Out West, the California Endowment is midway through a four-year, $26-million push for strong new state and local anti-obesity policies, including increases in children's physical activity, improvements in nutrition, and reductions in the risk for childhood diabetes and obesity. They call the initiative Healthy Eating, Active Communities.⁷⁸

Success is coming quickly. In 2005 Gov. Schwarzenegger signed the toughest laws in the nation banning junk food, soda, fruit drinks and sugared waters from the state's public schools. New state mandates also expanded physical education for all grades. Public health authorities called the actions “the most impressive gains in school nutrition since school lunch was introduced after World War II.”⁷⁹

What intrigues us is that, much as the Alliance for a Healthier Generation is leveraging the powers and responsibilities of business and industry to help reverse the epidemic, so, too, the California Endowment is leveraging the powers and responsibilities of government to do the same.

In the meantime, Philadelphia's private, nonprofit The Food Trust is recasting Lower North Philadelphia's food geography. And Arkansas is linking specific school-based policies with data collection and analysis to convince parents and children of the need to change fundamental aspects of their lives.

What we are witnessing is a rapidly maturing matrix of evidence-driven models that are defining what works through appraisal and evaluation and that have wide application locally and nationally. The best news is that, as we look toward 2015, we realize that pathfinders such as these are already clearing the trail.

In the daily workings of our philanthropy, we've made a promise to ourselves—that we will make a difference in our lifetime. And we are confronting this epidemic as a difference-making opportunity of a lifetime.

Each generation is given but a handful of chances to define for itself where it's going to wind up, how it's going to get there—and what it means for the generations to follow.

I can think of at least three moments in the past half century that dramatically shifted the course of American medical and scientific history.

The first was March 26, 1953, when Jonas Salk called a press conference to announce the discovery of a polio vaccine.

The second was just four weeks later, in the April 25, 1953, issue of the science journal Nature, when James Watson and Francis Crick published their discovery of the double helix structure of DNA.

The third time was January 11, 1964, when U.S. Surgeon General Luther Terry courageously reported that cigarette smoking causes cancer and other deadly diseases.

These are among the great medical and public health tipping points in the modern history of the world. America's reversal of the epidemic of childhood obesity will be of the same order of magnitude.

The Robert Wood Johnson Foundation has been in the business of seeking transformative social change for a little more than a generation. Along the way, we've gained world-class experience in identifying what needs to be changed, how to do it and when to do it.

John Gardner, one of the last century's greatest champions for social change, put it this way: “We are all faced with a series of great opportunities, brilliantly disguised as insoluble problems.”⁸⁰

Our job is to rip away the disguises, expose those seemingly insoluble problems for the opportunities they really are, and come up with solutions big enough and bold enough that their trajectories will take us far beyond the most distant horizon.

We are in the early stages of an epic undertaking that will be more difficult than the still unfinished 40-year campaign to break America's addiction to tobacco. One big difference: Unlike smoking, eating is a biological necessity. To transform the culture of how an entire society fulfills a biological necessity requires a clear vision and the will to turn it into reality.

We have the will and we have the vision. This is what we see when we look 10 years into our future and beyond:

The prevention of obesity in our children and youth is an ongoing national health and health care priority. Along with smoke-free air and flu shots, it is a given. Prevention and public health communities are united, motivated and effective. Energy in = energy burned is wired into the country's mind-set.

• Parents and families are informed and lead their children in healthy eating and physical activity habits. Children and teenagers, aware of obesity's threat to their own quality and longevity of life, are energetic champions of healthy behavior within their families and among their peers. (Parents remember how, as children themselves, they pestered their own parents to quit smoking.)
• Federal funding of prevention, behavioral and population research is reliable, up to the task and sustained. The government supports translation of key research into action. Through private sector collaboratives, the government also organizes national guidelines for school nutrition and physical activity, advertising and marketing to children and youth, and ensures the flow of credible, objective information to the public.
• Industry produces and markets healthy foods and beverages to children and youth with the same sophistication and effectiveness with which they previously promoted energy-dense, high-calorie products. Industry is a partner with the prevention field, advocating energy in = energy burned behaviors as a way to build brand, secure market share and improve the health of their customers.
• Schools are free of junk food and sweetened beverages and are no longer reliant on their sale. Instead, schools are aggressive providers of nutritious food and physical activity. Junk food is out, and recess and physical education are back. Energy in = energy burned is core curriculum.
• Civic leaders pursue bold public policies to curb obesity and promote the good health of their populations, similar to how local governments protect the public from secondhand smoke and how New York City banned transfats to improve heart health. Energy in = energy burned is a top-rank attribute of public planning as state and local governments decide how to improve the built infrastructure and better design public spaces for active living.
• Communities set as top public priorities access to affordable fresh fruit and vegetables for low-income families in disadvantaged neighborhoods. Supermarkets and farm markets are valued as necessary for the public's health and seen as good for the local economy.
• Finally, by 2015, the epidemic of obesity among our children is reversed. Societal observers conclude that the communal response to the obesity epidemic at the beginning of the 21st century transformed our national awareness that the health of a people is constructed through the efforts of all parts of society: schools, business, communities and public policies. The role of health care is to repair the damage we cannot yet prevent. They tell us that the abating epidemic in obesity is altering for the better the health future of generations to come.

This is our vision, our expectation and our call to action. John F. Kennedy, quoting Proverbs in a speech on the eve of his assassination, warned that “Where there is no vision, the people perish.” ⁸¹

We agree.

Our vision is driven by a compelling body of evidence that charges us to act and act now to reverse the epidemic with all the force and faithfulness of a public health imperative. We know it won't be easy. We know we cannot wait.

From the harsh history of Africa comes hard-earned wisdom:

We get it. The Robert Wood Johnson Foundation is seizing the opportunity today. Tomorrow will be too late.

Respectfully submitted,

Risa Lavizzo-Mourey, M.D., M.B.A.

President and Chief Executive Officer