Bracken Bower Prize 2022: excerpts from the finalists’ proposals
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Edited excerpts from the book proposals of the three finalists for the 2022 Bracken Bower Prize
The Unstoppable Rise of Private Capital in Public Health
How businesses can help or harm the future of healthcare
BY VICTORIA BERQUIST
The writer is a doctor, adviser to public and private healthcare organisations across several geographies, and is completing a masters in public policy at Harvard University
The future of our health is no longer controlled by doctors, governments or even you. Whether fervently capitalist or strictly socialist, healthcare systems around the world are being transformed by the exponential rise of business in medicine, fuelled by strained government budgets, relaxed regulation, and an explosion of private capital.
Globally, private equity investments in healthcare have increased from under $5bn in 2000 to more than $150bn in 2021. Venture capital investment in health start-ups has also ballooned, reaching almost $90bn last year. Medicine is big business, and companies new and old will stop at nothing to capture a slice. In the process of doing so, are they going to help us, or harm us?
There is much at stake. As a doctor, patient and adviser to both the public and private sector, I’ve seen at the coalface the occasionally unhappy marriage between business and health. Government-led healthcare moves slowly, and patients deserve better than the manual, hospital-centred systems that have persisted for decades. But businesses want to “move fast and break things”, with patients at risk in the pursuit of profit.
Private equity ownership of nursing homes, for example, has been associated with lower staff-to-patient ratios, worse quality metrics and higher mortality. Private acquisition of ambulances has been found to deliver lower wait-times but at a higher risk of death. The prospect that bankers could be harming grandmothers while private equity-owned healthcare assets grow in number around the world should be an impetus for policymakers to consider what the right guardrails are for the involvement of business in our health. More needs to be done to ensure people are protected as the influence of companies on our health grows.
If done right, protecting patients while enabling innovation will continue to transform our lives for the better. Private equity firms invested $34bn globally in life sciences in 2021, the highest amount yet. Innovation funded by this capital has been astonishing. New companies have found ways to edit our DNA to cure genetic diseases and personalise cancer therapies to specific individuals. Growth in venture investment has expanded access to care, with the exploding number of virtual health companies making healthcare more convenient for millions. Direct-to-consumer start-ups are reducing barriers to birth control, HIV prevention and more. With the right measures in place, we all benefit from the revolution that business in medicine is helping to create.
No area of healthcare remains untouched — fields as diverse as hospitals, therapeutics, healthcare data, clinical decisions and insurance are being transformed by the growth of business. And while some may believe their own country is immune, they are wrong. Healthcare systems in geographies as diverse as the US, China, India, the UK and Europe have become increasingly captured by corporations.
In China, privatisation was introduced in the 1970s and 1980s into a previously socialised healthcare system run by a communist government. Now there are more private hospitals than public hospitals, individuals can purchase private health insurance from American companies such as Prudential, and Chinese healthtech is booming. Even in a socialist republic, capitalist influences mean times have changed for healthcare.
The UK, long renowned for its government-run NHS, has recently seen US brands such as the Mayo Clinic and Cleveland Clinic open private facilities in London. Private provision of care may relieve pressures on the public system, but critics fear a growing “second tier” of healthcare, providing quicker and higher-tech care only to those that can afford it. Striking the right balance between equity and innovation as business grows can be challenging.
We should all be paying close attention. Globally, a narrowing window of opportunity remains to ensure policymakers protect citizens from negative side-effects that accompany the rise of corporations in healthcare. Individuals, business leaders and policymakers must do more to educate themselves on the changes happening before their eyes and understand what they can do to ensure the future of our healthcare system will help us, not harm us.
There is much to be gained by doing so. Knowing more about the benefits and risks of the intersection between business and healthcare means all of us can make more informed choices about factors such as the healthcare facilities we use and how our personal data is shared. Representatives can do more to improve the health of those they serve. Business leaders can make choices that put patients at the centre while still protecting their interests. If we all take action to manage the rise of business in healthcare, in our lifetimes we will see companies drive more life-saving cures and more incredible technology, here for us when we want and need it. All we need is for business to take a leaf out of the book of physicians and, first, do no harm.
Before the Dawn
Racing to net zero on the front lines of climate innovation
BY ÂrieL DE FAUCONBERG
The writer is a Gates Cambridge Scholar and a PhD student in her penultimate year at the University of Cambridge, as well as co-founder and research director of the Good Data Initiative, a youth-led think-tank
“What if we can’t do this?” Sam asked, looking straight at me. His question lingered in the air, ripe with undertones of hope, fear and despair.
It was late at night on the second floor of the WeWork where my cohort of climate technology entrepreneurs was based. Not a soul was around, save for the two of us in that large workroom filled with empty desks. The hallway lights were off. The reception staff had long gone home. Clusters of used coffee mugs sat on the wooden desk by the sliding glass entrance to where we worked, waiting to be carried back to the common kitchen. Outside, the night seemed to envelop the building — bike racks naked, streetlamps shedding their small circles across an abandoned street.
Today had been a long one, longer than usual even in the exciting, whirlwind days of early stage ventures. The Covid-19 pandemic was raging around us. We had just been released from a second wave of national lockdowns, so any in-person human interaction still felt like a rare treat. Despite this seeming reprieve, though, we had learnt that morning that the co-founder of this accelerator had suddenly passed away. Hundreds, thousands of people were dying in the middle of this pandemic, but this — this hit differently. The cohort had held a hybrid moment of silence for him during the morning meeting and then went back to work. The climate crisis, and each team’s aspirational goal of mitigating 10mn tonnes of CO₂ emissions per year with their innovations, weighed heavily on us.
Ambitious? Yes. Feasible? Potentially. These entrepreneurs were risking stable career paths, pivoting from decades of experience working in industry, or coming fresh from the lab with just an idea and their PhD in hand from the world’s top schools, to throw themselves into imagining and building the foundation of a new world by 2050. It didn’t hurt, of course, that McKinsey had predicted the climate tech market would grow to more than $2tn of capital investment per year by 2025. Over 18 months, I would follow these climate entrepreneurs as they built and dissolved teams, fought with venture capitalists over the sector-wide lack of hardware funding, be hyped in international news outlets, reject millions of dollars of needed venture seed funding based on personal value conflicts, and in some cases, secure contracts with members of the Fortune 100 — the biggest companies in the world — that would bolster their growth like rocket fuel.
These entrepreneurs were pushing to normalise regenerative agriculture in Latin America; to standardise business-to-business (B2B) software-as-a-service (SaaS) carbon emissions tracking practices; to build smaller and more efficient silicon batteries to accelerate a widespread transportation transition to all-electric vehicles; to train advanced artificial intelligence to more quickly identify the new materials needed to make future cargo transportation environmentally sustainable. And these were only four of the teams.
This wasn’t selling search engine optimisation. Their ambition was a fundamental transformation of global business practices and societal infrastructure. Losing one of our group heightened how aware we all were of the stakes ahead. Yet, I wasn’t there as an entrepreneur: I was embedded as a researcher for my PhD at the University of Cambridge, studying the challenges and opportunities these 60 founders faced. As I followed their journeys, I gained insights into how engaging with this climate tech innovation ecosystem offers one of the fastest and most effective routes we have to scale up the changes my entrepreneurs sought — across carbon emissions mitigation and adaptation efforts; to reduce racial, gender and socio-economic inequalities worldwide; to increase responsible consumption and production methods; and to strengthen opportunities for decent work that support multiple forms of social and environmental value creation. While my entrepreneurs provided the spark, it was their place within a rapidly growing network of engaged and informed consumers, employees, investors, and even other future founders that could stoke that flash into a roaring flame.
These founders were fighting their way to build effective teams that would scale the innovations needed to navigate the climate crisis and bring society to net zero emissions, taking the challenges of entrepreneurship and making it that extra step harder by pursuing environmental change and financial success without sacrificing either. They all had crazy ideas — mad, ambitious visions of how the future of business and society could be cleaner, greener, and better than before.
What I didn’t know was whether Sam’s question was about his team’s venture or the monumental task ahead of neutralising the ongoing climate crisis. It didn’t matter. The answer I gave was still the same.
I met his eyes. “We won’t know unless we try.”
Owning the Centre
Journeys from Silicon Valley to the Amazon rainforest
BY Julia marisa sekula
The writer is pursuing a joint MBA | MSc in nature co-design and climate-tech at Stanford University
“God is great, but the forest is greater”. So goes the Brazilian proverb; part warning, part veneration for the 60 per cent of the country covered in dense, wet, “otherness”. The rainforest has captured the imagination of scientists, artists, activists and even one of the richest men in the world named his company after a river in the world’s largest rainforest. While the rainforest brand has sold successfully for centuries, our political systems and economic frameworks were built largely in opposition to it; favouring uniformity over diversity; centralisation over distribution; obsolescence over circularity; and importantly, extraction over immersion. It is only now that the forest — and nature generally — is being called upon for more. And while this may seem radical, it is also obvious: after all, what other model has successfully iterated its product-market fit for more than 3bn years?
Today, more than half of all economic activity is “moderately or highly dependent on natural capital”, according to McKinsey. Tomorrow, “395mn jobs — [or] one-fifth of the total projected increase in the global labour force between now and 2030” are expected to be generated by the nature-economy, a World Economic Forum study says. By 2050, as much as 40 per cent of global gross domestic product will be impacted by “nature co-design” — a term for the leveraging of nature’s design principles and manufacturing capabilities, coined by Boston Consulting Group and Hello Tomorrow. Nature is, and will be, everywhere.
These developments inspire hope; they also encourage even bigger questions. In what ways are our political and economic systems founded on the domination of nature? How might we model our systems differently if we applied the organising principles of nature? How do we define nature’s intelligence and who owns it? Can it be owned, codified and patented? And if so — in what ways does this dismantle foundational principles of our judiciary and democracy such as, for example, property ownership? What does the nature economy of tomorrow actually look like? This book journeys to the centre(s) of the universe in search of these answers.
Satya Nadella, chief executive of Microsoft, stated: “San Francisco: Centre of the Universe”. Fifteen years ago he was talking about the computational revolution, today he would have been talking about the biological one. Eric Schmidt, former chief executive of Google, has declared that the “revolution at the intersection of biology and technology will be greater than the internet . . . that biology is the world’s greatest quantum machine”. And because nature runs on sunlight, knows no waste, rewards co-operation, thrives on diversity and fits form to function, it also creates the possibility to produce products less expensively, less wastefully, and, decisively for climate, less carbon-intensively. And Silicon Valley, which suffers its share of mysticism and reverence in pursuit of its designs for the future, is, once again, at the centre of this.
In times of climate emergency, though, it is the forest that becomes the centre of the universe. While nature around the world must be integrated and decarbonisation must be pursued everywhere, it is in the Amazon that we face our critical battleground. Relentless deforestation is fast approaching a “dieback threshold” that could release a decade’s worth of global CO₂ emissions and compromise the forest’s ability to annually absorb up to 2bn tons of CO₂. While carbon is lost to the atmosphere, the rainforest’s library of Alexandria of innovation (from the industrial revolution to trendy Veja shoes), is too.
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Naming the Amazon rainforest the centre of the universe — or at least, our universe — is also symbolic: we need a global dislocation and reframing of our systems. How and what we define as centre or periphery defines not only how these localities and concepts are hierarchically structured in our economic and political systems, but also in our minds.
There is no Silicon Valley without the Amazon, and no Amazon without Silicon Valley.
I hope to demonstrate, first, that these two centres are more alike than we may believe. Second, that one cosmovision empowers the other, and vice versa, and, third, that only in stretching these two poles towards one another, can we close the circuit on climate solutions.
In doing so, I hope to provoke a fresh “response” to a society in crisis and to embolden businesses and individuals with inspiration from the diversity of experience of the two centres that shape our world. It is about our rights to this new centre, but equally about being held accountable. It is about redefining our relationship with our planet, with the institutions that give us purpose, and critically, with ourselves.