April 22

Kyle Poplin

Weekly Roundup: Healthy Debate and Unhealthy Economics at Unite for Sight

I went to a global health conference last weekend and an economics lesson broke out.

That’s a bit of an oversimplification. The more than 2,000 people who attended the 13th annual Unite for Sight Global Health & Innovation Conference at Yale University will attest that lots of things beyond economics were discussed. It’s just that as I scurried from session to session around the campus, I kept hearing about the scarcity and/or misapplication of money.

It makes sense. People in global health are “solving the world’s toughest problems,” as keynoter Jordan Levy, chief external relations officer of the Ubuntu Education Fund, said. And that can’t be done without funding.

His take on the topic: “Stop linking small dollar amounts with massive change. … Invest in the long term. Transformative change won’t happen in our lifetimes.”

He’s in the business of raising vulnerable young people, and that requires a long timeline. “Why do we think we can transform a life in a 12-month grant cycle?” he asked. “Children don’t graduate in one year.” (It was a point later expounded upon by Charles MacCormack, president emeritus of Save the Children, who cited “an irrational marketplace of philanthropy.” Donors are driven by short-term, personal issues, he said, while global health problems are long-term and require scientific analysis.)

A key takeaway from Levy: When you apply unrealistic expectations, you limit your ability to be effective. “Don’t look at outputs, but outcomes. Real change is not measured by who gets a hot meal but by how they end up.”

In a session down the street from Levy, Derek Yach, chief health officer at the Vitality Institute, took an even more macro view, saying big companies should rethink the way they measure success. “Maximizing short-term shareholder return is not the best way to conduct business,” he said. “Thinking long term pays.” He backed that up by citing Cornell University Professor Lynn Stout, who writes in “The Shareholder Value Myth” that adhering to the old idea that entities should strive to “maximize shareholder value” actually damages investors, organizations and the public.

Don’t get Jeffrey Sachs, special advisor to Secretary-General of the United Nations Ban Ki-moon, started on the topic of harming the public. Speaking live via Skype on Saturday from the Vatican – where he was part of a meeting that included Pope Francis and U.S. presidential candidate Bernie Sanders – Sachs passionately talked about how corrupt leaders and flawed systems hurt the world’s poor.

Public health always delivers when it has resources, he said, pointing out successes in malaria, polio and AIDS. And, he added, it can even deliver at low cost. But it can’t deliver for free, and that’s what it’s often being asked to do: The global health effort is about $20 billion to $30 billion short of what’s needed, he said, and a global fund for health is the answer.

He pointed to waste in the system, especially in the U.S., which spends about $8,000 per person on health care. That compares to about $15 per capita among the world’s poor and is 50-100 percent higher than in other developed countries, with outcomes in the U.S. lagging. “Why do other countries have lower costs and better results?” he asked. “Single-payer (health insurance) is what’s needed. … And we need rational drug pricing. … If our politics weren’t so corrupt, this would end in a day.”

There’s a growing disparity between the world’s rich and poor – a topic on the table at the Vatican – representing an opportunity to tax the wealthy to help fund the world’s health. The disparity, he added, is “a policy decision, not a given of nature.”

He even offered a fix for the refugee crisis: End the wars. (It was enough to make one thankful for having attended the talk by Rich Leimsider, social enterprise consultant, earlier in the day, where he said, “I think the world’s been getting better for 100 years.”)

On a more micro level, Matthew Smith, director of operations, MASS Design Group, talked about how a single construction project can change a community’s economy. He said MASS built a hospital in Rwanda, where existing facilities were so claustrophobic and poorly designed that the buildings themselves were actually making people sicker, and used the opportunity to “invest in dignity.” They trained locals to use available materials like volcanic stone and to build by hand, using the unique topography for natural ventilation. He said the need for more health care infrastructure throughout Africa represented a “moonshot” for his firm.

MASS’s Director Amie Shao added, “A building can be the entry point into addressing a community’s biggest problems.”

Ned Breslin, an executive vice president at the Wounded Warrior Project and former CEO of Water for People, also hit on community buy-in. Most sanitation problems in developing countries are the result of poor use of aid, he said: “Africa’s not scarce in water infrastructure, it’s scarce in flowing water.” Water for People started finding sanitation solutions, he said, when it linked with allies and partners to “harmonize fragmented services.” And when they built new financial models that showed water and sewer was a good investment, politicians jumped on board. The government started doing its job (even bragging about its accomplishments) after Water for People reimagined its role and became a facilitator instead of implementer, Breslin said.

Bobby Jefferson, director of center development informatics, Palladium, had much the same idea in his talk, saying a project’s success often depends on getting others in a particular country to work together.

As for how all this talk of money relates to providers and would-be providers of global health, Paul Ellingstad, managing partner at PTI Advisors, had an interesting – and ultimately encouraging – thought to send conference attendees back out into the real world: “People don’t buy what you do, they buy why you do it.”


Kyle Poplin is the editor of NextBillion Health Care.


Small image: Jennifer Staple Clark

Big image: Jordan Levy. Photos by Chris Volpe Photography


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