An admirable goal, but a PHS 795 student notes the limitations of focusing on disease rather than determinants of health. She writes:
I came across this article while reading the BBC news. Zuckerberg and Chan recently created a Chan Zuckerberg Initiative, pledging 3 billion dollars to “cure prevent or manage all diseases by the end of the century”. While this is a very generous financial contribution to biomedical research, he and his wife are making a large claim that I’m not buying. They are looking at “disease” in a very narrow biological sense without taking into account the social determinants of health. It goes back to Evans and Studdart’s article “Producing Health, Consuming Healthcare” where they critique the healthcare system for focusing too heavily on expensive and timely healthcare interventions rather than addressing larger social conditions. If Zuckerberg is going to cure, prevent or manage all disease, this megabillionaire needs to come up with a plan to fix things like poverty, the housing crisis, and unemployment, all in a decade.
Mark Zuckerberg: “We all have an opportunity to leave the … Facebook’s founder and his wife aim to cure, prevent or manage all diseases by the end of the century.
The Fantasy Equation 
I think what surprises me most about this article is that they believe their relatively small grant will “cure, prevent or control all diseases by the end of the century.” This broad approach is quite unlikely to achieve its goals. I agree with my classmate that they would have a more upstream approach if they considered addressing issues of poverty, which seems to inevitably lead to poorer health outcomes. Alternatively, they might consider primary prevention strategies and look to reduce opioid use, tobacco use and excessive drinking or promote better nutrition and exercise. I’ll be curious to see where this $3 billion goes.
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I was also struck by the ambitiousness of this proposal. As noted in the original post, this plan can’t just address the biomedical causes of disease but also the societal and cultural leverage points. As such, they just shouldn’t fund experts whose research is limited to the biomedical causes of disease. The article notes that the duo funded an organization called Biohub, which will “bring together engineers, computer scientists, biologists, chemists and other innovators.” Moreover, they also outlined three principles that will guide their investments: “to bring together engineers,” “to build tools and technology that advance research,” and “to grow the movement to fund more science around the world.” Alright, but where are the economists, sociologists, and experts of other fields outside the natural and “hard” sciences? How about advocates of social justice? And even more importantly, what about the victims of disease disparities? Even if those groups of people are implied in the “other innovators” category, relegating them to the “other” implies a hierarchy where “hard” science and technology are most important in alleviating disease. That mindset can exclude perspectives that are crucial to overcoming health disparities. It can also guide major scientific advances that achieve their end goal but at the cost of the livelihood of traditionally oppressed populations (ex: the Green Revolution spurred unprecedented crop growth in developing countries and helped alleviate hunger on a mass scale, but it also displaced small-farmers and caused environmental/agricultural damage to their locales). It reminds of something that a friend said in a discussion on public policy in the United States: The only people who don’t have a say in policy on the poor are the poor themselves (he was paraphrasing a quote from someone else, but I can’t find the original source).
Still, it’s probably better than not doing anything at all, and this proposal is clearly in its infancy.
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I think it is interesting that Zuckerberg says, “that at present 50 times more money was spent on treating people who are sick than on curing the diseases that would stop them getting ill in the first place.” So, he is targeting slightly upstream factors, yet failing to expand upon that with with incorporation of the factors causing/influencing those diseases. I think this definitely demonstrates the importance of a socio-ecological framework when addressing public health issues. If he wants to make his charity effective and make the most of the (large amount of) money they have available, he should incorporate individuals with public health qualifications into the upper ranks of the charity. Makes such systematic changes is a costly endeavor, and with such an immense financial pool to operate out of, they might as well actively aim to make the most change possible with those means.
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I agree that this is a claim they’re making without having a strong understanding of the bigger picture that we learn about in class. Not to mention, I think this claim and the goals they set forward to use artificial intelligence and other ‘novel’ technologies makes it worse. It proves that because they have incredibly high economic and social power, they are able to try and accomplish things far beyond those who need the treatments most could ever wish to reach for. This only widens the gap between the lowest and highest SES statuses in our society. Rather than looking at the full story to understand SES determinants of health, which are also complicated and possibly expensive endeavors, they are continuing to perpetuate the problem by ignoring the possibly more influential determinants of health over genetics or biology. I have to say, it’s not surprising that they wouldn’t see the fault in their goals. I applaud them for using their wealth to try and improve the health of their community and the globe, but they’ve likely never learned about nor experienced first hand what it’s like to live in a low SES community, and how lack of access to clean water or a physician puts you at higher risk for disease than your genetic make up. However, now I’m making assumptions – so that’s not fair of me either. My hope is that some thoughtful MPH professionals show them how complex all of this really is, and that they’re inspired to shift their focus.
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It does seem somewhat overly ambitious for Zuckerberg to make this claim. Although, based on his track record in business and his relatively never-ending supply of resources, his point has to be taken into consideration. Also, despite his relatively narrow look at disease from a biological sense, he may get the input of public health officials to additionally consider environmental and social factors. At the very least, this large monetary gift from a prominent figure in society shines light on the downfalls and needs in the public health realm. I am optimistic that his ambition will ignite additional research that focuses on factors like poverty and unemployment, as well as biological disease.
Moreover, his acknowledgement that 50 times more money was spent on treating sick people as opposed to curing diseases that would stop them from getting ill in the first place illustrates he is aimed toward the root cause. Zuckerberg seems to want to focus on the upstream factors more than the downstream factors according to that statement. This is a great start by a powerful person to possibly make a real difference in public health in the future. With his money and resources, coupled with the knowledge and focused scope of public health officials, there may be a meaningful change emerging
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We’ve learned in class that spending on health care is high and funding for public health is low, but we haven’t touched too much on funding for medical research. The budget for the National Institutes of Health, an organization focused on medical research, was $31 billion in 2016 (http://n.pr/2d51oBh). On the other hand, the 2017 proposed budget for the CDC, an organization focused on public health, is $7 billion (http://bit.ly/2dIEe4O). Medical research probably doesn’t have quite all the funding it needs (or thinks it needs), but I think it is quite clear that when it comes to health, the true funding gap lies in public health work. This might be a more appropriate place for individual donors to step in to make a big difference. Just think, the Chan Zuckerberg Initiative’s budget could increase NIH funding by about 10 percent, but it could increase CDC funding more than 40 percent. What would happen if the CDC had 4o percent more capacity?
An article in The Guardian (http://bit.ly/2dfTVv5) offered both criticism and praise on the initiative, but argues that, maybe, the kind of lofty vision to cure all diseases isn’t so lofty in the face of medical advances that have taken place in the last century. What is fails to address is something population health students know well. Great advances were made in the last century (or two) because causes of the leading diseases were more specific and often biological. This is not the case for the diseases the Chan Zuckerberg Initiative proposes to focus three-quarters of their funding: heart disease, cancer, and neurological diseases. Other students have already commented eloquently on this misunderstanding of the causes of chronic diseases, the need to look at upstream determinants, and the need to bring in a broader array of experts.
I want to make one last point. It is foolish to think that curing all disease only involves finding the cure for all disease. Lots of people die from chronic, preventable diseases, but prevention can be very complicated in those cases. I think it’s important to realize that millions of people still die worldwide (many of them children) from preventable infectious diseases, diseases for which there is often a very simple prevention method (like mosquito nets for Malaria). In some places, even easy solutions are difficult to enact, because of lack of funding, corruption, governmental disarray, or any number of reasons. These are also upstream factors that need to be considered when proposing to “cure all disease.”
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Mark Zuckerberg and wife’s idea of investing all that money into curing, or preventing all disease by the end of the century seems grand. But is it feasible? I won’t try to argue the possibilities, however I am skeptical. I read an article from NYMAG, that stated that Mark along with Mayor Cory Booker and Governor Chris Christie worked together to fix neglected low performing schools in Newark, NJ, but failed tremendously. They pummeled hundred of millions of dollars and assumed that money and “innovative ideas” would be enough, and it failed. More details can be found reading Jonathan A. Knee of the New York Times in his review of The Prize: Who’s in Charge of America’s Schools? One can assume that they may have failed to research and/ or understand the context of Newark’s population.
Again, The idea is great, lets hope they’ve done their homework this time and are prepared for problems that will arise.
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I was interested to read everyone’s posts and comments about this article because I read it in a very different light. When Mark Zuckerberg and Priscilla Chan announced their decade-long $3 billion initiative, their ultimate goal was to “cure, prevent, or manage all diseases by the end of the century.”
I interpreted this to mean that they want the world to be able to address all diseases by the year 2100. In other words, if this goal is achieved, nobody will receive a diagnosis followed by a doctor being told, “and I’m very sorry, but there is nothing I can do to help you.” because we will EITHER have found a way to prevent the disease in the first place, OR found a way to treat and cure the disease, OR have found a way to treat and manage the condition, even if it cannot be fully cured. By now, it is obvious to us in this course that social factors play a huge role in determining health outcomes, and I don’t think that Zuckerberg and Chan are ignoring them altogether with this initiative. Zuckerberg even highlighted the role of disease prevention by making the point that, “at present 50 times more money was spent on treating people who are sick than on curing the diseases that would stop them getting ill in the first place.” He also gave three principles that will guide his and Chan’s investments:
1. bring scientists and engineers together
2. build tools and technology that advance research
3. grow the movement to fund more science around the world
Those principles are broad – who is to say that “scientists” do not include those working on studying the social determinants of health, that new “tools and technology” aren’t going to be used for addressing social determinants of health, or that “science” does not include studying the social determinants of health at all? (A side comment: I think the fact that one of the principles involves finding OTHER funding sources speaks to the fact that Zuckerberg and Chan are well-aware that this $3 billion over the next 10 years will most definitely not be enough to achieve their goal.)
Yes, the Biohub that had already been announced prior to this speech is committed to research of a more biomedical nature. But shouldn’t some of the investment go towards fighting infectious disease or new insights into how the body works? While maybe they don’t have as big of an effect as the social determinants, those things are still relevant in the overall health outcomes of populations. Finally, the philanthropic company that Zuckerberg and Chan created has a mission to, “make long-term investments in work that advances human potential and promotes equality.” To me, that sounds like it would include investing in research and interventions involving the social determinants of health.
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