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A progress report from one of the founders of the world’s largest network of designers delivering social, environmental products and programs that advance the United Nations Sustainable Development Goals.

Design for Good

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Design for Good was established in 2022. It's an extraordinary nonprofit alliance of leading designers and organizations dedicated to creating products and services that improve human life and address global challenges set out by the United Nations Sustainable Development Goals. Here to give us a progress report. On design for good impact to date and the projects they've got in motion, their goals for the future, is co-founder and chair Ben Shepherd, and I want to give a special thanks to Ben because he's been a stalwart supporter of Brainstorm design over the years, helped us with lots of ideas and put us in touch with a great community of wonderful and talented designers. So Ben, take it away. Right, here we go team, back from the shortest ever coffee break, we're going to go straight into it. I'm going to take you back to 2015. In 2015, the United Nations launched the Sustainable Development Goals, a set of 17 of the greatest challenges facing humanity, and their hope, their aspiration was that by 2030 we would largely have addressed those goals. Well, we're now 10 years later. We've only got 5 years left to go, and it feels like a relatively few time to ask ourselves the question, how are we doing? Spoiler alert, his answer is not very well. Let's have a look though at the exact data. So out of those 17 goals, 6 are in the most severe category of being going backwards. 11 are in the 2nd most severe category and at best stagnating. And none is marked as being on track. For those of you, I see a few of you have your camera phones out. If you want a particularly depressing photo, this is the one to take team. This is the one. If you want orange and red, this is, this is as good as it gets, and there is a reason why I'm bringing this up at a design conference. It would be fair to say we're designers, the design industry only makes up 1% of the total workforce. Surely this is a problem for government, for policies to solve, but if you look at the 231 KPIs that sit behind this, more than a third are directly impacted by the products, the buildings, the services that we in this room design. Indeed, I would argue that our impact as an industry is probably only second to that of government policy. So we have to ask ourselves the question, what can we do about it? What can we do? A group of organizations came together just as Clay mentioned a few years ago to ask exactly that question and to say with a sense of humility, can we try new ways of working, new approaches, new experiments to see whether particularly the corporate and private sectors can make a measurable and lasting impact on the sustainable development goals. And as of today, that alliance now comprises over 2000 designers, engineers, and researchers across 30 countries working on over 30 projects around the world. And the way that it works is that those designers give their time for free. They gave a minimum of 5 days per year. Most give far, far more than that. We put them into teams of 5 to 10. We partner them with charities, and they work together all the way from early concept through to execution and implementation to make sure that this actually leads to real world impact. Whilst it's still early days, we have found a set of guiding principles which is proving useful to make sure that the work we do is impactful. I'm going to share 5 of them with you. All of these will be in the category of what I would call diet and exercise. These are things that we know we should do, but often we don't, and each of these is something that we've seen from our own work has to be done if design companies and design agencies and design leaders are going to have real world impact. The first, perhaps slightly counterintuitively, is that we never start with design. We always start with the development organizations being the ones who set the briefs. We then allow the designers to refine and iterate the brief, but we never start with the designers. They're there to design with, not to design for, as we heard from Monica only yesterday. The second one is that we then build cross-functional and cross company teams. We even have teams with direct competitors like Nestle and General Mills and Pepsi working together for some of these particularly difficult systemic problems, you have to have these different companies working in the same team. The third one is on training. We invest a huge amount in training with the Royal College of Art. Everyone who goes through our program is given a formal academic qualification at the end of a year of working together, and the reason we put so much money and time into training. It's not only many of us weren't taught on how to design for vulnerable communities or ecosystems, but because when they then finish their projects, they go back into some of the largest companies on Earth, bringing those skills on how to design for sustainability into products and services that reach hundreds of millions of people. The 4th 1 is on law. Now I have to be careful here. I'm married to a lawyer, so I can't be too rude about lawyers, but on this particular topic, I do think that sometimes designers think of law and IP in particular as an afterthought. In the social impact space that does not work. You have to at the outset decide that the IP is going to be open source, worldwide, irrevocable, so that when you give it to a community they can actually use it and ideally make a profit. And then finally a zealous focus on implementation and measurement. Again, if I were to point the finger at us as the design industry, many of us in this room, myself included, have at some point in our careers led a hackathon or other activity which, whilst well intentioned, didn't lead to real world impact and therefore it's important that if we're going to do things we commit to measuring an execution, not just the fun bit at the beginning. Whilst it's still early days, we are starting to see early blossoms of impact coming from these approaches, and on the screen now you'll see examples of some of the impact numbers of the projects that we've been working on together. We don't have time to cover all of these today, but what we are going to do is cover 5 to give you a taste of the work we're doing and hopefully inspire your own social innovation efforts as well. The first one we're going to touch on is wealth. Now most of us in this room will take for granted access to clean water, but over half the world this year has faced some sort of water scarcity issue. And therefore we were lucky to partner with a charity called Biome in India to create the Million Wells app. It's now available on Android and iOS and it allows people in Bengaluru in India to access clean water and find where they can drink water which is safe for them and their families around where they live. It's a data source that didn't used to exist at all. There are now, since it launched a couple of months ago, already 1400 regular users using it to access safe water, and it's particularly exciting to see what biome the charity has planned for it. They're going to take this work, not only scale it to other cities, but also start using AI on the data set to work out how they can understand the water levels and give people the access that they need. We're going to jump onto another topic now, which is menstruation. Another depressing fact to share with you on this particular afternoon is that there are still large parts of the world where young women are missing as much a month of their school every single year because of stigma they have whilst they're on their periods. We partnered with a charity called Best Foot Forward Fund in Tanzania. And together with them we decided not to take Western trading materials and push them on to Tanzania, but instead we developed with the local communities personas, messages that were culturally sensitive to them. We took them to schools across the country. We trained young men and young women together on period positivity. And over the course of the pilot we've already been able to reach over 10,000 students. There are another thousands and thousands planned for next year, and this is where the IP gets interesting as we were working with the Foot Forward fund as we were hearing from them about their experiences, we got a call from neighboring Uganda and a charity who said, Can we take those materials and take them to Uganda? And because of our IP position, the answer was an emphatic yes. They could take those materials and start to train up another 2000 young people in Uganda. Our hope is within by 2030, hundreds of thousands will be reached across large parts of Africa. This is an exciting one to do an update on for those of you who are veterans of the Fortune brainstorm design, you will remember this project. It's a Cairns Lis nominated project, and the reason it exists is that today 2 billion. People still lack access to basic hand washing, so we partnered with the Wash Foundation to create a product that was aimed at young children who maybe don't have the ability to wash their hands at home but who we could teach to wash their hands in schools. And what we created together with the Wash Foundation was a very simple product. This is a product in the form of a flip book with no written words, so it transcends language which teaches young children on how to wash their hands in a fun and engaging way, something again that many of us in this room take for granted because we weren't brought up in these environments. Well, we're in a brilliant position, but since we talked about the idea last time, it's become real. We've already taken it to 2500 children. There are many more planned, and this is where it gets even more exciting. I can feel it's electric, isn't it? I won't let me stand by the edge of the stage to make it more exciting. The impact numbers are coming in. The Wash Foundation did a study. They looked at the children who used to be in these schools, fewer than 2 out of 5 used to be washing their hands. They gave them the flip book. They came back 6 months later to see did it make a lasting change, and now 90% of the children were washing their hands with this one single intervention, extraordinary work. The boo team is ever busy. They're now coming up with an app so that they can teach teachers on how to teach on this topic as well. And for those of you in the room who represent sustainability or work with your organizations on contributions, this is exactly the type of area where funding is needed. Another quarter of a million dollars would allow us to reach 600,000 children over the next couple of years, and for that group it would reduce the child mortality risk by as much as 50%. So this is one of the privileges of being at Fortune. I get to speak to other multinationals, other corporates. If you're in a position to help the Wash Foundation, please, please give. They're an extraordinary organization, and you can directly measure the number of children's lives saved through your charitable contributions. Now before we touched on the topic of wells, and here's another one on wells and pumps, but with a slightly different twist. So as before this was aimed at end users, this by contrast is a charity called Water Starters, and they're trying to help engineers, maintenance people to create a new job which is to fix the pumps, particularly here in Kenya where there are issues with access to water. And what this extraordinary team has done is put together not only an app but also a supply chain, a way of accessing parts and tools so that people can train themselves to become pump engineers, maintenance leaders, and to fix the pumps and equipment across Kenya for a profit. It creates a wonderful source of income for them and it creates access to clean water for the communities that they're helping. I'll stay quiet for just a moment, just so you can see some of the screenshots of the type of work that they've been working on together. All of this has now been launched as of this summer. The work has already started. The pumps are being fixed. 50,000 people have access to water now in December 2025 who did not have access to water in the summer, and by 2030, the estimate is that as many as 1.5 million people will have gained access to water because of this scheme. We have time for one more example which I hope will fill you with a sense of what can be done. This is not on water. This is on the topic of education. Now for many of us, when we think about education, we think about reading, writing, or arithmetic. This is a different topic. This is on misinformation. 96% of adults, let alone children, fail to systemically and systematically point out fake information online. We've been able to partner with a charity in a university in Scotland to create a new set of training materials aimed at young adults and adolescents to train them on fake information, on bad actors and people who may be trying to influence their behavior. It's fun, it's engaging, it's competitive, and it's designed to make sure these young people build up a skill set that many of us in this room were never trained on. It's already being prototyped and tested with schools. The response has been extraordinary. We'll roll out to a larger pilot with 10,000 students over the next couple of years, and our hope again because of the IP is that millions of children will be able to benefit by taking that curriculum into their schools when the work is complete. We don't have time to talk about all of the other charities that we're working with, but I do want to acknowledge the extraordinary work they're doing. And for those of you in the room who are interested in the work, please do get in touch. There are two things that we can already offer you. The first one is that academy. For those of you who'd be interested in upskilling your own designers, we've decided to make much of the training that we do free and available for everyone. There are master classes that we've put out from the likes of Patty Moore, from Don Norman, from Maro Pacidi, who we heard from this morning, all available from your designers, and we hope you take the opportunity to take that world class curriculum and teach them about how to design the social impact. The second offer we have is that we are able now to expand our group from the originals as of September next year. We will finish next summer our work on quality education, and next September we will begin a 4 year focus on the dual goals of people and planet health. For those organizations who want to participate, please get in touch and we'll tell you how to do so. That beautifully to the second brings us to the end of our presentation. Every year we come back, every year we'll tell you what we've learned in design for good, but for the moment just allow me to say whether you joined Design for Good or whether you're working on your own social impact initiatives, a huge best of luck to you. We look forward to working together, and together we can design for good.

Sarah London, Chief Executive Officer, Centene  Moderator: Erika Fry, Senior Writer, Fortune; Co-chair, Fortune Brainstorm Health

Brainstorm Health 2024: A Conversation With the Nation’s Largest Medicaid Insurer

Zarah. Thank you so much for being here. Thanks for having me. Uh So so much of what affects the health of the population you serve is outside the scope of the traditional health system, access to food housing. Uh Can people afford medications? Scenting takes an expansive approach to providing care? So I wanna ask you what works. Um How much do you know about the circumstances of your 28 million members? And how do you effectively address those needs to improve health outcomes? Yeah. Well, um you know, I think it's interesting this conversation around drivers of health or social determinants of health, I think has been emerging over the last couple of years, although the data has been very clear for a long time, um that you know, the vast majority, 80% ballpark and however, you want of health outcomes are really driven by factors outside of the traditional health care delivery system. Um But I feel like we're only just recently as an industry and from a policy standpoint at a place where this has become an active dialogue and for, from our perspective, that's incredibly exciting. Um But we need to do more than just talk about it. And so as you said, Centene, you know, one of the things that I found when I joined Centene 3.5 years ago was that, that intuitively, this was something that the organization understood because of its origins, right? So we have been in the Medicaid business for 40 years. Um And our focus for the unique platform of Centene is that we focus on government sponsored programs. So we serve 28 million Americans in Medicaid in marketplace and Medicare our customers, our members are among the poorest and the sickest and the most underserved in our communities. And so this question of what works really matters because we are also by virtue of being focused on government programs, essentially stewards of taxpayer dollars. And we are asked by states, we are asked by the federal government, we are asked by C MS through the subsidized population for marketplace to go out and figure out how best to support our members and essentially to deliver health outcomes. And so this question of what do you apply the dollars to that? Actually best deliver and best buy health outcomes is a question that again, it was sort of intuitively native to the organization. And, and it's interesting. So there's a, there's a health affairs article that uh came out in 2021 that I think has been um far too overlooked for, I think how insightful it is. There was a group that went out and did a bunch of polling and they went out and they asked black female democratic voters and white female Republican voters in North Carolina and swing voters. Latino, swing voters in Seattle and male Republican voters in Dallas Texas. The exact same question which was if you had $100 to spend, to buy health in your community, what would you spend it on? And every single one of those groups had the exact same answer, which was that they would put two thirds of that $100.66 dollars to housing food, child care jobs and only $33 to more health care. And so our members, you know, Americans know what makes a difference in terms of health outcomes and we just need to listen to them. And so that's really been how Sanin operates. We work directly in our communities and we of course, make sure that there is access to health care. But we also think about what are those things that are gonna actually drive health outcomes. And so when you're dealing with, for example, postpartum moms, yes, we wanna make sure that they have, you know, access during the pregnancy to good prenatal care, they have access to doulas and to midwives and to great hospitals. But afterwards, we want to make sure that they have access to healthy food and diapers and basics where if they can't, you know, they don't have access to transportation, how do we get them in for a postpartum visit? So those are all the things that Centene has really been focused on in addition to traditional health care access and how do you connect members to those things? Diapers or transportation, whatever it may be. Well, that's part of our local approach. We've always been local in how we approach health care and making sure that we have team members who live and work in the communities that we serve. And so our team in Nevada funded a van that goes out and literally delivers diapers to members, our team in Delaware. So Delaware just passed an 1115 waiver to focus on healthy nutrition and diapers for new moms. And our teams are already organized around that because we actually do that in multiple of our states already. Um healthy food drives, making sure that um we will fund internet access for um members and communities and community partners who allow for health visits. So it's just a lot of thoughtful community investment as part of the total calculus of getting health care outcomes for our members. Great. And I wanna come to the the audience for questions shortly. So think be thinking about them if you have questions for Sarah and you know, one barrier to health for the many in the Medicaid population is sort of the lack of affordable housing. I know this is uh something you're passionate about. We've seen other insurers invest in affordable housing, but you are trying something new and we're lucky enough to hear it here first. So I hope you could tell us about it and you know what, why you're doing it and what's different. Yeah, absolutely. So we're, we're very excited about this. We've talked a lot at Centene about partnership and having really strong local partners who believe investing in our communities with us. And to your 0.1 of the biggest barriers is um access to stable affordable housing. And one of the barriers to the the development of affordable housing units is actually the bottleneck of pre development dollars. And so one of the things we're announcing today, I'm really excited about is that the Centene Foundation is partnering with mccormick Baron Salazar M BS, which is um one of the nation's leaders in the development of affordable housing units and in urban revitalization and together addressing the pre development funds, we are going to unlock $900 million worth of development projects across the country focused particularly on the communities that we serve. And importantly not just create thousands of affordable housing units as a result of this, but it also it's a platform where we can deliver community services that are again critical to those other drivers of health. So think about grocery stores in food deserts, um community health clinics, community activity centers, um early childhood education, and some of those other critical services that really surround the affordable housing and sort of the health journey of our members. So we're really excited about this partnership um over the next couple of years. And I think it's a, it's a slightly different approach, you know, for Centene, it's about doing a lot with a little, which is something that our members are uniquely amazing at. Um And I think, speaks to our mission of transforming, not just health care but transforming the health of the communities that we serve. Great. Um And you know, raise your hand. If you have a question, I'm gonna ask uh Sarah about uh you know, a big, we worry about people falling through the cracks, especially over the past year with what's been dubbed the Great unwinding or the red terminations, 94 million Americans having to go through the process of re enrolling for Medicaid or lose their coverage. Meanwhile, a recent study found millions of Medicare aid beneficiaries weren't even aware they had insurance. Um You know, can you tell us how do you engage with your members? One to make sure they understand uh the benefits they have and then to make sure they understood the re enrollment process, you know, what were the challenges and how has that gone? Yeah, that was, has been a major focus of ours over the last year and actually, for almost 18 months leading up to when the red determinations process started, um We did a huge outreach campaign, we bef you know, within the first month, we had already done 9 million calls out to our members. And that rate and pace just continues through the process. Um whether it was, you know, phone calls, um mailings, we actually got to tech. So I wanna come back to that because that was a pretty important thing. We did 15,000 community events again just in the first couple of months, partnering with those institutions and those community partners that are really good conveyors of information, education, whether that's um churches, uh you know, uh pharmacy partners, clinical partners, really making sure that our members understood what was coming, they understood the process and to the extent that we could partnered with the Medicaid agencies to help our members through that process. And we were certainly not alone in that. I think the industry stepped up broadly um in a big way, but it is a, a consistent challenge in making sure that we can communicate with our members the way frankly they wanna be communicated with. So, one of the challenges coming into redetermining was the um T CPA and the fact that it actually precludes us from directly texting members. And so congress sort of waived that through this process. Um And the chairwoman of the FCC did some awesome work to make that possible. But I think it speaks to the fact that um in many ways Medicaid is due for a modernization, not just from an infrastructure standpoint or a process standpoint, but frankly, from a consumer standpoint, right. Our to think that our Medicaid moms are not attached to their phones. I think they're not juggling 8000 things is completely naive and we need to be in a position to be able to be in a position to serve them and to support them the way that they wanna be supported as consumers. So I think we saw some great strides but, um, it's an opportunity to push that forward. Uh Great. And we have a question over here. Hi, my name is Tim Leen. Excuse me, I work for the Association of Schools and Programs of public health. And you're, you're describing is a very public health approach which is fantastic. Um Can you talk a little bit about how we can scale this model in order to have even a broader impact um across the whole country or the world potentially? Yeah, I think so. So two things, one is um to me scale is kind of the the power of the fabric understanding that health care and public health is local in delivery and in sort of nuance. But then how do you extract and extrapolate best practices? Right. And so um the the first thing is making sure that we have an integrated approach and that we embrace this idea that the drivers of health are not just some buzzy progressive way of talking about health care, they actually work the math works. Um And we should be investing from a public dollar standpoint in health outcomes in this way. And then I think the other bigger answer longer answer um but I'll make it pithy is data because if we have broad access to data and we do the work to make that data liquid and to really look at it, not just around local be best practices, but then where there is there connectivity, where do you get scale and proof about what should be sort of standard of practice that that's how we're gonna start taking some of these great local innovations and pushing them out across the country and across the world. And that is really sort of the core of cent's thesis, which is our platform of 28 million Americans in 50 states. We see where the innovation is and we have that data and being able to pull that up and integrate that into the conversation, whether that's policy operations service, that's really how we innovate. Um And quickly before we're out of time, we got to. Uh Hi, so sorry. OK. Question the back very quickly. You mentioned scaling, I wonder how you are working across states because your 50 states only a few of them have those 1115 waivers. Like you just mentioned, how do you work across so many states that aren't even expand, hadn't expanded Medicaid at all? Um And how do you get the social determinants into those places? Well, so part of, it's a great question. Part of why I, I am so enamored with this polling that was done is that, to me, it is proof that while 1115 waivers certainly are increasing in their um adoption uh that sitting in 32 states for Medicaid, very different politics. But when you get on the ground, there is not actually a difference in terms of what people know, makes a difference and being in a managed care spot, we can actually direct those dollars and, and create the proof points and then move the conversation regardless of the politics. Great. Um Thank you, Sarah, good note to end on. Um And thanks again for being here.

Dr. Hala Borno, Founder and CEO, Trial Library
Vanessa Broadhurst, Executive Vice President, Global Corporate Affairs, Johnson & Johnson Dr. Aditi Mallick, Chief Medical Officer, Medicaid and CHIP, Centers for Medicare & Medicaid Services
Moderator: Rachel Lobdell, FORTUNE

Brainstorm Health 2023 - Dollars and Sense of Health Equity 

Dr. Hala Borno, Trial Library
Vanessa Broadhurst, Johnson & Johnson 
Dr. Aditi Mallick, Centers for Medicare & Medicaid Services
Rachel Lobdell, FORTUNE

Dr. Hala Borno, Trial Library
Vanessa Broadhurst, Johnson & Johnson 
Dr. Aditi Mallick, Centers for Medicare & Medicaid Services
Moderator: Rachel Lobdell, FORTUNE

I've been so personally impressed with the speakers we've had here over the last 24 hours and the leadership that they're bringing to health care, but really to the world, we obviously need more of that leaders who act with a sense of purpose. What Apollo Ono called Iki Guy and have a positive impact on all their stakeholders. Fortune is doing its part to help develop those leaders. It's, it's led to the creation of our membership driven community for next generation leaders called Fortune Connect. The goal is to create truly purpose driven leaders to help them understand what stakeholder capitalism is really about to help them understand what it means to lead truly equitable and inclusive workforces. The program is designed for mid career professionals who are rising fast on the executive track. I'm sure all of you have folks like that in your organizations. I would encourage you to check it out. Fortune Connect dot com or come to me directly if you'd like to get more information on it. So now let's continue our conversation here today where you're born, where you live, your age, your economic status, and of course your race all of those are just a few of the factors that figure into health equity. They're the so called social determinants of health. They can make the difference between a long relatively disease free life or conversely lead to excess morbidity and premature mortality. Inequities in health care have long been a chronic issue. We've talked about it on this stage before. It's a massive problem that will take a dynamic and multipronged approach to resolve. Uh Today. What we want to focus on is the economic impact of health inequity. There's data from Deloitte. New data that shows that the US US health system cost approximately $320 billion in equity costs. Approximately $320 billion could eclipse a trillion dollars in annual spending by 2040 if nothing is done to fix the problem and that's clearly not sustainable. Joining us now to talk about that, how equitable health can lead to better outcomes across the board are Hela Bono, Hela Bono, a former CEO of Trial Library, Vanessa Broadhurst, Executive Vice President of Global Corporate Affairs at Johnson and Johnson. Uh a male doctor, a male chief, medical Officer of Medicaid at the Centers for Medicare and Medicaid Services. All of them in conversation with Fortune's Jeff Colvin. Please welcome them to the stage. Ok, let's have a seat so much to talk about here. I want to start by asking you all for your views on the same question. Uh The pandemic changed everything is the United States as after the pandemic is the United States ahead of where it was on health care equity behind where it was pre pandemic or no change. I think all of us can recognize that the pandemic put a spotlight on health inequities in the United States. In the early days of the pandemic, we saw that racial, ethnic minorities were disproportionately impacted by the condition. It places an imperative on us to make sure that as we're developing vaccines, something that opened up society allows us to be in this room today, that we actually include the populations that are disproportionately impacted by the condition that imperative has led to a lot of innovation. I'm really excited about the innovation that we're seeing in improving and advancing access to clinical trials. It's also led to a lot of accountability. There's increasing regulatory pressure to make sure that study sponsors those supporting the implementation of clinical trials are actually fulfilling measures, mechanisms that are evidence guided to include diverse populations into studies or that will impact their ability to bring their drug to market. So that really shows this clear linkage that we've always recognized that doing the right thing, including everyone in clinical research is also good for business and that is a good outcome that has come out of the context of our pandemic. The innovation has also impacted the conduct of clinical research where we've seen a lot more decentralized models you know, using technology to access patients where they are engaging them, where they are to reduce the burdens that we're placing on them because we know that including everyone in clinical trials is actually good for all of us. Yeah, Vanessa, did we make progress on this during the pandemic? Listen, I think we did. I think what he said was true that it really exposes, you know, the underbelly of what was going on and COVID just amplified the problem and brought it front and center to everybody's attention which you know has good. Um I think that the the also the good thing that happened from a clinical trial approach, we had to do things very differently. We had to use A I to find out where the disease was going. We had to use predictive models. We had to think of different ways of recruiting patients that maybe were not as face to face intensive. So I do think that the industry is starting to change for good and just the critical nature of that need was exposed through the pandemic. What do you say? Totally agree. I think the bright spots I would highlight are to just foot stomp and echo what's been said, igniting a national conversation that centers health equity. Literally, I mean, you would be hard pressed now to find a health system and ensure any any entity that touches health care that doesn't have a diversity equity inclusion type of office if not entire sets of initiatives. The other thing that I highlight from a policy perspective is massive coverage gains. We are now in this country at historic levels of uninsurance. So a 30% increase in Medicaid enrollment or 21 million people that now have coverage through Medicaid and chip that didn't as of February 2020 right? And we know I will just add that that is disproportionately communities of color, right? So when you look at Medicaid expansion, both in the context of the AC and Medicaid expansion in the context of the Coronavirus Relief Act funding disproportionately that impacts people of color to have the peace of mind really that comes from having health insurance coverage. One of the other great things is just the massive amounts of partnership that it took to get through the pandemic. When you look at, you know, the governments, private corporations, health care providers, there was such a stress on the system that it really created a very unique environment where everybody was really forced to think about how we work together to solve big problems. Audie, I just can't help thinking. You, you mentioned all the people who got on to Medicaid among other things during the pandemic right now. Of course, that's coming to an end and a lot of them are going to be pushed out of Medicaid. What's going to be the result overall, I will say, I wish I had a crystal ball to know, I will say tremendous effort underway to ensure that every eligible person retains health care coverage. Whether that is in Medicaid through the exchanges for folks that are able to access employer sponsored insurance. The estimates are somewhere between 15 to 18 million people with of confidence intervals on either side are subject to coverage loss and about 50% of those people might be for administrative reasons, didn't have the right address, couldn't get a hold of them return mail, things like that, which suggests that they may, they may in fact be eligible and they may not know it. That's right. That's right. And so, you know, to everyone in this room, I think there are things that anyone everyone can do from your vantage point to make sure that people know where they can access coverage. It's check out this website, call, this phone number, go to this address. Um but we are um staring down the pike of what promises to be the single biggest coverage transition event since the launch of healthcare dot gov. Well, I can tell you what to say so. Well, I mean, I I'm concerned of course, that loss of coverage means that we're going to see unnecessary deaths. It's pretty well published that when patients cannot access preventative care, they present with more advanced disease. If they present with more advanced disease, they're less curable. And so that's a reality that we really need to think about and to and to put pressure to ensure that we don't have those unnecessary deaths in the United States. Yeah, there have been mentions of the clinical trials that were done in the uh development of the vaccines for the pandemic trials. Are your specialty? Uh What did we learn with regard to health equity about the clinical trials of these vaccine candidates during the pandemic? Well, the pandemic certainly showed us that clinical trials are a social good with vast benefits to society and an inclusive approach is worth it. But it takes effort. It takes community engagement and ear on the ground provider activation, activating the providers who are seldom offering these opportunities to their patients. So we've learned a lot about the ways that we can innovate to actually do the hard work to achieve inclusivity in clinical trials. And when you look at the demographics of patients that participate in the COVID-19 vaccine clinical trials, they were remarkably diverse and much better than what we have been doing for decades. We have known about a lack of representation in clinical trials for many decades. And there's been legislation around this since 1993. But now we're seeing this shift this real shift towards accountability and intention and actual investment in the innovation that's required to make the difference and continue this inclusivity. And I think importantly, getting out to the community centers, right. So when you look at, for example, cancer, uh if you take multiple myeloma it affects 20% of multiple myeloma patients in the US are African American. Now, they usually have a less severe form of disease, but they actually die earlier and that's because the diagnosis comes later and they aren't always afforded the opportunity because of, you know, inequities in the system to get the most infectious or recent medication. So when you look at how you change the clinical trial process and get um underrepresented minorities into the clinical trial process. You can't just go to the same institutions, talk to the same K O L s. You really need to expand the audience of who you're talking to in a culturally um with a health care, culturally appropriate dialogue uh to, to get them to seek care in that way. Uh We can't talk about any topic. Uh It seems these days without asking what's the effect of A I uh which has become so much more prominent in the past few months, Audie, I'll start with you. But uh what do you see happening? Uh One would suppose that a tremendous advance in technology must be good. Is it going to be two thoughts? One is, it's only as good as what goes in, right. So L's large language models are only as good as the data that they are trained on, right? We are all keenly aware of existing systemic biases. Certainly on the medical side, things like how we calculate kidney function, how we calculate heart function. Right. There are a variety of things that we think of as bread and butter. Certainly, I did as part of medical training that actually have race based adjustments to them. Um, garbage in, garbage out. Right. And so if that's what you are feeding an L L M to do, um, we, you know, it stands to reason that if we have trained it to be biased, the output will be biased. Um, And that's a, that's a solvable problem. So I don't mean to paint that as doomsday, I mean to paint that as let's all be keenly aware of what it means to make them equitable engines of innovation as opposed to perpetuators of inequities. I think the other thing I'll say is I think less so from uh well, I think this also has health activity implications around who exactly do, do A I tools sort of replace in the future of work, right? And I think generally speaking, um it tends to be the, I will say lower tendered or lower less skilled parts of the workforce. And so I think there is not just intentionality that needs to be put into how those LMS are trained, but also how they are deployed in such a way that is conscious of what that means for the future of work re skilling, upskilling. How do these models actually enhance productivity and not lead to uh employment and labor market implications that would disproportionately impact marginalized populations. I I think this is, this is critical because part of health equity and the bias there has to do with trust and has to do with historical trust within the health care system. So if we, we have to be really be careful um as we input data, garbage and garbage out to make sure that that trust is foundational because we could take a, you know, unit system and potentially um make it, you know, we need to use caution. Well, I totally agree that A I can perpetuate bias. If you're using biased data to train your models, you're gonna get biased recommendations. I think all of us understand that theoretically. But what does that mean in clinical application? I continue to see patients. I'm a medical oncologist at the University of California in San Francisco and I use risk risk scoring systems all the time, especially for patients with early stage disease. I'm trying to determine, are you at high risk for recurrence or are you at low risk? Should I give you more treatment now or should I put you on surveillance? So let's imagine, I have an African American woman with early stage disease where the model which was trained on non Hispanic white women with breast cancer tells me she's on, she has low risk and she recurs with metastatic disease. The next year I have failed her, I have failed her because I used biased data that gave me biased results that is a real harm. Let's think about the other scenario where we have a patient where we say she's high risk and I give her a lot of chemotherapy. She now has debilitating neuropathy and is on disability. She didn't need that chemotherapy again. I have failed her because I overt treated her based on biased data. So I am really concerned that if we are not, if we are more casual rather than cautious in our integration of A I in clinical practice, we can do harm. And that keeps me up at night. Uh I'm going to invite questions here in just a second, but just following up on this, uh if if we can get the bias out of the A I, I would think that it still could be a tremendous plus for equity in health care. Fair enough. I I think yes, of course, um technology can make a vast difference and we should be rapid adopters of technology. But we also need to look at the implementation of this technology which health systems in the United States are actually using these amazing technologies to deliver individualized treatment recommendations. Is it the same have and then we have the have nots. So really thinking also with an implementation lens to make sure that we have equitably distributed benefits of these technologies. But that's the same thought if we can get past the bias thing, which is gonna be a lot of work. But if we can do it then what's the issue? Well, I think that just like any other technology, there is also um non equitable, you know, resourcing of technology. So even if you think about, you know, a a medical center, a teaching center versus a community hospital, you can still get inequities of care if the same technology is not available everywhere. Um there are systemic issues that you know, the health care system in the United States is still trying to fix. For example, just having your records, you know, transfer and be visible throughout the medical system. So I think there is enormous hope here, but I think there's a lot of work to do before we get the great end state that we will be at someone who pays for it. Yeah. So like you can solve all the bias but like somebody's got to foot the bill comments, questions. They're so brilliant that there's really nothing we Yeah, I think so. Um Yes, uh a microphone will get its way to you very shortly. Yeah, there we go. Uh Please, if you could stand up, say who you are and hold the mic close to your mouth. I think, I think many folks who know me by now. I'm hi everyone. Um A general partner at X Capital. I'd love to hear a little bit more. We talked about A I but in the context of clinical trials, how you know, it's a crowded space there are a lot of companies doing, you know, trying to innovate and accelerate here. How can technology now actually change the game in a way that generations of companies have not been able to achieve earlier? Yeah, absolutely. Thanks for that question. So I am primarily focused on the oncology, therapeutic area that is the largest therapeutic area in research and development. And we know that in the United States, we see inefficiencies in recruitment, the vast majority of studies close early due to inadequate recruitment. We also see inequities, right? Um But what we also know is that only 13% of oncologists in the United States participate in research and there are a variety of pain points that are driving this and technology has a role to really activate providers to engage with them to make their lives easier so that they can see that research is an opportunity that they can implement into their actual care delivery. Yes. Yeah, I think that a lot has been tried, but the industry is really starting to see some successes and we saw that we see that in terms of a few things, one is the technology that we use, whether it be, you know, through partners or through our own organization to make sure that we are inclusive and and predictive of sites where they are, they're going to have diverse and qualified patients for clinical trials. So I think the application of using data sciences and A I to clinical trials is critically important in drug development and it's use that I have seen be most effective is expanding and to find the patient populations that we need to get into the trials. Personalization. Personalization. Yeah. Right. The ability when you've got billions and billions of records, you can be much more precise about this person. This treatment in a way that I don't think was possible before. Yeah, it's a great point. Uh, aggregating all of the data that's available has been this holy grail for a long time. We're actually apparently getting closer to it. Sound right. Yeah. Ok. That's great. Uh, our time has flown past but we're out of it now. So, uh, all I can say is to each of you. Thank you so much. Thank you. Thank you.

Joe Biden addresses American’s frustration over inflation

Politics

I want every american to know that I'm taking inflation uh, very seriously and it's my top for domestic priority. But here's the good news because of the actions we've taken. America is in a stronger position to meet this challenge than just about any other country in the world. Some of the roots of the inflation are outside of our control to state the obvious. But there are things we can do and we can address and we need to do. The fact is the average cost of a barrel of oil has been studied for weeks. So, so why do gas prices keep going up so high? Republicans would offer plenty of blame, but not a single solution to actually bring down the energy prices. You know, we have no plan. They have no plan to bring down energy prices today. No plan to get us to a cleaner energy, independent future tomorrow. So in the future, american families are no longer subject to the winds and of dictators half away around the world. Americans have a choice right now between two paths, Reflecting two very different sets of values. My plan to tax inflation and grows the economy by lowering costs for working families giving workers well deserved raises, reducing the deficit by historic levels and making big corporations and very wealthiest americans pay their fair share. The other path is the ultra mega planned put forward by congressional republicans to raise taxes on working families, lower the income of american workers threaten sacred programs. Americans count on like Social Security, Medicare and Medicaid and give break after break to big corporations and billionaires. I know you've got to be frustrated. I know I can taste it frustrated by high prices by gridlock in Congress by the time it takes to get anything done. Believe me, I understand the frustration, but the fact is congressional republicans, not all of them, but the mega republicans counting on you to be as frustrated by the pace of progress, which they have everything. They've done everything they can to slow down that you're gonna, will hand power over to them and enact so they can enact their extreme agenda. Look at their agenda. We'll put up on a web page somewhere. I think I can do this. The scott plan. It's in writing. We need a government focused on what families actually need. So I urge all America think about the path I've laid forward.

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