Commentary: The Long-Term Impact of Shared Value Health Strategies

This article, by MDG Health Alliance Vice-Chair Leith Greenslade, originally appeared in the Shared Value Initiative.

The top ten direct causes of premature death are concentrated in just a handful of countries. To have the greatest impact on global health and development, says Leith Greenslade, a Vice-Chair of the MDG Health Alliance, shared value initiatives between business and society targeting these leading threats are sorely needed. But as we learned in this interview, Greenslade sees unprecedented opportunities for business to have larger and longer-term impact on the development of nations by driving shared value initiatives directly related to one or more of the new Sustainable Development Goals.

The following interview is part of the series Leading Shared Value, spotlighting the presenters at the 2015 Shared Value Leadership Summit.

Why is shared value one of your priorities as a leader within the global health sector?

With most countries pursuing development through the expansion of markets, the private sector has become the major force for economic growth and job creation almost everywhere. As a result, improvements in the health status of the populations that live in the countries with the greatest health challenges increasingly depend on the actions of the private sector. In this context, shared value health strategies offer the promise of large and long-lasting impact because they are integrated with corporate investment and growth strategies. Health impact is also likely to be amplified because it takes place within the context of rising incomes from private sector-generated jobs growth. Over time the private sector should reap increasing returns to shared value health investments as healthy populations become more productive workers and more productive workers become more robust consumers. Shared value investments may also prove to be a more efficient development strategy because direct corporate investment in population health does not incur the heavy transaction costs of the traditional aid model, which must first identify, secure and then transfer money from external donors to foreign governments or pass it through one or more non-government organizations, each of whom captures a percentage of the funding as it travels to its final destination.

What are some of the most pressing social issues in the global health field today? How can these be addressed through shared value solutions?

According to the new 2013 Global Disease Burden estimates, the top ten direct causes of premature death (deaths among people under age 50) are injuries, newborn causes, heart disease, pneumonia, cancer, AIDS, malaria, diarrhea, diabetes and TB. These deaths are concentrated in certain sub-populations in just a handful of countries including India, China, Nigeria, Pakistan, Democratic Republic of Congo, Indonesia, Ethiopia, Bangladesh, Russia, Brazil, Tanzania, the USA, Mozambique, Uganda and Kenya. To have the greatest impact on global health and development, we need shared value initiatives that target the leading causes of premature death in these high burden countries (e.g. by improving road safety, increasing skilled childbirth, improving diets, and preventing and treating heart disease, pneumonia, cancer, AIDS, malaria, diarrhea, diabetes and TB). But we shouldn’t forget the underlying mega trends that are driving future global health challenges. Population growth, urbanization and rising income inequality are already interacting to produce shocking health disparities in specific populations, especially those across sub-Saharan Africa. Shared value initiatives can counteract some of these mega trends by investing in contraceptive access, urban job creation and by consciously targeting investments to the lowest income groups in each population, which is particularly challenging in a shared value context. These types of shared value Investments may also deliver a “peace and security dividend,” with major long-term benefits for business engagement and development.

How do the new Sustainable Development Goals (SDGs) present an opportunity for organizations to innovate for shared value, alone or in partnership? Share your favorite example(s) from the field.

The Sustainable Development Goals present an unprecedented opportunity for shared valued initiatives to have global impact on one or more of the seventeen global priority areas. There are several draft goals that relate to health, including ending all forms of malnutrition (Goal 2); ending preventable deaths and epidemics of infectious diseases (e.g. AIDS, TB, malaria, tropical diseases and hepatitis); reducing premature deaths from chronic diseases and road traffic accidents; achieving universal access to contraception and health coverage (Goal 3), and achieving universal access to safe drinking water and sanitation facilities (Goal 6). Achieving gender equity (Goal 5) will also have a major impact on global health as the discrimination faced by women in all aspects of life drives much of the poor health they experience and profoundly influences the health of their children. Shared value health initiatives should at the very least be responsive to these global priorities and seek to align business strategies with them, but the highest impact initiatives will integrate solutions across several goals and target those to the populations where the problems are concentrated. For example, corporations seeking big impact on women’s and children’s health could target integrated contraception, sanitation and skilled birth investments in India, Nigeria, Pakistan, the Democratic Republic of Congo and Ethiopia. Corporations seeking major reductions in premature deaths from chronic diseases could target heart disease, cancer and diabetes testing and treatment in India, China, the USA, Russia, and Indonesia. Corporations seeking impact on both infectious and chronic diseases could target population-wide nutrition improvements as good nutrition is an insurance policy against premature death from a variety of causes pretty much everywhere. And finally, corporations seeking to put a dent in the massive global burden caused by injury could target road traffic accidents in the emerging mega cities of developing countries including Delhi, Mumbai, Dhaka, Karachi, Cairo, Lagos, Mexico City, and Kinshasa, which will each have populations above 20 million by 2030. Importantly, the new Sustainable Development Goal for partnership (Goal 17) acknowledges the value of multi-stakeholder partnerships that share knowledge, expertise, technologies and financial resources to support the achievement of the new Goals. Companies can go it alone but increasingly corporate shared value initiatives that included governments, non-government organizations, academic institutions and even other small social businesses will be able to achieve greater impact.

What are you learning about measuring the link between social and business value?

A good indicator is worth its weight in gold! The seventeen new Sustainable Development Goals will be supported by hundreds of carefully chosen indicators which allow nations to measure their progress over time, and the world to aggregate national performance and assess global progress. Corporations with shared value investments should consider adopting some of these indicators as their own. For example, the indicators underpinning the global goal of ending malnutrition will include the rates of child stunting, anemia and underweight among women of reproductive age. Corporations building markets for nutritional foods or beverages should be routinely measuring and reporting progress on these indicators. Similarly corporations with shared value investments in healthcare, water, sanitation and hygiene, even transport infrastructure should measure their shared value impact using the new SDG indicators – the final list will be available by September 2015. Corporations with shared value health investments should also be routinely measuring their impact on specific non-health goals like the poverty goal using the new indicators, as the jobs impact of a lot of corporate investments is a critical but often unclaimed shared value benefit.

What’s the biggest challenge that you’ve faced in implementing shared value? What opportunities do you see on the horizon to overcome it?

The old mindset – that organizations that pursue financial profits are not welcome at the development table because they have a “conflict of interest” – is the biggest barrier. In reality all sectors – public, private, and NGO – face specific conflicts of interests when trying to achieve a public policy goal. Business has to make profits (although not always – let’s be clear); governments have to get reelected; UN agencies have to maintain their relative power; and NGOs have to continue to please their donors. At any one time any combination of these can compromise the achievement of a public policy goal. We need systems that minimize the conflicts of interest among all players and try and align (through a mix of incentives and penalties) the activities of all parties with public policy goals – which we assume are in the interest of the population they are seeking to help (not always true). Perhaps we need independent “honest brokers” to bring these multiple public and private sector players to the development table to negotiate shared value investments and achieve the best alignment of interests. There are also many shared value success stories that are not claimed as “shared value.” The best example in Africa and South Asia is the rise of mobile phones where the private sector has delivered the rising connectivity that has led to an unprecedented flow of information – a powerful public good that underpins so many different aspects of development. Shared value wherever it happens needs to be named and claimed!