Start Where You Can Start: Igniting the Next Global Health Turning Point

Rosenkranz Global Health Policy Research Symposium keynote speaker Mark Dybul talks about the great strides in international health systems over the last 25 years—but calls on next generation to disrupt a system that has become stagnant.
Mark Dybul-Eran Bendavid Rosenkranz 2024

Global health as a collective concept did not exist 25 years ago; improving health was all about individual countries creating jobs and growing their economies and GDPs.

Along came the UN Millennium Development Goals in 2000, when 187 nations committed to eight measurable targets to reduce poverty, hunger, disease and a lack of water and shelter, while promoting equality, health, education and the environment. The Millennium Declaration was followed by Gavi, The Vaccine Alliance, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and The Global Fund to Fight AIDS, Tuberculosis and Malaria.

“In 2000, extraordinary things started happening and health wasn’t on its own. It actually was in the context of a radical change happening around the world—an openness and the globalization of health that fit into development,” said Mark Dybul, MD, a professor at Georgetown University’s Department of Medicine and senior advisor at the Center for global Health Practice and impact.

Dybul—who gave the keynote address at the Rosenkranz Global Health Policy Research Symposium this year—was part of that radical change. He spent his last year of medical school caring for AIDS patients in San Francisco, when gay men were being hit hard by the virus and shunned due to ignorance and fear. He worked with President W. Bush as a founding architect of PEPFAR in 2003, which has since invested more than $100 billion to fight HIV/AIDS, savings 25 million lives and preventing millions of HIV infections. He was appointed to the State Department ambassadorial position of U.S. Global AIDS Coordinator and was executive director of The Global Fund from 2012 through 2017.

Dybul told the symposium sponsored by Stanford Health Policy and the Freeman Spogli Institute for International Studies, that a 2002 UN conference in Monterrey, Mexico, ignited a turning point in the concept of global health. The landmark Monterrey Consensus was an agreement between developed and developing nations in which all sides recognized their responsibilities in trade, foreign aid, debt relief and institution building.

“What we used to do was really based on post-colonial guilt and the Cold War,” he said. “And in 2000, we decided to change all that. But it was in the context of something much broader that was happening, which was an understanding of a globalized world, an engaged world—that we were in this together.” 

Two Steps Backward

Sadly, Dybul said, the commitment to this collective community is rapidly regressing, particularly as masses of people move around the world with unprecedented speed. When people see large numbers on the move, they become fearful. And the rapid growth of technology scares them even more.

“The world is afraid of losing what we have,” Dybul said. “And fear’s constant companion is hate. It really started about seven, eight years ago: getting back to nationalism, getting back to protecting our own, getting back to self-orientation, top-down, overriding countries—a lot of racist, paternalistic stuff.”

He told the Stanford students in the audience it is their time to overcome these xenophobic trends and come up with the next big solutions in global health.

“And that means we need to fundamentally disrupt and decentralize and decolonize our current international systems to get down to local systems and to have new centers of gravity,” Dybul said. 

A Slideshow of the Symposium Presentations from Academics and Keynote

Start Where You Can Start

Dybul told those in the audience who hope to become health policy leaders: “Start where you can start. And when you do that, you can change things.”

He recalled that 25 years ago, world leaders said it was impossible to deliver antiretroviral therapy to Africa; it was too complicated, too costly. “Impossible, they said. They didn’t have the systems, they didn’t have the education, they didn’t have the supply chain.”

But communities in some of the hardest-hit African countries proved them wrong. While the Global West had the money and the supplies, local health care workers and community activists figured out how to get antiretroviral therapies to those who needed it most.

“They figured out the solution, they figured out the implementation, they figured out how to solve the problem. If they have the control, if they have the mind, they will find the solutions and then—you start where you can start,” he said.

The world now has the incredible advantage, Dybul said, with the emerging technologies unimaginable 25 years ago, the ventech companies focused on health-care solutions via new technologies, data warehousing and application development. There’s AI, biotech, environmental health, agrotech—and young people working in these fields today understand they overlap and intersect.

We need to fundamentally disrupt and decentralize and decolonize our current international systems—and our current national systems to get down to local systems and to have new centers of gravity.
Mark Dybul, MD
Professor Department of Medicine at Georgetown University Medical Center

Dybul said he and fellow leaders at Purpose Life Sciences—a global research group attempting to modernize clinical trials by making them more accessible and equitable—routinely visit tech parks around the world. They believe that in the next decade, Africa will become the future of ventech, from discovery to new product creation and development.

“By far the most exciting thing is in Kigali; young dynamic people do not see health as separate from the environment, as separate from agriculture or food security,” he said. “They’re trying to come up with the tech solutions that will solve multiple problems, not just one problem. And if that is supported—then things can change.”

Dybul called on Stanford students to discover new solutions to global health.

“Come up with a new approach and a new system, and a new way of doing things because the old ways clearly are not working,” he said. “And don't be discouraged when people tell you that you can't, or that the problem seems too big. That's what people said about PEPFAR. You can solve almost anything—if you start where you can start.” 

 

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Natalia Serna Stanford Health Policy

Natalia Serna,  PhD, a health economist and assistant professor of health policy, is this year's winner of the  Rosenkranz Prize, awarded to a Stanford researcher working on a project to impove health in low- to middle-income countries. She will use the prize to investigate how women's health is impacted by price controls on oral contraceptives. 

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