities, they also limit the number of workers able to get to work. So, for example, reflecting restrictions in China, Bloomberg Economics has estimated that the country’s economy is running at just 50-60% of its normal capacity. That was underscored by the fact that domestic car sales plunged by 92% in the first half of February.
The coronavirus outbreak in Italy centered around Milan is threatening to shut down the richest segment of the economy. Milan alone accounts for 10% of the Italian economy, and the Lombardy region more than double that. The New York Times recently reported that “Milan is not a closed city, but it is a drastically slowed one, after a spike of cases in the region, raising anxiety about a broader slowdown.”
Coronavirus: The Corporate Impact
The day after President’s Day, Apple warned it would not meet its first quarter 2020 revenue guidance because of the effects of the coronavirus. The company pointed to demand and supply issues in China. On the demand side, all its retail stores were closed at some point, although some are now open. The stores that have reopened are operating in a limited way, and with very low customer traffic. On the supply side, Apple said all its manufacturing facilities have reopened in China but were “ramping up more slowly than we had anticipated,” leading to iPhone supply shortages.
Supply chain disruptions because of the coronavirus in China have been impacting companies across the globe. China is a supplier of key components essential to a range of industries, particularly electronics and automobiles. However, as noted above, it’s estimated that China’s economy is only running at 50‑60% of its normal capacity.
It’s likely that supply-chain disruptions associated with past crises — such as the 2003 outbreak of severe acute respiratory syndrome (SARS) that swept across Asia, or the 2011 Fukushima nuclear disaster — are not good benchmarks for the current epidemic. For a start, today’s supply chains are global and more complex than they were in 2003, which was before China established itself as a manufacturing powerhouse. And during that period China’s growth represented a much smaller portion of global GDP growth than it does now. Second, the Fukushima nuclear disaster greatly impacted the global supply chain for auto parts, but not many other sectors were affected. Moreover, the damage to the supply chain was relatively short term.
In terms of market reaction to these events, in the six months after the first occurrence of SARS, the S&P 500 posted a gain of 15% (using April 2003 as a base); after 12 months, it was up 21%. In 2011, the year of the Fukushima nuclear disaster, the S&P 500 ended flat for the year.
For the moment, U.S. corporations remain sanguine. A recent Bloomberg study of corporate transcripts of S&P 500 companies revealed that about half said it was too early to gauge how the virus might play out, about a third said the virus would have some impact, and only 5% anticipated a severe blow from the virus.
Coronavirus: The Financial Markets Impact
Financial markets dislike uncertainty. So far, the cases of the virus in the U.S. have all been traceable to overseas travel. However, if cases not linked to travel start to emerge, that could lead to quarantines in the U.S., business shutdowns, and negative earnings estimate revisions. These factors would undoubtedly weigh on financial markets. Even with the recent selloff, U.S. stocks still remain at the high end of the historical range in terms of valuations.
At this time Cornerstone is not recommending tactical shifts in asset allocation resulting from the virus, because it’s still too early to gauge the impact. However, we are closely monitoring potential economic impacts related to the spread of the virus.
Psychedelic-assisted psychotherapy is seeing a resurgence as a treatment approach for mental health disorders. It melds pharmacology and psychotherapy, using psychedelic substances such as lysergic acid diethylamide (LSD) and psilocybin, under medical supervision, to treat conditions such as post-traumatic stress disorder (PTSD) and extreme depression. Psychedelic therapy was a popular research topic in the 1950s and 1960s; however, it lost favor by 1966 due to backlash around poor research and a growing association with the ‘60s counterculture. In recent years, interest in psychedelic therapy has regained steam. Significant, rigorous research is being funded, and FDA trials are under way for certain treatments.
The old: mid-century experimentation
Movie star Cary Grant, writer Aldous Huxley, movie director Sidney Lumet and playwright Clare Boothe Luce, along with thousands of people globally, were tested and treated with LSD and other psychedelics between 1950 and 1965. More than 1,000 published studies and six international conferences on these studies were produced during this period. However, by 1962 US regulators began to restrict the use of LSD, and possession of the drug was made illegal in 1966.
This shift in attitude was the result of poorly constructed scientific research, reports of “bad trips” and the growing association of LSD with the political counterculture. For example, Harvard psychologist Timothy Leary was accused of giving psychedelics to undergraduates without medical supervision. He was also famous for his counterculture quote, “Turn on. Tune in. Drop out.” This backlash negated some of the past accomplishments in helping individuals cope with chronic depression and other psychological problems. 
The new: mainstream medical research
Starting in the 1990s, academics began a new round of psychedelic psychotherapy research focusing on depression and anxiety in people with cancer. Today research is moving forward and broadening in scope. Several psychedelic drugs, including ketamine, methylenedioxymethamphetamine (MDMA), psilocybin, and the aforementioned LSD, are being studied for use in treating psychiatric disorders including PTSD, depression, drug, tobacco and alcohol addiction, obsessive compulsive disorder (OCD), anxiety disorders and existential anxiety related to life-threatening diseases such as cancer. 
In September 2019, Johns Hopkins announced the launch of the Center for Psychedelic and Consciousness Research. Its goal is to study LSD and psilocybin for various mental health problems, including addiction and depression. The center was established with $17 million in commitments from wealthy private donors and a foundation. This announcement followed the launch of a similar center at Imperial College London in April 2019 with $3.5 million from private sources.
Mental health disorders: demand for better treatments
According to the National Alliance of Mental Illness, a patient advocacy organization, one in five U.S. adults (over 19% of the population, or 47 million people) experience mental illness annually. This figure includes one in 25 adults (11.4 million people) facing serious mental illness each year.
People with mental health issues often do not receive help until they are in crisis. Nearly 60% of those with a mental health disorder did not receive treatment in the previous year. Also, despite the introduction of a variety of medications during the past decades, the rates of mental illness are not declining – in stark contrast to the success of pharmaceutical advances in treating infectious diseases.
Given the scope of the problem and questions regarding the effectiveness of current treatments such as antidepressants, which often entail unpleasant side effects, interest has grown in new areas of treatment. Recent studies have been promising. In psilocybin trials at Johns Hopkins and New York University (NYU), 80 cancer patients suffering from cancer-related anxiety or depression received psilocybin in a session guided by therapists. In the resulting study published December 2016, 80% of the Hopkins volunteer subjects were reported to have experienced significantly reduced depression and anxiety from a single large dose of psilocybin. These improvements continued for six months or more. 
The challenge in considering use of psychedelic therapy is how to obtain FDA approval; the FDA typically focuses on the effectiveness of a medication rather than the effectiveness of a therapy. According to Dr. Thomas Insel, former Director of the National Institute of Mental Health, it is key that researchers focus on safety and medical/psychotherapeutic use, rather than recreational use. One very negative experience can risk derailing the research efficacy.
Promising trial results
In a step forward toward FDA approval, the non-profit Multidisciplinary Association for Psychedelic Studies (MAPS) is studying MDMA-assisted psychotherapy for people with PTSD. The objective is to find out whether MDMA-assisted psychotherapy can help heal the psychological and emotional damage caused by sexual assault, war, violent crime, and other traumas.
In 2017, the FDA granted Breakthrough Therapy Designation for a MAPS Phase 3 clinical trial of MDMA. Phase 3 is the final phase of research required by the FDA before deciding whether to approve a drug as a legal prescription treatment, which in this case involves MMDA to treat PTSD. Prior Phase 2 clinical trials showed that MDMA can reduce fear, enhance communication and introspection, and increase empathy, augmenting the therapeutic process for people suffering from PTSD. In the trial, participants all had suffered chronic PTSD for an average of more than17.8 years. After three sessions, over 60% of participants no longer had PTSD, and in a 12-month follow-up, 68% no longer had PTSD.
The advantage of MMDA-assisted psychotherapy is that MMDA is only administered a few times, unlike most medications for mental illnesses which are often taken daily for years, and sometimes forever. Many of these medications have unpleasant side effects as well.
MAPS also completed a Phase 2 pilot study using LSD-assisted psychotherapy sessions. The completed study found positive trends in reducing anxiety following two LSD-assisted psychotherapy sessions. LSD in these sessions seemed to be safely administered – and may justify further research. 
How and why does psychedelic therapy work?
In psychedelic therapy, neural networks are activated under the influence of LSD or psilocybin. The effect appears to link with the marker most correlated with personal “ego dissolution.” From the patient’s perspective this amounts to a “mystical experience.” 
Michael Pollan, a journalist and author who has written extensively about medical research related to psychedelic drugs, discussed his interviews with cancer patients participating in psychedelic tests using psilocybin at NYU and Johns Hopkins. Several described their guided psychedelic journey as similar to birth or enlightenment. It is important that participants are supervised by a qualified guide in case they have an episode of extreme anxiety, also known as a “bad trip.” The guide is there to ensure the participant has a positive experience while undergoing this type of therapy. 
A common theme that many test participants discussed was finally understanding the secrets of the universe or realizing that “we are all one.” Mysticism, love or unity are recurring themes. Many said that they visually encountered their cancer, and this had the effect of reducing its power over them. One woman who had been diagnosed with ovarian cancer years earlier and was worried about a recurrence said she envisioned a black mass while looking into her rib cage. This mass, she realized, was her fear of cancer and not the cancer itself. She confronted the mass aggressively and said she stopped worrying about a recurrence after the trial. This was one of the objectives of the trial.
Researchers know “how,” but not “why,” psilocybin tends to work in psychedelic therapy. One theory is that the drug interrupts the circuitry of self-absorbed thinking that is prevalent in depressed people, paving the way for a mystical experience. A neuro-imaging study at imperial College in London may explain why this therapy works:
The drugs appear to change “the default mode network” (shown above in (a) where there is heavier traffic over fewer connections) in the brain, which tends to be hyperactive in depression and is subdued when on psilocybin or in deep meditation. Information is usually processed in the brain using various circuits. Some circuits experience a steady stream of informational traffic while others are rarely used. Psychedelics appear to open up different circuits (shown in (b) above where more connections are utilized, freeing up space along the more heavily used ones shown in (a). This may explain the expanded sense of awareness and new perspectives among participants in psychedelic-assisted psychotherapy sessions.
Potential beyond mental health
Chronic low-grade inflammation is at the root of aging and age-related disease. Termed “inflammaging,” this impairment of the immune system contributes to the disease burden in older adults and accelerates the aging process. One notable example of this phenomenon is Alzheimer’s disease.
Studies dating back decades indicated that illnesses ranging from tuberculosis to diabetes responded well to treatments with peyote (taken in low dosages). According to Shlomi Raz, founder of the company Eleusis, which is focused on research in this space, “In 2008, the psychedelic compound related to the primary psychoactive alkaloid in peyote, mainly mescaline, was discovered to exert ‘extraordinarily potent’ anti-inflammatory effects at very low drug concentrations.” Very low dosages of this compound didn’t tend to induce changes in brain function that might alter perception, mood or behavior.
Additional studies have confirmed the capacity of psychedelics to modulate processes that perpetuate chronic low-grade inflammation. The psychedelics seem to exert significant therapeutic effects in a diverse array of preclinical diseases, including asthma, atherosclerosis, inflammatory bowel disease and retinal disease. 
Given the large and growing problem of mental health disorders today, it appears that current standard pharmaceutical options are insufficient to the challenge, especially for treatment-resistant conditions such as PTSD, chronic depression, high anxiety related to terminal illness, and persistent drug or alcohol addiction. A new approach, such as psychedelic-assisted psychotherapy, may offer a solution to a problem that traditional pharmaceuticals haven’t solved.
Currently, with a few exceptions, research in this space is still in the early stages. While near term investment options are very limited, this is a topic that bears watching and may offer some good impact investment options in the near future.
 Paul Summergrad (psychiatrist) & Thomas Insel (neuroscientist): Future of Psychedelic Psychiatry- April 26, 2017 with George Goldsmith – Executive Director of Compass Pathways
Gender lens investment approaches have expanded in recent years. All asset classes have seen a tremendous increase in the number of funds and assets under management since 2014. Fund strategies range from empowering women and funding women-run businesses to reducing gender violence and poverty for women and children.
At the same time, investors have also been seeking ways in align their activities in support of the United Nations Sustainable Development Goals (SDGs). Cornerstone Capital Group has contributed to this effort by introducing the Access Impact FrameworkTM, which illustrates the alignment of investment strategies to each of the SDGs. We identified the concept of access — the ability of individuals and societies to achieve desired social, economic and environmental outcomes — as a key common denominator of the SDGs and identified 11 “access themes” that translate the SDGs into investable opportunities.
SDG 5 is “Achieve gender equality and empower all women and girls.” For investments to have an impact related to achieving gender equality and empowering women and girls, investors do not have to invest solely in gender lens funds. Our approach to gender lens investing incorporates traditional gender lens themes with an analysis of the access themes that align most closely to SDG 5.
In this report we discuss each of the access themes that underpin SDG 5 in some depth. We also offer examples of investment vehicles that bolster access to these themes for women, their families and communities. Download the full report here.
SDG 3 seeks to promote health and well-being for all. While the overall health of the world’s population has improved, many population groups have been left behind. Many diseases remain widespread and deadly, yet are preventable with access to appropriate healthcare. Unsafe drinking water, polluted air, and poor housing conditions are all linked with negative health impacts, and the goal calls for change in each of these areas. Progress in SDG 3 means stronger, more productive individuals and communities, and fulfills the basic requirement of good health for the successful pursuit many other SDGs. SDG 3 is further refined by targets that can be more readily translated into actions. These targets highlight the interconnected nature of the goals: For example, strategies to support Good Health and Well-Being also promote progress toward SDG 5 (Gender Equality) and SDG 6 (Clean Water and Sanitation). Below are a series of synergies that can come from providing access to products, services and systems that address Good Health and Well-Being.
Access to Healthcare Services
Expanding access to healthcare services is fundamental to improving health and wellbeing. In many parts of the world, lack of access to essential care means high numbers of preventable deaths. More than 300,000 women died from maternity-related causes in 2015, mainly in regions where antenatal care is less common and where most women do not receive professional assistance during birth.1 Vaccine and medicine access worldwide is also insufficient for diseases like HIV, pneumonia, and measles, allowing outbreaks to persist.2,3 Even where quality health services are available, affordability often proves to be the greatest barrier; low-income individuals in the US are less likely to have health insurance or to pursue primary or specialty care,4 facing higher rates of morbidity and mortality as a consequence.5 Recent action to bring health care to more people has made great strides in each of these areas, but more work remains to be done.
Access to Clean Water
Safe drinking water is fundamental for a healthy life, yet 2 billion people still use a drinking source contaminated by human waste, and over 800 million lack access to a basic drinkingwater source.6 Contaminated water spreads diseases like typhoid, cholera, and diarrhea, which kills more than 2,000 children each day — a greater toll than AIDS, malaria, and measles combined.7 Even where improved water systems exist, contaminants like lead and nitrates can elevate the risks of blood poisoning and cancer.8,9 Few cases better illustrate the fundamental link between clean water and health than the recent water crisis in Flint, Michigan; in the 18 months following a switch in water source for Flint residents, 12 people died and 87 fell ill from the unsafe water.10 Fortunately, solutions are possible and impactful: A $1 intervention to provide clean water access creates $25.50 of benefits on average as people spend less time and money dealing with illness, and as deaths from unsafe water are prevented.11
Access to Clean Air
The health effects of poor air quality are a growing concern as pollution levels increase globally, contributing to one out of every nine deaths12 and creating unhealthy air conditions for 95% of the world’s population.13 The use of coal and fossil fuels releases a large amount of pollutants, including particulate matter and black carbon, which causes respiratory disease, cardiovascular disease, and cancer.14 Indoors, nearly 40% of the population still relies on the burning of biomass, coal, and charcoal for heating and cooking, making air inside the home unsafe to breathe.15 Replacing exposure to unsafe air with access to clean air is an urgent need to enable healthy and full lives for all.
Access to Adequate Housing and Living Conditions
Access to affordable and quality housing is foundational for healthy lives. Individuals who experience homelessness or housing instability suffer negative mental health impacts and have more difficulty adhering to health treatment.16 Poor housing conditions also have adverse effects on well-being, often linked to respiratory problems when mold or hazardous materials are present.17 Problems such as these combine with lack of sanitation and clean water for the nearly 1 billion people living in substandard housing conditions in the southern hemisphere.18 Fortunately, efforts targeting better access to stable and adequate housing have been shown to improve health outcomes for many residents.19
SDG 3: References
1 World Health Statistics 2018: Monitoring health for the SDGs, World Health Organization (WHO)
3 Progress and challenges with achieving universal immunization coverage: 2016 estimates of immunization coverage. WHO/UNICEF Estimates of National Immunization Coverage (Data as of July 2017). Geneva: World Health Organization; 2017
4 Dhruv Khullar Dave A. Chokshi. 2018. Health, Income, & Poverty: Where We Are & What Could Help. Health Policy Brief. Health Affairs
5 Andersen, R. et al. 2002. Access to Medical Care for Low-Income Persons: How Do Communities Make a Difference? Medical Care Research and Review
6 Progress on drinking-water, sanitation, and hygiene, 2017. WHO
7 Diarrhea: Common Illness, Global Killer. CDC
8 Elevated Blood Lead Levels in Children Associated with the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response. Hanna-Attisha M, LaChance J, Sadler RC, Champney Schnepp A. Am J Public Health. 2016; 106(2):283-90
9 Environmental justice and drinking water quality: are there socioeconomic disparities in nitrate levels in U.S. drinking water? Laurel A. Schaider, Lucien Swetschinski, Christopher Campbell, and Ruthann A. Rudel. Environmental Health. 2019
10 Flint Water Crisis: Everything You Need to Know. NRDC. 2018
11 Diarrhea: Common Illness, Global Killer. CDC
12 Ambient air pollution: A global assessment of exposure and burden of disease. 2016. WHO
13 State of Global Air. 2018. Health Effects Institute
15 Access to Modern Energy: Assessment and Outlook for Developing and Emerging Regions. 2012. IIASA.
16 Taylor, Lauren. Housing And Health: An Overview of the Literature. Health Affairs Health Policy Briefs. June 2018
17 Butler, Stuart and Marcella Cabello. Housing as a Hub for Health, Community Services, and Upward Mobility. Brookings Institute. March 2018
18 Slum Almanac 2015/2016. Tracking Improvement in the Lives of Slum Dwellers. Participatory Slum Upgrading Programme. UN Habitat
19 Taylor, Lauren. Housing And Health: An Overview of the Literature. Health Affairs Health Policy Briefs. June 2018.
On April 17, 2018 Viridian Capital Advisors and the Association for Corporate Growth (ACG) hosted a panel discussion titled “Cannabis- the New Investing Frontier.” ACG is a networking platform for the smaller to mid-sized business deal-making community. Viridian Capital is an investment bank and advisory company focusing on the emerging cannabis sector. The panel included a private equity investor, a venture capitalist, a general counsel and an investment banker all specializing in advising and investing in the cannabis sector. The panel addressed the current state of the industry including regulation, legalization, sectors for investments and challenges.
Growth Industry and Total Addressable Market
The cannabis industry is in the very early stages of growth in what could become a lucrative business. Cannabis could generate $75 billion in sales in the U.S. for recreational use by 2030, if federally legalized, according to Cowen Research. Medical applications for cannabis expand the potential US market size by another $55 billion or more as early as 2025. Globally, the total addressable market size could be big as well. Cowen forecasts the Canadian market alone as a $12 billion opportunity by 2025. Some of cannabis’s potential therapeutic values are suppression of vomiting and nausea, pain relief, and appetite stimulation. In addition, research indicates that marijuana is effective in providing relief to the patient suffering from HIV/AIDS, glaucoma, cancer, and multiple sclerosis. The growing number of therapeutic applications of the drug is one of the key factors that is propelling the market over the next 20-30 years.
Regulation and Legalization
The potential growth of this industry hinges on federal legalization. A Gallup poll shows increasing support by the American public for legalization. In 2016, 60% of Americans favored legalization — a number that rose to 64% in October 2017. Cannabis is legal for recreational and medical use in nine states and is legal solely for medical use in an additional 19 states:
Source: Business Insider
Further, multiple countries have approved cannabis for medical use and others are considering deregulation. In Canada, the federal Liberals have set July 2018 as the deadline to legalize recreational marijuana. Sales of pot will be restricted to people age 18 and older, although provinces will be able to set their own minimum age requirements. Provinces are also tasked with figuring out how to sell and regulate marijuana.
On April 13th, President Trump endorsed letting states decide how to regulate marijuana. This is a major boost for the legal pot industry. The administration is abandoning a Justice Department threat to crack down on recreational marijuana in states where it its legal, a move that could enable cannabis companies in states that have legalized cannabis to operate without fear of federal raids and prosecution. John Boehner, former speaker of the House of Representatives, reversed a long-held stance against cannabis, joining the Acreage Holdings advisory board, along with former Massachusetts governor William Weld. Acreage Holdings is a cannabis corporation that operates in 11 states. In a statement, Boehner said, “the time has come for serious consideration of a shift in federal marijuana policy.” The conference panel opined that the hold-up in regulating cannabis on a federal level is mainly due to the number of people who have been arrested for possessing or selling the drug, including the thousands currently incarcerated for such offenses. Regulators are in a bit of quandary about how to deal with people who have an arrest record or are in jail related to these infractions. The proposed Marijuana Justice Act, sponsored by New Jersey Senator Cory Booker and New York Senator Kirstin Gillibrand, who are working to gain support for the legislation, would legalize marijuana at the federal level, provide incentives for states to revise outdated marijuana laws, and expunge convictions pertaining to use or possession.
Market Capital Raised
In 2014, $148 million in capital was raised for the industry, including $59 million for public companies and $89 million for private companies. In contrast, more than $3.5 billion was raised in 2017, including $2.9 billion for public companies and $575 million for private companies. In the first quarter of 2018 alone, an additional $2.3 billion was raised, including $1.8 billion for public companies and $553 million for private companies. A large proportion of the money raised in 2016 through Q1’18 was for cultivation and retail (over $3.5 billion). The next largest sub-sector attracting capital was biotech/pharma, which raised over $1.3 billion in capital. Investments and mergers and acquisitions attracted much of the remaining capital ($1 billion), while other sectors such as extracts, software/media and real estate attracted smaller amounts of investments.
The number of transactions in the industry has grown as well. Viridian estimates there were 32 transactions in 2014. This number grew to 151 transactions in 2017 and an additional 61 in the 1Q’18 alone. Viridian notes that alcohol companies have been investing to offset cannibalization of alcohol sales. Viridian said that AllianceOne, a tobacco leaf merchant, is also investing in the sector by purchasing two Canadian Cannabis companies. Phillip Morris invested in a medical device company related to cannabis.
Potential Investment Opportunities
The cannabis industry may offer a good long-term investment opportunity. Venture capitalist Jeff Finkle, a former IT executive and internet investor stated he sees opportunities similar to those in the internet space of the late 1990s. However, given the regulatory challenges and nascent nature of the industry, members of the panel emphasized that investors must be extremely diligent in their analysis before investing in this rapidly growing and risky sector.
Heidi Bush, CFA is a Director, Global Research with Cornerstone Capital Group.
As part of Cornerstone’s ongoing research on antibiotics and livestock production, we attended the FAIRR Initiative’s event on antibiotic resistance and investment risk in New York City on Monday, March 20, at BlackRock’s office. (FAIRR, or Farm Animal Investment Risk and Return, is an investor initiative that aims to put factory farming on the ESG agenda.)
The event was well attended by a mix of investors, industry participants, and NGOs. Dr. Lance Price of the Milken Institute School of Global Health gave the keynote presentation. Erik Olson, Director of the Health Program at the Natural Resources Defense Council (NRDC), provided a policy and market trends update. The event closed with a session with panelists from Aviva Investors, Green Century Capital Management, Chipotle, and Perdue. Attendees who were new to the topic received a useful overview, while those that have been following the issue were presented with valuable perspective.
With increasing global demand for animal protein, traditional farming methods are being replaced by a new industrial model – the factory farm. While this new method has increased food production and lowered prices for consumers, antibiotics are being utilized more in the process. One speaker said Pew Charitable Trust data shows that approximately 80% of all antibiotics used in the US are fed to farm animals. We note that the Animal Health Institute refutes this figure, saying it was deduced by comparing two data sets that are not comparable. While the number may be debatable, our research indicates that the proliferation of antibiotic resistance is primarily attributed to the misuse and overuse of the drugs in human medicine and animal agriculture. (See our October 2015 report Antibiotics and Animal Health: Value-Chain Implications in the US, as well as subsequent updates.)
One of the most concerning developments is the discovery of the mcr-1 gene on Chinese pig farms and on meat in supermarkets. This single, easily spreadable gene makes the bacteria that carry it resistant to colistin, our “antibiotic of last resort”. The scientific report that originally reported this issue also presented evidence that the mcr-1 gene has already been transferred from pigs to humans.
From a regulatory standpoint, Maryland and Oregon are considering legislation like California’s SB 27, a bill limiting the use of medically important antibiotics (MIAs) in animal agriculture. In addition to prohibiting antibiotics for growth promotion, SB 27 prohibits the use of MIAs in a “regular pattern” (i.e., for growth promotion and disease prevention), thus going beyond federal policy outlined in the FDA’s Guidance for Industry (GFI) 213. This addresses concerns that animal producers may use antibiotics for growth promotion under the guise of disease prevention. As we have discussed in prior research, the potential for more restrictive regulation (as seen with SB 27) and shifting consumer demand poses a risk to antibiotics sales for animal health companies.
A discussion of company policies on antibiotic use at various points in the value chain provided valuable insight. One speaker said that in 2012 less than 10% of chicken was raised with no routine antibiotics. In 2015, that number had grown to 45%, illustrating the speed at which industry is reacting to changing consumer preferences. Perdue began the process of removing antibiotics from production in 2002 and by 2006 had completely removed antibiotics used for growth promotion. The company finished removing antibiotics in hatcheries in 2014 and in 2016 pulled animal-only antibiotics (ionophores). Currently, Perdue only uses antibiotics when chickens are getting sick, which occurs in about 5 percent of its flocks. This means that 95% of the company’s production eligible to be sold under the label “no antibiotics ever.”
Our prior research assessed poultry producers’ antibiotics use policies and we highlighted Perdue as a leading performer and Sanderson Farms as lagging. Sanderson does not believe the antibiotic-free (ABF) movement is grounded in proper science and ethics, and believes competitors’ efforts are a marketing gimmick aimed at charging higher prices. While Sanderson’s view about strict ABF policies compromising animal welfare is worthy of examination, we question the company’s strategy to combat shifting consumer demand. In February 2017, a non-binding shareholder proposal requesting that Sanderson phase out the use of MIAs for growth promotion and disease prevention failed, though it received support from 30% of votes cast.
In the restaurant space, KFC stands out as a major laggard in the NRDC’s 2016 Antibiotics Scorecard, which grades the US’s top 25 restaurant chains on their policies and practices regarding antibiotics use and transparency in their meat and poultry supply chains.
While most companies have been focused on reducing antibiotics in poultry, pork and beef are beginning to attract attention. One speaker said pork is where chicken was a few years ago and noted that the pork industry is more vertically integrated than commonly believed (he believes it is about 80% integrated). Vertical integration should, in theory, make the process of reducing antibiotics more achievable. The beef industry is “significantly” more diffuse. Companies’ recent actions also suggest movement on phasing out antibiotics from pork and beef. Subway committed to serve antibiotic free beef and pork by 2025, Tyson and Smithfield now have “no antibiotics ever” pork product lines, and Perdue purchased Niman Ranch, which adds an array of antibiotic free beef and pork to its product portfolio.
Rounding out the conversation, speakers discussed alternatives to antibiotics. Probiotics, vaccines, and biosecurity are being viewed as promising areas for growth. This supports our prior research highlighting investment opportunities in companies producing probiotics (e.g., Novozymes) and biosecurity products (e.g., Neogen). We also believe vaccines can help offset the pressure on animal health companies (e.g., Zoetis and Phibro Animal Health) due to falling sales in medicated feed additives.
Michael Shavel is a Global Thematic Analyst at Cornerstone Capital Group. He is responsible for researching industries, companies and trends in the field of sustainable finance. Prior to joining the firm, Michael was a Research Analyst on the Global Growth and Thematic team at AllianceBernstein where he covered the energy, industrials, and materials sectors. He holds a B.S. in Finance from Rutgers University and is a CFA Charterholder.
In late September, the Clinton Global Initiative (CGI) convened top leaders from business, government and civil society for the 12th and final time. The end of the CGI Annual Meeting brings to a close not just an event, but a force that has helped change the way that companies everywhere think about social responsibility.
It’s been a decade since the Rockefeller Foundation (RF) endorsed me to advance CGI’s global health work, which at the time was new and already starting to make waves in philanthropy. President Bill Clinton’s enthusiasm for encouraging the private sector to step up as key players in the social impact space — rather than leaving such work to governments and nonprofits — was met with both curiosity and skepticism at the time. But the leadership at Rockefeller recognized that CGI’s approach to addressing global challenges represented a fresh and needed way forward.
By facilitating the development of specific and measurable corporate plans to make a positive social and environmental impact — coined as Commitments to Action — CGI bet on the idea that corporate philanthropy could become more effective by embedding societal values into companies’ core business plans.
It turns out former President Clinton’s experiment worked. Taking philanthropy beyond the traditions of corporate social responsibility — “doing well by doing good” — is now the accepted norm for business ten years later.
Its success paved the way for similar approaches, such as Michael Porter and Mark Kramer’s shared value, PepciCo CEO Indra Nooyi’s “performance with purpose,” or Novo Nordisk’s approach to the triple bottom line. All of these new approaches seek to find a new and explicit nexus between financial performance and social impact. As an advisor to CGI, I witnessed the powerful way former President Clinton’s platform stimulated, guided, cajoled and excited companies to go beyond their quarterly earnings reports and bring about positive social change through their commitments to action.
The direct benefits to society have been most obvious in the myriad global health commitments that have been carried out since 2005. Because of the collective body of commitments made by the CGI community, more than 114 million people have increased access to maternal and child health and survival programs, and more than 33 million people have increased access to safe drinking water and sanitation. Because of these commitments, more than 36 million people received treatment for neglected tropical disease, and more than $318 million in research and development funds was spent on new vaccines, medicines and diagnostics.
Due to the CGI community’s embrace of “doing well by doing good,” many companies transformed their business models to place health gains as central to their work. Traditional corporate philanthropy was soon reframed to meet market failures, including research, human capacity and humanitarian crises.
In fact, many of the United Nations Global Compact’s (UNGC) member companies are also CGI members. From the start, the CGI Annual Meeting was held during the week of the United Nations General Assembly, in the hopes of spurring synergy between goals and visions discussed on the East and West sides of New York City. CGI companies brought their experiences into the U.N. system at a time of unprecedented support for new forms of private-public partnerships to complement the role of government in addressing the newly adopted Sustainable Development Goals. This could allow for CGI’s commitments to reach the scale needed to have true global impact. Health should be a major beneficiary.
To accelerate progress on health, the UNGC is collaborating with Discovery Vitality and Novo Nordisk to elevate health within business in other areas that have become the norm, including the environment, labor, human rights, and corruption. Discovery Vitality’s CEO, Adrian Gore, pledged to work with others to advance the integration of health metrics into corporate reporting in his plenary address at CGI 2013 in the presence of the Director General of the World Health Organization, Margaret Chan, and the session chair, Chelsea Clinton. This pledge is being advanced during the UNGC in 2016.
It has been a privilege to see how seemingly intractable health and social problems are being tackled in new ways that build on the joint expertise of companies, NGOs, academia and government. While I was at PepsiCo, our CGI commitments tackled undernutrition in Ethiopia and obesity in China, India, and Mexico. We also partnered with the Alliance for a Healthier Generation, the American Beverage Association, and private-sector peers to curb the marketing and sales of unhealthy foods and beverages in the United States. All of these commitments had profound implications for the future of business models of food companies.
At Discovery Vitality, we are now expanding our CGI Commitments to Action with a very sharp focus, as outlined in our just-released 2016 Sustainable Development report. Vitality Shared Value Insurance is leading our members around the world to live longer lives while also transforming one of the oldest business models – life insurance. Our plan is having impact on health in profitable ways. CGI’s leadership in supporting and steering companies to do this will have enduring impacts on peoples’ lives and on our planet’s survival.
Few global platforms can claim to have the direct and indirect impact of the Clinton Global Initiative. Even as CGI draws to a close, the important work and impact of our commitments will continue. Doing well by doing good – and valuing the integration of both business purpose and societal gains – is now an unstoppable force in best business practices and in modern philanthropy.
Derek Yach, MBChB, MPH is Chief Health Officer at Discovery Vitality. He has been a full time employee of PepsiCo and has been on the Advisory Committee for the Clinton Global Initiative since 2006.
On October 20, the Detroit Health Department announced an investigation into two cases of Hepatitis A potentially linked to Whole Foods’ stores. Whole Foods contacted the Detroit Health Department to report one of the cases, while the second case has not been definitively linked to Whole Foods. While we view the reporting of this incident to health officials as positive, we have concerns about the grocery chain’s food safety preparedness given its exposure to prepared/ready-to-eat food and its lack of food safety disclosure.
Ready-to-eat food accounts for the highest percentage of recalls in the US and Prepared Foods/Bakery accounted for 19% of Whole Foods sales in 2015. Prepared foods is a growing area for grocery stores, with consumers citing time and affordability as reasons for this choice. In June 2016, Whole Foods received a warning letter from the Food and Drug Administration citing ‘serious violations’ of federal regulations during an inspection of the company’s food preparation facility in Massachusetts. Whole Foods stated that it would respond to issues raised in the letter, but we have not observed an increase in disclosure.
Our review of previous food safety incidents revealed that grocery store sales suffer less than restaurants; however, growth in prepared foods may lead to an increased impact. In 2008, Kroger experienced a multistate outbreak of E.coli linked to ground beef but did not experience a material sales impact. Restaurant chains such as Jack in the Box, Yum Brands and Chipotle experienced multi-quarter same-store sales impact as a result of a food safety incidents. We identified a key factor being the amount of time between purchase and consumption—adulterated or unsafe food is more likely to be consumed at restaurants. However, Whole Foods’ prepared foods are consumed quickly, thus creating a possible restaurant-level food safety risk.
In our July 2016 report Food Safety: In a State of Transformation, we developed a food safety disclosure assessment tool comprising 11 elements. Elements included internal food safety systems and independent auditors/standards, board expertise and product traceability. We view disclosure as a proxy for food safety performance as it suggests the company is actively considering the relevant issues and is able to publicly discuss its approach.
Whole Foods currently provides limited disclosure related to food safety, even after the FDA warning. We could not locate disclosure on an internal safety system or external auditors for its operations including its prepared food facilities. Whole Foods requires mandated food safety plans for high-risk items (e.g. eggs and baby food) but suppliers are not required to comply with a food safety standard accredited under the Global Food Safety Initiative. There is no food safety expertise present on the board or published Key Performance Indicators related to food safety.
Whole Foods recognizes in its 10K that it is held to higher standard on food safety due to its reputation but, given lack of disclosure, we question whether Whole Foods is appropriately considering this risk should further incidents arise. Increased disclosure would provide investors with greater confidence that the appropriate processes are in place. Disclosure would also provide investors with confidence that issues will be managed quickly and efficiently to avoid significant impact to the business.
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Sebastian Vanderzeil is a Global Thematic Research Analyst with Cornerstone Capital Group. He holds an MBA from New York University’s Stern School of Business. Previously, Sebastian was an economic consultant with global technical services group AECOM, where he advised on the development and finance of major infrastructure across Asia and Australia. Sebastian also worked with the Queensland State Government on water and climate issues prior to establishing Australia’s first government-owned carbon broker, Ecofund Queensland.
Michael Shavel is a Global Thematic Analyst at Cornerstone Capital Group. Prior to joining the firm, Michael was a Research Analyst on the Global Growth and Thematic team at Alliance Bernstein. He holds a B.S. in Finance from Rutgers University and is a CFA Charterholder.
Recent survey results indicate a move away from antibiotics in emerging market poultry production. WATT Global Media surveyed poultry feed producers and consumers globally (i.e., nutritionists, consultants, veterinarians, production managers) and 43% of respondents said that more than half of their feed production is now antibiotic-free. Based on the regional breakdown provided, we estimate that emerging markets accounted for 60-75% of survey participants.
Possible divergence from company views. In fiscal 4Q16, Phibro Animal Health (PAHC: $25.54) reported modest growth in sales of medicated feed additives (MFAs) containing antibiotics. Weakness in the US was offset by international growth from emerging markets such as Brazil and China. On the earnings call, Phibro cited emerging markets’ growing populations and need to improve productivity in food production as a long-term driver for their international MFA business. Our read of the survey results is that investors should be cautious assuming that growth in emerging market poultry production will translate into similar growth in MFAs.
Nutritional and specialty feed additive opportunities in EM. Our October 5, 2015 report Antibiotics and Animal Health: Value-Chain Implications in the US highlighted nutritional and specialty feed additives as having significant growth potential. We believe the survey implies a broader opportunity in EMs with two-thirds of survey respondents exploring, testing or using feed additives as antibiotic alternatives. Probiotics and prebiotics usage is also on the rise, supporting our previous view that growth these categories would outpace other additives.
Investment implications. For animal health companies, the survey signals possible checks to future growth in antibiotic use in EMs. Nutritional and specialty feed additives are generally produced by major chemical companies and represent a small portion of overall revenue, but opportunities in the EM appear to be growing. For companies with more concentrated exposure, probiotic and prebiotic feed additives offer the greatest growth potential.
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Michael Shavel is a Global Thematic Research Analyst at Cornerstone Capital Group. Prior to joining the firm, Michael was a Research Analyst on the Global Growth and Thematic team at Alliance Bernstein. He holds a B.S. in Finance from Rutgers University and is a CFA Charterholder.
Sebastian Vanderzeil is a Global Thematic Research Analyst with Cornerstone Capital Group. He holds an MBA from New York University’s Stern School of Business. Previously, Sebastian was an economic consultant with global technical services group AECOM, where he advised on the development and finance of major infrastructure across Asia and Australia. Sebastian also worked with the Queensland State Government on water and climate issues prior to establishing Australia’s first government-owned carbon broker, Ecofund Queensland.
Discovery Ltd. is an innovative insurance company that was founded over 20 years ago. Today, its core purpose – making people healthier and enhancing and protecting their lives – is central to its shared-value business model.
When Discovery was founded in 1992, the complexity of the South African healthcare environment at the time provided a powerful incubator for innovation. South Africa’s high disease burden, an undersupply of doctors, and the vision of changing the way healthcare works required a new framework for addressing healthcare challenges. Health promotion and chronic disease prevention, as opposed to healthcare during illness, offered such a framework.
Incentivizing Behavior Change to Bring Down Insurance Costs
As reflected in its business model, Discovery’s focus has always been on placing the needs of society at the core of its strategy. Discovery designs its innovative insurance products around its shared-value approach, which manifests in its health-promoting integrated insurance programme, Vitality. These products use behavioral economics to translate positive behavior into immediate rewards, which in turn inspire long-term positive behavior change. Changed behavior results in lower insurance costs, and the savings are used to fund incentives that encourage the positive change in behavior. Members benefit from better health, increased insurance value and financial rewards; the insurer benefits from lower costs, and customer loyalty and retention.
Expanding Business Model
Discovery’s shared-value insurance model has become even more relevant in the context of the growing importance of the societal trends shaping the insurance industry. Shared-value health, protection and savings products that are dynamic in nature, offer people the opportunity to manage their evolving health needs throughout their lives and be rewarded for improvement. This will become increasingly important as populations age. For example, as the latest WHO report on aging has highlighted, effective health promotion programs that reduce the risks in older people for cognitive and mobility-related functional impairments save costs for individuals, families and society, as they allow people to live their lives to the fullest. On this chassis, Discovery can grow the business further in existing sectors and expand into new territories in adjacent sectors. The financial and societal success of the Vitality model has led to shared-value insurance becoming a compelling proposition for other insurers. Discovery recently established the Global Vitality Network, comprising partner insurers that employ the Vitality business model and participate in collective network assets such as global rewards partnerships, technology collaborations, and academic and media partnerships. Over the past five years, Discovery has partnered with AIA in Asia and Australia, Generali in Europe, John Hancock in the United States, Manulife in Canada, and Ping An Health in China – all of whom have evolved into ambassadors and proponents of shared-value insurance.
Targeting New Territory to Inspire Positive Change
By applying the same shared-value model, Discovery aims to expand into adjacent industries. Our evidence-based insights about many peoples’ inherent short-termism and seemingly “irrational” behavior has implications well beyond health insurance and applies, for example, to motor vehicle insurance. Discovery’s vehicle insurance business uses technology to track and measure clients’ driving behavior. The rewards programme incentivizes clients to improve their driving behavior and lower their risk.
Current available results validate the relevance of the shared-value approach in this area too: Driving behavior improves significantly, leading to fewer claims and lower claims costs for the insurer, and immediate and long-term benefits for clients in the form of financial rewards and savings, as well as increased safety on the roads. Considering the “irrationality” people generally display in their savings behavior, an opportunity exists to disrupt traditional business models in Discovery’s next targeted adjacency, the banking industry, through a shared-value model.
With this global expansion and because Discovery leverages personalized technologies to enable Vitality members to monitor their health and driving behaviors, the privacy and confidentiality implications from collecting large amounts of data are significant. To address this, Vitality has released a set of guiding principles for the responsible innovation of personalised technologies and the appropriate stewardship of data from these devices.
In August 2015, Discovery ranked 17th on Fortune’s first Change the World List, which recognizes organisations that have made significant progress in addressing major social problems as part of their core business strategy. This recognition for and impact of our model propels Discovery to continue to work towards and beyond our 2018 ambition of being the best insurance organization in the world and a powerful force for social good.
Gugu McLaren is Senior Sustainability Specialist at Discovery Limited. She has 10 years’ experience in driving the development and delivery of sustainability strategic frameworks and projects.
America, we have a problem:
Two Princeton economists startled Americans recently when they discovered that between 1999 and 2013, white, middle-aged, high-school-educated men in the United States died at an increasing rate from prescription and illegal drug overdose, alcohol and liver-related disease and suicide. Fortunately there is the impression that government and media are paying attention to this national epidemic. Earlier this month, President Obama announced his plans to invest more than $1.1 billion over the next two years to expand access to treatment for abuse of heroin and other drugs, avail the overdose-reversal drug naloxone to first responders, and support targeted enforcement activities. Also Congress passed the Comprehensive Addiction and Recovery Act (CARA), revising punitive drug policies, promoting best medical practices and strengthening data sharing among states’ prescription drug monitoring programs.
The Princeton study also forces us to recognize that drug abuse is not, as previously thought, a malady afflicting only poor, minority, inner-city communities, but rather is an across-the-country phenomenon, affecting in particular rural white adults. Interestingly, as the mortality trend demonstrates, the under-treatment of pain in minorities has inadvertently ‘protected’ them from overdose, reducing a decades-long death-rate gap between whites and non-whites. But will increased access to care for those already harmed by addiction; addressing the enduring shortfalls in prescriber education; and research for alternative abuse-deterrent medications actually reverse this deadly epidemic?
I think not.
Turns out the overdose epidemic is a social, not just a medical, problem.
First, researchers are struggling to understand why whites, in particular, are doing so poorly with drug abuse. Although there are no definite answers, many speculate that it is the combination of stress and lack of social support (risk factors for drug abuse in general) and acute job loss that are causing these deaths. Recession alone does not increase mortality, however when recession is associated with job loss, the rate of heart attacks, strokes and deaths rises. This may suggest that the increase in stress, despair and financial insecurity combined with engaging in unhealthy behaviors (like inactivity, smoking, drinking alcohol, and drug abuse) may be the cause of these deaths.
Second, and even more surprising, is that although awareness of the harms of opioid abuse is rising, the overwhelming majority of patients who survive an overdose continue to be prescribed high-dose opioids, often by the same prescriber. It is easy to attribute these results to poor care, bad decisions or sloppy prescribing, but many of these prescribers simply do not know that their patients are overdosing. Given the fact that there are no widespread systems in place to notify prescribers when overdoses occur, it is highly unlikely prescribers will suddenly increase the level of care for these patients.
Third, the notion that there is a small group of prolific prescribers that are driving the opioid overdose epidemic is not accurate. The bulk of prescriptions are made by general practitioners trying to help patients with a broad array of health conditions, and the distribution patterns of prescribing opioids between Medicare and Medicaid patients are no different than other drugs given for chronic diseases. These statistics suggest that adding law enforcement resources to address improper prescribing is not warranted. Fourth and most disappointing is that despite a plethora of local, regional, state and federal efforts to curb the overdose epidemic, things are actually getting worse. More people died from prescription and illicit drug overdoses over the past year than during any previous year on record.
Clearly there is a need to develop safer drugs and do a better job in prescribing and intervening before prescription drug misuse or other substance use progresses to addiction. But are these responses a big enough step in the right direction?
Under-assessment, the overlooked problem
The 18th century French philosopher Voltaire had many amusing quotes about medicine, such as: “common sense is not so common” and “the Art of Medicine consists of amusing the patient, while nature cures the disease”. However there is one particular quote that might provide an overlooked solution to the overdose epidemic. Voltaire said that “Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing”. How does this statement reflect on current practice?
Obviously, nowadays we know much more on how to prescribe and how to cure diseases, but what about “knowing our patients”? How well do healthcare providers ‘know’ their patients and how does this intimate, context-sensitive, unbiased knowledge contribute to the decision to prescribe (or not) drugs? When was the last time a healthcare professional used an online multidimensional, patient-reported outcome tool during a routine office visit incorporating data on sleep, movement and diet based on a wearable FitBit-like device? When was the last time a prescriber was able to show a patient their longitudinal treatment outcome on a dashboard in real time, to justify continuing or stopping treatment?
Well if your answer is never, you probably understand that the problem of medicine in general is not the over- or under-prescription of drugs, or the over- or under-treatment of anything, but rather a fundamental under-assessment of patient’s complex physical condition and nuanced life narrative.
One billion dollars of funding devoted to appropriate, cost-effective treatments can be expected to help many. But in order to halt and not just attempt to reduce rising death rates from drug overdoses, prescribers really need to get to know their patients. Beyond human contact, professionals need to start quantifying human social traits (“phenotypes”) at every clinical encounter in addition to the routine use of lab tests and imaging. Insurance companies need to pay for this, so that lack of time will not be an excuse for not measuring behavior, and patients need to have this actionable information (‘health data’) available. Not measuring pain interference, mood, diet, activity, exercise and sleep limits the understanding of the effects of any therapy, and makes prescribers unable to guide patients and their families to cope with, and remove, the obstacles that deny them the health and wellbeing they seek.
As for patients, my recommendation is: “next time you see your doctor, ask to see your data”.
Dr. Alex Cahana is Director of Medical Affairs at the Center for Lawful Access and Abuse Deterrence and theme developer for ARK Investment Management. He has over 15 years of experience in policy and healthcare redesign and serves as a consultant for the Department of Defense and the Veterans Health Administration.
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Health is becoming personal, predictive, and preventive through advanced technologies – wearable devices, embedded sensors, artificially intelligent robots, and virtual reality headsets. A deluge of data and feedback generated by these technologies nudge consumers to engage in healthier activities, or are aggregated and analyzed for insights about diverse populations across geographies. Major technology companies are investing in solutions powered by “big data” that promise to improve the health of populations worldwide. The opportunities appear boundless.
Despite this promise, ethical, legal, and social concerns associated with these technologies have emerged, which could very well hinder benefits to health. The US federal government has targeted several health technology companies that are unable to support their scientific claims with compelling evidence, and studies demonstrate that insufficient privacy and security features underlying such technologies can lead to harmful effects for users. If these challenges are not proactively mitigated, the potential improvements to health may not be realized at scale.
Overcoming these issues requires the collective views of disparate stakeholders and cross-sector collaboration. One voice is not as powerful as multiple in unison. As a start, colleagues from Vitality, Microsoft, and the Qualcomm Institute at the University of California, San Diego published an open-access, peer-reviewed commentary that called for a public consultation to identify best practices to eliminate ethical, legal, and social barriers to health technologies. For 90 days in 2015, a wide range of stakeholders offered input on a draft set of guidelines for the responsible innovation of health technology and the appropriate stewardship of data from these devices. Feedback came from organizations such as the EU Commission, the US Food and Drug Administration, the National Academy of Medicine, and the American Heart Association.
In March 2016, Vitality released the finalized guidelines for personalized health technology. They included five recommendations:
- Build health technologies informed by science: Integrate scientific and behavioral evidence into the design of health technologies to better understand health risks and outcomes.
- Scale affordable health technologies: Develop cost effective health technologies that are accessible by all populations to minimize health inequalities.
- Guide interpretation of health data: Facilitate interpretation of health data through software design to support better health literacy.
- Protect and secure health data: Embed privacy and security design features into health technology to ensure end-to-end protection.
- Govern the responsible use of health technology and data: Disclose practices associated with the governance of health technologies and data to create shared values for all stakeholders.
The guidelines provide the foundation for a working group to pilot the implementation of the guidelines. These will be measured independently using tangible metrics, and results will be shared. Collaborating across sectors, the proposed guidelines seek to shift the dialogue around health technologies to one that promotes shared values for all stakeholders. They are an attempt to convene leading industry players to consider bringing greater transparency and accountability to health technology and data—to avert the sorts of issues that recently emerged between the US Federal Bureau of Investigation and Apple. The guidelines are not an attempt to preempt government regulation, but aim to fill holes where needed in existing regulatory frameworks.
Can we learn from the past to know if we are on track? The Human Genome Project (HGP) is one example where proactive consideration of ethical, legal, and social concerns led to broader individual and societal benefits. Twenty-five years ago, the HGP was founded as an international research collaboration to sequence human genes. Leaders of the HGP set aside a portion of the budget to foster basic and applied research on these issues, and established the Ethical, Legal, and Social Implications Research Program. Today, the National Human Genome Research Institute (NHGRI) at the US National Institutes of Health has a legislative mandate to allocate no less than 5% of the NHGRI budget to these issues. As a consequence, established and accepted protocols facilitate the routine sharing of genetic data for research. The vision for our guidelines is informed by past achievements in proactive investigation of concerns with the possession of genetic information.
Technologies are created by people, for people. Technologies that improve the public’s health should be informed by science, affordable, safe and protect the user’s health data. We can collaborate to shape the future of this new frontier in health data, or we can wait in anticipation and uncertainty only to discover the unintended consequences.
Gillian Christie is a Health Innovation Analyst at The Vitality Group in New York City.
Kevin Patrick is a Professor of Family Medicine and Public Health, and a researcher at the Qualcomm Institute at the University of California, San Diego in La Jolla, California.
Chris Calitz is Director of the Center for Workplace Health Research and Evaluation at the American Heart Association in Dallas, Texas.
The idea behind sustainable and responsible investing is to invest in companies that reward shareholders with strong financial returns as well as deliver positive environmental, social and economic impacts. Beyond explicit sustainable investing, more and more stakeholders are expecting companies to marry purpose with profits and to do more good for society.
When it comes to the betterment of human health, such as raising the state of physical, mental and social well-being, this responsibility looms large, and the inputs, outputs, and impacts may be difficult to pin down.
Until now, this challenge has been met by accounting for social impacts in buckets of negligence or malpractice, such as human rights violations, occupational injury and illness, child labor, slavery, and the like. As such, the business case for well-being translates into avoiding reputational risks and ensuring that legal and regulatory requirements are met.
In this pursuit of simplicity we miss the forest for the trees. We effectively skip over all the “good things” that human well-being generates, like mastery, autonomy, purpose, good health, safety, security, trust, and belonging.
Moreover, well-being is greater than the sum of its parts. Well-being is a true reflection of a system that operates in a sustainable and healthy way: a business system that places well-being as central to its purpose, products, people, and the planet; that commits to developing human potential with opportunities for learning, progress, and collaboration; and that builds resilience for an evolving dynamic system by deliberately elevating the absorptive and adaptive capacity of individuals. In sum, we may appreciate and generate thriving if we value these things as much as, or more than, grievances or violations attached to various business activities.
Measuring the Forest
Now is the time to focus on the forest—the positive impacts on well-being that businesses consciously create. This pivot in attention could be the engine that drives social impact, the economy and civic engagement. If this is so, how do we measure it?
Researchers in the SHINE program at the Harvard Center for Health and the Global Environment have been busy working with companies to measure their well-being handprint — changes that companies cause to happen beyond doing business as usual.
Working with Johnson & Johnson, a participant with SHINE, our researchers have developed well-being metrics that connect the dots between the internal business operating environment, well-being (engagement) and performance (productivity). SHINE is using these measures to survey employees and take a pulse on the culture of well-being within the company and its effects on the business.
For companies motivated by measuring improvements in well-being, such as Owens Corning, these proof points may help to set priorities and align strategy. At EYP Architecture and Engineering, these metrics may translate into environmental features or building designs that improve human well-being. For Levi Strauss & Co, the idea of measuring well-being in the supply chain is tantamount to making the communities in which they operate thriving and healthy places to live and work.
Every June, these companies and others come together at the SHINE Summit to learn and share the science and business of handprint accounting—how companies measure positive environmental and well-being impacts—and to cheer on the race to the top organized by a NetPositive strategy, a deliberate intention to do more good than harm in the world. Altogether, this is a collective system for thriving.
In a recent book review, Peter Senge wondered: “What if growing our people was the true strategic core of the enterprise?” In the same vein, I wonder whether maximizing human capital is fundamental to sustaining all other capital resources (see Capitals, a report by the International Integrated Reporting Council that explains how 6 capitals of business—financial, manufactured, intellectual, human, social and relationship, and natural—are affected and transformed by the activities and outputs of an organization).
If human potential is core to the sustainable future of business, can well-being metrics capture the business impact? Research on well-being would say so. A recent study by Alex Edmans examined companies from the annual “100 Best Companies to Work For” list published by Great Place to Work Institute and found that the profitability of companies that valued and developed their employees outpaced the sector benchmarks.
Studies that have measured well-being, including those inside SHINE companies, have shown that higher levels of employee well-being are associated with better productivity and performance, such as less lost work time or unhealthy days, better engagement, and increased job satisfaction.
While individual improvements in well-being may accumulate to collective impact at the organizational level, the holy grail for the SHINE well-being studies is to “fingerprint” a thriving culture and climate according to its unique features. For stakeholders, including consumers, employees and investors, this global measure of company well-being could be the key to thriving at work and become the gold standard for integrated reporting.
Well-Being: More than Wellness
A sticking point for successfully implementing a well-being strategy that is hard-wired to the business operating system is that well-being is often confused with wellness programming: individual programs that target employee health behaviors such as exercise, smoking, nutrition, health care utilization, etc. Traditional wellness programs often narrow the focus on individual behavior and trade off corporate responsibility for employee responsibility.
The shift to well-being changes the emphasis from what employees should be doing to what companies can be doing to ignite higher order change at the system level. For a well-being strategy, health programming is only one part of the approach. The business goal for well-being is to first invest in human capital rather than to aim to reduce health care costs. Studies have shown that raising employee well-being enables better lifestyle choices that return better health and, ultimately, lower health care costs. At the same time, businesses that invest in growing human capital achieve returns on talent acquisition and retention through operational efficiency, quality, and brand reputation.
Can we agree on measuring, managing and reporting on well-being? SHINE companies believe this idea already has legs and is running through the forest!
Eileen McNeely teaches at Harvard T. H Chan School of Public Health. She is Co-Director of SHINE at the Harvard Center for Health and the Global Environment. SHINE works with companies to test new methods and develop the evidence base for positive impacts on people and the planet. She has extensive experience in health policy and environmental and occupational health.
Interest in alternative nutritional feed additives is growing. As we discussed in our October 5, 2015 report Antibiotics and Animal Health: Value-Chain Implications in the US, a confluence of regulatory action and heightened consumer awareness is exerting pressure on livestock producers to reassess their usage of antibiotics.
Our optimistic view on specialty and nutritional feed additives is supported by Adisseo and Novozymes’ recent launch of a probiotics product.
- On January 25, 2016, Adisseo and Novozymes launched Alterion, their first probiotic for poultry. The product is meant to improve feed utilization and provide an alternative to antibiotic growth promoters on poultry farms. It will be released to the US market in addition to the Middle East and Southeast Asia.
- Developed from a strain of Bacillus subtilis, Alterion can be added to feed to affect the composition of intestinal microbiota, providing growth and health benefits to animals when ingested. In addition, it also optimizes feed conversion by 2-2.5%.
- Novozymes and Adisseo entered a partnership to develop probiotics in May 2015. Novozymes performs in-vitro testing and manages Alterion’s development and production. Adisseo performs in-vivo testing and manages the marketing and sales of Alterion.
Rapid growth of probiotics market. Our previous research indicated that the global feed additives market, which we estimate to be valued at approximately $15 billion, could experience mid-single-digit growth annually through 2020. Adisseo and Novozymes have also adopted a favorable outlook on the market, estimating the probiotics market alone to be at “EUR 200-300 million and 8-10% annual growth.”
Figure 1: Antibiotics and feed additives
Source: Cornerstone Capital Group
Figure 2: Feed additives outlook
Probiotics are forecast to grow rapidly and face less competitive pressure
Bubble size denotes the current size of each market; market growth outlook is estimated through 2020.
Source: DSM, Novozymes, DuPont, Grandview Research, Transparency Market Research, Cornerstone Capital Group
Michael Shavel is a Global Thematic Analyst at Cornerstone Capital Group. Prior to joining the firm, Michael was a Research Analyst on the Global Growth and Thematic team at Alliance Bernstein. He holds a B.S. in Finance from Rutgers University and is a CFA Charterholder.
Sebastian Vanderzeil is a Research Analyst with Cornerstone Capital Group. He holds an MBA from New York University’s Stern School of Business. Previously, Sebastian was an economic consultant with global technical services group AECOM, where he advised on the development and finance of major infrastructure across Asia and Australia. Sebastian also worked with the Queensland State Government on water and climate issues prior to establishing Australia’s first government-owned carbon broker, Ecofund Queensland.
Andy Zheng is a Research Associate at Cornerstone Capital Group. Andy graduated from Bowdoin College with an interdisciplinary major in Mathematics and Economics and a minor in Visual Arts. He spent his junior year studying abroad at the University of Oxford and the summer prior to that at the Sorbonne in Paris. Andy passed Level I of the CFA Program in January 2014.
Cornerstone Capital Group research intern Chanelle Qi contributed to this report.
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