We face a paradox within Global Public Health.
We are fantastic at insight – surveillance – at outbreaks and rapid response. As a quick proof point, look no further than what the global public community was able to accomplish around Ebola. Sure, it took time to mobilize at scale, Of course, many challenges were faced and lessons are still being learned. However, the point is: responded, the global community did.
However, we are not so good at building enduring, systemic impact, in the environments which required the mobilization. Again, look no further than Ebola and the global shift towards Zika – the “next” significant health challenge, or “shiny object” as someone once put it – mobilizing attention away from building local capabilities in Ebola afflicted areas as it gets shifted elsewhere.
The figure below depicts the challenge: that of crossing the chasm between strategic intent (e.g., of responding to Ebola, or whatever disease outbreak) and building enduring impact, systemically. The result? The chasm, where lives are lost.
As we transition from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs), achieving our new global health goals and objectives will require that we cross the chasm between aspiration and execution, going beyond innovation to scalable and sustainable impact. We have succeeded in building deep research and clinical capabilities, are now better aligned and resourced, and have an impressive array of demonstration projects and pilots. What we need now is to be equally effective in building the conditions for assuring the enduring impact of our innovations at scale.
Crossing the chasm requires a new perspective – a new lens of insight. Much like the Hubble Telescope did for scientists who were looking at the same sky but with new vistas of insight and discovery, this new lens will provide the ability to see global health systemically and understand better the behavioral and systemic implications critical for scaling global health innovations sustainably.
Three elements make up the new lens. The first is an ecosystem perspective. Improving global health outcomes will be as successful as behavioral change is effective – and sustained – across all stakeholders. Health systems exist within ecosystems of engagement with ripple effects – both intended and unintended – across different types of people and organizations, stakeholders and markets. Therefore, changing the unit of focus from the typical global health perspective – whether of a pilot study, an innovative program or even a single disease condition – to the ecosystem in which they, and we, are engaged becomes essential.
The second is the pragmatic shared value framework and the concept of “currencies.” Different types of stakeholders care about different “outcomes,” or definitions of value, that motivate their behavior. “Currencies” reflect differing “units of value” that different types of stakeholders care about and motivate their action, e.g., health outcomes, employment, carbon footprint, or profit. Clarifying what these currencies are, who is motivated by which ones and how their “exchange rate” among them is impacted becomes a pragmatic method to establish a shared language across different stakeholders. This is an important first step in moving beyond global health as a public good or consideration for corporate social responsibility (CSR) towards something material and, hence, actionable to align collective efforts towards a common objective across different types of stakeholders.
The third, and arguably, the most important, is the new strategic question that builds upon the first two elements and consists of two parts:
- Where is value / impact being created and destroyed in the ecosystems in which we are engaged?
Every decision made and action taken has potential implications for facilitating or hindering the likelihood of sustainable impact. The new strategic question requires us to clarify what *is* the ecosystem in which we are engaged? Who *do* we get involved when, where and how to cross the chasm? Who is impacted – how much and how so – by that engagement? What *are* the ripple effects of decisions made and actions taken across the ecosystem of differing actors, stakeholders and actions? How *do* we identify and anticipate what these ripple effects are and how they will play out over time and location, actor and activity? - How *do* we influence the ecosystems in which we are engaged to build systemic, and enduring, impact while increasing both societal impact and economic value?
Attempting to do one without the other will not work and runs right into the “public goods” challenge or, from a private sector perspective, what is referred to as “the CSR black hole”. As Paul Streeten, one of the first World Bank economists, said, “The government is too big for the small things, and too small for the big things” and global health challenges, like other wicked problems — defined as extremely difficult challenges that require the orchestration of different types of stakeholders and organizations to overcome them — fall into this camp. The shift in the unit of focus towards the ecosystems in which we are engaged requires us to determine how to influence those ecosystems. But how *do* we orchestrate collective action from different types of stakeholders who are motivated by different conceptions of value and impact and what new capabilities do we need to do so? Further, how do we catalyze them and the different stakeholders critical to support, nurture and take advantage of them, while mitigating the risks of doing so? And, what *are* the new models of engagement to catalyze systemic change?
Where systemic approaches to healthcare currently exist, they are sporadic and evolving relatively slowly. We can accelerate progress if we learn important lessons and insights from others that have tackled similar wicked problems, including those that stem from other urgent and important public goods that entail private sector engagement, and innovation. Further, nearly every industry, across time and space, has faced the challenge of bridging the gap between strategic intent (aspiration) and operational reality (execution) – particularly in times of extra-ordinary change and explosive technical capabilities and we can learn from their experiences as well.
Consider three numbers: 8.2; 80%; and 2.6 trillion. The first reflects the market multiple of today’s most successful and new explosive growth companies as compared with 2.2, the average market multiple of successful companies. The second represents the percentage of companies that are no longer on, or have “toppled” from, the Fortune 500 list over the past 20 years – a ranking of the new winners and losers in the corporate world by Fortune magazine. Approximately 4% of companies fall off the list each year, a percentage that has been increasing recently. The third is the market cap of the top 15 public ecosystem-centric businesses that have risen quickly to the top of the Fortune 500.
There are two characteristics common to the new explosive-growth companies that are most relevant to crossing the chasm in global health:
- One, they all reflect a new type of business model, grounded around the new strategic question – of what *are* the ecosystems in which they are engaged and how *do* they influence them to capture new sources of (distinctive) value and (sustainable) impact?
- Two, they have all had to wrestle with the “crossing the chasm” challenge of how to “do for their back-end (scale) what they have done so well on the front-end (innovate & pilot)”.
We are at an inflection point and lessons learned from others argue for no less than a transformation in how we tackle global health system challenges, systemically – with speed and scale. Insights from industry – all based on new ways to engage their consumers, stakeholders and markets, taking advantage of new technologies, and changes in practices and expectations in the ecosystems in which they engage – can help us cross the chasm by shaping the global health ecosystem to create both greater societal and economic value. Now is the time.
Strategic Edge 