When is enough, enough?

Happy New Year.

This is usually a time when we tend to spend more time reflecting on what has been and what might be. And I’ve been no different over the break.

There were a couple of stories in the news that particularly caught my attention, and with my futures and foresight sensibilities, have made me think about how it might be indicative of some wider changes that we’re beginning to experience, or already in the throngs of.

I’d like then to explore what this might mean for executive leaders more generally and those with responsibility for developing them.

Big Healthcare

Let’s start with the widely reported story of the murder of United Healthcare CEO Brian Thomson in midtown New York in early December. Thompson, a 50-year-old husband and father was shot dead in broad daylight as he made his way to an investors meeting. United Healthcare is the insurance arm of United Health Group, which is the largest health care provider in the US. It’s been reported that under Thompson’s leadership UnitedHealthcare had increased profits from $12billion in 2021 to $16billion in 2023.

There followed a manhunt for the killer and the police eventually arrested the alleged shooter; 26-year-old Luigi Mangione, an Ivy League graduate who suffered from a lower back condition and was arrested with a manifesto in his bag about how many healthcare companies “abuse our country for immense profit”. The press have reported that the bullet casings from Thompson’s shooting were etched with the words, Deny, Delay, Depose.

The public reaction was immediate and spontaneous. Social media erupted with jokes about Thompson’s death with comments like “prior authorisation is required for thoughts and prayers”. The company’s post on LinkedIn had to be turned off because of the amount of likes and clapping reactions and on Facebook they removed it after it received more than thirty-six thousand ‘laugh’ reactions.

The FT led with the headline that “Endemic discontent leaves little sympathy for US health insurers” and the Guardian reported that the killing was viewed as a “violent expression of widespread anger at the insurance industry.”

They said, and I’m quoting here:

“In the immediate aftermath of Thompson’s killing, many Americans defended Mangione’s alleged actions because they viewed Thompson as complicit in denying or deferring what they saw are need care”.

Although high profile and earning a large sum of money, Brian Thompson like most CEOs, actually has quite limited power to change the system, even if he’d wanted to.

It’s widely recognised that the healthcare system in the US is deeply flawed and best and corrupt and broken at worst. And it appears that Thompson became the personification of a broken system.

How then do we tackle a broken healthcare system that now seems predicated on what we would call perverse incentives? In this case that denying medical procedures represents greater business success (measured in profitability) than in helping more people (measured in other human centric metrics).

These perverse incentives and poor human outcomes aren’t limited to Big Healthcare.

UltraProcessed Food

One of the most impactful books I read last year was Dr Chris Van Tulleken’s “Ultra Processed People”. It’s an engaging, if often alarming, exploration of the pervasive influence that ultra-processed foods have on our health, culture, and the environment. The book examines how these highly industrialised foods dominate modern diets, affect our bodies, and brains, and even societal systems.

Van Tulleken is a doctor and researcher and he combines rigorous science with personal anecdotes. He shares his own experiment of consuming a diet largely composed of these Ultra Processed Foods, detailing the physical and psychological impact it had on him, such as weight gain, mood fluctuations, and addiction-like behaviours.

The book delves into how UPFs are engineered for maximum profit rather than nutrition, exploiting human biology to create cravings and dependency. It made the bestseller list, not just because it’s an accessible and thought-provoking book. But more importantly because it chronicles and idea whose time as most definitely come.

Carols Montiero is the Brazilian public health professor who coined in the term Ultra Processed Food. He was one of the first people to share the story, also in December that a first of its kind lawsuit was being filed against 11 of the world’s largest food manufacturers, including Nestle, Kellogg, Coca Cola and Mars, alleging they engineer their UPF products to be addictive.

The plaintiff is an 18-year-old from Pennsylvania who alleges that consuming ultra-processed foods marketed by these companies led to his development of type 2 diabetes and non-alcoholic fatty liver disease, diagnosed at just age 16.

Reuters reported that the lawsuit contends that these corporations have deliberately engineered their products to be as addictive as possible, employing marketing strategies targeting children, and thereby have contributed to a public health crisis.

The lawsuit likens the approach of the food companies to the tactics previously used by the tobacco industry to promote cigarette addiction. The legal action includes claims of conspiracy, negligence, fraudulent misrepresentation, and unfair business practices.

I don’t know about you, but I’ve never venture back to the kitchen of an evening for more broccoli, but if there’s sweet and salty popcorn in the cupboard, whoof!

Changing the system

It’s clear that these are systemic issues. In both cases they represent a system that has mutated so far from its original purpose – health and sustenance respectively – that they are no longer fit for purpose.

What are the goals of a healthcare system that it widely criticised for withholding healthcare? And what are the goals of a food system that concocts ultra processed food that is massively harmful to human health rather than providing sustenance?

And where might we intervene in a way to positively change a system?

For big healthcare and big food, they’re already reaching the 11^th hour to change their own destiny. The excesses of these industries now represent an existential crisis for them. When advocates for change become the law and policy makers, the writing is on the wall for the unbridled profits of an industry

What can we ask of shareholders, Boards, CEOs and executive teams in these and other industries in the meantime? Perhaps it’s that they work together to clarify the company’s purpose and determine, when is enough, enough? Was $12billion in profits in 2021 not enough for United Healthcare? Is the $16billion in profit in 2023 enough?

We need to be asking these questions not just because it’s the ethical thing to do, which it is. But from a strategy and governance perspective, as these issues mature, they’re moving in an inevitable direction. We can all see that the tide is turning for many of these companies. For some, they’ll have moved too late.

And for many families late last year, the price was already tragically too high.