Karl Brown

Karl Brown, Associate Director of Applied Technology at Rockefeller and one of the main organizers of the Making the eHealth Connection conference.

In 1889 American steel baron Andrew Carnegie published an essay titled The Gospel of Wealth. The essay makes what was then a radical argument: that wealthy monopolists give the majority of their money back to society rather than to their children. “The problem of our age”, it begins, “is the proper administration of wealth, that the ties of brotherhood may still bind together the rich and poor in harmonious relationship.”

That essay had a profound impact on another of America’s wealthy barons at the time, John D. Rockefeller, founder of Standard Oil, which today survives on as ExxonMobil.

Those two titans of the industrial age established a culture of American corporate philanthropy which remains unmatched anywhere else in the world (though this is now starting to change). We now take it for granted when more recent billionaires like Bill Gates (software), Howard Hughes (aviation), John D. and Caterine T. MacArthur (insurance), Henry Ford (automobiles), W.K. Kelogg (cereal) J. Paul Getty (oil), John Knight (newspapers), and Ted Turner (cable TV) allocate the majority of their life’s earnings to the philanthropic foundations which carry their names. Other major philanthopists include investors, both the overwhelmingly respected like Warren Buffet and the largely controversial like George Soros, and corporations themselves which are increasingly spawning foundations like Google.org and the Nike Foundation.

The mission of all of these foundation is, in one way or another, to make the world a better place. Which, as you could guess, means a lot of investment in health and healthcare. “Repairing weak, outmoded health systems” to make ” modern health systems stronger, more affordable, and more accessible in poor and vulnerable communities” is one of the seven major focus areas of the Rockefeller Foundation.

To a certain degree it felt awkward, if not ostentatious, to hold a month-long conference about health in the developing world at Bellagio, one of the most affluent municipalities in the world with its necklace of villas and mansions wrapping around Lake Como’s shoreline. But each of those villas and mansions was a reminder of all the wealthy elites around the world who have never given a cent to philanthropy. We should remember that the second wealthiest person on earth is a Mexican who used to poke fun at philanthropy. (Though more recently has given luke-warm promises of expanding his foundation’s endowment to $10 billion, one-sixth of his current net worth.)

With so many philanthropic foundations now focused on global health (a paper published in the New England Journal of Medicine calls this the beginning of the golden age of global health), how do those foundations ensure collaboration and avoid duplicate investments and initiatives? I put that question to Karl Brown, Associate Director of Applied Technology at Rockefeller and one of the main organizers of the Making the eHealth Connection conference. The complete audio from our conversation is available below. What follows is an edited and abridged transcript. I encourage you to also read an interview with Karl by my new friend Boakai M. Fofana who I will get to see again in Monrovia in October. As Boakai and I asked a lot of the same questions, the transcription below focuses on what wasn’t covered in detail in Boakai’s interview.

DS: Why did the Rockefeller Foundation decide that now is the right time for a conference on eHealth?

KB: There are a number of converging movements. The growth of communications infrastructure in the developing world: you see mobile phone penetration reaching 20% in Sub-Saharan Africa and higher in other parts of the world, and it’s growing at 40% a year. The same is true of internet penetration which is growing at 40% a year in Africa now. The other thing that is happening is there is a shift in the health care burden. With the advent of effective treatments for things like HIV, TB, and malaria, what used to be diseases that you would die from have now become diseases that are treatable, but they are the ‘chronic diseases’. We also see in the developing world in places like Mexico or India, a rise in chronic disease. This shift in the health care burden from acute care to chronic care means that you have to manage those patients in a different way and you have to manage their healthcare over a longer period of time which implies keeping some sort of longitudinal record.

Another factor is the question of interoperability. In places like the United States where the health care system has been built up over the past 30 years, there are multiple overlapping systems, none of which talk to one another. The cost of retrofitting that is going to run into the tens of billions of dollars if not more. Interoperability early is actually very cheap. We think that the developing world cannot afford to go down the path that a place like the United States has gone down. We think that if we act now, and if we act in partnership with the developing countries to help them build integrated health information systems and not ‘siloed’ systems, then we stand a chance to end up with much better information systems five or ten years down the road.

DS: ‘Leapfrog’ is the word I keep hearing over and over again. So that is the goal of this conference is to start that leapfrog to interoperability?

KB: Yeah, the leapfrog to interoperability, but there are a number of leapfrog movements that are happening. One of the things we were just talking about is the potential for the South to become a center of innovation for eHealth and I think there are a number of things which are aligned in their favor. First of all, there are not as many legacy systems. Secondly, they can leapfrog to the best learning methods and the best technologies. Finally, I think that in other domains we are seeing that innovation is coming from new places. Some of the most innovative mobile banking platforms are in South Africa and in Kenya; not in Manhattan or Chicago. People are starting to experiment with these technologies and I think that the future is that the North is going to learn from the South in eHealth.

DS: How do you plan on bringing together all of the information that comes from the eight different sessions across four different weeks? What is your communication strategy for the conference?

KB: There are a number of different pieces to our communication strategy. One of them is that we are doing video interviews with a number of the participants and we’re posting that on the website. Those interviews will eventually be collected into a short documentary that is both about the conference and about the wider questions of eHealth in the South. Another part of our communications strategy during the conference is the use of a wiki. So we are using the wiki to collect ideas from various groups to refine the joint vision statement that I talked about earlier and to capture the notes and summaries and so on. Coming out of this conference, all of the organizers are going to be preparing a chapter and the chapter will include some of the key commissioned papers from the week in addition to some of the outputs and recommendations from the conference. Those chapters will be compiled into a book that we will release sometime in 2009.

There are a number of other issues we’re looking at such as how do we feed some of the outputs of this conference into other larger meetings that will be happening over the next couple years. There is a large conference on public health informatics in September and we will be on panels for that conference sharing some of the outcomes of this one so that we distribute it to a wider audience. There is a meeting of all of the health ministers around the world in Bamako in November – there will also be a session there where we’ll have a chance to share some of the outcomes of this conference.

DS: There is so much buzz right now about the $50 million of the Gates Foundation and also Google.org’s focus on global healthcare. What is philanthropy’s role in global health and how is Rockefeller, for example, coordinating with other foundations to make sure there is not duplication and that there is collaboration as far as funding goes and as far as conferences like this go as well?

KB: Specifically with the Gates Foundation and Google.org, we have been in many discussions with them already and are in ongoing discussions with them about potential joint efforts. We have participants from the Gates Foundation in several of these conferences and we have already done some joint work with Google.org in Southeast Asia on support for a network called the Mekong Basin Disease Surveillance network. One of their areas of focus in information technology so we’ve done some joint work with Google on that. Google and Rockefeller both funded InSTEDD.org, which is a new NGO that was launched by Google last year and they are looking at innovative uses of mobile technology in an open source manner for disease surveillance and humanitarian emergencies.

DS: So you see philanthropy’s role as one of bringing different groups together and forming partnerships?

KB: I think the role that philanthropy can play is in catalyzing new issues and bringing the to the fore. The amount of funding and resources we can bring is very small to the size of the problem. So, another important thing that foundations can do is using their convening powers to bring together a diverse group of partners – whether they are from other donors, from multilaterals like the World Bank and WHO, or whether its private sector players (large multinationals or small companies in country), in addition to country governments.



In the final five minutes of our discussion, Karl explains why he invited bloggers as well as print journalists to cover the conference, who else he would have liked to invite to the conference in hindsight, what grabs his eye in terms of future opportunities – both personally and for Rockefeller – and what kind of cel phone he uses and what he uses it for.