The Philanthropy Handbook by Tej Kohli (Chapter Seven - Developed World or Developing World?)
A Serialisation Of 'Rebuilding You: The Philanthropy Handbook' by Tej Kohli
In the developed world, enough money is already spent by Governments on health, sanitation and education to ensure that easily preventable or treatable diseases are indeed prevented and treated. So the ‘first world’ problems that we are left with are invariably the ones which it would be relatively expensive to solve.
By contrast, poverty means that many developing countries are still plagued by diseases and unaddressed medical ailments that cost comparatively tiny sums to control in the ‘first world’.
In the United Kingdom for example, the National Health Service (NHS) considers it cost-effective to spend up to £20,000 for every single year of healthy life that can be added for a patient. That provides a lot of latitude for ‘expensive’ treatments across all manner of ailments. By contrast, the maximum cost deemed as acceptable to prevent a child's death through the distribution of specialist anti mosquito nets from the Against Malaria Foundation in Africa was $3700 in 2019, about the same as the NHS . would automatically spend this much money just to add two months of life to an elderly patient in the United Kingdom.
More Than Money
But solving the ‘treatment gap’ problem in developing countries is rarely as simple as ‘turning on the taps’ with more funding. For example, in 2018, India commenced the world’s largest experiment in Universal healthcare when the Government granted 500 million people the entitlement to free health insurance overnight. This will mean that those living below the poverty line in India will no longer have to pay for hospital treatments that would until now have pushed them into crippling debts.
Yet whilst on the surface this is a hugely positive step forward, too much optimism entirely ignores the fact that it will still take many decades and billions more dollars to bring all of India’s healthcare systems up to the equivalent standard of that in the West. Until then, highly pervasive treatment gaps will continue to permeate the poorest communities, and even those who can obtain treatment will not enjoy Western standards.
Closing these gaps is about more than money – it is also about logistics, resources, education, knowledge, cultural understanding and having a reach into communities.
Therefore, even though the developing world is plagued by problems that are seemingly solvable, you must be wary that your money by itself will not solve them.
Moonshot Thinking
This has been wholly evident in my mission to eradicate poverty-driven blindness. It is unthinkable in the West that any human, let alone any child, would be forced to live with blindness or severe visual impairment that could potentially be cured by a single procedure. Yet this is the reality for millions of people worldwide who live with ‘poverty blindness’.
Yet even if there was enough money to fund this procedure for every person on the planet who is living needlessly with poverty-induced blindness, the challenge of identifying those people, engaging with them, transporting them to treatment and having enough doctors and nurses and medicine to treat them and to provide the requisite aftercare, is logistically impossible.
Yet there is much that can be done, not just to advocate change, but to take that change to the poorest people on the planet. And we know this because it has already been done many times before. Smallpox was eradicated worldwide by 1980 following a WHO initiative launched in 1959. A highly contagious disease, it had been particularly devastating in South Asia, where it killed up to half of those affected, and left most survivors maimed.
Guinea worm, an excruciating and debilitating condition, is likely to be eradicated in the next few years thanks mainly to the efforts of The Carter Center, WHO and UNICEF: between 1986 and 2016 the number of annual cases of Guinea worm fell from 3.5 million to just 25.
The Institute of Health Metrics and Evaluation estimates that between 2000 and 2014 the $73.6 billion spent on child health by donors (including both private and public) averted the deaths of 14 million infants and children. This is in addition to the $133 billion spent over the same period on child health by low- and middle-income country governments, which is estimated to have averted the deaths of a further 20 million children. So, it is certainly not all bad news.
The Impact Multiplier
For my part, I wholly believe that the kind of philanthropy which manifests itself as direct grassroots interventions is most effectively deployed in the developing world because of what I call the ‘impact multiplier’.
This ‘impact multiplier’ enables substantially enhanced impact for every dollar of spend in the developing world, and it arises due to a number of factors. Firstly, because many treatments can be deployed less expensively in poorer countries due to lower costs. Secondly, because the gap between an individual’s wealth and the cost of treatment is likely to be substantially greater within poorer countries. And thirdly, because the impact of bridging treatment gaps and making direct interventions within poorer countries is much greater than bridging the relatively small (almost non-existent) gap in the West.
Unfortunately, the world is rarely this simple. To explain my advice on the question of whether to direct your philanthropy into the developed or the developing world, it is important to first delineate the two different strands of my own brand of philanthropy, since it is from my own experiences that I draw the advice which I now offer.
The first area of focus of my Tej Kohli Foundation is about making direct interventions to improve people’s lives. In this regard I am wholly convinced that the best ‘impact multiplier’ can be achieved by directing wealth into grassroots activities within poorer countries.
The second area of focus of my Tej Kohli Foundation is developing solutions to major global health challenges, which most often involves working with technologists and scientists. In this latter objective my strategy has been to divert my accumulated wealth into the places where world-changing new research and innovation is taking place; despite the fact that even though many of these new innovations offer the promise to improve lives in the third world, their invention is typically – though not exclusively – the preserve of the first world.
The dichotomy is that creating large scale solutions to human problems that are accessible, affordable and scalable within the world’s poorest communities often involves funding the development of those solutions in rich Western nations first. A cynic might call this the ‘trickle down’ approach, whereby developing nations accrue crumbs from the table of the technological and scientific feast that is currently being enjoyed in the rich West. But the truth is that the nature of developing affordable and scalable solutions is far more nuanced.
Take for example the nano-string project that I have provided funding for, which is being developed by the leading professors of Ophthalmology at Harvard Medical School. When successful, this project will enable very rapid on-the-spot diagnosis of the kind of infections and diseases that cause a huge proportion of blindness. At the moment diagnosis requires the taking and culturing of samples in a lab for testing, which can take weeks or even months. But the nano-string project will allow instant diagnosis based on as little as one molecule.
This project will have its greatest impact in countries such as India, where a good proportion of the incidence of entirely avoidable blindness arises because individuals are unable, or are too scared, to seek out a diagnosis, not least because of the cost of visiting a doctor. More rapid and efficient diagnoses could prevent hundreds and thousands of cases of blindness every year, but only if the nano string technology is available in the first place.
But do you think that nano string technology will be ‘affordable’ in these poor communities? To begin with the answer is an affirmative no, not by a long shot.
But in time, the cost of this technology will fall, and it will become more affordable in developing nations. And thankfully the chain reaction of rapid technological progression means that this process now occurs significantly faster than it ever has before.
Now vs Later
Understanding this process will be vital when you are making the calculus of allocating your wealth to the alleviation of problems ‘here and now’ versus the long-term elimination of the original source of those problems. In my capacity as an investor, I have relied heavily on the precepts of the ‘Six Ds’, which are taken from the Peter H Diamandis book ‘Bold’. The Six Ds explain how technologies can grow exponentially, including the key phases of ‘demonetisation’ and ‘democratisation’, which are the point at which new technologies become widely accessible as ‘cost’ is increasingly removed from the equation altogether.
By understanding how the chain reaction of rapid technological development can can lead to the exponential adoption of new sciences and technologies on a global scale, you can make a more informed calculus about how to split your wealth between immediate interventions and alleviation in developing nations today, versus funding long term solutions being developed in the West, which might one day also become viable in the developing world.
So how can you resolve whether to allocate your wealth into philanthropy in the first world or in the developing nations of the third world? For this you must devise a guiding philosophy against which you can map out the options available to you.
I urge you to immerse yourself amidst people at the grassroots level within the communities that you plan to provide help to, so that you can truly understand the challenges in those communities from every possible angle. This will help to guide your decision making as to whether you should invest in short term human interventions that can improve individual lives right now, or in scientific or technological innovations that can solve the problem on a grander scale – but years in the future.
As an example of how this can work in practice, when my Tej Kohli Foundation is approached to back a technological or scientific project, we have to ask three questions. One: What are the prospects that the project will lead to a solution that can materially reducing poverty-induced blindness? Two: What will it cost to achieve this success and what it the risk-weighted most likely outcome? Three: How does that outcome compare to what could instead be achieved by spending the same funding making direct human interventions today?
To back a project, there must be a very clear quantum that the potential future outcome could help many multiples more people than could be helped today through immediate and direct interventions.
And Don’t Forget Your Local Community
On the surface my advice may seem to be clear: you should divert your wealth into philanthropic activities in the developing world, or into first world projects that in the fullness of time will yield much-needed benefits into the developing world. Yet there is also another factor at play, and it is about being as good a local citizen as you are a global one.
I feel very strongly that every individual should seek to give back to the community in which they choose to live their life. Since 2006 my family and I have lived in the United Kingdom, and It would have felt wrong for me to be focusing the entirety of my philanthropy on the developing world when there were visible opportunities to help people in need within my own community.
It is from this that my Future Bionics program was born to help disabled children in the UK, as well as a collection of highly ambitious ‘food support’ programmes designed to alleviate hunger and to combat holiday hunger. All of these programmes fall within the objective of my Tej Kohli Foundation to ‘rebuild people and communities’ but they do not advance my mission to eliminate poverty blindness. They are more about the importance of being a part and playing a role in my own local community.
The quantum of ‘first world versus third world’ is therefore not entirely simple and whilst a guiding ‘mission’ is entirely useful, I also advise you to allow yourself to allocate at least a portion of your philanthropy into the country and community where you and your family choose to live and to spend your time.