Oxford Public Health Magazine Issue 4 by Oxford Public Health

The Magazine of the Oxford Public Health Global Network Cover Photo Credit: Dr. Andrew Bastawrous

Innovation & Social Entrepreneurship

April 2016

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The beauty of the Oxford Public Health Global Consultancy Network is that we connect and match organisations with consultants in all sectors worldwide, while providing opportunities to consultants at any level, ranging from new graduates to experienced professionals… and it’s free to join! 3

What we do to benefit Public Health We promote careers in public health, increase public health capacity worldwide, and integrate public health perspectives into the wider workforce, including but not limited to journalism, radio, television, film, law, policy, architecture, urban design, engineering, entrepreneurship, healthcare and academia. We do this through: Events (Masterclass & Innovation Mashup) Resources (Oxford Public Health Magazine) Services (Global Consultancy Network, Career Coaching, Training & Capacity Development)

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In this issue... Dr. Catlin Powers

One Earth Designs

Dr. David Van Sickle

Propeller Health

Dr. Andrew Bastawrous

Peek

Dr. Teresa Chahine

Alfanar Lebanon

Farouk Meralli

mClinica

Dr. Mark Berman

One Medical Group

James Gupta

Synap

Dr. George Lueddeke

Education Consultant

www.truehealthinitiative.org

LIFESTYLE AS MEDICINE. Our vision is a world where all people live long and healthy lives, free of preventable chronic disease. Our mission is to create a culture free of preventable chronic disease by demonstrating and disseminating the global consensus on the fundamental, evidence-based truths of lifestyle as medicine. Together we can build a movement around the fundamentals of healthy living, preventing as much as 80 percent of chronic disease and premature death.

MANY EXPERTS. 6 PRINCIPLES. ONE VOICE. The True Health Initiative offers clarity over confusion; we work to spread the fundamental evidence and consensus-based truths about lifestyle as medicine. Decades of published research support six core principles of healthy living that most effectively add years to lives, and life to years. 6

Dr. Catlin Powers

Dr. Catlin Powers is the co-founder and CEO of One Earth Designs, which she has led from its humble beginnings in a nomadic tent in the Himalayas to reach customers in over 60 countries. One Earth Designs’ solar-powered stoves have brought cleaner air to thousands of people and have served as a leading example for sustainable production practices. As a result, One Earth Designs holds one of the highest Global Impact Ratings yet awarded and has been named among the 50 most responsible business in the world on the Best for the World List for three years in a row. In addition to her work with One Earth Designs, Dr. Powers' also lectures on Sustainable Business and Technology at Harvard University. Her work in the clean energy and environmental health fields has been recognized by the US National Science Foundation, Environmental Protection Agency, and American Institute of Chemical Engineers, as well as St. Andrews Prize for the Environment.

“ Be

100% in or be out. Building a company, especially in areas with little business infrastructure, requires you to be fully present. Make sure that being present with your venture is what you really want first. If you don’t love what you are doing day to day, you’re likely to burn out no matter how much you believe in the mission.”

I had left my research lab and was living in a Tibetan nomadic community in the Himalayas trying to help the community develop solutions for household air pollution. In the beginning, the other women and I started making improvements to the adobe stoves that the women built every time their family migrated. The men, however, didn’t see the benefit of waiting an extra half day for the chimney to dry before they could get hot food. Also, it was considered core to women’s identity to be able to build a good stove and women found it embarrassing to go to each other for help with making the new stove design. Instead, everyone came to me and I became a bottleneck to spreading the new stove design.

SolSource, an environmentallysustainable household solar energy solution for developing and developed countries. How did you come up with your idea?

In frustration, I asked the women and elders to meet to discuss better solutions. During this meeting, one of the elders told the story of how he had received a solar

Actually, it was our customers who came up with the idea.

Credit: Dr. Catlin Powers

cooker from the government but that it weighed 95kg and broke within three months of arriving. He told us that the solar cooker had shown him the power of the sun at a time when women were having to walk further and further to the forests each year. He cautioned, however, that they needed a solar cooker that was not only powerful, but also portable, durable, and safe for them to use.

It’s just like using your regular stove except SolSource is powered by the sun. It reaches the same temperatures as your traditional stove and heats up five times faster than a charcoal grill. Our customers use SolSource instead of cooking over conventional dung, wood, and coal fires. In places where families pay for coal or charcoal, SolSource saves money. In places where people collect wood or dung, SolSource saves time, thereby opening more income and educational opportunities, especially for women. By providing clean solar energy for cooking, SolSource reduces deforestation and abates carbon emissions from cooking fires.

I took this as a challenge. I brought a stockpile of scrap material to the village and we all began prototyping together. Five years and 54 prototypes later, we had developed the first production model of SolSource, our solar-powered stove. Since then, we’ve gotten SolSource to customers in more than 60 countries around the world.

Perhaps most importantly, SolSource reduces stove pollution in the home. The WHO estimates that exposure to carbon monoxide and particulate pollution from stove pollution kills 4 million people each year and leaves many more with chronic health conditions that decrease productivity. Loss of health and life due to household air pollution can drive already struggling families into poverty and make it difficult for afflicted nations to pull themselves out of poverty. SolSouce offers a zero-emissions cooking solution for solar-rich regions.

Please see this 4-min video for a quick background: www.youtube.com/watch?v=DHTbJJz8csU. See this 26 minute video for a more in-depth interview on the origins of SolSource: www.youtube.com/watch?v=8hjqnElxqt4.

Exactly how does it work? Once you came up with your idea, what were the steps involving in taking it from theory to practice?

SolSource uses solar energy to cook delicious meals in 10-20 minutes.

When we started, we didn’t have any concept of building a company or selling products internationally, we just wanted to make a better solution for one village to access clean energy for cooking. That took us five years of prototyping and testing with all the families in the village participating. Once we developed SolSource, everything accelerated quickly. More people wanted SolSource, and then their neighbors wanted one. Few people had cash income, so we developed a barter-based business model. People spoke different dialects in each mountain valley so SolSource ended up spreading village to village via the sisters of our customers who married into other villages. There were few roads so we delivered by yak back, horseback, and motorcycle. Essentially, with little preexisting infrastructure , we became the designers, makers, bankers, and distributors all at the same time.

Credit: Dr. Catlin Powers

When people started calling to give us innovation awards, we didn’t have anywhere to put the money so we incorporated the company so we could open a bank account. After that, our funding needs grew quickly. Once demand reached the hundreds, we knew we had to start a proper manufacturing process and that this would be capital intensive so we turned to impact investors and ended up bringing on board two of the most well respected impact investing firms in the world, DOEN (in the Netherlands) and Calvert (in the US). They led a financing round that gave us the capital necessary to get SolSource into production.

We wanted our manufacturing process to be consistent with our social and environmental principles, so we spent a long time looking for the right partners. When we found them, they all refused to take our order because we were so small. This was one moment where my pension for stubbornness came in handy. Refusing to give up, my team and I marched into the factory boss’ offices and explained why our work was important. It turned out that many of the bosses grew up in homes who faced the same challenges we were working on solving. Thus, in the end, they ended up working with us as true partners. This allowed us to develop responsible supply chains that earned us one of the highest Global Impact Ratings (GIIRS) yet awarded.

customs and norms. We enjoy adapting. We enjoy cooking together and learning our customers most cherished recipes. Most of all, we enjoy experiencing how similar we all are at our core and knowing that we all cook our food with sun energy, whether fresh or stored in ancient fossils.

What did you need to learn to make your idea a success? To tell the truth, I feel like I’m still learning critical skills each day. Here are the ones I believe have been most important: How to Listen - My parents and teachers will tell you that I was the little kid that constantly asked ‘but Why?’ and refused to believe anything that couldn’t be fully justified, especially if it went against my own conclusions. Growing up, my family lived on several continents and I quickly learned that my deductions were only accurate when based on the right foundational knowledge. This insight has served me well both in my scientific and business careers. It showed me that to truly listen, one must to put aside one’s own context and seek not just to hear the words but to understand the perspectives behind them.

From that point on, we’ve faced the same challenges just in different arenas. Where in the Himalayas we adapted to the local situation by bartering and delivering on horseback, in Latin America we use a rent-to-own model and in Europe and the US we sell online. We’ve learned that building our own infrastructure in each place we go is untenable. Instead, we’ve focused on finding local partners who are already building that infrastructure so that we can focus on our core competency of providing high-quality solar powered stoves.

How to Accept Help - I used to want to prove that I didn’t need help from others. Living with the nomads squashed that illusion. I had to rely on other people for day to day

Each new village and country we go to has its own

Credit: Dr. Catlin Powers

survival. It was incredibly humbling. It was also the best thing that ever happened to me. It showed me the depth of trust and friendship that comes from healthy interdependence. This experience also prepared me to put aside my own pride in order recruit team members far smarter and more skilled than I, to ask the stupid questions when they needed to be asked, and to create a team culture focused on experimentation and innovation without fear of failure.

We would have failed long ago if it weren’t for our customers pulling us up by our bootstraps and showing us much better ways of operating locally. The US Environmental Protection Agency, US National Science Foundation, Massachusetts Institute of Technology, Wellesley College, and Harvard gave us some of the early funds and laboratory access that enabled our first breakthroughs. The law firms Goodwin Proctor and Hogan Lovells stepped in to provide us with our IP strategy. All of our partners throughout our supply chains from factory to customer play an important role not only in delivering our products but also in closing the feedback loop with our customers so that we can continue improving our products, services, and operations. Our impact investors DOEN, Calvert, Village Capital, and Transist have been instrumental in enabling us to scale and in supporting our development along the way. Importantly, the patience and tolerance of our families was critical through all our late nights at the office, working weekends, foregone salaries, and months away from home visiting customer villages.

How to Trust My Team and Sleep - I used to work constantly and be present for every major decision or milestone in the company. I slept 3-4 hours per night until, one day, a colleague pulled me aside and said, “Don’t you trust us?” I explained that it wasn’t that I didn’t trust my team to be capable. It was because so much of what we were doing was new and I didn’t want them to bear the burden of the many failures I knew we would have along the way. I wanted to share our successes but take the failures on my shoulders alone. My colleague nodded at me then said, ‘We will never feel that the successes are ours unless the failures are ours as well. Please trust that we are strong enough to shoulder both alongside you’. This was an important moment for me. Following his advice unlocked our teams true potential and freed my time to lead a more balanced life, including sleeping peacefully through the night.

How did you inspire and recruit others, especially investors, to join you? 40% showing how important our work is for the world. 30% showing how much I cared about it. 15% showing a clear business model. 15% demonstrating with actions that we were serious about building a good business with real, measurable social and environmental impact.

You've been recognised for your work with the Marry White Peterson Prize for Scientific Innovation. Do you feel that innovation or entrepreneurship are skills you could learn or train in, or do you feel they are 'innate' traits that you just have or you don't?

Are you still using any of the skills and knowledge you gained during your academic training at Harvard? Absolutely! I use the skills of observation and analysis honed during my doctorate at Harvard every day at One Earth Designs. My research at Harvard dealt with measuring the impacts of energy technologies on health and family finances. As a result, we’ve set up a robust monitoring system at One Earth Designs that helps us see successes and catch failures quickly. Those of us who work in development know that it is near impossible to completely avoid unintended consequences, the best we can do is set up a strong feedback loop that helps us adapt quickly in the field. My training at Harvard was instrumental to understanding how to do this in a lean, yet robust manner.

Insight is the key. Whether we come to it by personality, training, or by being in the right place at the right time, innovation and entrepreneurship ultimately come from having a unique insight about how the world works or how we can improve quality of life. Once you’ve had an insight, all you need is the confidence to believe in yourself and the ability to recreate your vision in the minds of others.

Who else did you need to team up with to develop your idea? Our customers play a huge role in the development of our products and localized business models. 10

Credit: Dr. Catlin Powers

Dr. David Van Sickle

David Van Sickle, PhD, is the co-founder and CEO of Propeller Health, a Madison, WI based company that develops digital health programs for chronic respiratory disease. Previously, Van Sickle was a Robert Wood Johnson Foundation Health and Society Scholar at the University of Wisconsin School of Medicine and Public Health. From 2004-2006, he was an Epidemic Intelligence Service officer at the Centers for Disease Control and Prevention in Atlanta, where he was assigned to the Air Pollution and Respiratory Health Branch. Van Sickle received his PhD in medical anthropology from the University of Arizona in 2004. In 2011, he was named a Champion of Change by the White House for his work on innovation.

â&#x20AC;&#x153;There is more opportunity and urgency than ever to apply digital approaches to health and healthcare problems.â&#x20AC;?

The Propeller, technology that helps patients with asthma and chronic obstructive pulmonary disease (COPD) track their medication use. How did you come up with your idea?

From there, a set of smartphone applications and enterprise tools for patients and physicians, respectively, put that information to work to improve and encourage effective selfmanagement and more optimal care and treatment. For example, Propeller is able to monitor how often a person uses their regular medication and encourage them to be more adherent through reminders on their phone or the inhaler itself. Over time the system learns about the factors associated with the onset of symptoms, such as relevant locations or particular exposures, and can educate individuals about how to avoid or mitigate those influences. And because the time and frequency of use of bronchodilators is a marker of disease status, information from their medication sensors serves as a vital sign of impairment and risk, so that we can alert physicians to individuals who need more attention.

Despite the development of effective medications, chronic respiratory disease remains a persistent health problem. Today, guidelines encourage physicians to more closely monitor whether treatment is truly controlling symptoms and improving quality of life but few have the means to do so between visits. For their part, patients often assume that little can done to eliminate their symptoms and allow them to participate fully in the activities they choose. They need help recognizing when they need more attention and better ways to communicate that to their physicians. More than a decade ago, I was working in applied public health at the Centers for Disease Control and Prevention (CDC) in Atlanta, and came to believe that we were limited by a lack of timely and objective data about the burden of asthma. I realized that clinicians and public health experts suffered from the same gap in information, and saw a simple remedy: Add electronics to the inhalers that people carry around and use to manage their asthma so that we could measure how people are doing in real time.

Exactly how does it work? Propeller builds small electronic devices that attach to the different types of inhaled medications people have to manage their asthma. That includes both the daily anti-inflammatories and the short-acting bronchodilators. These sensors passively capture details about the use of these medications in daily life and communicate that information to Propeller. 12

Once you came up with your idea, what were the steps involving in taking it from theory to practice? We spent the first few years developing prototypes of the system and examining its reception in small populations and its potential to help individuals improve their day-to-day management of asthma. In these trials we were able to show that such information was meaningful and useful to individuals and could contribute to their efforts to control their symptoms. Next we decided that there would be value in creating an organization around commercializing the technology and the mission to apply emerging digital tools, such as smartphones, to the work that respiratory disease requires of individuals and their physicians.

What did you need to learn to make your idea a success? Each stage in the development of the company has proven uniquely challenging and educational. As the company has

grown, my role has evolved to one focused on developing and encouraging an inventive and enthusiastic company culture and to thinking about and planning for how digital can continue to spark and strengthen improvements in therapies for chronic respiratory disease. At the same time, I try to keep the team committed to delivering technology that has practical benefits and mechanical advantage. In other words, tools that make it easier to more effectively manage chronic respiratory disease with less effort.

Do you feel that innovation or entrepreneurship are skills you could learn or train in, or do you feel they are 'innate' traits that you just have or you don't? There are some people who, either for reasons of timing or personality, struggle to appreciate or prosper in the face of the daily ambiguities we confront when building a company.

Credit: David Van Sickle

Do you have any advice for students or new graduates considering a similar career pathway?

Others, particularly people who never think to create imaginary obstacles for themselves or their colleagues, thrive in this social context. Working with a collection of people characterized by this energy may be the most rewarding thing about Propeller.

There is more opportunity and urgency than ever to apply digital approaches to health and healthcare problems in the US and around the world. For the most part, these are messy and persistent problems characterized by multiple challenging, and rewarding, sides. As an anthropologist, my suggestion is to spend time developing a clear-eyed, up-close understanding of the human behaviors and practices that will ultimately represent the practical context for your proposed solutions.

How did you inspire and recruit others, especially investors, to join you? The argument for Propeller, and much of digital health in general, has revolved around the potential for technology to help improve outcomes and lower costs from chronic disease. We know that in the case of asthma, for example, an individual who does not have their symptoms under control requires considerable additional healthcare each year. Our commercial model is built on our ability to put information and power in patient and physicians hands so that organizations can avoid these costs while reducing the unnecessary suffering they represent. The potential role and value of digital health in emerging models of clinicallyintegrated, financially-accountable healthcare has grown quickly and attracted considerable private investment.

Are you still using any of the skills and knowledge you gained during your academic training and experience at the CDC? Understanding paths to better clinical outcomes and potential utility across populations continues to be an important part of my job. Our goal is to help health care systems figure out ways to benefit their communities of patients and members. It is effectively an epidemiological problem. But digital health can simultaneously improve and connect both individual and public health. I continue to be encouraged by the potential for digital tools to serve as an organized and ad hoc bottoms-up complement to the more traditional top-down approach of municipal public health. Where traditional public health surveillance has focused on using a small number of sentinel events such as hospitalizations to try to understand patterns of disease epidemiology, today we have the ability to collect direct information about the burden and management of chronic diseases among populations in daily life.

Dr. Andrew Bastawrous

Andrew Bastawrous is an Ophthalmologist (Eye Surgeon) and Clinical Lecturer in International Eye Health based at the International Centre for Eye Health, London School of Hygiene & Tropical Medicine. Andrew was recently voted one of the world’s 30 most influential people in public health, one of the world’s “Top 40 Ophthalmologists under the age of 40” by The Ophthalmologist magazine and was selected as a “Young Global Leader” by the World Economic Forum. Andrew is also working with astrophysicists to crowd source retinal data, TED Fellows to map health systems, National Geographic explorers to reach isolated communities and with his wife Madeleine has established a social enterprise bakery in Kenya that provides employment and profits pay for eye care.

“Globally there are 39 million people who are blind, 90% of whom live in Low and Middle Income countries. 80% of all blindness is avoidable.” How does it all work?

The Portable Eye Examination Kit, or Peek - an app that uses the camera in a smartphone to test vision, helping people at risk of blindness in developing countries. How did you come up with the literal flash of genius?

Peek is a combination of software diagnostic tests, hardware adapters for smartphones and systems. We have a suite of diagnostic tests, the first of which to be released is called Peek Acuity. Peek Acuity enables non-healthcare workers to objectively and rapidly measure visual acuity with accuracy comparable to standard measures. Our first hardware product is Peek Retina which clips onto a smartphone and changes the optics of the smartphone camera enabling it to work like a direct ophthalmoscope. It enables a view of the retina to appear on the phone screen and be saved for further review for sharing. Our systems capture all of this data and attach it to a patient record enabling information to be shared with a healthcare worker, who can either action a decision for management or arrange follow-up with that person. One example of this is our diabetic retinopathy system which is currently being rolled out in Tanzania. Non ophthalmologists in peripheral health clinic’s examine in diabetic patients using a smartphone and Peek. They measure visual acuity and take a retinal image and share this with the eye clinic. The images are then reviewed by an ophthalmologist who makes a decision as to where and when that patient needs to be further reviewed all referred to the hospital. The peripheral clinic is updated on the decision and the patients automatically receive a personalised SMS with the referral for review decision. We are working on multiple other diagnostic tests and systems.

Throughout my career in ophthalmology I’ve spent quite a bit of time working or doing research overseas. What I continually saw was that in places with minimal access to infrastructure such as roads or electricity would be where the highest number patients with sight loss would be. In this same period I was seeing incredible advances in technology and in particular mobile phone technology. This got me thinking that there must be away of using technology to support eye care. In 2011 I left the NHS and started on a PhD at the London School of Hygiene and Tropical Medicine. A year later, with my young family, we moved out to Kenya to start a cohort study in which I was required to set up 100 temporary eye clinics in an attempt to retrace 5000 people who had been seen six years earlier to determine the incidence of blindness and visual impairment. As in my previous experiences it was in the places with no infrastructure and furthest away from healthcare provision where we would find the greatest number of patients waiting to be seen. What had changes was that those very places now had good mobile phone connectivity. This was really when the opportunity to take Peek from an idea in to something tangible began. With a great team (pro-bono developers, engineers and ophthalmologists as well as the incredible field team) we started developing software and hardware and testing it on the ground hoping to access those who need it most.

Credit: Andrew Bastawrous

What were the steps involving in taking it from theory to practice? In the earliest phase I started playing around with smartphone camera optics and engineering adapters (not very neatly) that worked to some degree or other. I would regularly come home with eyedrops to dilate my wife’s eyes and tried various prototypes. I then met an engineer in Scotland, Mario Giardini, who very generously supported with his time and expertise to improve and eventually completely revamp the design. For the software development a developer volunteered to come and work with me in Kenya for two weeks, this turned into nine months and now Stewart Jordan continues to lead on software development and commercialisation for Peek (three years on). Everything we built was tested and retested in the field in the hands of typical users. By continual observation and making multiple mistakes we’ve been able to improve and adapt the technology to be effective environment it is intended. We have since spent considerable time validating all of the technologies against reference standard diagnostic tests and publishing data to provide credibility. The next stage is for us to make this widely available and this has required funding, business model planning and an understanding of implementing programs. All areas we’re actively working on now.

Beyond your medical and surgical training, what did you need to learn to make your idea a success? So many things. The process of software and hardware engineering, iterative design, user centred approaches, fundraising, medical device certification, intellectual property, institutional collaborations, service delivery and many more. It continues to be a fascinating learning process and a real joy to see some of the early ideas becoming a reality.

Do you feel that innovation or entrepreneurship are skills you could learn or train in, or are they 'innate' traits? I think that everyone is creative given the opportunity and space to create. This underpins innovation and entrepreneurship and is often when you’re in scenarios, such as a remote village in Kenya, that you are forced to think creatively. I do think that the skills that support innovation can be taught as having the idea is actually easy bit, seeing it through is much much harder. 19

Who else did you need to team up with to develop your idea?

eyecare, but not as important as the people who actually deliver it on the ground. Our role is to support all the amazing eye organisations and health workers to do more of what they are already doing. It is hard not to get passionate about this cause.

See the response to the third question earlier. As well as software and hardware engineers I’ve had incredible institutional support from the London School of Hygiene and Tropical Medicine as well as partner institutions and funders. We continue to get support from designers, user experience experts, business development managers, and so much of the general public who have supported our mission to bring eye care to all who need it, such as backing our crowd funding campaign which funded the development pipeline for Peek Retina.

Your work led you to become a TED Fellow and speaker at the prestigious TED Talks in March 2014. What was that experience like? It was a real honour to be made a TED Fellow. The experience was like nothing else I’ve done previously. The fellows team made every one of us feel incredibly special and to be given the opportunity to share our stories with such an influential audience was humbling. The audience included the Google founders, Bill and Melinda Gates, and multiple other well-known people to whom it was great to be able to put eye care and the lack of it in their consciousness. The fellowship has included workshops, retreats, coaching, networking opportunities and visibility for our work. The TED talk going online undoubtedly brought us further interest and support.

How did you inspire and recruit others, especially investors, to join you? I think once people are aware that so many people in the world are unnecessarily living with visual impairment and that something can be done about it they become passionate about the cause and get behind us. I always try to focus on why we’re doing what we do, and less so on the technology. The technology is exciting and important for delivering

Credit: Andrew Bastawrous

Dr. Teresa Chahine

Teresa Chahine is the Social Entrepreneurship Program Leader at Harvard T.H. Chan School of Public Health, Center for Health and the Global Environment. She teaches social entrepreneurship at Harvard Chan School and Harvard Extension School, and trains social entrepreneurs worldwide. Dr. Chahine is also the director of Alfanar Lebanon which she launched in 2012. Alfanar is a venture philanthropy organization supporting social entrepreneurs in Lebanon and Egypt since 2004. Her new book "Introduction to Social Entrepreneurship" is due for release in April by Taylor and Francis. To learn more about her work and how you can get involved, visit www.chgeharvard.org and www.alfanar.org. Connect with her on Twitter @teresachahine “Public health as a field has existed for just over 100 years. At first, it was information that was lacking, and so we became research focused because that was the limiting factor. Now, action is the limiting factor. We still haven’t applied all the valuable information and insight that came out of a hundred years of research! ”

Credit: Thomas Morgan Reframed Pictures

Each person has a responsibility to challenge the status quo. And each person can do it in their own way. You don’t have to start your own company or organization – if everybody started their own shop, we’d all be competing for resources and lessen our collective impact. Entrepreneurship and innovation is something you can do within your existing organization, by partnering or collaborating with other organizations, or by taking initiative as a citizen within your community. You can absolutely learn new skills that will make you a more effective entrepreneur and innovator. You can learn how to start by characterizing the challenge, gathering data on why it exists, what has been tried before, what has worked and what hasn’t. You can learn how to catalyze the exchange of knowledge from global experts in your field of interest, and local experts, the people who are most affected by this challenge, and who are unfortunately now usually seen as the experts. You can learn basic management and finance skills, which most people in public health don’t actually have any formal training in these days. And most importantly you can learn that it’s okay to try something that might fail, because we have to keep failing until we succeed. People are so afraid of failure, that it’s paralyzing us, and it turns into a moral hazard because we’re not implementing new approaches to tackling these social and environmental challenges.

From a doctorate in environmental health to teaching social entrepreneurship at Harvard. What spurred your interest in this field? When I came to Harvard for my doctoral degree, I always thought I’d go back home and continue to do more of the same work that I was doing before. My first job was at the Ministry of Social Affairs working on a project with the United Nations Populations Fund (UNFPA). But after five years at Harvard I just couldn’t wrap my head around the way we’d been conducting our work. Millions of dollars, decades and valuable person-time were dedicated to projects and programs that were just not getting any tangible results. I started thinking of different ways I could contribute to society when I went back home. I had this burning restlessness to actually see the impact of my work! That’s when I realized that many others around the world felt the same way, and that there was even a word for it, and that this is what it means to be a social entrepreneur.

Some say that entrepreneurship and innovation are skills that you must have innately. How do you teach these skills to students?

Has your course helped develop any social entrepreneurs or innovators who have helped improve public health?

I think that everyone has the potential to challenge the status quo. We’re trained to do things the way they’ve always been done before. But when you open up the possibilities by asking people “Why?” it’s incredible what can happen. Why are we doing things this way? Is this really the best way? What can be done differently? And most importantly, what can YOU do about it.

Absolutely. I won’t boast of results which take much longer than four years to produce (the length of time I’ve been teaching this course). 21

But I’m honored to serve on the board of Y-Bank, an incredible new organization developed by a former student during the year that she took my course, and whose team I mentored through a summer internship at the Harvard Innovation Lab (iLab) after the course ended. Another inspiring organization that was developed by a former student of mine is Du’Anyam, which won the MIT IDEAS Global Challenge two years ago. I’m always careful to caution people though that it’s not something to boast about when you form a new organization or win an award. You actually have to get results.

How does your new book, Introduction to Social Entrepreneurship, help readers develop and implement social entrepreneurial knowledge and skills to tackle the challenges facing our world today? It’s built like a “how to” guide that walks the reader through key steps in formulating and implementing an innovative, effective, and financially viable solution to a social challenge. I use the word social broadly to refer to the

challenges facing our society today, which include environmental, health, education and other subject areas. The book contains examples and case studies of existing social ventures in different sectors, interviews with social entrepreneurs around the world, and tools and templates to actually help the reader go through his or her own idea and iterate it until its implementable. Most importantly, it tries to make the process fun, especially the aspects that many of us find boring or scary! These include the business side, legal side, funding, monitoring and evaluation, and others.

As Director of Alfanar Lebanon, a venture philanthropy organisation, why do you focus investments in social enterprises that improve children's education and women's economic empowerment in the Arab region? These two sectors have been our historical focus because this is where you see the greatest social return on investment, due to the ripple effects which impact many people over time. However, we’re constantly testing out new sectors, and challenging ourselves to find opportunities to

Credit: Teresa Chahine

create measurable impact in other pressing problems, such as the environmental disasters we face today in Lebanon.

What's your top advice for anyone seeking investment? You need to show results. Ideas are a dime a dozen, and you’re not the only person with an inspiring story that this investor is talking to today. Try to keep your head down and just do the work. Then your work will speak for itself. Get results first, and then you can go out there and talk about it. Not the other way around!

What have been some of your success stories with Alfanar? I launched Alfanar Lebanon four years ago, and it’s incredible to think that we created something with a truly tangible impact that didn’t exist before. Alfanar has been working in Egypt for a dozen years, and is literally the first venture philanthropy organization in the Arab world. In Lebanon we support (at the time of writing) five amazing organizations serving the most marginalized populations. In public schools where the pass rate in official government exams has been historically 25%, students served by one of our investments (MMKN, Arabic for Possible) have a 100% pass rate. This is simply due to their being tutored and mentored by volunteers from local universities, who are specializing in education. The volunteers, in turn, gain an appreciation for how education takes place in some of the most marginalized communities in Lebanon. This changes their own career path, with ripple effects to other schools and students down the line. Another one of our education investments, Ana Aqra’ (Arabic for I Can Read) is revolutionizing the way children learn in their primary education and pre-school years. They have been working in public schools in Lebanon for twenty years, and when the Syrian refugee crisis occurred they were ready. Without them, thousands of refugee children would still be out of school today. Ana Aqra’ worked with public schools to get these children back on the learning track. Some of them had been out of school for up to four years.

In a few years, they will be teenagers. Imagine all the risks that these rapidly growing young people, and the communities they’ve been displaced to, would face if the basic human right of education was not achieved. I wish I could tell you about all our investments, but I know you have limited space. Please visit our website at www.alfanar.org to learn more. We also have a very fun two minute video posted on Kickstarter which over-achieved its fundraising goal! The video is still up and you can watch it, just google “Lebanon refugee food truck” and you will find it., on rooftops and in courtyards in cities everywhere.

Given your experience with the Gulf Sustainable Urbanism research study, how do you feel social entrepreneurship and innovation have helped sustainable and healthy development of cities around the Persian Gulf region? We’re not there yet. So far the efforts have been constrained to a handful of initiatives by governments and foundations. Some of these are pretty impressive, but the tipping point will only be reached when private players start taking initiative. This is already happening, the Gulf Cooperation Council countries are investing heavily in creating innovation ecosystems, so I hope we’ll start seeing some exciting results soon.

Do you have any advice for students or new graduates considering a similar career pathway? Yes – Just get started! Roll up your sleeves and get your hands dirty. Don’t sit around thinking in the ivory tower. I spent many years doing that when I should have been taking action. So don’t be afraid to just dive in, this is the only way you’ll truly learn what you’re capable of. 23

Awaken the social entrepreneur in you 24 Pre-order on Amazon today

Farouk Meralli

Farouk Meralli is the Founder and CEO of mClinica, a venture-backed mobile health technology company creating digital networks of pharmacies, physicians and patients across Asia. Prior to mClinica, Farouk held senior roles at Sanofi-Aventis, Johnson & Johnson, Pfizer, and Roche, where he focused on data & analytics, product marketing, and patient programs in the emerging markets. He also serves as an investor and advisor to several companies in the healthcare space including Medix and Lifetrack Medical. Farouk holds a Bachelors in Biomedical Sciences and International Development Studies from McGill University and a Masters in Health Policy and Management from Harvard University.

“Some of our best hires were people who came from outside the world of public health” mClinica, what's it all about and how does it help public health? mClinica’s simple goal is to help healthcare organizations use data to operate more effectively in emerging markets. Across much of the developing world, healthcare systems have not yet been digitized, resulting in an absence of data that we often take for granted in more developed countries. Fragmentation in healthcare supply chains and low levels of connectivity further compounds the problem. mClinica addresses this issue by developing data collection and patient engagement technologies that are custom-built for fragmented, low-resource settings. From our base in Singapore, we’ve deployed these technologies across Southeast Asia, from rural provinces in the Philippines to bustling cities like Jakarta and Ho Chi Minh City. These programs connect thousands of pharmacies and physicians onto a single digital network that allows us to better monitor public health trends and outcomes. Since our founding, we’ve worked with both public and private healthcare organizations on a wide range of projects. As just a few examples, we’ve used our technologies to evaluate TB incidence in at-risk populations, improve adherence to diabetes medicines, and identify potential bottlenecks in pharmaceutical supply chains. It’s deeply rewarding to see that our services are helping patients in some of the world’s poorest places.

How did you come up with your idea? I started my career working in numerous strategy positions at global pharmaceutical companies. In almost every project I did, I faced the same challenge—data on

healthcare systems in emerging markets was limited or nonexistent. Since many of these markets offered substantial commercial opportunities, these were priority markets for the companies I served. Yet it was exceedingly difficult to operate effectively when we barely had enough data to identify problems, much less track our progress towards solutions. After I started mClinica and began working heavily with the public sector, it was clear that governments, foundations, and NGOs faced the same problems. Without good information on epidemiological trends and patient demographics, these organizations also had major trouble allocating scare resources and evaluating the impact of their work. When we saw that so many different healthcare organizations in both the public and private sector had the same problem, and saw a common solution to that problem, we knew we were on to something.

Once you came up with your idea, what were the steps involving in taking it from theory to practice? We started with a simple realization: in many emerging markets, small pharmacies rarely have budgets for modern IT systems, but all of them had mobile phones that could be used for data collection and patient engagement programs. Based on this realization, we set out to create services that help these pharmacies better serve their customers and also contribute to public health in a broader sense. Once we built these data assets, we had to develop the technical talent to interpret the data and make it useful for the private and public sectors. In doing so, we were able to organically develop a top data analytics team that was able to use the latest statistical and visualization techniques to derive invaluable insights across the data set. 25

What did you need to learn to make your idea a success?

are capable of being entrepreneurs and innovators, but innate factors probably play some role. I have observed that most entrepreneurs I come across have a great deal of conviction in their beliefs and are able to demonstrate a keen vision for their ideas. That said, I’ve come across successful entrepreneurs of all types along this journey. I don’t think that there’s any specific formula for an entrepreneur per se and I believe that the right environment is often the most important in cultivating an entrepreneurial culture.

One of our early lessons was in the importance of hiring people with passion. Some of our best hires were people who came from outside the world of public health, but who showed dedication and a desire to learn. They brought fresh perspectives from other disciplines, such as big data analytics and digital marketing, that allowed us to do things that were unique and impactful. We also learned a lot of lessons about how to effectively grow and scale new technologies. In the early days, we put more effort than we should have into perfecting technologies that ultimately had limited utility. As time went on, we discovered the importance of iterative product development strategies. We learned to be listeners first and talkers second. When building a new technology, it’s usually better to start with a question rather than an answer.

Who else did you need to team up with to develop your idea?

Do you feel that innovation or entrepreneurship are skills you could learn or train in, or do you feel they are 'innate' traits that you just have or you don't?

We also learned a tremendous amount from our clients along the way. In startups, it’s extremely important to constantly get feedback from the people you serve. Continuous innovation is one of the most critical keys to startup success, and for that reason, I often see my clients as almost like an extension of my team.

From the start, I was extremely lucky to find amazing colleagues and advisors to support me on this journey. Part of my luck was that I ended up identifying great tech talent that helped me rapidly build and test new technologies. I also managed to connect with some smart advisors who helped me look past the day-to-day operations and strive towards a big picture vision.

With the right attitude and coaching, I think most people

Credit: Farouk Meralli

How did you inspire and recruit others, especially investors, to join you?

learnings came from my colleagues, advisors, and clients, and most of the most important skills were developed on the job.

Part of what inspires people to work for us is our vision. We believe that we are transforming healthcare, and see our technologies as having substantial global impact. We’re also using some of the coolest and most-cutting edge technologies to achieve this, and doing so in a manner that is profitable, sustainable, and scalable. These factors excite both employees and investors alike, which is how we’ve managing to attract great people and smart capital to our efforts.

Do you have any advice for students or new graduates considering a similar career pathway? As a student and new graduate, many clearly defined professional and academic paths will present themselves. Some will offer opportunities for professional stability and status, which can be quite attractive, yet they are far from the only option, and they’re certainly not right for everyone.

Are you still using any of the skills and knowledge you gained during your academic training at Harvard?

To those who are unsure if they want to pursue these structured paths, I usually encourage them to make sure they take the time to form their inner perspective and truly try and determine their interests, their passions and their aspirations. Many of the world’s most successful people had the courage to go their own way, and ended up discovering wonderful rewards on their journey.

Harvard gave me a strong foundation in hard skills like biostatistics and epidemiology, as well as a general understanding of how healthcare systems work. Yet while it was a great launch pad, many of the most important 27

Dr. Mark Berman

Mark Berman, MD, is an internal medicine physician and social entrepreneur whose work focuses on obesity, plant-based diets, and health information technology. Mark is the past medical director of Keas Inc., an employee health-gaming software company and former VP of health for Mark One Lifestyle Inc, a consumer health device company. At present, Mark directs and practices lifestyle and obesity medicine at One Medical Group in San Francisco and is the head of health for FareWell, a lifestyle medicine health technology startup. He is also a director and fellow of the American College of Lifestyle Medicine. â&#x20AC;&#x153;Bringing a big idea to life requires collaboration between people who share the idea and who have a breadth of skill sets and experience to realize it.â&#x20AC;?

Are innovation and social entrepreneurship skills you could learn? As with most nurture vs. nature questions, it's usually a both-and rather than an either-or. I grew up in an entrepreneurial family and even though I gravitated to science and medicine, was exposed to business and innovation work my whole life. Despite that, my business skills and knowledge after finishing medical training were quite basic to be kind. I opted to learn via real-world experience and from those with training and experience in business and innovation sectors. Like medicine, it's a life-long process. Many of my colleagues have paired medical training with an MBA or other business degree and certainly that path has informed their entrepreneurial pursuits. Ultimately perhaps the bigger question is whether one has a passion or interest in going through a long learning curve... where that passion comes from is quite mysterious and very individual.

How can entrepreneurship and innovation help public health? Public health must respond to he biggest health threats of our time, everything from Ebola to obesity. Since we live in a rapidly changing world, we need to innovate solutions to new problems or old problems that exist in a new context. The process of inventing new solutions can be thought of in evolutionary terms, with most solutions failing to survive in a complex and ever changing environment. However, the quickest way to get to the best solution is to invent many variations on a theme and test them out in the real world. Some survive, a few thrive, most will die. This process is the heart of entrepreneurship and innovation and applying it to any sector tends to advance it meaningfully.

What have been your success stories? Thus far I've been privileged to work with many pioneers in the health information technology arena and have worked on some of the earliest applications of gaming to health promotion, the use of physical devices to impact dietary consumption and new models of integrating technology into medical practice. That said, like most, I prefer to think my greatest successes lie ahead of me.

Are there any specific examples of social entrepreneurship or innovations that inspired you? Paul Farmer and Partners In Health's work with HIV and TB which began in Haiti as well as Dean Ornish's development of a lifestyle medicine model to reverse Heart Disease both offer inspirational examples of doing and scaling what most said could not be done.

How do you come up with ideas in the first place? Public Ideas are very easy to come up with, especially if you are enjoy thinking about how emerging patterns in one world (e.g. computer technology) might apply to a different world (e.g. health and wellness). For me, the vast majority of ideas come in moments of relative relaxation or movement, for instance during or after exercise or while walking from one place to another. The hard part is not coming up with the idea, though. It's much harder to figure out if the idea is one who's time is here now and if so how to execute on the idea.

Many may come up with ideas, but don't take action. How have you been able to take the leap and materialise your ideas?

investors, ultimately they are most interested in the business case of course.

You regularly consult health information technology (HIT) startups; what would be your top advice for anyone contemplating a new venture?

Most ideas are flighty - they seem amazing, but lose their appeal after a few days. Fortunately, a few are stubborn - they keep coming back over and over again and refuse to die. Those are the ideas I look to develop. What I've realized, however, is that I can't go at it alone. Bringing a big idea to life requires collaboration between people who share the idea and who have a breadth of skill sets and experience to realize it.

There is a balance to be had between thinking boldly/ differently and understanding why the status quo is the way it is. Many HIT enthusiasts have a pretty superficial understanding of the medical status quo. They routinely fail to involve people who worked or trained in the status quo and as a result they design fairly shallow solutions that sound cool but do not meaningfully change health outcomes.

How do you inspire and recruit others, especially investors, to join you in developing your ideas?

Do you have any advice for students or new graduates considering a similar career pathway?

It's not easy to bring an idea to life, so one has to be able to articulate the importance, urgency and do-ability of the solution you propose. It's important to explore how others can be an integral part of the solution. I've never been able to just sell "my idea". When it comes to 30

Any final words?

I wouldn't advise people to follow my career path verbatim per se. For example, setting out to work in technology for the sake of working in technology won't get you that far. Instead, I always advise people to follow their passion to improve the lives of others or to help solve an important problem. If the solution happens to involve technology, that's great, but one shouldn't constrain their thinking such that it *must* involve technology.

I'm still early in my career and don't claim to have all the answers, but thus far I think entrepreneurship demands: a) a love for new ideas or new ways to do something better, b) a willingness to try hard and fail (which for me stems from seeing great value in the process of trying), c) developing a niche skill-set or knowledge base, and d) fostering collaboration

www.epiprev.it/INPHET/home

James Gupta

James is a serial entrepreneur, developer and medical student at Leeds University. His current venture, Synap is an online learning platform that uses neuroscience research and artificial intelligence (AI) algorithms to optimise the way people study, helping them to learn more in less time. Synap recently raised £200,000 investment via crowdfunding, and was named as one of the ‘Top British AI Companies to Watch in 2016’ by Business Insider.

“I encourage people to ‘just go for it!’. It’s an incredibly rewarding career path and one that gives you a level of freedom and variety you just could not find anywhere else. You are in charge of what you do, you ’ll be working within a range of disciplines from marketing to accounting to leadership to strategy, towards implementing your vision what could be better than that! ”

Synap, an online educational platform that harnesses the power of artificial intelligence and social networks to revolutionise the way we learn. How did you come up with your idea?

Exactly how does it work? From the student’s perspective, Synap encourages you to write your own MCQs, practice them in short, regular bursts, and share them with your friends. It’s really, really simple - and honestly I couldn’t believe no one was doing it already. Behind the scenes however, there’s a lot going on. The ‘create, practice, share’ technique incorporates a lot of learning techniques that have been advocated in psychology papers for decades, but have largely failed to gain traction in mainstream education. Metacognition is a fascinating line of research that involves looking at how the brain works, and how we can use that information to our advantage.

Synap grew out of a problem we encountered in our own lives as students. There's a lot to learn in a very short period of time. We’re not really taught much about metacognition - learning about learning - which is a real issue because the methods we and most students use are very time consuming, passive and unreliable. It leads to a very superficial form of knowledge that we can only access in a very static way, and is often forgotten hours or days after reading it. In medicine, this means that doctors are unable to apply their knowledge effectively in acute situations.

The thing that most people don’t realise is - the brain is not a simple ‘recorder’ of information. Living in a digital age, it’s really easy for us to make that analogy to explain the brain - we watch a video, listen to a song or read a book, and the information goes in to be ‘saved’ in a file somewhere. In reality, it’s far messier than that, information is heavily filtered, edited and split into multiple regions across the brain. Techniques such as Spaced Repetition, which Synap’s algorithms are based on, take advantage of this and help people to learn in a way that consolidates understanding, and promotes long-lasting retention of knowledge.

So rather than reading through textbooks over and over again, Omair (my co-founder) and I started to write multiple choice questions (MCQs) and challenge each other to take them. It made what was previously a dull, socially isolating activity into a game - and more importantly, it kept us focused when reading, as we were actively trying to pick out challenging questions, and confronting gaps in our knowledge as we were doing it instead of passively scanning the text. We went into our exams that year and, frankly, nailed them! So that summer we decided to build it into an app and website that other students can use, and over time we’ve incorporated elements of AI and neuroscience to further enhance the process, taking advantage of research into how the brain consolidates and stores information to help students learn more in less time. 32

Once you came up with your idea, what were the steps involving in taking it from theory to practice?

What did you need to learn to make your idea a success? So many things. Honestly, if I’d known how much there was to learn up front, it would probably have scared me off pursuing this career in the first place! But it’s all manageable, the startup world is a fantastic community with people sharing amazing resources and case studies about what worked for them - including very successful entrepreneurs and investors.

We operate on what’s called a ‘Lean Startup’ model, which is an approach to developing ideas and products that emphasises agile development and rapid shipping of your product. It’s a model that is counter-intuitive to many traditional business approaches, and academics to whom careful, up-front planning before execution is crucial, but it’s common for technology companies to act this way. Technological enablers such as cloud computing and open-source software mean that new products can be built incredibly quickly, for a negligible cost - so the best way to test your idea is just to put it out there and see what people think of it.

For me, the most important things to learn have been how to delegate effectively: there are only 24 hours in a day, which means that your limited time should be spent on whatever areas you can add the most unique value to. As soon as you can hire or train someone else up to take on an area of responsibility, you free yourself up to focus on those areas, and give the business way more ‘bandwith’ to get things done.

Central to this model is the concept of a Minimum Viable Product (MVP), which is a stripped-down version of your offering. It may not offer all the features you want it to, and lacks some of the polish you’d expect in a finished product, but it allows users to engage with your core value offering. We built our MVP with a basic app called MyCQs, and it evolved over time as we learnt more about what we and our users wanted.

Secondly, has been really getting to grips with the idea itself and really understanding it inside out from multiple angles. The most important thing I can do for Synap, and the best way to spend my time, is selling the idea to other people, whether that’s potential users, investors, team members or journalists - I want them to be as excited about Synap as I am, and to do that I have to condense years of research into a pitch lasting around 60 seconds! This is a skill that you develop and refine over time just by speaking to different people about the business, and even though I’ve been doing it for a few years now, it’s still very much a work in progress!

In terms of research, we conduct user interviews and surveys regularly, using tools like Intercom to help automate the process. We check out what other companies in the field are doing and what students and teachers say they need on social media, as well as pursuing this career in the first place! But it’s all manageable.

Credit: James Gupta

Do you feel that innovation or entrepreneurship are skills you could learn?

Who else did you need to team up with to develop your idea?

I think it’s a combination of both nature and nurture. Entrepreneurs are an incredibly heterogenous group of people and it’s hard to find a single predictive trait that would lead to someone becoming an entrepreneur. They can be introverts or extroverts, scientific or creative, methodical or spontaneous - their personal style will be reflected in the culture of the company they work for, but there’s no right or wrong approach. The most common trait I find amongst entrepreneurs is a sort of stubbornness in accepting the status quo - which makes sense, many people are inspired to start a business that solves a problem they encounter in their own personal or professional lives - something that other people either don’t notice is a problem or choose to live with. The second thing is an ability to work in a number of different fields - definitely in the early days, you’ll have to operate outside of your comfort zone quite a lot - some people handle that really well, whereas some people’s abilities and passions lend themselves more to one specific area.

As we grew, and obviously still being full time medical students we expanded the team to include new people who could share the workload and add different perspectives to the team, so we now have directors for Marketing, Strategy and Development, and a Community Manager who works on our content strategy, customer engagement and other areas of the business.

In the early days, we did everything ourself, and as we grew started to take support from The University of Leeds, who have a fantastic program called Spark which gives funding and office space to student entrepreneurs. We also had support from an educational charity called Jisc in the early days.

Are you still using any of the skills and knowledge you gained during medical school? All the time! I think medics make great entrepreneurs, and contrary to popular belief, a lot of the skills taught at medical school are incredibly valuable in this world. We learn how to communicate complex ideas in a simple way, how to lead a team in high pressure situations, how to critically appraise evidence - all incredibly useful skills I use every day running Synap. In addition, if you’re working specifically on a medical startup, then the ‘on the ground’ experience you gain by being on the wards as a medical student, or as a junior

I think you can definitely train the skills needed but you’ve got to have that initial drive and passion to see it through. Definitely in the startup world, whilst there are great resources to ‘train’ you - books such as The Lean Startup, experiences of other entrepreneurs and the resources they publish online - it’s still an evolving field and everyone, regardless of how experienced they are, is still figuring out the rules of the game. It’s part of what makes it so exciting! 34

Credit: James Gupta

our ‘gut feeling’ again. In medicine and science, we try to ignore our gut feeling as much as possible because we want to be evidence driven. In a startup, however, almost by definition you’re doing something that hasn’t been done before, and that means you’re never going to have a perfect set of information. Your gut feeling is likely what inspired you to start a business in the first place, so whilst you should gather as much evidence as possible to support it, at some point you’re going to have to take a leap of faith and trust it!

doctor, are going to give you invaluable insights into how the NHS operates and how to improve it.

Do you have any advice for students or new graduates considering a similar career pathway? I encourage people to ‘just go for it!’. It’s an incredibly rewarding career path and one that gives you a level of freedom and variety you just could not find anywhere else. You are in charge of what you do, you’ll be working within a range of disciplines from marketing to accounting to leadership to strategy, towards implementing your vision - what could be better than that!

Any final words? I’m on Twitter and LinkedIn and always happy to speak to people who are considering starting a business and would like some advice. Synap is available now at https://synap.ac, would love to hear what people think about it! We’re also looking for medical professionals to get involved writing quizzes which they can offer for free or charge for them - if you’re interested, check out the site and get in touch!

In terms of tangible advice, particularly for scientists and medics I’d say we need to learn how to embrace

Credit: James Gupta

Dr. George Lueddeke

George Lueddeke, PhD, is an educational consultant in higher and medical education. He has held senior posts in educational and organizational development in both Canada and the UK. Positions in the UK include serving as senior lecturer in medical education at Southampton University’s Faculty of Medicine and as a consultant education adviser with the Kent, Surrey and Sussex Postgraduate Deanery in London. Dr. Lueddeke has written widely on future trends, education and innovation, including his current book, Global Population Health and Well-Being in the 21st Century: Toward New Paradigms, Policy and Practice. (Springer; 2016).

Achieving the UN-2030 Sustainable Development Goals through the ‘One World, One Health’ Concept (Extending ‘Community of Life’ Chances in an Era of Complexity, Uncertainty and Instability)

Preamble

September, 2015 as an extraordinary day, it may in due course be seen as highly significant for the future of the planet and people. On that date the 193-Member United Nations General Assembly ‘formally adopted the 2030 Agenda for Sustainable Development, along with a set of bold new Global Goals, which SecretaryGeneral Ban Ki-moon hailed as a universal, integrated and transformative vision for a better world’ (1).

The recently agreed UN 2030 Agenda for Sustainable Development, including the 17 sustainable development goals (SDGs), present exciting and meaningful opportunities to explore approaches for implementing these on a global scale. However, while the UN Agenda has been carefully crafted, much work remains in terms of translating broad vision and goals into practice on the ground and in finding ways or systems not only of 'doing things better' -the traditional approach to change - but also -and arguably much more important - of learning to do 'better things,' engaging in transformative - often 'out of the box’ – holistic thinking and interventions. This article provides a starting point in this direction as it calls for a better understanding of the many social, economic, ecological and geopolitical hurdles we face, the global goals to which nations are asked to aspire and their relationship to an interdependent and interconnected planet, which must support the health and well-being of all species humans, animals, plants – ensuring their survival in an increasingly threatened environment. The task is formidable and our success depends on our capacity to effectively address what some have called an historic “ingenuity gap,” whereby our present-day solutions fall far short of the myriad complex problems we face. In the long term our best chance for doing so may be by nurturing imaginative or innovative thinking throughout the student learning experience to raise awareness about the world we inhabit and how we can make it better, thereby fundamentally reflecting the “One World, One Health’ mindset in order to safeguard - through collaborative and enabling action - the sustainability of the planet and the future for this and future generations.

The Goals build on the historic Millennium Development Goals (MDGs), ‘which in September 2000, rallied the world around a common 15-year agenda to tackle the indignity of poverty.’ In his opening address to the UN General Assembly (UNGA) on 25 September, Ban Ki-Moon the UN, SecretaryGeneral, hailed the new framework as an agenda for shared prosperity, peace and partnership as it ‘conveys the urgency of climate action,’ and ‘is rooted in gender equality and respect for the rights of all.’ Resonating with one of the main aims of this brief article, the UNGA members also vowed to ensure ‘the lasting protection of the planet and its natural resources’.

Global Challenges in the 21st Century However, while the UN September summit was filled with goodwill and optimism, the challenges facing the planet continue to be enormous though not insurmountable given the strength of the human spirit and creative enterprise (3).

The UN-2030 Agenda for Sustainable Development While most will understandably not recall Friday, 25

They call for global responses that address intractable issues relating, among others, to conflicts and terrorism, prompted largely by territorial ambitions and violent jihadism; population growth and urbanization made especially vulnerable by climate change and fragile ecosystems; renewed nationalism coupled by social intolerances; and continuing economic uncertainties, many precipitated by geopolitical and economic forces, including on-going self-interests and corruption across a wide range of human activity (4).

Credit: United Nations, Sustainable Development Knowledge Platform, 2015

The UN 17 global goals accompanied by 169 targets and presently 231 indicators to ‘wipe out poverty, fight inequality and tackle climate change over the next 15 years.’ represent a major step forward. According to Johan Rockström, director of the Stockholm Resilience Centre, the SDGs ‘may be the biggest decision in history…a much more complex agenda, which requires humans to reconnect with their planet.’(5).

The impact of these imbalances is felt by everyone but perhaps most acutely by children and young adults. Far too many have been and are presently being displaced or caught in conflict and war zones and suffer the most – physically and emotionally. With more than 13,000 children killed already (overall more than 250,000 people), Syria is a cruel example of a total “social breakdown” as intolerable as any in preceding wars (6). Reflected starkly in the UNICEF report, ‘Committing to Child Survival: A Promise Renewed Progress Report 2015’ (7), we are reminded that while ‘Globally, major progress has been made in improving child survival,’ the toll of under-five deaths over the past two decades is staggering: between 1990 and 2013, 223 million children worldwide died before their fifth birthday.’

One of the main hurdles facing global decision-makers is harmonising the vast imbalances and inequities that characterise much of the world today. As one example, most of the people live in the South and East -over 5.7 billion, but 90 per cent + of the funding for global health (now over US $7.5 trillion annually) is allocated in the North and West supporting around 1.5 billion people (3).

Moreover, according to UNESCO’s 2015 Global Monitoring Report, Education For All 2000-2015: Achievements and Challenges (8), there are still ‘58 million children of out of school globally. Of these children, 25 million are in the rural, low-income regions.’ It is now estimated that ‘More than a million migrants and refugees crossed into Europe in 2015’ (9) most in fear and desperate for basic human needs and likely with many more to come, a situation in 2016 that is at once unfathomable as it is intolerable.

While In terms of trying to achieve WHO ambitions for Universal Health Coverage, the statistical disparities are equally breathtaking. While leading western nations annually spend as much as US $900.00 plus per capita, Myanmar (Burma), as one example, with a population of over 60 million spends only about US $2.00 per person per year!(3).

sustainable future outlined in the Earth Charter (14). In the intervening years these have regrettably not been fully translated into wide-scale global adoption nor practice as huge disparities remain with regard to social justice, democracy and violence. Ecological integrity across the globe continues to be compromised evidenced by extreme weather as are the “respect and the care for the community of life.”

Progressing the UN -2030 Agenda for Sustainable Development through the ‘One World ,One Health’ Concept The complex and growing global challenges necessitate ‘renewed global partnerships’ (1, 2). To gain the support of civil society top priorities for the UN SDGs are twofold: first, planners need to reinforce and urgently communicate a compelling humanitarian justification for the SDGs to convince the public that the goals are critical for the survival of our species. In many cases it is about giving people a reason to live, founded on a basic and increasingly critical truth that ‘social ties save lives and their absence is toxic’ (10). In this regard, we need, as the Secretary-General strongly advocates, ‘to look beyond national boundaries and short-term interests and act in solidarity for the longterm’(1), a lesson from history that should not go unnoticed in Europe and many other parts of the world.

Marco Lambertini, director general of World Wildlife Fund International (WWF) , observes in the Living Planet 2015 (15) that the status quo is unsustainable: ‘…in less than two human generations, population sizes of vertebrate species have dropped by half. These are the living forms that constitute the fabric of the ecosystems which sustain life on Earth—and the barometer of what we are doing to our own planet, our only home. We ignore their decline at our peril, and should cause us to stop and think.’

And, secondly, while a forthcomingWorld Humanitarian Summit (11), spearheaded by the UN Secretary‑General, is warranted and timely, its main raison d'être ‘to protect humanity’ is not enough. We must be equally concerned with protecting all other species upon which our survival as human beings depends. As argued in my book, Global Population Health and Well-Being in the 21st Century: Towards New Paradigms, Policy and Practice (3), achieving long -term continuance as a species requires a major shift in our worldview. Fundamentally, we must move beyond human egocentrism and replace our present mindset that ‘the world is a place made especially for humans and a place without limits,’ to one that ensures the world is compatible not only ‘with our needs as human beings’ but also recognise ‘an outer world that is compatible with the needs of our ecosystem.’(12).

He challenges global leaders to respond to three main questions: ‘What kind of future are we heading toward?’ ‘What kind of future do we want?’ and, ‘Can we justify eroding our natural capital and allocating nature’s resources so inequitably?’ His concerns go beyond the UN -2030 global goals and demand finding, first and foremost, a lasting ‘unity around a common cause,’ and, echo Secretary-General Ban Ki moon’s global SDG partnership priorities (1). For the WWF Director General the time has come for the public, private and civil society sectors to be proactive and to ‘pull together in a bold and coordinated effort’ and for ‘Heads of state’ to think globally; businesses and consumers, ‘to stop behaving as if live in a limitless world’ (15) -- before facing inevitable and potentially disastrous consequences.

This re-orientation in our thinking is certainly not new and ‘is as old as culture’ going back more than 2,500 years to Hippocrates who ‘urged physicians to consider where their patients lived, the foods they ate and waters they drank, their lifestyles, and the seasons of the year’ (13). In the 20th century Canadian epidemiologist/veterinarian Professor David WaltnerToews, concluded that: Much of this integrative thinking was pushed into the background in the mid-twentieth century as many leaders and scholars were lured by the vision that infectious disease had been conquered and that through basic scientific understanding, advanced technology and unlimited electrical power, humanity had somehow been freed from the bonds of nature. In the late 20th century, this vision was clearly demonstrated to be an illusion. Leading up to the MDGs in 2000, UNESCO commendably focused on four core principles for a

Credit: International Earth Charter Organization, 2008

The One Health Commission (16) together with the One Health Initiative (17) along with other partners are presently working on a project proposal that would support educators to enable learners from K-12 and Beyond to a gain better understanding of and appreciation for the values and principles underpinning the One Health concept and approach. The initiative provisionally called Transforming K-12 and Beyond through One Health Education: Toward the “World We Need”. Themes such as our fragile planet, prevention, global interdependencies and threats (e.g. such climate change), cultural diversity and respect for others, and care for the community of life (14), underpinned by collaborative and critical thinking, could raise the learners’ awareness of the need for ecological sustainability and their crucial role within it (3).

The One Health (and Well-Being) Movement and the World We Need The One Health movement - spearheaded by the One Health Commission (16) and the One Health Initiative (17) - that recognises ‘the inter-dependencies in the health (and well-being) of people, other animals and the environment in which we live’ unquestionably provides the essence for the enduring ‘unity’ the WWF director general is seeking. Given the many idealogical mindsets that appear to divide us in the 21st century, ensuring the longevity of the planet and people is arguably the only dimensions upon which we might build a sustainable future. Doing so will increasingly demand going beyond personal gain and self-interests and place much greater emphasis on collaboration rather than competition, on finding peaceful means to deal with crises and ensuring that ethical responsibilities are rooted in interdependencies and the sanctity of life (3). Our global mission is nothing less, as UNESCO Director-General Irena Bokova articulated several years ago, than evolving ‘a new humanism that reconciles the global and the local, and teaches us anew how to build the world’ while simultaneously facing ‘our greatest common challenges, particularly respect for the environment’ (18, 3).

A final word: It is becoming clear that the 20th century fixation on individualism and “mechanistic understanding of the world and ourselves” (12) has to change. Current events painfully demonstrate on a daily basis that we must find more creative and constructive ways to engage with each other and the planet and evolve a much more fluid or organic and altruistic approach to decision-making across all human activity, drawing on a future consciousness to inform the present. As the World Economic Forum cautions, we must be careful: “We’re at the crossroads for humanity. It could be our best century but it could be our worst because our capabilities of spreading risk are greater than ever before” (20). Implications for refashioning our institutions and systems and “transforming our current attitudes to virtually all aspects of society and the economy,” posited, for instance, by Development Alternatives in India (21), and that also may hold lessons for other nations, are considerable and likely inescapable, according to Dr Alexander Likhotal, president of Green Cross International (22).

In terms of implementing the 17 SDGs, and as illustrated below, applying “One World, One Health” values and principles seems essential regardless of the global goal we are trying to achieve. There is little room for doubt that the next fifteen years will provide decision -makers at all levels a unique window of opportunity to shape a worldwide consciousness about what truly matters in terms of the sustainability of the planet and people. As things stand, the SDGs coupled with One Health values and principles, espoused in the UN direction-setting report, Transforming our World: the 2030 Agenda for Sustainable Development (2), may offer us the best chance yet to ‘free the human race from the tyranny of poverty and want and to heal and secure our planet,’ while balancing ‘the three dimensions of sustainable development: the economic, social and environmental’ (2).

Altering our way of thinking, as Pope Francis urges, that “regards the world as a means rather than an end” (23) may be one of the most significant and profound steps we need to take, and not without recent precedent. The Paris Climate Agreement at the end of 2015 and reduction in emissions attested to what can be done when 196 countries decide to unite against a common global threat. The same holds true for many other aspects that sustain life on the planet. To these ends, getting young minds involved with the global picture, such as the UN-2030 Agenda for Sustainable Development and the One World, One Health concept and approach , is surely the best path for securing the health and well-being of our planet and people. Failure to do so cannot be an option.

With an eye on the future, policymakers are particularly urged to listen to the “children’s voices,” reinforced at the Children’s Summit on the World’s Sustainable Development Goals (19). Among their aspirations, their pleas for equality, health, security, and recognizing the devastating effects of social intolerances - child labour, child marriage and child trafficking - cannot be ignored. For the children and the younger generation as a whole, education and working together are the keys to the future as they must be for us all.

Credit: George Lueddeke

Acknowledgements

10. Appleyard B. A review of A Journey into the Science of Mind over Body. The Sunday Times (Culture)p. 33; Feb 7, 2016.

Sincere appreciation is extended to members of the One Health Commission (OHC) (16) and the One Health Initiative (OHI) (17) for their continuing encouragement and support in helping to shape the substance of this article and thereby raising awareness about the critical interplay between the UN 2030 SDGs, the ‘One World, One Health’ concept and educational engagement.

11. United Nations. One Humanity, Shared Responsibility: Report of the United Nations Secretary-General for the World Humanitarian Summit.’ Available at: http://sgreport.whsummit.org/ 12. Hanlon P, Carlisle S, Hannah M, Lyon A. The Future Public Health. Open University Press; 2012.

Note: This article is also being published in the OHC ‘Narratives of One Health in Action’: www.onehealthcommission.org/en/one_health_resources/ narratives_of_one_health_in_action/

13. Waltner-Toews D. One Health for one world: A compendium of case studies. Retrieved 2014, from Veterinarians Without Borders: http:// www.onehealthinitiative.com/publications/OHOW_Compendium_Case_Studies.pdf

and in the OHI One Health Newsletter: http://epi.ufl.edu/onehealth/news/onehealth-newsletter/

14. UNESCO. Earth Charter International. Sustainable development and the Earth Charter. Retrieved 2010, from Slideshare: http://www.slideshare.net/EarthCharter? utm_campaign=profiletracking&utm_medium=sssite&utm_source=ssslideview

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16. One Health Commission(OHC). Mission. Retrieved 2015, from OHC home page: https://www.onehealthcommission.org/en/why_one_health/ohc_mission/

2. United Nations. Transforming our world: the 2030 Agenda for Sustainable Development. Retrieved 2015, from Sustainable Development Knowledge Platform: https://sustainabledevelopment.un.org/post2015/transformingourworld

17. One Health Initiative (OHI). Mission Statement. Retrieved 2014, from OHI home page: http://www.onehealthinitiative.com/mission.php

3. Lueddeke G. Reflections on Global Population Health and Well-Being in the 21st Century : Towards New Paradigms, Policy and Practice. New York: Springer Publications; 2016.

18. UNESCO. UNESCO general conference: Irina Bokova sworn in as directorgeneral. Retieved 2010 from UNESCO: http://www.unesco.org/new/en/unesco/aboutus/who-we-are/director-general/singleview-dg/news/ unesco_general_conference_irina_bokova_sworn_in_as_director_general/ #.VX8Rx_lViko.

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7. UNICEF. Committing to Child Survival: A Promise Renewed Progress Report. Retrieved 2014, from UNICEF: http://files.unicef.org/publications/files/ APR_2014_web_15Sept14.pdf

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23. The Vatican. Encyclical letter Laudato Si’ of the Holy Father Francis on Care for our Common Home. Retrieved 2015 from: http://w2.vatican.va/content/dam/ francesco/pdf/encyclicals/documents/papa-francesco_20150524_enciclica-laudatosi_en.pdf

9. BBC. Migrant crisis: Migration to Europe explained in graphics. Retrieved, 2016, from BBC News: http://www.bbc.co.uk/news/world-europe-34131911

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