EY helps clients create long-term value for all stakeholders. Enabled by data and technology, our services and solutions provide trust through assurance and help clients transform, grow and operate.
At EY, our purpose is building a better working world. The insights and services we provide help to create long-term value for clients, people and society, and to build trust in the capital markets.
How leveraging innovative technology makes a difference in healthcare
In this episode of “Better Innovation,” Global Tax Innovation Leader and host Jeff Saviano interviews Susan Garfield, Chief Public Health Officer at EY.
Susan Garfield, Chief Public Health Officer at EY, believes we’re at the precipice of a transformational moment in health equity, leveraging innovative technology to make a difference in the lives of millions. Jeff and Garfield chat about the cascading effect of technology in healthcare, its impact on the democratization of high-quality care, and how the public sector can learn from the pandemic to improve resiliency and the overall quality of healthcare.
For your convenience, full text transcript of this podcast is also available.
Jeffrey Saviano
Hey, Better Innovation. It's Jeff. Today we have Susan Garfield on the show. Garfield is the Chief Public Health Officer and one of the Life Science leaders here at EY. I met Garfield just over a year ago. We worked together to mobilize a team to support PathCheck, that really important nonprofit that was developed in contact tracing technology that had spun out of the MIT Media Lab. Our regular Better Innovation listeners will know all about health check. We've had on a few guest on the show talking about how that organization help stop the spread of the virus, especially in the early days of the pandemic. Garfield has such a thoughtful point of view on public health reemergence from this crisis. Public health infrastructure has been severely threatened this past year. Garfield will help us better understand the innovation necessary to advance public health as we emerge in 2021. Here we go. Susan Garfield.
Garfield, welcome to the show.
Susan Garfield
It's so great to be here Jeff and so great to talk to you.
Saviano
We have this great studio that we use for the show. It's right on Newbury Street in Boston. Garfield, you and I both live in the Boston area. I have to say, it would have been so much fun to do this live today on a beautiful Spring day in Boston on Newbury Street, that would have been a blast.
Garfield
Oh my gosh! can you imagine, but we're getting close Jeff. Vaccinated, I'm ready, I'm ready to see you in person.
Saviano
I do feel like we're getting close too and, we're also so fortunate uh, that you're with us today Garfield and I thought we would start with the work that you and I did together just about a year ago and can't believe it's been a year and this incredible experience that we had supporting a non-profit called PathCheck. What was PathCheck all about and what was your role in the organization Garfield?
Garfield
Yeah. It's interesting to go back in time right, to the beginning of the pandemic where everyone, academics, technologists, us in the private sector, we're trying to come together to figure out what we could do to help get the world on track after the introduction of this terrible virus and PathCheck emerged out of some really good thinking from MIT and Ramesh Raskar the, the leader over there coming up with, with ideas of how to use technology to solve one of the critical challenges in Public Health which is how do you contact trace? How do you tell when an infection happens, who else is at risk, how far that has penetrated into families, communities etc., and, and try to contain it, right? So, so contact tracing is one of the essential dimensions of public health containment efforts as it relates to infectious disease. So, as COVID emerged early on uh, we though gosh, isn't there a better way to do contact tracing than having just folks call other folks and ask them who they've been in contact with and, and, and the people at MIT came up with a really good technology enabled idea and then PathCheck as an organization grew out of that bringing together people from around the world to, to advance it.
Saviano
It was such an incredible experience and, I know that we feel the same way. We really both believe in the vision of Ramesh Raskar and he was on the show last year. We just loved to hear his story of how it started and I know the room that he was in, in the media lab and how quickly a few hundred of frankly the world's strongest and uh, leaders converged on this intense problem and this was, go back a year ago, we got the call from Ramesh, I think it was on March 7th of last year and you came in shortly after that and, what role do you think contact tracing played to help stop the spread of the virus? Now, here we are a year later after PathCheck started and that experience, do you think that contact tracing with a material contributor in certain parts of the world to limiting the spread.
Garfield
It's such an interesting question because early on yes. Early on when the virus was, was limited in certain places, I think contact tracing came in and could help identify when people were infected, who they had contact with and it helped us understand not only the spread of the disease but how quickly it was moving through communities. So, it was a really useful tool. Now, did it contain the virus as, as we saw, no, right and part of that wasn't contact tracing failing, it was the infrastructure behind contact tracing. We've been chronically under-funding public health for decades and then we asked the infrastructure to step up and respond to this global pandemic, pandemic and it just wasn't prepared and that's what was really kind of an interesting thing about PathCheck and this technology driven movement to say can we supplement a very people based process with technology and really expand its reach, make it more effective and, and really fit it for this 21st century challenge. So that was the, the hope, I think the virus out-paced the solution um, and I think it, as with everything, it's really hard to take excellent ideas and technology and translate that into widespread adoption at scale in the market and, and, and I think that's what we've seen over the last year.
Saviano
And there's so many great aspect of the, the PathCheck story. I know in those days; we would refer to it as PathCheck time. How long something took to actually start something and see it through to completion. I remember lots of occasions we would be on calls early morning and then by the end of the day there would be a deliverable that was complete and something was done or a software code that was written. I think it was such an amazing part of the PathCheck story was nice to have Ramesh join the show last year to talk a bit about this was how, so dozens and dozens, as you said, a few 100 people within weeks came together with really no egos and no expectation of personal gain or gain to the organizations that they represented and, and I was so proud of our firm donating time of so many people to be able to help the organization in those early days. Maybe just to, to stick with contact tracing for a minute. As we look forward Garfield, what role do you think uh, contact tracing may play going forward? Do you think that it will be a viable tool for Public Health officials?
Garfield
I do. I think contact tracing though is really set up for a different type of infectious disease, a different type of pathogen. So, contact tracing works really, really well when a small number of people are infected and you're, and you're trying to trace that around the community. For COVID as we've seen, it's not, it's not tens of people or hundreds of people, it was thousands and eventually millions and it's really hard for contact tracing to keep pace with something at that scale. Moving forward though, there will be other infectious diseases, other emerging pathogens and in contact tracing remains a really critical part of, of our Public Health toolbox and we need to continue to improve it. So, I think those ideas of using technology in combination with people, it will be the foundation for how we contact trace moving forward. We've already seen enormous uh, improvements over the last year so that's, that's really exciting um, but I think the conversation is changing. So, we started with contact tracing and said how can we use technology to really change this and make it better. On the other side of the pandemic a year later, we're now starting to talk about things like vaccine passports and how can you use technology to track testing and vaccination status to, to help people re-emerge back into society, open things up. So again, it's this consistent theme about innovation and technology, holding hands with Public Health to improve the status.
Saviano
It's also I think, and I just love how you phrase that and it's such an interesting part of the story that, as we look at the role of technology in this past year and how frankly impossible it is to even think about contact tracing without leveraging technology but, it's not as though we're ready to just hand the keys over to the machines. That we're talking about um, and I think the, the terminology of the human in the loop is important. That you can't take the person out of it and I think contact tracing is a great example, isn't it? That the technology didn't replace the contact tracers but, instead it was helping them and supporting them but, it's this, it's this interplay of man and machine and the inter-dependency that each has that seems like it is the future, even with as you said, pivoting to vaccine passports that, that uh, it's the ingenuity of Public Health officials and others that will have to implement these technologies. Did I get that about right?
Garfield
Yeah, absolutely. I mean, look, all of this has humans at the center and, and people like dealing with people and especially when you're talking about things that feel private like your health status or who you've been in contact with and what you've been doing and it's much easier to have a human to human conversation than interface with some, you know, faceless robot or piece of technology. So, I think you're right, I think it's, it's hand in hand, I think it's finding that, right combination of humans and technology, but what we have to recognize too that there's a tremendous amount of distrust in our institutions and our governments and even in our leaders that, that make some of the core concepts underpinning these innovations like privacy, like data protection, like interoperability really critical to consider, as we move forward uh, with contact tracing or vaccine passports or whatever some of the new tools are going to be. We've learned so much about people's willingness to adopt and some of the very valid fears they have about things. That reality of the human experience, the human perspective the um, the centrality of privacy and, and concern about government over-reach it's very real and we, we have to account for that as we're innovating.
Saviano
It is very real and, and I think that's a good, a good pivot point for us. Let's, let's come out of this PathCheck experience Garfield and talk a bit about a new role that you're in at EY teams and this is not just a new role for you but, this is a new role for the firm as our first Public Health Officer. What does that role entail?
Garfield
Yeah, I'm so excited. I'm privileged to take on, on the role with EY and it really just shows the organization being very forward looking and recognizing that the health of populations is not only a Public Health issue, it's central to economics, it's central to the way businesses function and it's central to a lot of how our uh, economy and, and society are going to evolve and emerge from this pandemic. So um, as part of my role I'm working very closely with our government and public sector teams as they work with governments to think about ongoing strategies for COVID response and recovery, but also working with our private sector clients to think about ongoing business resilience as it relates to health issues. What are the lessons learned from the pandemic and how can we build them in uh, to strategies and program moving forward as an interconnected eco system? So, not thinking about health on one side and business on the other but, instead really thinking about the public health, which is the health of populations as, as a collective responsibility for all of us.
Saviano
And of course, we at EY, we principally serve the business community, also serving governments, and I would think that your new role is a recognition of a greater responsibility perhaps that employers will have in managing public health, managing their employee health. Talk a bit about that Garfield. The interplay with the employer responsibility and, and I'm just so curious to know that as we look at, even our firm naming you as a Chief Public Health Officer, it does seem as though that there is a recognition of that responsibility that employers have as important organizations within the management of Public Health.
Garfield
I really hope so Jeff. I believe really strongly that the employer has a, has a critical role to play in this next chapter which I think has more focus on, not only on individual health, right? How can we provide access to individuals to the right medicines, the right doctors, the right um, interventions, but also in the health of populations? How can I take my entire community and improve their access to nutrition, make sure the environment is safe um, make sure that they have appropriate education and Public Health resources etc. etc. and, and when you think about those two different dimensions, kind of the individual and the population and players have a, have a role to play on both? They, they are trusted um, interface with, with folks on a day to day basis um, and I think their role can be pretty significant. Here in the US as you know, a lot of folks get their health insurance through their employer. The employer is actually already a primary source of healthcare for, for most people and their families but, they haven't historically taken it that, that next step forward about being extremely proactive around health and well-being more broadly and, taking their role as, as a conduit to a better healthcare experience and connectivity to resources and helping with preventive good positive preventive behaviors etc. So, I think we're hearing more about employer’s willingness to do that and recognizing perhaps their increasing responsibility to do that um, both from an altruistic standpoint but also, to improve business readiness, right? So, the health of populations is not independent from the health of our businesses and organizations and I think as employers and businesses recognize this, you're going to see more and more investment in their people and their health.
Saviano
And you look in the, the past and how important employers have been. You mention as the employer is the gateway for insurability for, for workers and the important role that organizations have played and also the rise of, of employee unions and the importance, the important role that unions have played and, and perhaps more recently the opportunities for employers to offer wellness programs, whether they're physical well-being, mental well-being or even seeing more recently uh, financial well-being that has a connection to, to the um, the physical well-being and the health of, of their workers. Do you think that that, that's a trend that we'll see continue as we emerge from the pandemic that, this notion of employers assuming? this greater responsibility and let's face it, it's good for society's and good for communities, it's also good for the employer too, isn't it? It's a real win-win for everybody.
Garfield
Yeah, I think so. I, I agree completely. When, when you see some of the trends and things that employers are doing more broadly. Look, look at the investments they're starting to make in sustainability. Look at the investments they're starting to make as leaders in climate change management and all of these, these moves for greater corporate responsibility and activation start to take a longer term perspective, right? How can our investments today help um, our people and businesses over the long term and I think for healthcare there's a similar shift in point of view? It's not just about paying for health insurance, the health resources my teams are going to use this year but, if I invest in preventive services, I can improve their health and how the outcomes over the long term if I consider things like nutrition and weight and access to good um, good services beyond kind of core healthcare services. This really has a material improvement on health outcomes, both in the near term but longer term. So, employers are seeing that, I think they're recognizing that, they can play a key role in, in access but they can also connect the dots for their employees. So, one of the exciting things we're also seeing is employers starting to collaborate with other key healthcare stakeholders. So, not just going it alone or working with their health insurer but, working with local provider groups, hospital groups, technology systems, even transportation systems to make really innovative health and wellness programs available to their employees very specific and targeted to the populations that they have. So that's a really exciting uh, innovation that we're seeing.
Saviano
You've mentioned a few already, even in this discussion, we talked about how technology is affecting contact tracing and um, vaccine passports. What, what other innovations are you seeing Garfield? You've been at the center with NEY of new innovations within life. You've been at the center of new innovations within life science, what are some of the other innovations that you're excited about?
Garfield
Well, we started talking about collaborations a little bit but, one of my favorite things that I've seen over the course of just pandemic response that, you know as, as you know, this pandemic has accelerated the adoption of so many digital tools and remote monitoring and tele-health opportunities um, as people haven't been able to go to the doctor, as people haven't been able to get together in person and that acceleration has led to some I think really exciting innovations but, starting with collaboration, one of the fun things um, I was watching TV the other night and I've been doing a lotta work with, with vaccination and I got a ping on my phone and it was from one of the ride share companies and it said hey, if you need a ride to go get a vaccination hit this button and they had collaborated with one of the big retail pharmacies to offer both transportation to the vaccination and rapid access at the site of care and I thought wow, that's a really great and innovative way to increase access and decrease barriers. So, that was one example that I really liked recently on the on the remote tele-health side we, we saw the launch of several um, digital therapeutics this year that allowed patients in the mental health space to use technology to, to treat their, their um, mental health diseases um, through an interface with a um, AI enabled app and, and these digital therapeutics I think are really a very interesting way that we, we're using some of the emerging technologies and AI machine learning to get closer to the patient and create these real-time feedback loops to impact very traditionally hard to treat um, diseases um, things like mental health disorders and otherwise. So, that was, that was a really exciting point this year as well and we're seeing different pockets, right? Um the, the third thing I would mention that I was really excited about, we a ran a, a big survey this year um, among clinicians, among doctors and said, you know, what has changed this year for you and, and what do you think's going to persist uh in, into the future and the vast majority said at the beginning of the pandemic I'd never, I'd never video chatted with a patient, I wasn't interested in that, I liked having patients in my office and now I'm very comfortable having a very meaningful engagement with patients over the video chat online through tele-medicine and that gets me really excited for people who live in rural areas or people who have mobility challenges and can't get to a doctor’s office and you start thinking about the tremendous democratization of high quality care that, that can enable. So that, that's another really exciting innovation, I think. Not necessarily from a technology standpoint but, from its, from an adoption standpoint. That this whole population of doctors now feels comfortable doing things in a new and different way.
Saviano
Those are great examples and I love all of them. The first uh, connecting the dots and it reminds of that great Steve Jobs quote about how innovation, ‘isn't it really just about connecting the dots sometimes?’ So, here you have great innovation and rights to your technology and vaccine access and, and somebody had the ingenuity to connect the two and, you know, it becomes about accessibility and I think that's, that's perhaps the thread that runs through all of your examples is accessibility. How can we as a society make these great technologies and innovations more accessible? I mean, to some extent that's a business model and those are innovations in how the particular solution can find a new channel to citizens and I think it's often an area of innovation that we explore on the show Garfield, that can be overlooked. That everybody is so focused on products and, innovating around a new product or a service but, in those examples, you know, they're about the conduit and medium as to how do you, how do you transfer value. Garfield, your Public Health work uh, of course has been really focused this past year on the pandemic, the personal tragedies associated with COVID-19 of course have been so horrific, it's also exposed the systemic inequalities across the globe. You have examples of public institutions that are emerging pretty fractured from the pandemic. I'm still curious Garfield, how can we address these inequalities through the lens of innovation?
Garfield
Yeah, it's been heartbreaking hasn't it Jeff to see different parts of the world get hit in such dramatically different ways and it's not just about burden of disease it's about the infrastructure that's, that's available to respond.
Saviano
Yes.
Garfield
Right, right now we're seeing an unparalleled tragedy unfold in India and, and it's just heartbreaking. I think we are seeing the ramifications of under investment in Public Health infrastructure. We're seeing the need for I think better rapid response systems and I think we're seeing the absolute inter-connectivity of countries around the world; you can't treat any health issue in isolation. If, if you do, you're just going to miss the boat and I'm hoping um, that what comes out of this year is a greater recognition of our connectedness, a greater recognition that innovation shouldn't be isolated but something that is most valuable when rapidly deployed and scaled across borders and I think that we have to be very careful when we're deploying a solution with an isolationist mindset. Cause it's, it's very counter to actually the best interests of everybody but, certainly ourselves uh, from, from a US perspective. I'm so...proud of the pub, the global Public Health community who has been really loudly banging the drum on, on health equity issues globally from, from the start and those within the US who, who were incredibly persuasive at the Federal level to say wait a minute, look at the disproportionate impact of this disease on our minority populations, on our urban population, on those folks who have co-morbidity's and you saw something that was different than, than any other vaccine roll out we've had in the past which was the Federal Government saying let's focus on those at highest need first. Not just from an age stand point but from a demographic and burden of disease standpoint and that was really a very foundational change and a win for those folks working in health equity and as you saw the vaccines themselves rolling out from the Federal Government to States, they were being prioritized in communities hardest hit by the disease itself. They were being prioritized obviously to the oldest members of the population and that's really critical. We were able to do that in the United States pretty effectively now the challenge is to how do we, how do we globalize that and recognize the tremendous need in the countries around the world for, for our help but also for technology to help themselves?
Saviano
Let me get you on something really important too Garfield and we're we've talked about how do you fix specific programs versus fixing infrastructure and, you know, this programmatic versus infrastructure dynamic. What does that shift from programmatic been? I don't mean this to minimize what a programmatic spins plan may look like but, but what does it mean to shift from programmatic stand to real infrastructure building look like? Is that an important distinction in your mind?
Garfield
Yeah, you're hitting on something, I think that's a really big emerging change in the public policy response. So, we're hearing more and more that funding is not going to go to programs that instead it's going to go to infrastructure and there's this recognition that we can have a program, an initiative, an attempt to solve something specific but, programs depend on ongoing funding. programs depend on continuity, programs are often done in isolation whereas infrastructure and platforms and data connectivity can actually enable a broader set of impact across many targeted outcomes or um, or issues. So, we're hearing both at the Federal level and at the State level an interest to target this next wave of resources to infrastructure versus programs and I think that's really interesting. The pendulum is likely to swing back to some degree when we have invested in infrastructure and then we need to start to target that and really think about what we're solving for next. I, I had a really interesting conversation with some policy makers last week and they were saying, you know, with infectious disease we really were behind the 8 ball and we need to do X, Y and Z and I said yeah, that's absolutely true but after we, we have addressed and solved for the COVID challenge, the bigger challenges are not infectious disease. They're with chronic conditions, they're with managing our elderly, it's with health equity and the interventions needed for that could be quite different and, might require some program level response in addition to some infrastructure to support it. So, it's going to be a challenge to see how, how we best move forward on both fronts.
Saviano
And very different isn't it, as we're both um, we're both here in the US. It certainly feels like we have been somewhat under-invested let's say in certain aspects of infrastructure and we were doing some research Garfield, getting ready for today and we were reviewing the America's Jobs Plan and this was just recently released. There's a March 31st statement on the White House website that summarizes the America's Jobs Plan and there's a significant Public Health component. There's new spend to fix systemic problems, here at home, across the country. As a tax guy, we're very focused on the tax changes to pay for all this and you must see many of these proposed initiatives as just so critically important for Public Health. Just to flip through the summary there's a focus on clean water, enhancing VA hospitals, providing relief to home care workers. How do you feel about the Public Health aspects of some of the proposed changes from the new Biden administration?
Garfield
It’s really a dream for a lot of us who've been in Public Health for a while and try to raise the flag of attended to many of these issues. I think one of the most stunning inclusions in the, in the Jobs Act from a Public Health perspective is the recognition of the care giver as an essential part of American Infrastructure and this concept of unpaid workers, predominantly women, taking care of our elderly, our infirm, our children and it's this huge part of our economy that's been marginalized for so long, completely under-funded and also carries a disproportionate, not only burden of work but of disease. Care givers have terrible health, health outcomes, interestingly enough and so this concept of how do we actually create more strength in this care giving community and how will that um, have a positive cascade effect to the, to the rest of the economy? I certainly think is a great idea and I think probably a lot of my Public Health colleagues would agree so I think that's exciting. I think this concept of really thinking through what the true determinance of health are. Things like clean water, things like getting rid of lead pipes um, really, really, really important stuff that I think we as Americans will be very proud of if instituted. The challenge I, I fear as, as with everything in our country right now is so many of these issues shouldn't be political, right? Clean water isn't a political issue. Uh, care giving isn't a political issue but, as soon as we put something in a Bill out of Washington, we get two sides opposed and, and pro and, you know, I'm just hopeful that we can take some of these really good foundational ideas that are really good for everybody and shouldn't be controversial and maybe take, take them out of the um the, the heated partisan discussions, we'll obviously have to see.
Saviano
I think that's well said that, if there is certainly issues like taking lead out of drinking, drinking water and fixing the antiquated pipe system should be apolitical, shouldn't it and, and I'm reading from the White House summary that I mentioned. Uh, it says "the past year has led to job losses and threatened economic security eroding more than 30 years of progress in women's labor force participation. It has unmasked the fragility of our care giving infrastructure" and I think that really hits the point Garfield, that you made doesn't it that, that has been perhaps uh, it's been an under-invested area in this country so you must have been quite pleased to see that included in the Bill?
Garfield
Yeah, absolutely. It's under-invested and it creates a whole part of our society that's over-burdened and it is predominantly supported by women in our communities. So, this concept of a second shift or even a third shift of caring for families and mostly elderly, sick children. This is not, this is not a universal burden that everyone feels, this is a predominantly female shoulder challenge in our society so I was, I was excited on two fronts. There's a Public Health dimension that the care giver equation starts to address that there's also a gender equity issue around pay equity, around the burden of, there's an issue around pay equity, there's an issue around the burden of work and there's an issue about how we get women better represented in our economy and in properly paying jobs that are recognized and appreciated um, by all.
Saviano
Garfield, on a related note, as a result of the pandemic, we're seeing more and more organizations realize that they have bigger roles to play in Public Health than perhaps they previously thought they did. We talked a bit earlier about some of the new employer wellness programs that we're seeing. A collaborative effort really seems to be needed to tackle these big problems. We had one of our friends of Better Innovation, Dante Disparte who I know that you've met. Um, he calls these collaborations uncommon coalitions and I love he phrases that. How do you think industry and government can more effectively collab, How do you think industry and government can more effectively collaborate in this re-emergence?
Garfield
That's a great question Jeff. I'm a Behavioral Economist by training and I'm a big believer in incentives. I, I don't think big change happens when people are motivated purely by altruism so, I think what you need to do is figure out what the incentive for each of the stake holder groups are, government, private sector, health care sector and figure out where the alignment is and when we identify.
Saviano
It can only go so far, right? It only goes so that, I think you, you're, I just want to make sure we hit on it. It only goes so far there's, and we've seen, there's been so much great philanthropy in the world this, this past year but, what you're talking about as Behavioral Economist is the incentives necessary for society and for communities in the response, is that right?
Garfield
Uh, that's absolutely right and so the incentive can be specific to a company's bottom line, it can be a societal incentive, it can be an individual incentive and I think that's, that's one of our challenges. Is to figure out how to align incentives for these bigger goals um, around health and well-being, around Public Health, around the environment, around the economy and that will drive the type of collaboration you're talking about. I think also those incentives can be proactive and reward the type of collaboration and behaviors we're trying to seek out. So, instead of these point in time ideas, these longitudinal investments that continue to learn and deliver positive impact and, are agile in their approach so they continue to learn and change and deliver and bring more people into that kind of changed community and, and I like your connection to Dante. His work is so striking because I think he's, he's articulated really well, not only this idea of bringing, different constituents together but, how to really activate that in the real world and I like it.
Saviano
And it's, it's not easy, is it and how difficult that is Garfield for policy makers to, to understand the levers that they can pull, the buttons to push that, that let's just look at from uh, the business community and industry. What, what are some things that policy makers can do and actions that they can take to incentivize the business community and industry uh, to push initiatives that actually benefit the health of our communities? Are there some, some things that you have seen in your travels Garfield that has been effective for policy makers in this space, what really focused on the incentive mechanisms? What's working in the world?
Garfield
Yeah well, it's interesting. In the past year what's worked is in this emergency environment, people have just been able to act without all the red tape. It's been really interesting the speed with which, not only the private sector has been able to go but, governments and I think we can learn from that and we have to, I think carry some of that agility forward. On the. On the more traditional front, you know, once things go back to "normal", I think we, we have to look at our behavior change research and, and recognize that, that change isn't something that happens once, it's something that happens over time and you have to continually reinforce the type of behaviors you want. So, when I think about incentives, I think about long term positive nudges that really drive either individuals or communities um, populations, corporations in the right direction and, and you as a tax guy, we know how taxes could be a very powerful um, form of incentives but, but there are other ones as well, I think coming together as, as, as a policy community, really identifying how to, how to drive those uh, is important and then in the private sector side there's an enormous toolbox of, of incentives that can, that can be leveraged. We don't often think about that in a collaborative format, we think about it in a business specific, what am I going to do to sell my products? What am I going to do to accelerate the development of my product etc., but there's power in thinking about incentives across different stakeholder groups and, and I think more, more work needs to be done there?
Saviano
I love how as a Behavioral Economist you snuck in the key word the "nudge" and how important the concept of the "nudge" is. What's a nudge?
Garfield
So, I love to eat ice-cream. So, every night I wander over to my freezer and I think about having ice-cream but if, if there's something on my phone that says hey, don't forget health and wellness is important, it's a positive nudge, right? It might make [INTERRUPTION] me take a left turn towards the fruit instead of a right turn towards the freezer. So, nudges are ways to, to intervene and reinforce positive behaviors in small ways but ongoing, right? Not a, not a single point in time but continuing to positively influence people at the point of that decision.
Saviano
And the role of a nudge is an innovation. I love this, I love this topic because we're seeing such a cross-over to artificial intelligence system that we've seen governments using AI systems to determine the right communication to the right target of the community in order to "nudge" them to achieve the desired outcomes and, in the old world the government may issue a blank form letter to millions of people that may have some effect but, there are now AI systems that are informing policy makers to nudge people differently based on those outcomes. I just think it's such a fascinating area of the opportunity to leverage behavioral uh, behavioral science and the concept of the nudge and incentives in order to, to assist policy makers because these, at the end of the day, these are tools that policy makers have today because of the advent of these technologies that they didn't have them even five or six years ago, did they?
Garfield
Yeah it, it's so true. I think when you think about the nudge I, I often think about my, my Jewish mother and there's a real fine line between the nudge and the [noodge]. So, the nudge is a helpful, don't forget to do something. The [noodge] is have you done it, you know and so we always laugh um, about, you know, the [noodge] can be the, the call three or four times, have you written you thank you note, have you written you thank you note? The end outcome is you write the thank you note. The nudge is a nice reminder on your calendar and you feel better about it. So, the, the, the technology coming into play trying to leverage some of these, some of the research. The research suggests a nudge is important. The, the nuance, the art between the science is going to be making sure the nudge doesn't turn into a (noodge).
Saviano
Um, I like how you said that and we're seeing technology and new systems advance uh, so fast and it's been exciting for us to see policy makers. We, we had a, a session with the uh, Australia um, a particular government agency in Australia about a year and a half ago and, and learned how they were using AI systems to, to target in a very very sophisticated way. Communications with citizens and, you know, they were claiming that, that the results were overwhelmingly positive and, and not surprising, right? When you compare it to the old method of having a universal, right? Uh, everybody's different, people are affected differently and they, they need to be incentivized differently.
Garfield
Uh huh.
Saviano
Okay Garfield, we've had such great conversations about some organizations in the world that we've seen, have been incredibly effective this past. We talked about one, right? We got a good discussion about PathCheck but, another organization that uh, we've had good discussion about is GAVI, the Global Vaccine Alliance and I've been so impressed with not just the particular outcomes around the great outcomes that they've achieved around vaccinations but also the governance model. It's been a new, I think a fresh way to lead this necessary collaboration across many stakeholders, many actors in this big play that we're in. What's impressed you about GAVI just as an example of an organization that has played an important role in the pandemic?
Garfield
Yeah. GAVI is a tremendous example of a global organization that understands the nuance between a, a big idea and actually executing it on the ground and they have this wonderful, connected team that goes all the way from access to innovations, to funding, to the teams that are needed to bring them into the local uh, settings. All the way down to getting shots in arms in very rural hard-to-reach areas and this is not new. GAVI has been solving this problem for, for decades and what they've learned over time is the necessity of connecting very large powerful multi-national stake holders with the people on the ground the, the local trusted resources in communities and I think that extremely big down to the micro-targeted community based approaches is, is a real powerful thing about them.
Saviano
So, keep going with that Garfield. In what role for example, do you think wealthy nations can and should play in helping the world to re-emerge stronger and more prepared for some of these future Public Health shocks and, and I think you can talk about the concept of GAVI which has been interesting, the inter-play of the wealthy nations and uh, perhaps dis-advantaged nations that need support but, I'm just so interested in your thoughts on the specific role that you think the wealthy nations should be playing?
Garfield
Wealthy nations are going to play an increasingly important role in the innovations that we develop, not only for use in some of the advanced economies but those that are going to have transformational impacts in the less developed communities and this democratization of technology, innovation um is, is so, so critical. So, let's take an example from this year uh the, the MRNA vaccines. Developed faster than we've ever developed a vaccine. Not by a little bit by, by a tremendous amount and that technology is going to be a foundation, not just for the COVID vaccines but going to be leveraged to solve really critical infectious disease that are endemic to other parts of the world, in Africa, South America and otherwise. So, when we think about the promise of that technology, yes, born in the developed world um the, the massive impact is much broader than that and that's just but one example. I think the infrastructure we have here in terms of just massive computing and analytical weight. The ability for big countries to leverage our technology infrastructure, the data and analytic tools within that, to not only consider big problems but then to deploy solutions in those areas, across the world that most, that most need is going to be significant and that's where I think that these large economies, more...better funded economies are going to have a huge influence moving forward as hopefully innovation, incubators that can then be deployed to areas around the world and most need.
Saviano
Such an excellent point Garfield to anchor on as we come to a close today. Tell us something about the future that you're really excited about.
Garfield
I'm hopeful that in the future we are going to have a more equitable access to some of the innovations that make people's lives better on a day to day basis. I, I am a big believer that technology can improve the health and well-being of populations as well as individuals and your health status is such a fundamental driver of happiness on a day to day basis and, and, and that's my great hope and, and, and so, why have I gone into healthcare and Public Health is because it's, it's part of the happiness equation for, for billions of people around the globe and I think we are sitting on the precipice of this transformational moment where we're focused on health equity, we're focused on leveraging technology to improve health and we have a real shot at making a difference in millions of people’s lives so I'm, I'm hopeful Jeff.
Saviano
Oh, that is so well said Garfield and uh, I've really enjoyed this conversation today and it's been so much fun talking to you about these issues and, and it's so interesting because you and I have actually uh, never met live. You're in this group of people in my life who I've met virtually this past year and I can't wait to go on a world tour to actually meet all these new friends and here we are, we are right in the Boston area. So, thank you for, for taking some time with our Better Innovation audience today. We always end the show with some rapid fire questions, quick questions and quick answers as if this hasn't been fun enough Garfield. This is the, uh, this this the loads of fun uh, part of the show. Are you ready for it?
Garfield
I'm ready.
Saviano
Alright, here we go. What book do you have on your night stand or, I can, I can modify that a bit if um, uh, if this is easier. What books have you gifted most to others, either way uh, you want to answer to that, is okay with me.
Garfield
Uh, the book on my night stand right now is Alice Hoffman’s Magic Lessons.
Saviano
Uh, okay, okay. What's that about?
Garfield
It's about three generations of witches from Salem and their uh, kind of integration into the lives of modern society and, and kind of how as powerful women they're accepted and rejected all at the same time.
Saviano
Oh, that is so fascinating. I have picked and I get this uh, I get this from my mother uh, because I grew up in what used to be called Old Salem Village where actually all of the witch trials took place. As a kid I've got memories of these archaeological digs coming into my home town of Denver that used to be part of Salem and so it's been uh, a big part of our history and uh, half of my family is from Salem so it's um, it's such a, it is such an interesting part of our nation’s history isn't it?
Garfield
Yeah, I'll have to send you these books. They're um, they're, they're kind of fun.
Saviano
Oh, that's really good, love it. Okay, great Garfield. Uh, tell us about a historical figure that you most admire.
Garfield
A historical figure, I think maybe Michelangelo just for the sheer volume and variety of bringing together kind of art and science and, and creativity. I can't imagine doing as much in a life as, as he did so, that maybe one example.
Saviano
Oh, I like that and the pressure that he was under from some lets’ say highly influential people who were uh, commissioning him for his work. Yeah, I love it. Okay, last question Garfield, you're doing great. What do you see as our greatest opportunity to build back stronger as we emerge from this pandemic?
Garfield
Uh let's, let's get some of these investments and infrastructure done. I like the idea of fixing what is broken so we can have a better foundation to build the future on top of.
Saviano
What a great way to close and it's uh, it is an important as we are recording today just at the very, very end of April heading into May and so we're all very hopeful that we're going to see this infrastructure moving forward. Garfield, thank you so much. Really enjoyed our conversation, appreciate you coming into our virtual studio today.
