Investing for Impact, Investing in Health in Africa

In a new series of interviews, Friends will hear from our board members about what drives them to support the fight against AIDS, tuberculosis and malaria. For our first discussion, we spoke with Jonathan Orszag, Senior Managing Director and member of the Executive Committee at the economic consulting firm Compass Lexecon.

Friends: Thank you, Jonathan, for taking the time to chat with us. You have an extraordinary resume – among your many endeavors, you currently work as a senior managing director at economic consulting firm Compass Lexecon. You have also traveled extensively in Africa with the Clinton Foundation and other philanthropic efforts, visiting such countries as Rwanda, South Africa and Tanzania. How did you first become interested in Africa?

Jonathan: I like to think of the future. If one ponders what the world will be like 40, 50, or 100 years from now, it is highly likely that Africa plays a far more important role – both economically and politically – than it does today. The probability that Africa, as a continent, has economic growth rates that outstrip the United States and Europe over time is quite likely when one considers Africa’s vast mineral resources, growing population and untapped potential.

Given that, how could I not be interested in Africa? Then you add the fact that philanthropy is an important part of my life. As an economist, I think about the efficiency of my philanthropic efforts: how many lives can I help save or how many kids can I help educate on a per dollar invested basis? And I believe that one can have a bigger impact in Africa than just about anywhere else in the world. Then Africa has one more great passion of mine – natural beauty and wildlife – which allow me to return to my youth by taking photographs.

Friends: Can you tell us a little bit about what you’ve seen on the ground in those experiences? What is your impression of African health systems?

Jonathan: I have had a real diversity of experiences in Africa. I was at the opening of the Butaro Cancer Center of Excellence in Rwanda, a partnership between Paul Farmer’s Partners in Health, Jeff Gordon’s Foundation and the Dana Farber Institute. It is a stunning site in rural Rwanda – a brand new cancer hospital sitting on a hill overlooking vast forests and farmlands. And I have been in rural health clinics that have virtually no resources and lack sanitary equipment, medicines and even basic essentials.

Friends: You work in economics and served as an economic policy advisor on President Clinton’s National Economic Council. Has your economic background informed your philanthropic efforts, and your interest in global health?

Jonathan: The simple answer to the question is “yes.” The more complex answer is “definitely.” I have a relatively simple view: A life helped or saved is a life helped or saved, regardless of whether that person lives in Africa, Europe, the United States or down the street from where I live. Thus, I have concentrated my philanthropy close to home so that I can see the benefits directly – for example, so that I can easily meet with a kid who we helped attend college – as well as globally, where we can potentially have a broader impact. Take health in Africa, as an example. The costs of care in Africa are so much lower e.g., the World Health Organization estimates show that the cost per bed per day at a hospital in Africa is a fraction of the costs in developed countries. On a pure “per lives saved” metric, investing in Africa is more efficient than investing elsewhere. In addition, there are so many more holes in the health system in Africa, so there are greater opportunities to have a truly significant effect on health outcomes, instead of a marginal effect when one invests in developed countries.

Friends: Congratulations on your approaching one-year anniversary as a board member for Friends of the Global Fight Against AIDS, Tuberculosis and Malaria (Friends)! How has your involvement in our organization impacted your work and perspective on global epidemics?

Jonathan: First, thank you for inviting me on your board. The organization does great work and I am proud to be part of it.

Like many aspects of life, when you join an organization and learn more about what it is doing, it opens up new thoughts and perspectives about issues – especially when one doesn’t focus on those topics daily. Despite my desire to do philanthropy as often as possible, I still need a day job to help fund my efforts. The issues surrounding African health systems, which I have been involved in for years, have been particularly important this year with the Ebola pandemic. But adding in the knowledge and perspective from other pandemics – although slower moving than Ebola – certainly provides additional information and helps to inform my views and thoughts about what more needs to be done to ensure that we can more effectively combat these diseases going forward.

Friends: Your philanthropic efforts are impressive. In addition to Friends, you also work with the Clinton Foundation, the Tiger Woods Foundation and Ambassadors Council for Grassroots Soccer. What elements of philanthropic work do you find most rewarding?

Jonathan: I usually do not like to quote the Bible, but it says “Everyone to whom much was given, of him much will be required.” I have lived a very lucky life – to be raised in a stable home; go to good schools; work at the White House; start and then sell a business; to be healthy; and to be married to an amazing woman. Thus, it is the ability to give without wanting or needing anything in return which makes philanthropic work so rewarding. It is the knowledge that we can help save a life or give a young child an opportunity to live out their dreams that brings a smile to my face – and makes giving so rewarding. And to add an economist’s view to it: What else am I going to do with it? I am not taking my wealth with me when I reach the limit of my days and I am not a huge believer in intergenerational wealth transfers, so giving is the best use of my financial resources.

Friends: Your fellow board member Helene Gayle recently remarked that, in recent years, she has seen the private sector increasing its investments and innovations in global health. Have you also noticed this trend in your personal experiences, and if so, can you give some examples?

Jonathan: Absolutely. I think Bill Gates – and then Warren Buffett and many others – have made giving back part of the culture for the uber wealthy. To be sure, some of today’s greatest foundations were started by the wealthiest Americans in the past: Ford, Mellon, Rockefeller, Pew, etc. But many of those foundations, if I am not mistaken, were started at the end of their lives, not as a central part of how the original wealth creator lived. The fact that many of the great capitalists of today are also great philanthropists helps to incent other people in the private sector – like myself — to give back.

Friends: There has been a renewed focus in the business world this year on the idea of “doing well by doing good.” How has this concept influenced your business practices, what private sector practices have you observed that are mutually benefiting companies and the developing world?

Jonathan: I think businesses – especially publicly traded ones – need to focus on maximizing profits. Of course, for many businesses, maximizing profits may involve doing well by doing good. But in other sectors, doing good may not help improve shareholder value. So we can’t have a one size fits all approach and argue that all businesses should try to “do good.” But there are all kinds of ways in which “doing good” can maximize profits. For example, locating a store in an impoverished area may be considered “doing good” but it may just be a great business opportunity because there is often both a high concentration of people and less competition. Locating a facility in Africa may be cost effective and allow a business to compete more aggressively with its lower cost structure. Thus, in the end, if businesses have shareholders, they need to consider what is best for them – but that often will involve decisions that help Africa or other developing areas.

Friends: In December, Friends celebrated its 10th anniversary. What would you like to see the organization prioritize in the fight against AIDS, tuberculosis and malaria over the next 10 years? What do you personally wish to bring to the future of this fight?

Jonathan: We have made such amazing progress on AIDS, tuberculosis and malaria over the past 10 years. But there is still so much more to do – we can fight these diseases more efficiently and one day, hopefully in the next decade, eradicate them completely. I hope through my other efforts – and the Global Fight – that I make a small contribution to those goals.