Global Health Challenges Offer Social Entrepreneurs Opportunity
This post was originally produced for Forbes.
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“We have grown far too tolerant of businesses not acting in alignment with the public good,” said Derek Fetzer, director of Johnson and Johnson’s CaringCrowd crowdfunding site for global health. “Shouldn’t all business, all entrepreneurship be for the public good? ”
“The spirit of social entrepreneurs is crucial in solving global health challenges, and has been a driving force in uncovering innovative solutions to tackle the ever-changing global health landscape,” Carol Pandak, PolioPlus director for Rotary International, said. (I am a member of Rotary and once wrote an article for the Rotarian Magazine.)
Pandak noted that global health issues hold a unique space on the plant. “It could be easy to diagnose many global health challenges as problems of individual regions and nations.” After all, it has been decades since anyone in the Americas got polio.
She pointed out that the United Nations’ Sustainable Development Goal number 3 targets healthy lives and well-being for all. “When it comes to global health, there really is no issue from which any group, any nation is immune.” Even with only 15 cases reported so far in 2017, polio is just a plane ride away.
To get a better perspective on global health opportunities for social entrepreneurs, I invited 12 experts and practitioners to join me for a roundtable discussion. You can watch the entire 90-minute discussion in the video player above. Pandak participated only in writing. In a wide-ranging discussion, we covered challenges and opportunities in global health along with specific examples and some key lessons learned.
Leslie Calman, Engineering World Health
Leslie Calman, CEO of Engineering World Health, extended Pandak’s idea. “The answer must be broadly systemic, not singular: a combination of broad public health measures; an educated and paid healthcare workforce including doctors, nurses and technicians; support from governments and NGOs for public hospitals and clinics that serve low-income people; [and] the education of women and girls.”
Entrepreneurs have many roles to play in global health, said Deepak Kapur, the Chairman, India National PolioPlus Committee. He highlights needs assessment, monitoring, cutting red-tape for rapid response to emergent needs, special perspectives of business and industry and piloting new programs.
Challenges in Global Health:
There are no shortages of challenges in global health for social entrepreneurs to pursue as opportunities.
Jill O’Donnell-Tormey, CEO and director of scientific affairs for the Cancer Research Institute, argues that fundamental research is the key to disease eradication. “Ultimately, I believe it comes down to research, and that means funding and time.” She added, “And without that, I feel we don’t get to deliver anything.”
She responded with a hint of irritation to a question about how long will it take to cure cancer, noting she is frequently asked how much money it will take, “Science doesn’t work that way.”
Calman put disease eradication into a broader perspective. “There is much more to health than the eradication of diseases. It is one benefit of a reduction in poverty and war. Health requires good nutrition, education (especially of women and girls), stable governments, public investment, peace. ”
UNICEF’s Stefan Peterson, who has spent most of his career working in or for resource-constrained countries, did take issue with the idea that scientific research should be the priority. “I think we need systems innovation more than product innovation. When two out of three kids and mothers die on necessarily because we have the technology and the knowledge and it doesn’t reach them. We need market research. We need delivery science and systems innovation.”
Contemplating that disagreement, I couldn’t help but wonder if they weren’t just looking at opposite sides of the same $20 bill. Without research, there would be nothing to implement in the field; without distribution, the research has no value.
Social entrepreneur Dean Ornish, the founder and president of the non-profit Preventive Medicine Research Institute and Clinical Professor of Medicine at the University of California at San Francisco, has focused his career on lifestyle’s contribution to health. He concludes that good global health requires attention to both lifestyle and cell biology.
Bruce Aylward, Senior Advisor to the Director-General, of the World Health Organization or WHO, noted that Ornish’s work is important because of what is coming. “The escalating rates of non-communicable diseases are the great epidemic in front of us and not just in industrialized but in middle-income countries and low-income countries as well.”
Agreeing, Ornish noted, “More people are dying today in most countries in the world including much of Africa from heart disease and type 2 diabetes than AIDS, TB [tuberculosis] and malaria combined.”
Highlighting the challenges of dealing with the coming epidemic, Calman noted, “We work in hospitals that don’t have blood pressure cuffs.” Her organization works to train local technicians to service and repair hospital equipment. There are people around the world who have no way of knowing they have high blood pressure.
“The question is what’s available within the first mile the first-mile health system from your house,” she continued. “And chances are that it won’t be a hospital.” These frontline health workers may be at the nearby pharmacy.
Women and Children:
In the global health sphere, there is little that is more important than helping women and children. Peterson cleverly explained, “The best advice to an unborn child is to pick your mother well and make sure that she’s healthy and has a good pregnancy.”
More soberly, he said, “If we are serious about achieving the SDG goals, we need to focus on building strong health systems that deliver quality of care for every woman and every child, everywhere.”
When thinking about women’s health, it is important not to limit the discussion too narrowly. Discouraging girls from becoming parents or getting married as teenagers and staying in school are also public health issues but they don’t happen in hospitals, Calman noted. Organizations and entrepreneurs need to pay special attention to keeping girls in school during menstruation by ensuring they have access to feminine hygiene products and education along with adequate facilities. “Women do in fact hold up half the sky.”
Examples of Social Entrepreneurship in Global Health
Mellanie True Hills, the founder and CEO of StopAfib.org, who participated in the discussion is a great example of a global health social entrepreneur. “We’ve educated people not only in the US but around the globe around this whole issue of atrial fibrillation which for those who are not familiar with that is an irregular heartbeat that leads to strokes.”
Mellanie True Hills
Founded in 2001 by two University of Memphis professors, Bob Malkin and Mohammad Kiani, Engineering World Health set out to train technicians to service medical equipment. Calman notes that if you show up to a hospital with a broken x-ray machine it isn’t any different for the patient than showing up and finding the hospital doesn’t have one.
Calman added, “We encounter over and over again folks who are willing to train or retrain doctors and nurses and as vital as that is if they’re 21st-century doctors and they’re working with 18th-century equipment it’s a waste of resources.” Training technicians should be just as high a priority.
There are opportunities in cancer research as well. O’Donnell-Tormey notes that a revolution in immunology began about five years ago. “I think the medical community believes now that the immune system can be used to treat and control cancer.”
Innovation in cancer treatment doesn’t end there. Acknowledging that some cancers are caused by lifestyle choices, others are caused by viruses, meaning that they can be prevented with vaccines.
Ornish, a consummate social entrepreneur, has spent 40 years working on treating public health with lifestyle changes, focusing on helping people move to a whole foods, plant-based diet.
WHO’s Aylward, noted, “And this is what makes the kind of work that Dean’s doing and others are looking at so exciting when you look at those and say lifestyle choices and changes may actually not only reduce risk but reverse disease that gets really exciting and that starts to eliminate some of the excuses we frequently find when we’re trying to look at how do you tackle this big epidemic in front of us.”
Ornish remarkably reported, “We found that in just three months over 500 genes were changed turning on the good genes turning off the bad genes and particularly the what are called the oncogene to promote prostate, breast, and colon cancer just turned off within just a few months.”
“We found that we could actually lengthen telomeres, in a sense reverse aging at a cellular level,” he added. The length telomeres at the end of each strand of DNA have been shown to correlate with a person’s remaining lifespan; the longer the telomeres, the longer the remaining lifespan.
Dr. Dean Ornish, Preventive Medicine Research Institute
In the context of the discussion on global health, Ornish noted the irony that the diet he advocates is the traditional diet of many low-income countries. As countries become richer, they get KFC and McDonalds, changing the traditional healthier diet.
“You know the natural foods and organic foods and healthy foods market is exploding whereas the soft drink sales are down 50% the last few years,” he added, emphasizing the entrepreneurial opportunities in this arena.
Curt LaBelle, president of Global Health Investment Fund, is a venture capitalist whose limited partners are committed to balancing impact and financial returns. He shared some of his strategy.
“Every investment that we make we have to evaluate not only is it an innovative product that can serve a need in the developing world but is there a way to actually get it to the people who need it,” he said.
The range of possible investments is wide. “But our goal is to take innovative products–and these can be vaccines; these can be pharmaceutical products; these can be medical devices or medical diagnostics–and get them to the people who can benefit the most while generating positive returns for investors.” The firm does exclude medical devices that require substantial capital investments as they are not a fit for resource-constrained markets.
One example of the investments the firm has made is in a cataract treatment company called IanTech that make an affordable, handheld device that doctors can use to treat cataracts with results comparable to the current standard of care. He notes that doctors can learn to use it in just a few days so when the trainers leave, they leave the skill set in country with the device.
Another portfolio company, Path, produces a drug to treat hookworms and roundworms. This is a huge market; LaBelle notes that in terms of people impacted by their products, this has the potential to help the most people.
What happens if a disease is successfully eradicated by one of the portfolio companies? “We want to get rid of the disease and we want to make some money along the way but if we get rid of it and no longer make any money that’s actually fantastic. All of our investors would be thrilled.”
Derek Fetzer, CaringCrowd
Big pharma is sometimes accused of serving the market to treat a disease rather than the business of curing it. Johnson and Johnson’s Fetzer responded:
There is a powerful financial incentive to find and produce a cure, particularly if you think (which is the case) that other companies are also trying to find the cure anyway (and quite possibly not participating in the treatment market). So better you find the cure than someone else.
A great example of this is the hepatitis C market, which commanded huge premiums. The prior standard of care was expensive and had a low cure rate, less than 50%. Gilead with no prior hepatitis C treatment business came in with shorter treatment and a high cure rate, in the neighborhood of 80%, and produced record breaking profits for a single drug.
Fetzer’s argument suggests opportunities for entrepreneurs and researchers.
Opportunities in Global Health:
UNICEF’s Peterson suggests that one overriding reason for business to pursue global health initiatives is that all the people they save are potential customers.
Jack Andraka, who invented a new diagnostic tool for pancreatic cancer as a teenager and now studies at Stanford, says the big data movement presents an especially interesting opportunity. “I think one of the most important things are happening right now is this kind of big data movement that’s going on in cancer with machine learning as well as all these interesting biomarker discovery processes”
“And if you can’t prevent the cancer you can detect it early when treatment is, first, less expensive but also way more effective,” he continued. “And we could really see that with pancreatic cancer where if you’re diagnosed early enough you have a 100 percent chance of survival and you don’t have to do things like the Whipple resection which have huge mortality rates”
Similarly, he thinks the opportunity in the gut is interesting. “Looking at your microbiome inside your gut and looking at these unconventional ways are beginning of treating cancer.”
The Cancer Research Institute, under O’Donnell-Tormey’s leadership, raised a venture philanthropy fund to de-risk promising research and make it more appealing to investors. Of course, this means that some of the projects the Institute funds don’t succeed, but knowing another path that didn’t work is almost as important as knowing what does work.
“So, if we can as, a not-for-profit, create a mechanism where we help to de-risk early, do hard core correlative and translational science to understand mechanistically even when things fail why they fail.” This helps prevent research projects proceeding to phase three clinical trials they would likely have failed, allowing more funds to go to projects with greater promise.
Deepak Kapur, India National PolioPlus
In another vein of opportunity, Kapur noted that “In India, we have already begun leveraging the infrastructure and the experience of polio to routine immunizations against all diseases for which vaccines are available.” The lessons and infrastructure are significant. The Journal of Infectious Diseases recently published an article by John L. Sever and others about the lessons and legacy of polio eradication.
Aylward noted one example. “You can’t eradicate a disease if you can’t see it if you can’t find it. And the polio program has got incredible experience putting in place a disease surveillance infrastructure globally where we often do very little else.”
Innovation in polio eradication did not end with Jonas Salk and Albert Sabin and their respective polio vaccines, Aylward said. “Contrary to conventional wisdom, many of the greatest innovations in the eradication of the poliovirus were not those that took place to get us to the starting line of the global eradication initiative, but those that were conceived and taken to scale as we got closer to the finish line.”
The opportunities in global health for social entrepreneurs are as rich today as ever.
Lessons from Global Health:
Global health efforts over the past decades, especially polio eradication, provide lessons for social entrepreneurs hoping to operate in the field.
Long-term opportunity: Despite all the energy we put into disease eradication and lifestyle improvements, the need for health care is not going away. “People may think when somebody arrives at a hospital that public health ventures have already failed. But, you know, people do have motorcycle accidents; they do have pregnancies; they do need maternal care; they do need neonatal care,” Calman said.
Measurement and improvement: “We must build in, from the start, mechanisms to track progress and impact, and to make course adjustments when needed,” Peterson said. “Contexts change, often unexpectedly, and programming needs to adjust accordingly, and rapidly, if impact is to be sustained.” This approach is called “implementation research” and it dovetails nicely with lean startup models that emphasize execution, feedback and improvement cycles.
Quick returns: Ornish asked rhetorically, “Why should I spend my money today for some future benefit that some other company whether it’s another corporation or another insurance company is going to get?” The answer is that with his lifestyle changes, the benefits begin to accrue almost immediately. “We did a demonstration project with Mutual of Omaha and they found that over that they saved almost $30,000 per patient in the first year because under their doctor’s care most of these patients were able to avoid having the bypass surgery angioplasty or stent that they were told that they otherwise would have needed.”
Social transformation: Not all social entrepreneurs begin as social entrepreneurs. LaBelle said, “One of the things that has been really rewarding to me is to really open the eyes of entrepreneurs who otherwise wouldn’t think about these developing markets around the world.” He notes that products like IanTech’s cataract surgical device that has broad application in low-resource countries around the world is just as appealing in developed countries where it can deliver comparable results at a fraction of the price of the standard of care. He calls these “dual market opportunities.”
Global health is ripe for social entrepreneurs to improve the lives of people around the world at the same time they create profit opportunities.
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