Panel, Conference Presentation
The Health of Nations: Meeting the Sustainable Development Goals
- Moderator Context: The panel addresses the implications of the UN Sustainable Development Goals (SDGs), agreed upon in September by global governments, which challenge world performance across 17 goals and 169 targets, with health and wellness as a central pillar.
- Data Frameworks: The Social Progress Index, developed with Harvard Business School, correlates highly with the SDGs, measuring "basic human needs," "foundations of well-being," and "opportunity" rather than purely economic metrics.
- Performance Gaps vs. GDP: Current data shows countries like New Zealand, the USA, and Norway deliver more social progress per unit of GDP than the global average, while Russia, Kuwait, China, and India fall significantly below the curve.
- Global Projection: Under current policy trajectories, the global Social Progress Index is projected to rise only marginally from 61 to 62.4 by 2030, whereas achieving SDG targets requires reaching a score in the mid-70s.
- Inequality in Developed Nations: The United States performs significantly below the expected curve for high-income nations in both basic nutrition/medical care (similar to Saudi Arabia) and health/wellness metrics, indicating a "dual epidemic" of diseases of poverty and affluence (obesity, mental health).
- MDG Limitations: Previous Millennium Development Goals (MDGs) successfully reduced under-five mortality and prevented mother-to-child HIV transmission (60% decline) but failed to reduce adult new infections by more than 15%.
- Demographic Shift: The success of the MDGs led to an unexpected 40% increase in the adolescent population in Sub-Saharan Africa (e.g., average age 15 in Uganda), creating a new, vulnerable cohort for HIV that existing health frameworks do not address.
- New SDG Strategy: The DREAMS intervention is launching under the SDG framework to specifically target young women, integrating gender equality, education, and multisectoral support to end the HIV/AIDS pandemic.
- Granularity Argument: Stefano Bertuzzi argues that country-level data masks critical disparities, citing Mexico where HIV therapy initiation rates at the clinic level vary from <25% to >75%, necessitating "sunlight" on granular, site-level data.
- Management Data Gap: There is a significant gap in data transparency in the US public health sector; unlike private entities (e.g., Starbucks) that track individual store performance, US health systems lack visibility into unit-level service outcomes.
- Incentive Design: High-quality data adoption relies on feedback loops where data is immediately useful for managers, contrasting with MDG-era self-reporting which often resulted in poor quality due to lack of utility at the source.
- TB Vaccine Crisis: Current incremental improvements in TB are insufficient; the global investment in TB vaccines (approx. $100 million in 2014) is a thousand-fold lower than the level required to eliminate TB by 2030.
- Pipeline Stagnation: The TB vaccine pipeline is stalled due to low returns for pharmaceutical companies and a lack of parallel development; 13 of 15 current clinical candidates originate from Europe, with only two from the US.
- Private Sector Role: David Barash (GE Foundation) emphasizes that private entities cannot tackle all 17 goals individually; instead, they must leverage specific expertise (health, energy, water, education) and form cross-sector partnerships to simplify and scale interventions.
- Oxygen Pilot Model: GE Foundation piloted district-hospital-based oxygen generation plants in Kenya and Rwanda to solve the "last mile" distribution challenge for pneumonia and maternal care, creating a revenue-generating model for hospitals to supply rural facilities.
- Scaling Mechanism: To scale pilot programs, the panel suggests a progression from foundation seed investment to "angel investors," venture capital, and industrial partners, requiring a shift from pure grant funding to impact investing.
- Public-Private Partnership Evolution: The U.S. government is shifting from asking private partners for solutions to proactively defining challenges (e.g., the DREAMS program), leveraging corporate branding skills (Nike, Girl Effect) and data analytics to drive behavior change.
- Incentive Structures: Proposed mechanisms to spur vaccine innovation include "pull mechanisms" such as guaranteed government purchase orders and regulatory vouchers that extend patent life (e.g., a one-year extension) for companies developing new global health products.
- Dual-Use Learning: There is a strategic opportunity to share solutions between developed and developing nations, such as applying lessons on engaging men in health services in Sub-Saharan Africa to improve male wellness metrics in the US (e.g., L.A., Boston).
- Maternal Mortality Anomaly: The United States faces a unique challenge with increasing maternal mortality rates in a time of peace, driven by extreme inequality and pockets of poverty that mirror developing world statistics.
- Obesity Paradox: The panelists note that obesity is increasingly a disease of poverty in developing nations, where the poorest 20% have transitioned from underweight to significantly overweight, surpassing US levels in some metrics.
- Panel Priority 1 (Data): The immediate priority is the adoption of granular, site-level data disaggregation to eliminate the "tyranny of averages" and identify specific underperforming units for targeted intervention.
- Panel Priority 2 (Funding): Governments must commit resources to basic and translational research outside normal political cycles to enable the development of new tools required to meet SDG timelines.
- Panel Priority 3 (Ecosystems): Success requires building sustainable ecosystems for simple interventions (e.g., safe surgery, girls' education) through bold experimentation and leveraging diverse private-public partnerships rather than maintaining business-as-usual approaches.
- Future Outlook: The consensus indicates that achieving the SDGs requires a fundamental shift from "charity" models to "shared value" models, where private sector engagement is driven by long-term societal benefits and mutual economic gains.