Public health vs business thinking: a case study from the Hult Prize Competition

This week, regular PLOS blogger and Oxford academic Dr Kremlin Wickramasinghe writes about the nexus of public health and business thinking – as well as some reflections on the global Hult Prize. Kremlin is currently doing a DPhil alongside his work as a researcher, quantifying the outcome of health policies addressing sustainable healthy diets.

Do public health academics and entrepreneurs think along the same lines? What would happen if we asked them to identify solutions to a problem that both groups care about? Would solutions be the same or drastically different? I had an opportunity to find some answers to these questions at the Hult Prize regional finals.

hultThe Hult Prize is funded by the Clinton Global Initiative to provide start-up funding (one million dollars) for the young social entrepreneurs who come up with the most compelling ideas to solve a problem faced by billions of the world’s population. This year the challenge was around solving the problem of rising non-communicable diseases (NCDs) such as cancers, diabetes and cardiovascular diseases amongst slum dwellers.  The judges for the prize largely come from a business background including top multi-nationals.

One of the doctoral students in my research group within the Nuffield Department of Population  Health at the University of Oxford took the initiative to form a team and enter this competition. The focus of my research group is also solutions to the problem of NCDs and we felt this would be a great opportunity to contribute to a global issue that we have a passion for. Our team comprised of three members with a background in public health and two engineers from the Healthcare Innovations Unit at the University. We were delighted to hear that we have been selected for the regional final which was held on 8th March in London from more than 10,000 entry level applications.  I am going to explain the thought process we (public health researchers) used to analyse our potential solutions and how the judges (who predominantly represented the business community) analysed them at the regional finals.

Before I go on, I need to make it clear that we did not win the regional final. But the judges gave our solution a “special mention” before announcing the winner. They said it was innovative and we should think about taking it forward. This is exactly what we heard earlier, that only one team would win, but that we should use this as an opportunity to find the energy to develop our idea into a successful social- enterprise.

One of the key criteria was that the winning solution should be able to reach 25 million people in five years.  We started brainstorming, produced a list of possible ideas and critically analysed them within the team.Through our research group, we had access to expertise in NCDs to inform our thinking.

Visiting slums in Sri Lanka One of the questions we considered was how to make screening for NCDs  more affordable and accessible in slums. However, when we shared our thoughts with public health experts they asked us what we would do when we identified people with the disease and whether we could provide the cost for treatment and further management.   The majority of slum dwellers do not have access to free healthcare and can’t afford to pay for treatment.  The public health community generally believes that it is “unethical” to screen people unless you can provide any necessary treatment. We struggled to come up with a sustainable business plan which could provide affordable treatment to patients identified through screening.

The post 2015 development goal  discussions have recognised “universal health coverage” as a major priority, but discussions with global health experts confirmed that it is unlikely to be achieved within 5 years.  Therefore we thought it would be impossible to win, if we only increased screening without assuring treatment.  We dropped that idea and decided to move ahead with a different idea that didn’t involve screening.

At the London regional finals, three out of the top four winning solutions were based on screening. It was interesting to see how judges with a business background approached their task. The winning team clearly showed how they were going to screen people for diabetes with bees!  Clearly innovative and excellent presentation by them.  They said they would send any patients they identified to the “local hospital”. They did not say how people would afford treatment. As the reason for their winning, the judges mentioned that they were able to “ focus” on one important aspect of the problem of NCDs amongst slum dwellers. This clearly shows the difference in how public health and business communities analysed the same solution.

Two teams, out of the top four, proposed to use animals for screening. When public health professionals consider novel methods of screening we think about false positives and false negatives.  So, for example, if we are going to screen people we should know how many actual cases are we going to miss (false negatives) and how many people we are going to take through for treatment even though they don’t have the disease (false positives). No screening test is 100% accurate but we need statistics on false positives and false negatives to decide the cost-effectiveness of a test before scaling up. We thought it would be impossible to win the prize without those statistics, which take time and money to produce. But judges didn’t ask about false positives and negative  nor did teams provided this information during the pitch. Judges just asked “can animals survive in slum conditions ?”. This shows that they had concerns beyond the financial model, but they were completely different to the concerns of the public health community.

Our inability to ensure that screened patients had access to treatment and the challenges of quantifying the sensitivity of potential innovative screening methods led us to conclude that it would be impossible to win if we presented a “screening solution”. However, the other teams managed to win without having solutions to these problems. As public health professionals we often attend conferences and meetings with likeminded people and take similar approaches to tackle NCDs. The Hult Prize, by contrast, brings people from different backgrounds to the same stage. It provided me with a unique opportunity to learn that the business and public health communities approach the same problem in completely different ways.

This difference in approaches might explain why most public health professionals are not successful entrepreneurs. My public health colleagues might say that this is why, despite millions of dollars in investments, we still haven’t tackled some of the biggest problems in the world. The problem is this: we invest in ideas that are attractive and “fancy”, but not necessarily tested with public health tools. If we changed the composition of the judges to a panel with 50% public health background and 50% business background, what would have been different? We will never know. This is a business plan competition and (obviously) organisers invited top business professionals to judge. They were very passionate about these issues and provided feedback and comments to teams. But I certainly gathered enough reasons to answer the first question I raised in this blog.  Public health academics and entrepreneurs do not think along the same lines.

Why does the public health opinion matter in this competition? The aim of the 2014 competition is to address one of the main public health problems in the world and the solution is supposed to reach 25 million people.  The wining solution should be implemented in many countries, which would require the approval from local and national level public health regulators around the world.

How can we move forward to align these two approaches to ensure success in our future endeavours? Clearly we cannot do this by working only within our own disciplines. Here are the important questions: Are public health professionals ready to think out of the box? Would business professionals value public health opinions at all when they make final decisions?  As the next generation, we will have to work harder to integrate these various ways of thinking if we really want to change the world.

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