Cooperate! A paradigm shift for health equity.

The role of competition and cooperation in relation to the goal of health equity is examined in this paper. The authors explain why the win-lose mentality associated with avoidable competition is ethically questionable and less effective than cooperation in achieving positive outcomes, particularly as it relates to health and health equity. Competition, which differentiates winners from losers, often with the winner-takes-all reward system, inevitably leads to a few winners and many losers, resulting in social inequality, which, in turn, engenders and perpetuates health inequity.Competitive market-driven approaches to healthcare-brought about by capitalism, neo-liberalization, and globalization, based primarily on a competitive framework-are shown to have contributed to growing inequities with respect to the social determinants of health, and have undermined equal opportunity to access health care and achieve health equity. It is possible to redistribute income and wealth to reduce social inequality, but globalization poses increasing challenges to policy makers. John Stuart Mill provided a passionate, philosophical defense of cooperatives, followed by Karl Polanyi who offered an insightful critique of both state socialism and especially the self-regulating market, thereby opening up the cooperative way of shaping the future. We cite Hannah Arendt's "the banality of evil" to characterize the tragic concept of "ethical fading" witnessed in business and everyday life all over the world, often committed (without thinking and reflecting) by ordinary people under competitive pressures.To promote equity in health for all, we recommend the adoption of a radically new cooperation paradigm, applied whenever possible, to everything in our daily lives.

Food labels: a critical assessment.

OBJECTIVE: Foods sold in packages have both front-of-package (FOP) labels and back-of-package (BOP) labels. The aim of this review is to determine the role they play in informing consumers as to the composition of foods in order to help select a healthy diet. METHODS: Recent literature was evaluated and findings combined with assessments made by the authors of food labels used in the United States and Canada. RESULTS: Research shows that most consumers have difficulty understanding the information provided by both FOP and BOP food labels used in the United States and Canada. Research has evaluated the merits of alternative designs. FOP labels should be based on a clear and simple design. They should present information on key nutrients (total fat, saturated fat, sugar, and sodium or salt) and also energy value. They should have color and words that indicate "high," "medium," and "low" levels. Labels can also state quantity per serving. The traffic light system is the best example of this design. An extra traffic light indicating the overall health value of the food should be added. A clearer BOP label also is needed. Implementation of a new food labeling system will probably be opposed by the food industry. More research is needed into which food label designs are most effective, especially for persuading consumers to select healthier food. CONCLUSIONS: Both FOP and BOP food labels used in the United States and Canada need to be redesigned using a traffic light system.