Unite for Sight Conference: The Conversation Continues

Last weekend, Yale hosted the sixth annual Unite for Sight Conference, entitled “Achieving Global Goals Through Innovation.” Two hundred speakers, including six impressive keynotes, presented their experiences in developing countries and suggested ways to fix public health problems. Although each of the speakers addressed a diverse range of issues, all agreed that advancing public health in the developing world requires systemic change that involves education, satisfaction of basic needs such as food and clean water, sufficient finances, infrastructure, organizational partnerships, and open, fair trade.

During the course of the conference, many speakers suggested community-based approaches to solve problems of access to health services. Some of their suggestions dealt with changes in government’s provision of services on a local level. For instance, Doruk Ozgediz said that training Uganda’s police to act as lay first-responders in trauma situations could help improve the poor trauma outcomes attributable to Uganda’s lack of centralized medical resources.

Other speakers advocated that we re-think public health initiatives altogether. Scott Hillstrom, the Chairman of the Board and co-founder of the HealthStore Foundation, suggested that public health programs follow the model of business franchises. He highlighted the need for consistent, quality standards of health care delivery and promoted the idea that health care facilities should be run more like businesses.

Still other suggestions focused on the role of specific groups within local communities. Nicholas Kristof, a New York Times columnist and one of the keynote speakers, spoke of the practical advantages of empowering women to serve as leaders in their local communities to promote preventative care and handle minor medical problems. Gene Falk from mothers2mothers, meanwhile, suggested that women develop peer support networks. Global initiatives that foster women’s leadership in the provision of basic health services have worked in many countries, and it is probably time to consider more serious investment in expanding these models.

One of the central themes of the conference was the role of money in advancing global health. Columbia Professor Jeffrey Sachs pointed out the systematic neglect of donating to the poor. While nations that have health care for all of their citizens also give the most money to the developing world, countries that have numbers of uninsured (such as the United States) give significantly less, Sachs pointed out. To attempt to make up for the lack of governmental donations, Sachs suggested, for instance, that Wall Street executives be asked to give away at least half of bonus money to people who need it most. Matthew Bishop, a business writer for the Economist who also spoke at the conference, has suggested that the wealthy have an obligation to participate in what he calls “philanthrocapitalism.”

Of course, a lack of capital is not the only problem faced by developing nations. The United Nations Millennium Declaration and the Millennium Development Goals have set benchmarks for eliminating global poverty. However, lack of effective global policy enforcement threatens the successful elimination of poverty and inequities in access to health care.

Neither is money the solution to all public health needs. Many nations with a low per capita gross domestic product have good health outcomes — take Costa Rica, for example — and some nations with higher per capita GDP, such as Botswana, have populations with significantly lower life expectancies because of factors such as civil unrest, unstable regimes and lack of access to clean water. The worst health outcomes occur in places where women are disempowered; education is insufficient and inaccessible; the impoverished do not have access to basic needs; societal unrest continues; and “brain drain” contributes to loss of educated medical professionals. These countries clearly cannot fulfill the Millennium Development Goals without outside help and guidance.

I found it very interesting that topics at this conference resonated strongly with the issues discussed at the Harvard Bioethics Conference earlier this year, where speakers such as Professor Dan Wikler analyzed bioethical problems faced by developing nations. Ethically, we must act against poverty and extreme inequality that perpetuates the spread of infectious diseases and poor health outcomes. As speakers at the Unite for Sight conference emphasized, fulfilling this ethical obligation will require diverse practical solutions. Thousands of lives are lost for every day that we do not, as Yale Professor Elizabeth Bradley suggested, pool all of our efforts, all of our skills from different areas — business, medicine, engineering, public health, law, and even arts — to seek out innovative solutions to problems in the developing world.


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