Many suffer needlessly from incontinence

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Content Nº 1 2009
6
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Did you know that 96 percent considers paper
towels the most hygienic for drying hands? Or that
we treat ourselves with expensive chocolate despite
bad times? Read more on the Shape up pages.
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Incontinence is the public health problem nobody
wants to talk about. Still, one in ten suffer from
urine leakage. Few seek help.
$B@3<2A
Demands made on the food packaging industry are getting tougher. Also, why magazines
survive when newspapers don’t, and the search
for ethical investments by today’s investors.
21
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Shape met with Hans Rosling, who dedicates his life
to global health research. His aim: to do away with
preconceptions about the “Third World.”
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Windpower is gaining in global popularity as a
source of energy. But how does it work?
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30
SCA has been recognized as one of the world’s 100
most sustainable companies for the fifth year in a
row. Read also how the current financial crisis is
affecting SCA’s strategy.
!1/;3@/
Merlo Castle outside Sundsvall holds a wealth
of Swedish industry history, including some five
kilometers of SCA archives.
24
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air from hand dryers in public toilets raises the bacteria level on newly
washed hands by several hundred percent. Mechanical rubbing with a
paper towel, on the other hand, removes some of the remaining bacteria
from the hands after they’ve been washed.
Using paper towels reduces the number of bacteria by 58 percent on
average. Textile towels cut their numbers by 45 percent, while warmair dryers increase them by 25 percent.
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a growing public health problem
One out of 10 people today have to live with incontinence.
As more and more people live longer, that number
will increase. A number of effective treatments and
incontinence aids are available, but still there are
many people who do not try to get help.
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ncontinence is a widespread
public health problem. It’s hard
to say exactly how many are affected, but a frequent estimate
is one out of 10 people. In Sweden alone,
that means about 800,000 people.
“People don’t talk much about urine
leakage, but the fact is that it’s more
common than other chronic illnesses like
hypertension, diabetes and depression,”
says Aino Fianu Jonasson, an associate
professor and senior consultant at the
Women’s Clinic at Karolinska University Hospital in Huddinge, Sweden.
Urine leakage is most common among
women. The problem is found among
women of all ages, but the risk increases with age. In the over-50 group, one
out of three women suffer from incontinence. How often they leak or how
much varies – it can be anything from a
few drops to larger quantities.
The most common type of incontinence is stress incontinence. It pretty
much affects only women and involves
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leakage of urine as a result of laughter,
lifting heavy objects or exercise. The
cause is often the weakening or stretching of muscles in the pelvic floor (below
the pelvic diaphragm) as a result of pregnancy, childbirth or hormonal changes
related to menopause. Other explanations could be asthma or chronic bronchitis, smoking and obesity.
Urge incontinence involves the leakage of urine when a person suddenly
feels the need to pee. It’s often difficult
to control oneself for longer periods,
and some people have to pee more often than others. Many have a hard time
making it to the bathroom in time. The
causes vary here as well, but it may be
due to a lack of estrogen in women, prostate enlargement in men, a urinary tract
infection, a bladder infection, uterine
fibroids or a neurological disease.
Incontinence is often seen as a problem that only affects women, but the fact
is that many men also suffer from urine
leakage. Men have a longer urethra and
stronger perineum, which means that
they are not affected to the same extent.
But from age 75 up, urine incontinence
is almost as common among men as it
is among women. One common cause
is that the nerves controlling the bladder deteriorate as a person ages. Another cause can be prostate problems.
An enlarged prostate can result in stress
incontinence, and prostate operations
can weaken or damage the muscles temporarily.
7<1=<B7<3<13 1/< have a very
negative impact on a person’s quality of
life. The fear of not being able to control oneself prevents many people from
leading a normal life. Many studies
have shown that urine leakage can lead
to a lack of initiative, reduced physical
capacity for work, fewer social contacts
and low self-esteem. There are also side
effects like poor sleep at night, an increased risk of falling when getting up
to go to the bathroom at night, recurring
urinary tract infections and depression.
“Not being able to control your bladder can mean incredible suffering,” says
Aino Fianu Jonasson. “I’ve had patients
who don’t dare leave the house – or if
they go out, they take precautions like
fi nding out where there are bathrooms.
Some dare not have sex because they’re
afraid of leaking or smelling bad. It’s
not normal to live like that.”
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0CB63:>7A/D/7:/0:3 That’s why
it’s important that people with problems
consult a doctor or clinic. The most common form of treatment involves various
types of exercise. Perineal or kegel exercises, where the muscles are strengthened
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with different flexing exercises, can result
in improvement for 60 to 70 percent of
women with stress incontinence. This
type of exercise also helps men.
For urge incontinence, bladder exercises and scheduled visits to the bathroom are an effective form of treatment.
“It’s never too late to exercise,” says
Aino Fianu Jonasson. “But studies have
shown that it’s important to get professional help with exercising. At our clinic, we have a physiotherapist who helps
patients and monitors their results. It’s
much more effective than just sending
the patient home with a slip of paper
that tells them what to do.”
;3271/B7=< 1/< mainly benefit
people with urge incontinence. Some
patients can get relief from medicine
that relaxes the bladder muscles. Estrogen treatment can help women who
have had a reduction in estrogen due to
menopause.
For stress incontinence, medication
is only minimally effective. But surgery
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can be an option if muscle-tightening
exercises have not had any effect. The
aim of surgery is to provide support for
the urethra. The most common method
is called TVT, tension-free vaginal tape,
and involves the placement of a synthetic mesh tape that acts as support. Another non-surgical method is to inject a
compound into the walls of the urinary
tract, which tighten the urethra.
But exercises, medication and surgery cannot remedy every case of incontinence. That’s why many are dependent on incontinence aids. There are a
number of different kinds of aids, but
the most common ones are products designed to absorb urine.
Health care providers play an important role here. Nowadays there are absorbent products with different forms
that are adapted based on how much leakage there is. “It’s important that patients
get to choose what best suits them,” Aino
Fianu Jonasson says. “No one should
have to walk around in sanitary pads just
because they don’t know there are other
products that can work better.”
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Access to treatment and incontinence
aids varies from country to country. In
many European countries, such as Sweden, the Netherlands and Germany,
the health care system provides prescriptions for aids at no cost. But there
are also countries where people who
are affected pay the costs themselves.
There is no reliable information about
what urine incontinence costs society,
but large sums are involved. In Sweden
alone, it is estimated that the cost of incontinence aids runs around SEK 1.4
billion (USD 175 million) a year. Add to
that the cost of medical testing, surgery
and patient care.
23;=5@/>671B@3<2Aalso mean
the incidence of incontinence will rise.
The percentage of seniors is increasing
throughout the world. The rate varies
but the trend is clear. Numbers from
the UN indicate that the median age
has risen in almost every part of the
world since 2000. One explanation
may be that fewer children are being
born, but another is that economic and
medical developments mean we’re living longer.
“Because there are more and more older people, it also means that more people
at some time in life will be affected by incontinence,” Aino Fianu Jonasson says.
“Women going through menopause still
have a third of their life left. To me, it’s
obvious that they should be able to live as
free of problems as possible.”
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3D3< B6=C56 many people suffer
from incontinence, few of them talk
openly about their problem. Wetting
oneself is considered shameful. It’s also
a problem that has gotten relatively little attention in health care.
“It’s been an unglamorous research
field and there is still a lack of knowledge about urine leakage,” says Aino
Fianu Jonasson, an associate professor
and senior specialist at the Women’s
Clinic at Karolinska University Hospital. “The subject is taboo, which is
strange considering how many people
are affected.”
A number of surveys have shown that
many people don’t dare seek help even
though they have a problem holding it
in. Some are bothered by urine leakage
every day but don’t get in touch with a
health care provider. A survey of attitudes carried out by SCA in nine countries shows that 71 percent of women
and 64 percent of men see incontinence
as something you absolutely do not talk
about out loud. Other studies show that
only a quarter of those who wet themselves seek medical help.
There are other explanations for this.
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One is that many older people think that
incontinence is a natural part of aging
and that nothing can be done about it.
Another explanation is the feeling of
shame and discomfort that is associated
with wetting oneself. Many younger
people think they are alone in having a
problem – that incontinence only affects
older women and men.
“I’ve met a lot of patients who haven’t
dared to tell anyone they’re leaking – not
even their closest family members,” says
Aino Fianu Jonasson. “But then they
meet someone who tells them about
their own incontinence, and that’s when
they dare to open up. They often experience a great sense of relief.”
7<=@23@B=A>@3/2 information,
break the silence and influence general
opinion about incontinence, associations have been formed in a number of
countries for people who suffer from
it, for family members and for health
care workers. The World Federation of
Incontinent Patients is an international
group, while in Sweden the incontinence
organization Sinoba has been around
for almost five years.
“Urine leakage is not exactly something you talk about at a dinner party,”
says Märta Lauritzen, the chair of Sinoba, who also works as a urotherapist
at Karolinska University Hospital in
There’s a very
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A6/>31=D3@
Huddinge. “We want to downplay the
issue by informing people about what
the problems are due to and what you
can do about it. There are many people today who don’t know that it can be
treated.”
There are a number of drawbacks to
considering incontinence as taboo. Because many people never get in touch
with a health care provider, the number
of unreported cases is large, leading to
medical undertreatment. People who
could get the right products, medications, exercises or surgery instead suffer
in silence. A survey of 4,500 women in
Sweden, Germany, England, Italy and
Spain has shown that one out of three
women with incontinence avoid activities like dance and travel for fear
of wetting themselves. The same survey showed that one out of five women
avoid exercise, which in turn can have
negative effects on their health.
”You should also remember that incontinence can be a sign of another seri-
ous disease,” says Aino Fianu Jonasson.
“It may, for instance, be due to a tumor.
So it’s important to get in touch with a
doctor or clinic that can do a thorough
investigation.”
0CB E6/B 1/< 03 2=<3 to improve the situation and increase knowledge about urine leakage? Both Aino
Fianu Jonasson and Lauritzen think the
most important thing is to have more
people talk openly about the problems
and treatments that are available. A
large share of the responsibility falls to
the media, which Aino Fianu Jonasson
thinks has done a good job bringing attention to the matter and reporting research results in recent years. But health
care providers bear a large share of the
responsibility and have to get better at
identifying patients who can’t control
their bladders. Clinic nurses and primary care providers play an important role
here. It’s a question of taking the time
and finding what type of incontinence
µ6/@2B=;/@93BE6/B
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ers cautiously,” says Björn Uddenberg,
category director for incontinence care
at SCA.
In the last 20 years, SCA’s sales of
incontinence products have increased
an average of 11 percent a year. Demographic trends mean that the need for
incontinence protection will continue
A1/A6/>3I 'K
to grow. For suppliers, it means big opportunities – but it also places demands
on marketing. Selling incontinence protection for adults is not the same thing
as selling a fast car or a nice bottle of
perfume.
“To stretch it a bit, you could say that
we’re selling a product and trying to develop a brand around something that
is involved, what it might be due to and
what treatment or aid can work for a
particular patient.
“It’s not unusual today that women
with incontinence are sent home with
the advice to tighten their muscle,”
Lauritzen says. “In some cases, they
might get a slip of paper with instructions – sometimes they don’t even get
that. That’s not enough. If someone’s
going to successfully complete an exercise program, it’s important they get
the guidance they need. And if exercises
don’t work, then you’ve got to look at
other treatment options.”
Care programs have been developed
that health care providers can use, she
notes, and the solution often doesn’t
have to be very complicated.
”I recently had a patient who never
left home because she leaked,” Lauritzen says. “We set up an exercise program, gave her medicine and made sure
she got the right incontinence aid. Now
she can go out and live a normal life.”
nobody wants to have,” says Björn Uddenberg.
The market for incontinence aids can
easily be divided into two groups: light
incontinence and heavy incontinence.
The light incontinence group includes
many “deniers” who don’t consider
themselves incontinent. They choose
regular sanitary napkins because they
think incontinence protection is associated with illness or old age.
“This group is really difficult to reach
through marketing,” Uddenberg says.
“Instead, you have to target the people
who are at the next level – those who’ve
started to accept that they have a problem.”
But in that group too, consumers
have to be approached cautiously. It’s
difficult to use exaggerated humor or
glamorous settings in this kind of adver-
tising. You can also come across wrong
if the approach is too positive or too
medical. “Because the problem is still
taboo, you’ve got a relatively narrow
area to work in.”
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/<=B63@ 4/1B=@ that places demands on marketing is that you have to
reach different target groups and different channels at the same time. It’s
not just a question of reaching a person
who suffers from urine leakage – you
also have to reach family members,
stores, pharmacies, assisted living establishments and health care providers.
Packaging and advertising can also be
adapted depending on whether you’re
addressing men or women.
“If you want to sell diapers, you really just have to focus on one target
group: parents,” Uddenberg says. “This
is a much more complex target group.
In countries where many older people
live at home, the idea is to reach family members. In countries that provide
prescriptions for incontinence aids, you
have to reach purchasers and employees. And it can often involve procurement contracts, so you need to go all the
way up to the politicians who make the
decisions.”
SCA has already had a strong position
in Europe and North America for many
years. The aim is to further strengthen
the position in these markets and also
grow in the emerging markets of Eastern Europe, Asia and Latin America.
<3E A/:3A 16/<<3:A such as
the internet, also provide attractive opportunities. Experience has shown that
incontinence aids are often well suited
for e-trade.
“The products are bulky so it’s convenient to buy them online instead of
having to carry the items home yourself,” Uddenberg says. “You also get
around the taboo issue because you
avoid shopping where other people see
you.”
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Obviously, marketing is about selling
products and making money. But Uddenberg also thinks that, through marketing, companies can change attitudes
and break the silence on incontinence.
This is also done by arranging seminars in which patient groups, different
health care professions and politicians
have a chance to meet. “We want to normalize the whole thing and show users
that they’re not alone,” he says. “Buying products that protect against urine
leakage shouldn’t be any stranger than
buying sanitary napkins.”
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mjuka barn är glada barn.
Nu lanserar Libero ett helt nytt sortiment
nyttigheter för småttingar. Vår babyol ja,
lotion och kräm är något av det mest
skonsamma du kan använda när huden
inte riktigt håller ordning på sig själv.
(Och det gör den som regel inte.)
Svanenmärkta, oparfymerad e
med mjukgörande rapsolja och
naturliga E-vitaminer. Bevarar
hudens naturliga fuktighet och håller
den mjuk utan att kladda. I sortimentet
ingår också svanenmärkta tvättservetter,
shampoo, duschtvål och amningskupor.
Läs mer på Libero.se
Shampoo som inte
svider i ögonen.
Aj!!
Det kan göra ont
att amma. Babyoljan
verkar lindrande,
och amningskupor gör
livet lite bekvämare.
Svanenmärkt
såklart!
Investors
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ore and more investors are taking climate
issues into account in
their decisions. “Despite these financially
unsettling times, social, ethical and
environmental factors are all increasingly important to investors,” says
Matt Christensen, executive director
of Eurosif, the European Social Investment Forum, which concentrates on
sustainable investments in the financial markets.
Eurosif’s surveys of managers show
that sustainable and responsible investment, or SRI, represented more
than 17 percent of the asset management industry in Europe at the end
of 2007, double the level of just two
years earlier.
The European SRI market’s growth
is driven by increasing demand from
institutional investors, for whom
responsible investment becomes a
matter of risk management; external
pressure from non-governmental organizations and media; and growing
interest from individuals.
Other players, such as the independent Carbon Disclosure Project, also
3<
see a growing role for environmental
issues in making investment decisions.
“Given the signals being sent by the
new American administration and
other governments, we can expect more
regulation in the area of global climate
policy, which will further highlight
the issue in the minds of investors,”
says Paul Simpson, the organization’s
chief operating officer.
>/B@79 7A/9AA=< , SCA’s vice
president for environmental affairs, gets a lot of questions about
the Group’s environmental work.
He rarely has trouble providing an
answer, because SCA’s production
units provide in-depth accounts each
year of all resources used, from raw
materials and energy consumption to
emissions and waste management.
“Sustainability analyses are attracting growing interest among investors,” Isaksson says.
An independent survey by the European Business School found that
about 20 percent of SCA’s shares are
owned by shareholders who examine the Group’s sustainability work.
That percentage has grown significantly in recent years.
“A small portion of these shareholders have a strategy of simply investing in companies that are ‘best
in class’ – that is, those that perform
best in terms of their sustainability
work,” Isaksson says. “Other investors uses the companies’ sustainability work as an extra risk parameter.”
A greater focus on emissions and
resource use means that SCA’s handling of these matters will grow in
importance in the future.
A1/¸A ACAB/7</07:7BG report,
distributed with the company’s annual report, includes a compilation of
resources used by the entire Group.
The system for collecting data from
all the units – called the Resource
Management System, or RMS – is
unique in the industry.
“Production leads to the use of resources, including energy, water and
transportation, and different types
of air and water emissions as well as
solid waste,” Isaksson says. “RMS collects, processes and analyzes all these
aspects. It’s unusual for companies
like ours to include the transportation
of raw materials to our plants and finished products to our customers.”
The RMS work is examined by a
third party, which independently audits both the reported figures and the
work that goes into developing the
data.
“Without RMS, we would basically
be groping in the dark,” Isaksson says.
“Having an overview of the impact of
our activities on the environment and
our resource use is a question of credibility and responsibility. RMS is also
an important part of many decisions
we make. The auditing by a third party
means our data are very reliable.”
B63 @;A AGAB3; is Web-based,
and clear instructions and descriptions of methods are available to
make sure all figures are comparable
and correct.
“By using a single tool we depend
less on individuals, so the figures are
very reliable,” says Ingela Keskitalo,
who leads the work with RMS.
Keskitalo says there have been a
few problems with some resources
and emissions being reported differ-
ently in various countries, perhaps
because of different traditions or
local requirements.
“All information has to be comparable in order to clarify how the company develops from one year to the
next,” Keskitalo says. “When there’s
a new acquisition, it’s important
that the new facility quickly joins the
system, so it’s really valuable to have
clear instructions for how the reporting should be done.”
=<3 <3E 7B3; this year is that
RMS has been adapted to meet the
Group’s more stringent requirements
for carbon dioxide emissions. Starting this year, RMS will include carbon
dioxide emissions from the electricity
SCA purchases.
“Obviously, it’s nothing we can control entirely, but we still want to include
it because it provides a clearer picture
of our total resource use and its impact
on emissions,” Keskitalo says.
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7B¸A3/AGB=0:/;3 the Internet.
But daily newspapers were already
losing readers long before anyone
heard the term “World Wide Web.”
In the late 1980s, the positive circulation trend reversed for news dailies in Europe. Morning newspapers
in Sweden, for instance, have lost one
out of five readers since then. The
evening tabloids have been even harder hit – their circulation has dropped
by nearly half. The figures are similar
throughout Western world.
What’s the biggest cause?
“The strongest factor is probably
&A1/A6/>3I 'K
the development of a totally new and
more multifaceted media picture that
began around 1990,” says media analyst Olle Lidbom.
Back then, the number of TV stations in Western Europe multiplied
with the advent of satellite TV. At the
same time, the number of radio stations also increased significantly. A
few years into the 1990s, free newspapers, which are now available pretty
much around the world, were introduced.
In the new media mix, newspapers
– which have looked much the same
for decades – suddenly seemed stiff
and impersonal.
“People learned there were alternatives to straight newspaper reporting,” Lidbom says. “They wanted a
personal voice, with analysis and embellished explanations.”
In response, the number of magazines began to rise slowly but steadily for a few years until the market in
Europe exploded with the start of the
new century. In the US, the trend had
started a few years earlier.
“The enormous technological progress hit on a broad front,” Lidbom
says. “Basically, it became so much easier
to produce a newspaper, which prepared
the way for a new generation of creative
newspaper publishers.”
At the same time, the advertising
market grew sharply, which meant
there was money around to make new
ideas happen.
“Up until now, there’s been room
for a number of fairly similar products
aimed at the same target group, like
people interested in cars or home design,” Lidbom says.
In recent years, the curve for commercial magazines has leveled off, which is
due at least in part to the general economic downturn. “We’ll see a decline,
in any case in the short term,” he says.
Lidbom also thinks we’ll see a winnowing in the genres where a number
of titles compete today. He notes that
there’s also a category of newspapers
that has been growing but doesn’t show
up in the statistics – customer and company newsletters.
Still, Lidbom thinks rumors of the
imminent death of the morning paper
are highly exaggerated.
“They won’t die, but they can never
again compete at being the primary
channel for news,” he says. “Instead,
they’ll be more analytical, more indepth and therefore more expensive
and more exclusive.”
The situation for US daily newspapers is more acute – there, it’s a question of simply surviving. The venerable
Washington Post is losing 10 percent of
its circulation every six months, and a
number of major dailies have closed
their doors. Several magazines in the
US have also been forced to throw in the
towel.
“American newspapers are more
vulnerable because they’re fi nanced by
advertising to a far greater extent than
Swedish papers, for instance,” Lidbom
says.
Lidbom thinks it’s impossible to predict how the recession will affect the press
in Europe over the long term.
“The difficulties are already here, and
things will get worse,” he says. “But it
won’t get as bad as in the US.”
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;=AB =4 B63 4==2 we buy these
days is packaged, and packaging is becoming an increasingly important part
of the food supply chain. Usually it’s
made of corrugated fibreboard, cartonboard, paperboard, plastic or glass.
Naturally, it’s important that the food
doesn’t absorb compounds from the packaging material. Packaging should preserve
the food’s nutrition, taste, flavor and scent,
and it should also protect against light,
moisture, oxygen and microorganisms.
New food products and manufacturing methods and a greater awareness of
risks have led to calls for higher safety
standards for food packaging. Consumers and major supermarket chains
demand good hygiene and safety in the
packaging material.
While standards for producing food
and beverages have been strict for years,
the standards for packaging have not
always been so exacting. But nowadays
they are becoming more stringent.
“This will no doubt promote a greater understanding among packaging
producers of expectations in the food
industry for traceability in the material used,” says Jacob Tidemand, head
of quality control at the Danish fish
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producer Rahbek Fisk. “However, over
time most packaging producers have
gotten a pretty good grip on this. ”
The European standard EN 15593
for hygiene in the production of packaging material for the food industry was
adopted on February 7, 2008. This regulates everything from standards for clean
work clothes, use of restroom facilities
and general cleaning to how assembled
pallets should be stored hygienically and
at the right temperature. Premises must
be sealed so that mice, rats, flies and other insects do not come into contact with
the material.
>/19/57<5 ;/B3@7/: that comes
into direct contact with the food is subject to its own manufacturing regulations. Obviously, the material should
not be unsafe, yet that’s not as easy as it
sounds. The EU specifies what material
may be used in food packaging and also
regulates labeling, various gases, temperature requirements, weight specifications and how the packaging material
is to be handled when it is recycled and
also eventually becomes waste.
An exciting development is “intelligent
packaging.” This involves outfitting the
package with an indicator that changes
color to reveal if the food has become too
warm during transportation.
More and more prepared food is being heat treated in the packaging it is
sold in. It is still not known with certainty how all these materials react with
microwaves. The research is under way,
and new regulations are expected.
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t all started with coffee beans.
That’s how Hans Rosling,
a professor of international
health at Karolinska Institutet
in Stockholm, explains his interest in
the link between economics and global health.
For the past two years he has
traveled the world giving lectures to
full houses. With the help of his own
software program Gapminder Hans
Rosling links economic development
to public health. It’s not something
that usually entertains big audiences,
but the software turns heavy statistics into popular science. He makes
different countries dance across
the screen, changing places as they
progress through the years. Family size, life expectancy and infant
mortality determine where you are
on the grid. If you compare stages of
development over time, you can see
how countries like India, Turkey and
Bangladesh are moving closer to Europe and the US in great leaps. If you
look at average life expectancy, you
can see that Vietnam is now where
the US was when the Vietnam War
ended in 1975.
“We’re still talking about the
Third World, even though it’s the
world where 80 percent of the Earth’s
population lives, and the differences
between so-called developing coun-
I 'KA6/>3A1/ >@=47:3
tries are as great as between Sweden
under Karl XII in the early 18th century
and [Prime Minister] Tage Erlander in
the 1950s,” Rosling says. “I want to
change this view of the world. There are
no ‘industrial countries’ or ‘developing
countries.’ So much has happened.”
Rosling traces his interest in global development to his father, who was a coffee
roaster in Uppsala, Sweden. Sometimes
the bags of coffee beans contained coins,
which his father found and brought
home, telling him about the conditions of
coffee pickers in different countries.
/B67A;=B63@¸A urging, he enrolled
in medical school. In 1979 he traveled to
Mozambique, where he worked for two
years as a medical officer. There he discovered a previously unknown paralytic
disease that got him started on his career
as a researcher. The disease was given the
name konzo and turned out to be linked
to the prussic acid in tainted cassava root.
For 20 years, Rosling did fieldwork in remote parts of Africa, studying the links
between food, health, social relations
and the situation of women.
In 1993 he helped found Doctors Without Borders in Sweden. But the inspiration for the lectures that Rosling gives as
he tours the world came a dozen years ago
when he gave a course in global health to
medical students at Uppsala University.
“It was awful to see that the students
were still living with old notions that
weren’t based on facts,” he says. “They
thought the world looked like it did the
year their teacher was born. I tested the
teachers’ knowledge about development,
and unfortunately theirs wasn’t much
better.”
Rosling wanted to find a way to explain the world the way it actually is.
The solution was the computer program
Gapminder, developed by his son Ola
and daughter-in-law Anna. The program brings together public health data
and economic development over time,
based on information from sources like
the United Nations, the WHO and the
World Bank. The result is a set of colorful “bubbles,” or floating circles on a
A1/A6/>3I 'K
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grid, illustrating the shifting conditions
of health and welfare in various countries over the past several decades. Work
on the software began in 1998, but the
big breakthrough came in March 2006
when Rosling appeared at a TED Conference in California.
“The presentation had an enormous effect,” he says. “Between two and 10 million people have seen the lecture online. It
has been more useful than everything I’ve
done in my whole life put together.”
Since then, it’s all gone quickly.
Rosling is a popular lecturer with both
politicians and businesspeople. He tells
with delight how one of his performances got the actress Meg Ryan to bouncing up and down in her seat – and he has
discussed health, economics and global
development with powerful people like
Al Gore, Bill Gates and Fidel Castro.
”I’m not the one meeting them –
they’re the ones who’ve asked to meet
me,” Rosling says. “Independent professors can be good to talk to sometimes,”
he adds with a wry smile.
B=2/G63A>3<2A 90 percent of his
time as the head of Gapminder, which
is now run as a foundation, and 10 percent as a professor at Karolinska Institutet. He does what he calls “fact-based
common-folk simplification.”
“You don’t have to fiddle with the
facts to be understood,” he says. “My
goal is to get everyone to see in an easy
way that it’s not ‘us’ and ‘them’ – most
people are in the middle. Anyone who
still has these old notions runs the risk
of making the wrong decisions. You
have to try to see every country on the
basis of its conditions.”
Rosling keeps coming back to the
idea that health is not an isolated phenomenon. How well people feel, how
many children they have and how long
they live are closely linked to economic
development, political development,
social relations and gender equality.
Changes in living standards have an
impact on public health and can create
new needs. One calculation Rosling has
made shows that the number of menstruations has increased 10-fold within
a generation. The explanation is only
partly that there are more women.
“Menstruation is not the body’s normal state,” he says. “It’s an indication
that a woman is not pregnant or breastfeeding and can become pregnant. Today, Indian women are having fewer
children, which means they have their
period more often. Nonetheless, they
don’t have the same access to sanitary
pads and tampons that we have.”
B63@3¸A<=2=C0B that Hans Ros-
ling is absorbed by what he does. He
rattles off numbers and displays pictures that fly across his computer screen
at lightning speed. He also has an opinion about almost everything. When we
show up for an interview at 9 a.m., he’s
just been telling the science radio program “Vetenskapsradion” that one of
their segments was surprisingly biased
and a specimen of what he calls “internship journalism.”
Rosling paints the world in broad
brush strokes – something that might
provoke his research colleagues who
have their eye on the details. Yet Rosling
says he has surprisingly few critics.
“It does happen that various people
who are fighting poverty think I give too
positive a picture of the development in
poor countries,” he says. “I really want
to describe how many people are still living in extreme poverty, but I don’t think
anyone is better off if people get a false
picture. Take Tunisia, for instance. Tunisia today is at the same level Sweden
was at when we began giving them assistance. It’s an incredible success that
people should talk about.”
Rosling’s optimism helps to captivate
his audience. On stage, he mixes laughter
and seriousness. He is one of five sword
swallowers in Sweden, something he’s
demonstrated at a few of his lectures.
Perhaps it’s revenge for the time he was
refused a place in his school’s theatrical
production. “The director said I couldn’t
portray anybody else but could only play
myself. Now I get to play myself as much
as I want – it suits me perfectly.”
His main message is that there’s hope
for the future. Rosling shows how countries that are often seen as poor and
backward can get on their feet and move
forward.
“I don’t think being sad and assigning
blame is a successful approach,” he says.
“And you can be positive when you see
the progress. Look at infant mortality,
for instance. In the early 1970s, infant
mortality was 20 percent in Egypt and
25 percent in Bangladesh. Today they’re
down to 4 and 8 percent. It’s all gone incredibly quickly.”
But what are the most important factors for boosting health in the countries that still lag behind? According to
Rosling, several things work together:
sensible public administration, democratic freedom, economic growth, a functioning judicial system and a functioning
health care system that covers everyone.
Another critical factor is gender equality
that gives women greater influence in the
private sphere as well as the public arena.
“To sum it up, you could say that the
solution is a more just world,” he says.
“It’s not harder than that.”
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sing wind for power is an
old trick. Since ancient
times, people have ground
grain and run pumps with
the help of windmills. During the 1970s
oil crisis, there was serious discussion
about using wind power as an alternative source of energy. In Sweden a referendum on nuclear power encouraged
the development of experimental power
stations, and one of these was once the
largest in the world.
As the climate changes, interest in
fossil energy alternatives has picked up
again. In the late 1990s, the development of wind power increased throughout the world, and in 2007 more than
20,000 megawatts of wind power capacity was installed – an increase of 30
percent over the year before – with the
US, China and Spain prominent players
in the field. The US may surpass Germany, which previously led the league
of wind power producers, in installed
capacity as early as the end of 2009.
Developing wind power is expensive.
A single wind power station involves an
investment of about USD 5-6 million
(EUR 4–5 million).
A station consists of a tower and a
turbine (that is, a hub with blades) as
well as an engine house with a generator. Between the engine house and the
tower is a yaw system that keeps the turbine facing the wind.
There are usually three rotor blades.
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In theory, an infi nite number of tiny
blades would be most efficient, but
that is hardly defensible economically.
Three blades provide three times more
energy than two, but two weigh less and
consume less material. The blades are
thicker closest to the hub and twist out
toward the tip. The angle and direction
of the blades can be set depending on the
force and direction of the wind.
When a stream of air passes over the
front edge of the blade, some of the air
goes over the blade and some goes under,
creating a lifting force that turns the rotor. The turbine blades slow the wind
down and harness some of its kinetic energy. Even though the blades cover only a
fraction of the surface, they can employ
a large portion of the wind’s energy. The
low number of revolutions of the turbine are transformed via a gearbox into
a higher number that can be used by the
generator, which transforms the kinetic
energy into electrical energy.
A wind power station automatically
starts up at a wind speed of around 3–4
meters per second and begins to generate
electricity. A doubling of the wind speed
results in eight times more energy. The
wind power station achieves full effect
at wind forces of about 13-15 meters per
second, so any wind force higher than
that does not increase electricity production. At 25 meters per second, the station
closes down because the mechanical load
would otherwise be too great.
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become the name of the product. For many
people in Germany, “Do you have a Tempo?”
is the same as asking for a tissue.
The Tempo tissue has helped runny noses
for the past 80 years. Since 1929, Tempo has
been at the top of the German tissue market.
Today, more than 9 million packets of
Tempo are produced daily in the German
town of Neuss near Düsseldorf.
Tempo is celebrating its anniversary with a series of activities.
Among other things, Tempo Plus packs will be produced in a
designer version featuring emotionally inspiring images. At the
same time, consumers are invited to send in photos of some of
their own personal and emotional moments. The most beautiful
pictures will be printed on Tempo packets at the end of this year.
Two factors for success for the German tissue were the “Zfolding system” from 1975, which enabled the user to unfold the
tissue with one hand, and the resealable packets from 1998.
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63@323A75<7A;=@3B6/<23A75<
A1/ =>3<32 / >/19/57<5 23A75< 13<B3@ in the
French town of Rochechouart in November. The center aims to
break new ground in providing clients with unique packaging solutions.
Because the customer is deeply involved in the process, the
design center becomes a part of our corporate image, says
Veronique Leys, marketing and communication coordinator,
Western Europe.
It should be an inspiration center where we can capture the
needs of the customer and develop total packaging solutions
with added value for the customer and for ourselves. We want
customers to come to SCA for innovation and
new products.
Today SCA Packaging Nicollet is a provider of advanced packaging solutions for
a vast range of consumer products across
numerous sectors, including premium foods
and beverages, luxury goods and detergents.
SCA Packaging Nicollet covers the European
market and produces more than a billion
packages a year.
The business group has 20 design centers
around Europe and an innovation center in Brussels with a total of more than 250 designers.
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These increasingly hard times mean that
better cash flow is now SCA’s highest
priority. At the same time, the company is
continuing its long-term investment in
hygiene.
B3FB(5r@/<:7<2>6=B=(A1/
&A1/A6/>3I 'K
A1/7<A723
B63@313AA7=<and the fi nancial
crisis have left almost no industry untouched. Companies are affected not
just by generally lower demand. The
rapid developments in this economic
downturn have also generated an
unusually large amount of uncertainty about the future, something that
applies to parts of SCA’s markets as
well.
“In a short time, we’ve gone from
economic boom to deep recession,
and it’s perhaps harder than ever to
make forecasts about the future,”
says CEO Jan Johansson. “We know
that things will turn around sooner
or later – the question is just when.”
As a result of the weak economy,
SCA has adjusted the company’s
near-term strategy. More focus is
now being given to reversing the trend
in cash flow and reducing costs.
“Cash flow has the highest priority
in the current situation,” Johansson
says. “The goal is to improve cash
flow by a couple of billion kronor over
the next two years, despite the negative impact of the weak economy.”
5@3/B3@ 3;>6/A7A is also being placed on improving capital efficiency in the company’s plants. In
packaging operations SCA has already reduced production capacity.
“If volumes continue to decline
and the market does not respond
by eliminating capacity, prices will
continue to stay under pressure,” Johansson says.
There is hardly any doubt that
reductions are needed. In containerboard (liner), variable cost exceeds
the sales price at 60 percent of all
producers’ plants in Europe.
SCA’s new strategy now is not
simply to “slam on the brakes.” With
continued investments in innovation and product development, SCA
intends to strengthen its position
as one of the three leading hygiene
companies in the world. Hygiene
operations are less affected by the recession and show strong underlying
growth.
A1/3F>31BA the market for personal hygiene products to grow 5-7
percent globally.
“SCA’s aim is to grow at least in
line with the market,” Johansson
says.
However, some changes will also
be made in the strategy for hygiene
operations. Here, as in other parts
of SCA, the European market will
be given greater scope. Europe accounts for 80 percent of the Group’s
sales and 85 percent of operating
profit. With the exception of incontinence protection, SCA will hold off
over the next few years on expanding
in markets where it does not already
have a strong market position.
“More concentrated geographic
growth also contributes to strengthening cash flow,” Johansson says.
7<>:/7<English, that means SCA
is focusing on Eastern Europe and
Russia, Latin America, the Middle
East, Malaysia and Thailand, while
holding off on other “emerging”
markets.
SCA is also consolidating its tissue product portfolio in Europe.
There will gradually be fewer
brands, and the portfolio for the European market will be simpler and
more straightforward. The streamlining now under way is a result of
SCA’s tissue purchase in 2007. The
goal over the long term is to create
pan-European brands for SCA’s tissue products.
This change also means that
SCA’s tissue products in Europe
will be streamlined into two different brand categories. One category targets personal hygiene like
toilet paper. The other targets object hygiene, which includes paper
towels.
A1/¸Astrategy in the recession:
Greater emphasis placed on cash
flow. The goal is to improve cash flow
by a couple of billion kronor over the
next two years.
Higher capital efficiency.
Consolidation in packaging operations.
Continued investment in innovations in hygiene.
More concentrated geographic
growth in new markets.
Greater focus on the European
market.
SCA has set a target for return
on capital employed of 13 percent
within three to four years. One
condition necessary to achieve this
return in that time frame is that the
economy rebounds toward the end
of 2010.
SCA also has a new environmental goal of reducing by 20 percent its
carbon dioxide emissions from fossil fuels and from new purchases of
electricity and heating relative to the
level of production by 2020, using
2005 as the reference year.
“SCA’s new environmental goal
is specific, measurable and within a
given time frame and has a clear reference to the EU’s climate aims in
terms of emission goals,” says Patrik
Isaksson, vice president of environmental affairs at SCA.
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Y
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OMTHE SHELVES OF
CFROM
Villa
Merlo
Merlos
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D7::/;3@:= is not your typical in-
dustrial manor house built of wood and
painted white. Merlo today looks like
a fairy tale castle, and inside it holds
SCA’s vast archives, shelf after shelf of
everything from minutes of board meeting to old photographs. The building
was erected in splendid seclusion away
from the lumber industries of northern
Sweden’s Timrå Valley.
Built between 1883 and 1885 on the
order of Fredrik Bünsow, the building
was originally intended as the family’s
summer residence.
The architect was Isak Gustaf Clason, who was also behind projects like
the Östermalm Covered Market and the
Nordic Museum, both in Stockholm.
Fredrik Bünsow was a German-born
entrepreneur who wound up in Sweden.
He became a timber merchant in Sundsvall, then the largest and fastest-growing timber district in the world.
With an innate sense of business he
I 'KA6/>3A1/ !
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was the second-richest person in Sweden after Alfred Nobel at the end of the
19th century.
Bünsow bought forests and floated
timber, set up sawmills, built railroads
and started Skönviks AB, which later
become one of the foundation stones of
what is now SCA.
Some 20 years after Bünsow’s death
in 1897, Villa Merlo was sold to Skönviks AB, which used it as a residence for
senior management until the 1950s. After that, Villa Merlo became the central
archive for the SCA Group.
“There’s an industrial treasure collected under Merlo’s roof,” says Kjell-Åke
Hermansson, the head of the archive.
In all, 5,000 meters of shelves are
filled with correspondence, forest maps
and other documents.
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Lower profit and reduced devidend. At the same time
growt for hygiene operations. That sums up the SCA
year end report for 2008.
Tough times but hygiene grows
:/ABG3/@ was one of the most dra-
matic periods in modern business. In a
short period of time, a strong economy
was overwhelmed by a fi nancial crisis
and falling demand. SCA’s net sales
for the year rose 4 percent to SEK 110
billion. At the same time, profit before
tax fell by SEK 2 billion to about SEK 6
billion after a weaker second half. As a
result of the lower earnings and uncertainty about the economy, SCA’s board
proposes that the dividend be reduced to
SEK 3.50 a share from SEK 4.40.
Looking at the different business
areas at SCA, however, the picture is far
from uniform. Hygiene operations, including Tissue and Personal Care, were
relatively unaffected by the economic
downturn. This is especially true for
Tissue, which increased sales by 15 percent and operating profit by 38 percent
in 2008, thanks to acquisitions and price increases. Demand was stable in the
mature markets and continued to grow
in Latin America and Russia.
Personal care products saw growth of
6 percent during the year. Profit was somewhat lower, down 2 percent, because
of higher raw material costs and a technological shift in baby diaper production.
SCA believes the overall positive trend in
hygiene operations can hold in 2009.
4=@A1/¸Apackaging operations, the
situation has been considerably more
difficult. Sales declined marginally,
slipping 1 percent to SEK 33 billion,
while profit fell 44 percent to about
SEK 1.5 billion. Higher costs for raw
materials, energy and transportation,
together with SCA’s production cuts
in containerboard (liner) operations,
had a negative impact on earnings.
The fourth quarter in particular was
weak, with sales dropping 9 percent.
Earnings from Packaging could continue to weaken if the decline in demand
persists.
The forest products sector was also
affected by the weak economy. Net sales
fell by 5 percent (adjusted for transport
operations that starting in 2008 are reported as other income) and profit fell
by 23 percent compared to 2007. Solid-wood products had a significant fall
due to lower prices and higher timber
prices.
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Our vision is to be considered as
the Supplier of Choice, by growing
and differentiating SCA Containerboard
products and services to offer our
Customers increasing value
B
eing the Supplier of Choice carries with it great
responsibilities. We see these in terms of three
basic pillars:
Security of Supply
With us as your partner our Customers can feel secure in
the knowledge that their containerboard supplies will arrive
on time and in excellent condition, keeping their own
production and customer delivery on schedule.
Validation of the Offer
For the smooth functioning of their businesses, our
Customers count on reliable supplies, consistent quality,
expert technical assistance, updated market information
and punctual administrative services. Assuring this is
SCA Containerboard Customer Service, a wide range of
essential customer services.
Effective Communication
Communication is the basis to efficiently work together.
Through continuous dialogue with our Customers, our
people and experts develop a full understanding of the
latest requirements and industry developments.
s c a c o n t a i n e r b o a r d.c o m
Illustration: Sweco
Energy from the forest
SCA FOREST PRODUCTS
www.forestproducts.sca.com
MELLERSTEDT DESIGN
SCA and the Norwegian power company Statkraft are investing heavily in wind
power. The two companies will construct six wind farms in the woodlands of
central Norrland, with a total of 400 wind turbines. When fully constructed,
this venture will generate 2,800 GWh of renewable electricity per year,
ccorresponding to 2% of Sweden’s total electricity consumption, substantially
more than the total current wind-power production in Sweden – an investment
of more than SEK 16 billion.
Our growing forests bind carbon dioxide, provide valuable raw materials for
Sweden’s most important industry and provide renewable electricity – without the
need for burning first-class industrial raw materials to produce energy.