Jeffrey L. Sturchio is committed to looking for what works in health care, wherever the answers may be found, and adapting these best practices to local circumstances, whether in Rhode Island or Rwanda.
Sturchio is president and CEO of the Global Health Council in Washington, D.C., one of the world’s leading nongovernmental organizations, and before that, president of the Merck Co. Foundation, as well as chair of the U.S. Corporate Council on Africa.
He is at the forefront of creating private/public partnerships directed at global health issues, including HIV infection, malaria, tuberculosis and other infectious diseases. He believes that businesses have a clear stake in global health issues.
Providence Business News recently asked Sturchio to provide his perspective to local and national developments in health care practices and innovation from a global perspective.
PBN: In a recent article, you ask: “Can we now imagine a world without AIDS?” Is that more than a rhetorical question?
STURCHIO: The results of recent clinical trials have generated tremendous optimism in the fight against AIDS. At the International AIDS Conference in July, the Centre for the AIDS Programme of Research in South Africa revealed that a vaginal gel microbicide containing tenofovir was shown to reduce the rate of HIV infection in women by 39 percent. A few months later researchers studying men who have sex with men and are at high risk of developing HIV infection announced that a once-daily tablet called Truvada (containing tenofovir and emtricitabine) was 44 percent effective in reducing infection.
Beyond Cash Donations: How New Forms of Giving Are Transforming Not-for-Profit Accounting
Evolving Funding Landscape for Not-for-Profits Not-for-profit organizations are being asked to do more with less,…
Learn More
These positive results are encouraging – but they must be matched with momentum to replicate the studies and to conduct the further research needed to turn these promising trials into programs that can help prevent HIV transmission at scale.
There’s been good news on the vaccine front as well. The RV144 study is the largest HIV clinical trial done thus far. The results, released in 2009, demonstrated for the first time that a vaccine could prevent HIV infection. There have also been breakthroughs recently in understanding the role of neutralizing antibodies in the cycle of HIV infection, which hold promise for the design of potential new vaccines to stop the virus in its tracks.
But additional funding and considerable testing are still needed to confirm these findings and to make these products widely available in the future. In times of economic crisis, inevitably there is a tug of war between supporting direct programs and services in the short term, and research and development that can help in the long term. We need to continue to do both.
PBN: While the science is progressing, the major stumbling blocks are often politics, cultural norms and a lack of funding – both here in the United States and overseas. What are the most effective strategies to overcome these obstacles?
STURCHIO: Public/private partnerships are essential to creating the most effective approaches to improving global health – whether new products or expanded and novel programs for prevention, treatment and care. No one wins with a go-it-alone strategy.
Just as global health affects everyone on the planet, efforts to advance it must be equally wide-ranging. Businesses have a clear stake in global health. There is both social and economic value in making critical investments and developing sustainable solutions. High disease burdens create a ripple effect: productivity slows if employees aren’t healthy enough to work; companies face higher health care costs; and reduced income means families have less to spend and put back into the economy.
Conversely, improvements in health mean that people can remain productive, supporting their families and communities, as well as more robust economic growth.
The business community has a critical role to play as a key partner with governments, nongovernmental organizations, faith-based groups and others in working to achieve the Millennium Development Goals set by the United Nations in 2000. We’re now just four years away from the 2015 deadline for meeting these goals, which include targets for improving child survival, reducing maternal mortality, and tackling the challenges of HIV/AIDS, TB, malaria and other infectious diseases.
One of the MDGs calls explicitly for creating a global partnership for development. That includes working with pharmaceutical companies to provide access to affordable medications in developing countries and making the benefits of new technologies more widely available. There has been important progress in both of these areas, but there is still more work to do.
When businesses team up with governments or NGOs, each sector plays to its strengths and the collaboration becomes more powerful, as the partners can achieve more together than either could working alone.
PBN: The doctors who run the HIV/AIDS clinical trials at The Miriam Hospital here are advocating for universal HIV testing as part regular checkups to take the stigma away here in the United States. Do you agree? Is there a way that a state health department could take the lead on this?
STURCHIO: Even if we get so many other things right – strengthening health systems, providing universal access to HIV prevention and treatment, funding critical research – our impact is limited if we can’t reduce the stigma often associated with HIV infection. Universal HIV testing is one proven approach to limiting stigma where the developed world has learned from the developing world.
Botswana, which has one of the world’s highest rates of HIV infection, offers an example that’s relevant to other countries. A few years ago when a partnership was developed among the government of Botswana, the Bill & Melinda Gates Foundation, and Merck & Co. Inc. to help transform Botswana’s national response to the HIV epidemic, it was clear that reducing the stigma would have to go hand in hand with increasing access to life-saving medications. The government supported opt-out HIV testing as part of routine medical visits (thus integrating HIV testing into primary health care), which had an immediate impact by bringing the conversation about prevention and treatment into the open. The number of people tested increased dramatically, as did the number willing to take advantage of the treatment and care services available.
Botswana’s experience became an important input to later recommendations by both the World Health Organization and the U.S. Centers for Disease Control and Prevention to implement routine HIV testing in other settings, including the United States.
Routine testing enables earlier diagnosis, reduced transmission rates and lower treatment costs. It’s important to make an effort to achieve universal testing and to educate people on the importance of being tested for HIV infection. Of course, such programs should be done in a way that addresses concerns about informed consent and pretest counseling. Members of the health care community, citizens, advocacy groups and lawmakers all have a say on these question.
A state health department can take the lead by convening stakeholders to raise awareness of the issues and developing a plan to move forward – and it sounds like the HIV physicians at The Miriam Hospital in Providence understand the potential public health benefits of following Botswana’s lead.
PBN: As president and CEO of the Global Health Council, and previously president of The Merck Company Foundation and chair of the U.S. Corporate Council on Africa, you have often been at the nexus of corporate philanthropy, health advocacy and private sector investment overseas. One of the more innovative enterprises in Providence has been the new manufacturing facility for Edesia, producing ready-to-use food products to prevent malnutrition in the developing world. What kinds of similar opportunities exist for both the private and nonprofit sector?
STURCHIO: Fortified foods are an important tool for addressing malnutrition and an area ripe for innovation. Edesia’s project clearly has important potential. It shows that private sector organizations can apply their expertise and resources to global health challenges, even if they’re based in a city like Providence, that might seem far removed from the problems of the developing world. But good ideas know no borders – and globalization provides many opportunities like this for companies to expand their horizons.
PBN: What is your perspective on the efforts to implement health care reform in the United States?
STURCHIO: Health care reform has generated considerable debate, but one thing that just about everyone agrees on is that the current system isn’t sustainable. But this problem isn’t confined to the United States. Every health care system in the world faces a crunch among growing demand, rising costs and strained resources. The World Health Organization’s most recent World Health Report says that strengthening health systems financing is key to achieving universal access to services. Countries all over the world are looking for new ways to address rising health care costs and to reach those who are uninsured and underinsured.
In a recent book, “Turning the World Upside Down,” Lord Nigel Crisp makes an interesting observation about the search for solutions in global health. While poorer countries have to cope with high burdens of ill health, poverty, disability and lower life expectancy, and can use the resources, knowledge and health professionals that richer countries have, “it is also plain and obvious … that health systems in rich countries are in trouble.”
Standing the usual model of developed and developing countries on its head, Lord Crisp notes that “we all have something to learn and all have something to teach.”
So the answer to the question about lessons learned is most assuredly yes. We face daunting challenges in the fight against both infectious and chronic diseases around the world, and the global economic downturn has given new urgency to finding solutions. Looking for what works – wherever the answers may be found – and adapting these best practices to local circumstances offers a good path forward for improving population health, whether in Rhode Island or Rwanda.
