When the Clinton Foundation launched its early childhood education initiative Too Small to Fail in 2013, it turned to some unexpected business partners to help the movement succeed.
One was the national playground industry, which aligned with the Foundation to create over 1,000 literacy-rich playgrounds at local WIC centers, preschools, and parks. The playgrounds feature interactive learning stations that encourage parents and caregivers to help their children learn to read, count, and sing while they play.
Recognizing that low-income families spend about two to four hours a week at coin-operated laundromats, the Foundation also partnered with the national Coin Laundry Association to build hundreds of learning libraries in laundromats around the country. When space inside a laundromat was limited, the Foundation enlisted the help of the shipping container industry and repurposed donated containers into portable libraries that could be installed adjacent to the laundry shops.
“We are so much trying to do whatever we can with whomever we can,” Foundation Vice-Chair Dr. Chelsea Clinton, PhD, said during a recent appearance at the Yale Innovation Summit.
Clinton was one of several keynote speakers to appear at the two-day Summit, which is considered Connecticut’s largest entrepreneurship event, attracting over 2,000 innovators, investors, and industry leaders from around the country. The daughter of former President Bill Clinton and former Secretary of State Hillary Clinton, Chelsea Clinton has a Master of Public Health degree from Columbia University and a PhD in international relations from Oxford University. She is also a best-selling author, philanthropist, and venture capitalist who teaches as an adjunct professor at Columbia’s Mailman School of Public Health. Clinton spoke with Yale School of Public Health Dean Megan L. Ranney, MD, about championing health equity through innovation during her Summit appearance.
Watch a complete video of Dr. Ranney’s and Dr. Clinton’s conversation here.
A Place at the Table
Whether she’s working with the Clinton Foundation or her own venture capital firm Metrodora Ventures, Clinton said inclusion and collaboration are important drivers in everything she does.
“One of the things that we always try to do is not be the only people around the table. We want to have diverse stakeholders, people who are actually living the challenge, in the room and at the table,” Clinton told Ranney during their May 29 chat. “We don't think that empathy or lived experience should be bolted on later. It should be designed in from the beginning.”
Ranney praised the Clinton Foundation for its success in confronting challenges through innovative partnerships that promote the public good, ensuring that advances in science and public health benefit everyone, especially those who have historically been overlooked or marginalized. The Foundation’s work, she said, is a great example of the creative cross-sector collaborations that are vital to the future of public health.
“When we think about social entrepreneurship, we often get stuck in one model of thinking about creating the science and then disseminating it out into the world, which is usually through philanthropy and only people who have been trained in public health or in medicine or maybe the environment,” Ranney said. “As you're describing your various streams of work…I'm struck by the ways in which you've brought different groups together and are making sure, from the get-go, that the science gets out beyond its usual beginnings in philanthropy.”
Public Support for More Partnerships
Public-private partnerships were instrumental in America’s response to the COVID-19 pandemic, with Operation Warp Speed delivering new vaccines to the public in record time. Eager to keep up this momentum, public health officials are exploring new ways to work with organizations and businesses to improve health. In March, five national health care organizations launched an effort to strengthen partnerships with public health leaders – including the Yale School of Public Health – called the Common Health Coalition. The coalition has grown to 50 members in the first three months.
Current public opinion supports more purpose-driven partnerships, like those created by the Clinton Foundation. A Milken Institute-Harris Poll of 500 U.S. business leaders and 4,000 other Americans released last month showed that 76% of respondents felt that business leaders should work more closely with government to solve our social challenges. “The next generation of solutions and opportunities will be anchored by locally led innovation and new, outcomes-based, public-private partnerships,” Karen Kornbluh, the Milken Institute’s senior advisor on geo-economics said when the findings were released. The Institute outlined a new purpose-built framework for evolving public health partnerships in a separate 2022 report entitled Learning from Covid-19: Reimagining Public-Private Partnerships in Public Health.
One of the things that we always try to do is not be the only people around the table...We don't think that empathy or lived experience should be bolted on later. It should be designed in from the beginning.”
Dr. Chelsea Clinton
For Clinton, the human-centered, innovation-rich culture that drives all of her and the Foundation’s work was nurtured during the early days of the Clinton HIV/AIDS Initiative, now called the Clinton Health Access Initiative or CHAI. In the early 2000s, the Initiative collaborated with generic drug manufacturers, nonprofits, and government entities to reduce the cost of antiretrovirals for the prevention of HIV and make them more available globally. When the campaign started, the average price for a year-long supply of name brand drugs was about $10,000 and fewer than 10,000 people in the global south were accessing the lifesaving medicines. By reshaping the market through guaranteed bulk purchases, the Clinton Foundation was able to reduce the annual medications’ cost to $60. The CHAI team recently negotiated new market-shaping agreements for treatments for hepatitis C and hepatitis B. Collectively, the two viruses affect 320 million people every year.
“We've worked with a variety of partners to lower the annual cost of hepatitis C treatment from about $2,600 per person to, again, less than $60,” said Clinton, vice-chair of CHAI’s Board of Directors. “And we're now trying to marshal similar levels of resources from philanthropic funders and bilateral funders like the United States to hopefully ensure that anyone anywhere is able to access the vaccines that any of us should be able to access, as well as the treatments that we may need.”
Multi-generational Impact
If public-private partnerships are to succeed in achieving sustainable, systemic-level change, there needs to be a shared sense of purpose among all of the stakeholders and clear lines of responsibility and accountability, according to a 2021 report by the Brookings Institution titled “Partnerships for public purpose: The new PPPS for fighting the biggest crises of our time.” “By harnessing the technical expertise, approaches, and networks possessed by governments, private-sector organizations, nongovernmental actors, and donor agencies, these new [partnerships for public purpose] can provide innovative mechanisms and promote collaboration to address challenges that traditional government resources and competing priorities struggle to negotiate,” The Brookings report said. “In doing so, they can increase capacity, improve quality, enhance equity, and target poor or marginalized populations for the delivery or financing of services.”
Clinton’s entrepreneurship models this approach.
“You have to have stakeholders around the table who have a shared ethos and commitment to building for scale and sustainability and not just something that has an impact on a community today but hopefully has multi-generational impact,” Clinton said. “We're very clear about what we can provide…and what we can't, and we also do a tremendous amount of work to ensure that the agreements work not only for patients, providers, and governments, but also for our drug and device partners. Because if the agreement on hepatitis treatments doesn't work for the generic drug manufacturers today, they're not going to have an interest in working with us on the next priority tomorrow.”
Ranney agreed.
“That mandate of sustainability as we launch new things into the world matters so much for health because we have an obligation to the communities in which we're working,” Ranney said. “One of the worst things that we can do is to come up with a brilliant idea, have funding for two or three years, and then disappear from a community that's already marginalized and is already distrustful. I think that worsens health and partnership in immeasurable ways, and I think that you have created some really nice models of how to not disappear.”
A Moral Imperative
A longtime advocate for women’s and children’s health, Clinton reminded the Summit audience that currently less than 2% of all venture funding goes towards women’s startups and less than 15% of all federal health research funding targets maternal and child health. Philanthropist Melinda French Gates, in response to this scarcity of funding, recently announced a $1 billion fund to support women and families around the globe.
“I will talk to anyone who's doing anything in women’s or kids’ health because we haven't spent enough time talking about it or studying it or investing in it,” Clinton said. “For me, it is a moral imperative.”
Leading with Confidence and Humility
During a question-and-answer session, Clinton was asked how she selects which projects to pursue and which people to partner with given the multitude of requests she receives.
“I like working with people who have a blend of confidence and humility,” Clinton said. “Confidence about what they know, confidence in their purpose or their passion, and also humility about what they don't know. They may know a lot about the science, but they don't know a lot about implementation; or they may know a lot about how to navigate a local health system, but they don't know a lot about the science or how to think about what the right metrics of success should be over time.
“I like working with people who like working with people, who want learn from each other, who want to collaborate, who want to problem solve, and who recognize that the whole is greater than the sum of the parts,” she continued. “I like working with people who find joy in the work even when it's really hard. I like people who believe in the importance of persistence. I like people who don't run toward conflict but aren't afraid of it. I like people who both respect and expect others in turn to be respectful. I like to work with people who understand why I say to my children, ‘I hope a lot of things for you, but as your mom, what I hope I'm able to give you are the resources and the understanding of the importance of being kind and being brave.’”
Always attuned to the latest political winds, Clinton closed her appearance with an appeal to everyone in the audience to vote.
“Everything that we've talked about, everything that was probably already talked about (at the Innovation Summit), everything that will be talked about, will be impacted by the elections in November,” Clinton said.