April 15, 2025 • 47 mins
Ever thought about how a quick cataract surgery or a new pair of glasses might change not just someone's life, but an entire community's future? We're diving into that idea today, exploring how the economics of eye health can drive significant changes globally. Our guest, Jack Hennessey, brings over a decade of experience in health economics, tackling big challenges and shaping policies that impact eye health across various regions. He shares some eye-opening insights about how accessible eye care isn’t just about health—it’s a key driver of economic growth and personal independence. We’ll discuss real-world impacts, from how a simple eye exam can unlock opportunities to the broader economic benefits that come from improving vision health in communities.
Check out the shownotes for now!
Takeaways:
- Quick cataract surgery or new glasses can transform not just an individual’s life but the entire community's future.
- Improved vision can unlock opportunities for work, learning, and social connections, driving economic growth.
- Making eye care accessible is crucial for development and lifting communities out of hardship.
- Jack Hennessey's insights reveal how small health interventions in eye care yield significant societal benefits.
- Healthcare economics plays a vital role in ensuring that eye health services are accessible to all, regardless of income.
- Investing in eye health not only improves individual lives but also boosts national economies significantly.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Ever thought about how a quickcataract surgery or a new pair of
glasses might change not justsomeone's life, but an entire community's
future?
Imagine being in a world wheresomething as small as improved vision
unlocks work, learning andsocial connection, sparking economic
(00:23):
growth and personal independence.
Today we're diving into thatidea, exploring how the economics
of healthcare, especially eyehealth, can spark big changes globally.
Our guest today, JackHennessey, is a veteran in this field
with over 10 years ofexperience tackling big challenges
(00:44):
in health economics.
He's not only shaped policiesin Australia, but also steered eye
health projects across SouthAsia, Africa and the Pacific.
Jack's work shows us thatmaking eye care accessible isn't
just a health win.
It's a key to drivingdevelopment and lifting communities
(01:05):
out of hardship.
In this episode, we chat aboutthe real world impact of affordable
eye care.
How can a simple eye exam ortimely cataract surgery bring new
opportunities to individualsand economies alike?
Jack will share insights fromhis hands on work, demystifying how
(01:26):
small interventions in eyehealth can lead to significant, significant
benefits far beyond the clinic.
My name is Hetul Daman andyou're listening to the Global Health
Pursuit.
You've spent your last decadein the world of health economics.
(01:47):
I think that for our audience,what, in your own terms is health
economics?
Yeah, good question.
Economics is generally likethe study of how resources are allocated.
Essentially there's scarceresources in the world and economists
want to study how to optimizetheir allocation.
So when it comes to economics,obviously people think about money
(02:10):
straight away just because ithappens to be like sort of one of
the most important and scarceresources in the world.
But sort of more and morelately, economists have branched
out into other types of fields.
So things like healtheconomics, development economics,
environmental economics,because these are all sort of resources
that are scarce.
And we sort of study as healtheconomists, I guess, as a sort of
(02:32):
sub discipline of economics,how scarce resources such as health
services, such as money forhealth services, etc.
How they could be sort of, Iguess, optimally distributed.
Really for me, healtheconomics is really the study at
the moment or finding ways ofachieving universal health coverage.
So that's kind of the ideathat, you know, there should be healthcare
(02:54):
accessible for everyone, right?
And it shouldn't be thathealthcare is free for everyone.
Maybe if you have a bit moremoney, there are ways that mechanisms,
financing mechanisms thatcould allow you to pay for health
services.
But if you don't have as muchmoney, that for sure shouldn't mean
that you can't access thesehealth services.
So I guess as a whole, healtheconomics is about how we enable
(03:17):
universal health coverage andhow we enable everyone to access
services for health, no matterif they're rich or they don't have
as much money.
That's kind of how I woulddescribe it.
Give me an example of howhealth economics actually impacts
people.
An example is, say there's acountry where there's only 10 ophthalmologists
(03:37):
doing.
Doing cataract surgeries, right?
But if we just let things go,I guess as a free market, maybe,
maybe naturally we'd probablyfind that the only people that get
these types of services arepeople that have lots and lots of
money and they can afford topay these services and maybe skip
the line.
But what we want to do is, ashealthc economists, is make sure
(04:01):
that everyone can get these services.
And it doesn't matter if youhave lots of money or a little bit
of money.
We want to find ways to eitherif it's setting up sort of government
systems, whether it's throughtaxation or whether it's through
foundations like the FredHollows foundation, or through other
sort of financing mechanisms,set up innovative ways to increase
(04:24):
access to these services foreveryone, no matter how much money
you have.
So you help people accesshealthcare services no matter how
much money they have.
And in a previous conversationthat we had, you said that you actually
worked for the bad guys inthis realm, right?
Yeah, I think.
I'm not sure if I should everdescribe anyone I've worked for as
(04:45):
the bad guys, quote, unquote.
But, you know, so I think so,certainly more often than not, people
are trying to do the right thing.
I think economists sometimesget a little bit of a bad rap because,
you know, a lot of the timewhat we're doing is modeling costs
and benefits associated with aprogram that, that we might want
people to invest in.
(05:05):
And if it's for a private firmor if it's for a government with
a certain political agenda,often there's a bit of pressure to,
I guess, skew, skew theresults in certain ways.
And so we see this all thetime, right, with sort of any health
intervention, any biginfrastructure project, you know,
if they want a new.
If they want to build a newfootball stadium in Kansas City,
(05:25):
right?
They say the return oninvestment for the economy is going
to be, you know, $300 billion.
People do it the same withhealthcare, right?
So if there's a pharmaceuticalcompany that's really pushing for
FDA approval or Medicareapproval in Australia, there's these
cost effectiveness studies orreturn on investment studies that
say, hey, yeah, this is agreat investment, it's a great investment.
(05:46):
So that's when I was kind offraming individuals that there's
bad guys.
And it's certainly not thecase, but I guess with what I would
call the good guys at the FredHollows foundation, where I've been
for about five years now, it'scertainly not the case there because
we kind of have these verystringent approaches to cost effectiveness.
(06:06):
And there's a book by PeterSinger called the life you can save
and this philosopher, but heessentially talks about this sort
of concept.
You know, there's, there'sbasically every intervention gets
shown as being pretty costeffective or having a good return
on investment.
There's, there's not too manyeconomists who are doing these things
and saying, hey, you know,that's a, that's a really bad idea.
(06:26):
But there is when you followquite a scientific approach and you
know, I'm pretty privileged towork at the foundation where they,
they take that relativelyscientific approach to things.
And I'm not having to go outthere and justify interventions that
I know might not be best forthe population.
And the fact is that, youknow, it's, I always say it's like
kind of like a dream job forhealth economists working in eye
(06:49):
health because we havecataract surgery and refractive air
treatment for glasses are twoof the most cost effective interventions
on the planet.
So I'm not out there trying toprove the cost effectiveness that's
been done.
That's like a fact of science already.
I'm out there working withgovernments to see how we can get
these services to the peoplewho are most vulnerable.
I guess that's the sort ofdichotomy of maybe bad and good in
(07:10):
that respect.
Explain to me a little bitwhat cost effectiveness is and why
this pertains to eye health.
I think people throw it arounda lot.
It's got kind of like atechnical term which is like the
cost per health outcome inhealth economics is, is what you
look at.
So if you're talking aboutcost effectiveness of something,
(07:31):
it might be the cost pernumber of glasses distributed, the
cost per cataract, surgery, etc.
But the way to say somethingis cost effective compared to other
health interventions, etcetera, is to sort of standardize
this approach.
So health economists use athing called usually quality adjusted
life years.
(07:51):
It's essentially saying like aparticular health intervention, whether
it's, you know, cancer, a typeof cancer treatment, or whether it's
cataract surgery, this mightresult in X number of additional
life years live, so it mightenable you to live longer.
But what quality adjusted lifeyears do is they take into account
(08:12):
the quality of life livedduring those years.
So essentially we look athealth interventions as we judge
cost effectiveness by thedollar per qaly added.
So for instance, if you get ahealth treatment, say, say you get
some type of surgery and itenables you to stay alive longer,
(08:33):
but you extremely cognitively,like, you know, reduce cognitive
abilities and stuff like that,we can't just say, hey, it's the
same as living another fivelife years.
We might equate that to liketwo quality adjusted life years or
something like that.
And so that's what we talkabout when we talk about sort of
cost effectiveness from atechnical point of view.
(08:53):
It kind of allows us to assessand standardize and prioritize health
interventions based on a ratioof cost to qualities added.
That makes a lot of sensebecause I feel like with eye health
you can just throw on a pairof glasses or do a quick cataract
surgery and then you're ableto see and you're able to work and
(09:15):
all of that, right?
So your quality of life is wayhigher than say you have cancer and
you have to go throughchemotherapy and that chemotherapy
has a lot of different side effects.
Yeah, absolutely.
I think the main thing aboutwhy cataract surgery and refractive
air treatments areconsistently like top 10 in the world
(09:37):
amongst immunizations, etcetera, as being the most cost effective
interventions is becausecataract surgery, right, you do it
with minimal equipment, you doit in like eight minutes and someone
goes from bilaterally blind,like literally potentially hasn't
been able to see for 10 years,a decade or whatever, and suddenly
they can see again.
(09:57):
So the cost of this surgery isreally, really low.
But that effectiveness interms of the quality of life impact,
ability to hang out with yourfriends, look after your children,
you know, go back to work, iswhat a lot of governments care about
these days.
That's, that's why it's so, socost effective.
So it's not just because it'slow cost.
It's like a low cost plus it'sone of the most effective changes
(10:19):
that you see so quickly.
Some of the work that you doright now with the Fred Hollows foundation
is kind of negotiating withthe government and different public
health entities to fund eyehealth treatments.
Why is it, why is that such adifficult thing to do?
(10:39):
Like, why is that such ahurdle when like, like what you just
said?
You know, it's Just an eightminute procedure or you can throw
on some glasses.
Why is that so almost likedeprioritized in governments?
Yeah, that's a, it's a, it's agreat question.
And I guess like that is the,the, the challenge and the privilege
(11:02):
of being a health economist atthe Fred Hollis foundation.
Because you know, if youlooked back 100 years ago, right,
and you, and you say, hey,like someone who's completely, you
know, bilaterally blind, wesay in eight minutes you can see
again.
Like we would all be likecelebrating in the streets and be
like, we've got it, we've gotthe cure.
Like, that's awesome.
Like there's no reason really.
(11:22):
Like, you know, polio vaccinecame in the 50s or whatever, in 10
years, polio is essentially eradicated.
Like it's, this is the greatchallenge of what we do.
And my role is why isn't this prioritized?
So there's, there's a coupleof reasons, I guess.
In, in more resource heavysettings, in more developed countries,
sort of like Australia and theUS we have really stringent ways
(11:45):
that, that healthinterventions are prioritized for
public funding.
So in Australia, for instance,we've got Medicare and so this is
publicly funded health services.
So for anything to be fundedthrough that, essentially you have
to have quite a rigorous costeffectiveness study to be done.
And for instance, things likecataract, et cetera, they pass these
(12:07):
rigorous cost effectivenesstests and often they are publicly
funded.
So it's, it's, it's not asmuch of an issue in, in these countries,
but in low resource settings,especially countries with sort of
fledgling health financingsystems, you know, they don't have
necessarily universal healthcare set up.
They don't have things like,we call it Medicare in Australia,
(12:29):
but it's obviously a differentmeaning in the US but essentially
publicly funded health systemsfor people who need it.
And so a lot of theseresource, I guess, constrained settings,
they don't have huge teams of,you know, Ministry of Health health
economists who are doing allthese sort of studies and prioritizing
interventions.
And in fact that's where mostof our work is done.
(12:53):
So we'll work with governmentsand we'll say, hey, you know, what
do you need to, we'll show youthis intervention, we show you cataract
surgery, we show yourefractive error, we show you our
ability to scale servicedelivery throughout these countries
and treat large proportions ofthe population really, really cheaply.
We say, do you need a costeffectiveness study?
Do you need more evidence?
Like what's what's the thingstopping you from funding this?
(13:17):
And it might just be lack ofresources where we end up cost sharing
with them for a little bit.
There's, there's so manydifferent things, things that we
do to, to sort of advocatefor, for eye health to be prioritized.
One thing I'll just touch onand something.
One of like my big researchprojects is at the moment when I
was talking about thosequality adjusted life years, which
(13:38):
again, like the, a sillytechnical term, but something very
similar called a disabilityadjusted life.
Here it's kind of just the opposite.
So quality adjusted life yearswe want to add through an intervention,
disability adjusted lifeyears, we, we want to like, save.
So they're kind of like a bad thing.
So what happens is theInstitute of Health Metrics and Evaluation,
(14:01):
based in Seattle, they publishthese things called the Global Burden
of Disease Disability weights.
And essentially it weightslike all different qualities of life
between zero, which is like,like essentially full health, and,
and one, which is, which isdeath in this.
You know, it seems reallyarbitrary to do that, but it rates
(14:23):
this on this scale.
And so blindness, forinstance, used to be rated up at
like 0.6.
So that was sayingessentially, you know, again, very
arbitrary, but saying, youknow, being bilaterally blind is,
you know, you're 0.6 and, and1 is death.
It's really, really bad onyour quality of life.
(14:44):
But these got reviewed like 10years ago and that they assess these
in a number of different waysand that dropped right down to, I
think it's at 0.19 now.
So 0.2.
So essentially they're saying,you know, it's really not that bad
at all.
I think, you know, compared toother things like skin conditions
and like, you know, mildalcoholism is like higher than really
(15:08):
blindness, mild alcoholism,0.26, rheumatoid arthritis, 0.29.
So we are essentiallyundertaking a big sort of systematic
review to delve into like, themethods that we use to calculate
these weights.
And they do them in a bunch ofdifferent ways.
But this is, this is one of mymain projects this year, is working
with London School of Hygieneand Tropical Medicine to really challenge
(15:33):
why this happened, what'sgoing on.
Because to say that bilateralblindness is a 0.19, when a moderate
skin disfigurement with anitch or the pain, or a pain is 0.19
as well.
There's.
There's something going wrong.
So, so yeah, so this is when Iwas talking about how governments
use cost effectivenessanalysis to prioritize interventions
(15:54):
that cost effectivenessanalysis inherently has to use these
weights.
So that's why, despite so muchresearch showing that these are these
incredible cost effectiveinterventions, when they actually
take it to trial and they tryand prove this to a government, often
they'll come out aspotentially less cost effective when
they're using thesestandardized disability weights as
(16:15):
the metric.
Tell me if I'm wrong, but oneof these metrics is mortality as
well.
Does it cause death?
So, yeah, exactly.
That's the, the crux of it.
So those, those metrics don'tgo into the, the weight calculation
but for the quality or thedaily calculation for sure.
And that's again why when wewere talking about cancer treatments
(16:35):
before, obviously like a yearof extra life is weighted the most
like for, for, for everyone.
That's, that's the goal,right, to, for everyone working in
health economics, the goal isto, to live another year longer.
Right.
And so when it comes to eyehealth, there's a fair bit of evidence
showing that, you know, poorvision is related to increase of
(16:59):
risk of falls in, in olderpeople and this might contribute
to mortality, but essentiallythere's no mortality involved in
that calculation of thatdisability weight.
When you compare to thingslike, as we said before, cancer treatments,
where, you know, thesetreatments, although they might be
really expensive, they havethe potential to avoid mortality.
(17:20):
So that's, again, you're spot on.
That's the reason why perhapssome governments don't necessarily
prioritize these eye health interventions.
I think my question is why?
How did it reduce so much from0.6 to 0.2?
That's like a huge drop.
It's enormous.
There's been a number ofpeople in this sector that have sort
(17:40):
of challenged this over time.
Hugh Taylor, who's aresearcher at University of Melbourne
and great friend of thefoundation, has been pretty vocal
about challenging this.
And I think, you know, we'resort of taking that next step now,
trying to produce somerigorous evidence and really articulate
why it has been done.
These studies have arelatively consistent approach, but
(18:01):
estimating those weights can,can take a number of different, I
guess, experimental processes.
So there's things like healthstate preference surveys where they
go out to, you know, 10,000people in certain regions and they
say, would you rather livewith, you know, a range of comorbidities
of a health state or would yourather this health state?
(18:23):
And so within those that mighthave like poor vision, it's like,
would you.
Rather be blind or deaf?
Literally?
Quite literally, yeah.
Yeah.
So would you rather be, wouldyou rather be blind or Would you
rather have a limb amputationand things like this?
Right.
And they, it's, it's not as,it's not as coarse as that, but that's,
that's essentially how they do it.
Health state preference surveys.
So the methods of those canrange from, you know, smaller sample
(18:46):
sizes in discrete regions thatactually go up to this, you know,
this, this disability waythat's influencing health service
priority for literallybillions of people worldwide.
And some of these methodsaren't necessarily as robust as others.
That's insane behavior, I feellike, to do that.
I mean, like, it's becauselike, obviously.
(19:09):
I would say I don't want mylimb amputated, you know, so.
Yeah, yeah, yeah.
But I don't, yeah, I don'twant to be bilaterally blind either.
Like, can, can I havesomething else?
It's, it's, yeah, it's, it'sfraught with, it's fraught with measurement
error and it's a really hard thing.
Right, because clearly peoplearen't going to have those sort of
preferences.
That's why a lot of people aredoing importance on like outcome
(19:31):
related quality of life.
Right.
So would you rather be ableto, like not saying like about a
health state specifically, butyou know, would you rather be able
to.
How much do you value beingable to play outside with your children,
for instance?
And these types of sort ofoutcome based quality of life type
surveys are getting used moreand more.
And I think that's, that's,you know, we're only about a quarter
(19:53):
of the way through this study,but that's probably likely a method
that we're going to sort ofpush for including in disability
weights associated with eyehealth as well.
Also about how they, they askthe question, you know, would you
rather this one, would youwant to do this, et cetera, all that
can influence how these are measured.
And again these, these weightsare just used by, by governments
(20:15):
and decision makers all overthe world.
And sometimes, yeah, we thinkthey're very wrong.
That's so interesting.
I wonder, and I'm sure thishas been done, but I wonder if there's
been a study where they justfollow, you know, people who are
bilaterally blind and juststudy the way that they live.
(20:36):
Right.
And then do a study on that.
But it's just like that's, Ifeel like that's so much harder than
just asking the question.
It's, it's hard because like,I'm certainly not trying to knock
what the Global Burden ofDisease team have done because you're
estimating one Disabilityweight for the world.
(20:57):
Right.
And so being bilaterally blindin Australia, in living in Melbourne
is very different on myquality of life.
If I'm bilaterally blindliving in rural Cambodia, for instance.
And so there's, it's, it'svery hard to sort of standardize
these measures.
We've done lots of research onthe impact of eye health on quality
(21:20):
of life and obviously likeyou're saying, you know, these, when
we sort of follow people preand post cataract surgery or pre
and post refractive areatreatment, the benefits aren't limited
to just being able to see.
Right.
You know, it's all the socialinteractions that they can have.
They can return to work, theycan increase productivity, et cetera.
You know, all these benefitswe know, but measuring it on that
small scale in sort of moreprimary data collection research
(21:43):
studies with smallerpopulations, we always see the benefits.
But it's when you're trying tosort of aggregate these at a global
level, I think is where we runinto difficulties.
Right, that makes a lot of sense.
I think that, I think my nextquestion is really just all about
like investing in eye health.
Right.
As a health economist, why andhow would investing in eye health
(22:06):
actually boost the economy?
So how does, how does actuallyimproving somebody's eye health improve
the economy in terms of money,for sure.
Great, great question again.
I think.
Yeah.
You know, I still have friendswho ask me to like help with their
taxes so bad with that sort of stuff.
So that's what economics doesto you, I get.
But, but you're 100% right.
(22:27):
So kind of before when we weretalking about, you know, how do we
advocate to some, somegovernments about prioritizing eye
health?
Well, one of these methods isshowing that investing in iHealth
can actually impact theirbottom line.
So a lot of, you know, a lotof policymakers, a lot of governments,
maybe they're only in powerfor, you know, one to five years,
sometimes less.
(22:48):
And so they want to keeptheir, they want to manage their
budget and they want to getreturn on investment within their
budget for the intervention.
So this is kind of somethingwe started thinking about over the
last sort of three to four years.
And it's and it's by no meansa new idea, but the fact that after,
you know, so many decades andso many years of having these really
affordable life changingtreatments, why hasn't it been prioritized
(23:13):
by governments?
And is the, is the individualbenefit to someone going from, again,
from having really poor visionto full sight, isn't that enough
to, to get Governments toinvest, you would think.
Clearly it wasn't so.
Yeah, you think so?
So, so, yeah.
We did a study that wereleased about a year ago.
It's called our sort ofInvestment Case for Eye Health.
(23:34):
And, and what we did is weessentially went to sort of 19 countries
where the foundation works andwe did some pretty rigorous costing
around what each of theseinterventions might cost in, in each
country.
So we did it for cataractsurgery and for, and for refractive
error treatment, giving people glasses.
And we essentially collected awhole bunch of data.
(23:56):
So it was based on sort of ahealth systems cost.
So we, so we know that there'sthis, you know, eight minute cheap
surgery that we can do forlike 25 bucks in some places.
25 bucks?
That's like a, that's a reallysignificant number.
Yes, yeah, yeah.
For the direct medical cost,for sure.
But when we did this study, wetook a more sort of, I guess, holistic
(24:17):
approach to sort of healthsystem development.
So we were talking about, youknow, trying to factor in all the
things like, you know,surgical outcome monitoring, management
and monitoring and evaluation,case finding exercises within the
community to get like areally, I guess, real picture of,
hey, in donors, governments, etc.
If you actually want to fundthis, like, this is what it's, this
(24:37):
is what it's going to cost.
And we compared that to theestimated benefit in terms of three
sort of benefit pathways, I guess.
So.
The first was increasedreturns on investment for education.
So often children, if they'rein school in Southeast Asia and South
Asia as a whole, there's areal sort of epidemic of myopia,
(24:58):
which is what I have when youcan't see things far away that well.
And essentially there's lotsand lots of evidence saying that
children are not getting theright education.
And in fact, a lot of them aredropping out of school and entering
the workforce, et cetera,because they're experiencing these
learning difficulties whichcan manifest as, you know, it's,
it's not easy for a child tobe able to, you know, see the chalkboard,
(25:21):
say, oh, it's because I can'tsee the blackboard.
Yeah, that's, that's why I'm,that's why I'm messing up at school,
et cetera.
So that's one of the benefitpathways we modeled.
The second was an increase inlabor force participation.
So this is people often with,with more severe levels of visual
impairment who, you know,economists talk about the labor force
and essentially that's peoplewho are willing and able to work,
(25:43):
but there's a whole bunch ofother people who, for various reasons,
whether it's health conditionsor otherwise, they're not even considering
work.
So you know, I haven't appliedfor a job in 10 years because I'm
blind and I couldn't doanything in the region where I'm
working.
Say I'm in a agriculturalregion in India for instance.
Be very difficult for me toenter the labor force.
And the third was returns oninvestment for people who are already
(26:06):
in the labor force, but theycan increase their productivity while
they're at work.
So there's lots and lots ofresearch on this both for cataract
and refractive error.
If you think of people in, youknow, there's lots of manufacturing
in South Asia and in Africaand a lot of the continents and countries
where we work.
And some of this is, you know,really small tasks.
(26:26):
Some of these people, youknow, sort of 40 to 40 plus years
old and they might getpresbyopia where they can't see things
in front of them so well.
So there's been lots ofstudies in, you know, on tea pickers
in India for instance, thatshowed, you know, giving press biobic
glasses which are, you know,sort of reading glasses essentially
can really improvesignificantly productivity.
(26:47):
And so essentially that's,that's a summary of what, what the
sort of economic benefits welooked at in this study, but we found
with, with cataract surgery inparticular, it was about a 20.5 to
$1 return on investment.
So what we found in theparameters again were 19 countries
where hollows worked.
We said, okay, hypotheticallyif we increased cataract surgery
(27:12):
surgical coverage by 40percentage points and we increased
refractive area coverage by 30percentage points, which are World
Health Organization goals foruntil 2030.
If we did that, the economy inthese individual countries all, all
aggregated up would be anaverage of 20 to 1, which is an enormous
return on investment that'sreturned to the government's bottom
(27:35):
line.
Right?
That's, that's the economiccontribution that would happen as
a result.
And obviously the governmentwould have, you know, income taxes,
et cetera, in formalsituations that is, is returned at
this point.
So it's, it's really sort of ano brainer in investment from that
perspective.
Brad Wong from Saver and heworks at IPB as well, did a, did
a pretty similar model butlooked at India and found even, even
(27:58):
higher returns on investment.
When we looked at things like,you know, even zooming in on places
in our investment case studylooking at Laos for instance, had
an over $50 return oninvestment for refractive error treatment.
So essentially that's saying50 for every $1 that you put in for
(28:18):
refractive error treatment programs.
That's, that's because of thedemographic distribution.
In Laos there's lots and lotsof young people in school.
So we found that a lot more ofthem would, would be likely to stay
in school and have returns oninvestment to education later on.
That's enormous for these lowcost treatments.
And you know, I know it's,it's certainly not a competition
amongst, well unfortunatelysometimes it is a competition amongst
(28:40):
prioritization of eye health interventions.
But you know, things that havebeen modeled in similar studies.
Team we worked at, withVictoria University have written
a number of these types of papers.
World Health Organizationpublishes a lot of investment cases
and they're quite, quite rigorous.
But when we're Talking about a20 to 1 return on investment for
cataract.
Across the countries where weworked similar investment cases,
(29:02):
there's been one that'smodeled treatments for anxiety and
depression that was a 4 to 1return on investment.
Treatments on adolescenthealth and Wellbeing was about a
10 to 1.
And treatments oncardiovascular health, which obviously,
you know, hugely burdensome onthe economy and health around the
world was about 11 to 1 returnon investment as well.
And again that's not sayinglike one is, is better or worse than
(29:27):
the other, but it's just areflection of how cheap these interventions
are.
And kind of what we talkedabout earlier, that, that quality
of life impact and theeconomic return associated with that
is just so massive compared tothese, you know, broader sort of
wraparound treatments that aremore comprehensive.
For instance, cardiovascularhealth isn't just one little intervention.
(29:47):
And when you're measuring likethe return, are you estimating like
somebody's given salary orsomething like that, you know, over
the years and how much theyspend and feel like there's just
so many, so many nuancedthings that you have to estimate
and assume.
And this is my likeengineering brain working right now
because I'm like how would youdo a study like this and how would
(30:10):
you, what, what would be allthe factors that you have to assume
and what would be the controls?
Yeah, for sure.
So, so there's so many, youcan, you know, if anyone interested,
I'm always happy to chat to them.
But we've got the reportonline, our investment case for iHealth.
So, so things like,essentially it was a, it was a model.
So we incorporated a number ofassumptions from specific studies.
(30:32):
For instance, saying that achild who would be given glasses
is more likely to stay inschool for, for one more year.
And there's a number of otherstudies that say that staying in
school and they, and theydisaggregate by country.
Staying in school for an extrayear in this country increases their
potential earning by X amountof dollars.
Right.
And so we essentially bring ina number of these assumptions.
(30:54):
There's similar ones forproductivity improvements in eye
health and labor forceparticipation and where we could
be disaggregated by countryand used, you know, probabilistic
assumptions otherwise andessentially extrapolated that out.
And we had, you know, it was,it was quite a detailed model.
We looked at, you know, yourlifelong productivity curve.
(31:15):
You get sort of moreproductive up to the point where
you're about close to 40.
I'm not quite there yet, if,if my, if my manager's listening.
So it's a good time to investand then, then, then drop off afterwards.
So we incorporated all these,these assumptions within the model
and essentially extrapolatedthat out to a return on the GDP per
(31:35):
per capita per country.
And so that was the quote,unquote, economic return.
It's really, it's, it's alittle bit difficult.
And sometimes I've struggledto grapple with this.
You don't see economists toomuch saying, hey, this is the X percent
return that you're literallygoing to get in your pocket as a,
as a government budget holder.
(31:56):
It's like the equity kind of thing.
Yeah.
Or something like that.
Yeah, yeah.
Because.
Because what economists tryand do is, is bring this sort of
this economic cost togetherand say, because obviously, you know,
even if you're getting Xamount from income tax return, you're
investing in these interventions.
So you have to take out thecosts, you have to take out these
(32:17):
holistic treatments.
And so that's why we used GDPas this sort of proxy for economic
returns, because it's the mostconsistent way for us to estimate
the returns to the economy asa whole.
And GDP per capita is, youknow, if you ask most economists,
saying it's probably the bestindicator for economic wellbeing
and prosperity in a country.
(32:37):
So essentially the argumentextended is that, you know, investing
in eye health can't just.
Won't just help individualsand their families, but will increase
your country's gdp, you'llstart being more productive, you'll
become a larger player on theglobal scene, and eventually you'll
be able to fund theseinterventions yourself without the
need for foundations, etcetera, to step in, which is, which
(33:00):
is the ultimate goal.
You mentioned that there areplaces in the world that are tackling
this in the case of eye healthand you mentioned LV Prasad Eye Institute
and that it's like the goldstandard of eye treatment and it's
in India.
Like why do you think thatthat works so well?
(33:21):
This is, you know, this is, ifyou go to any eye health conference,
it's kind of the questionthat, that people seem to ask every
year.
And the, the LV Prasad modeland, and some other models in India
in particular are based onkind of like this, this almost fundamental
aspect of universal healthcare.
So individuals who can, canafford to pay for, for treatments
(33:44):
will, will pay for them or,and often pay a premium for a premium
service if they, if that'skind of what they're after.
And essentially these models,these, these eye clinics or eye hospitals
cross subsidize those feepaying patients to other individuals
who can't afford.
(34:06):
So they essentially arefunding, you know, paying a premium
for a service knowing thatthey'll both get a, they'll get a
great service, but also someof this will be used to fund those
who can't afford this serviceand truly deserve it.
So that model, in my, youknow, limited experience, I haven't
worked extensively in India,only a little bit.
(34:26):
But from what I've seen, thatsort of model of altruism works especially
well contextually in India.
And I think there's, you know,a number of different factors that,
that might contribute to thatperhaps that notion of altruism and
I guess charitable giving in asense is just more ingrained in some
cultures within or throughout India.
(34:47):
They've tried to replicatethis model and others have tried
to replicate this model in anumber of other countries and it
hasn't worked as successfully.
So that's something we'restill looking at.
You know, it's, it's, it's oneof many financing mechanisms that
we're looking at more and more.
There's things like largeinstitutional donors or large family
foundations, high net worthindividuals, et cetera, who are really
(35:11):
focused on impact investingand outcomes based financing, social
investment schemes, et cetera.
So we're certainly looking ata lot of those as well.
You know, there's things likesocial impact guarantees where a
big high net worth individualor a foundation or someone might
come along and say, hey, youknow, a cataract hospital in, in
(35:32):
Vietnam, we'll pay you Xamount of dollars as long as you
achieve a certain number ofoutputs and a certain amount of quality.
And so a donor might say that,then you have a guarantor who says,
okay, no matter what, ifthere's some months that you don't
achieve that quality, we'llwork with you to improve that, but
also we'll pay the donor backfor you for those things.
(35:55):
So there's all these sort of,I guess innovative financing mechanisms
these days that are beingexplored to sort of de risk the risk
of investing in iHealth forsome of these countries that might
be kind of on the fence aboutprioritizing it.
I just had a thought because,you know, my family's from India
and I, I know that in Indiait's a pay first model, right.
(36:16):
You have to go and you have toshow the money and then you get treated.
Right.
I just wonder why it's sodifferent when it comes to eye health.
You know, in this model.
And yes, in India there is a,there is a sense of altruism, but
then there's also a for likethe very poor, if they break a leg,
(36:40):
then they have to sell theircow and you know, get surgery like
that.
But I just wonder like how it,how could it be translated to like
all of these other conditions.
Right.
Whether it be cancer or trauma.
Yeah, I, I think, and I, and Ithink one of the things is again,
these, these interventions areso quick and low cost, right.
(37:02):
These hospitals, they, theychurn out cataract interventions.
So there's not this point of,you know, it's not a long like trauma
based service and we can'tsort of accurately predict demand
for paying for these things.
You know, they're based onliteral life events, cataract and
refractive error.
You can relatively easilypredict, you know, insulin incidence,
(37:23):
prevalence, etc.
And kind of develop thesebusiness models around treatment,
knowing that you'll get acertain proportion of the population
willing to pay X amount forthese services.
So I think maybe it's comesfrom the sort of the ease of planning
for these interventions andthe ease of setup.
You know, you don't need these gigantic.
(37:44):
Like a CR or anything like that.
Yeah, exactly.
The eye hospitals like that wevisit a lot of the time, you know,
it feels like you're in like aportable or in like a school or something
like that.
They're not necessarily thesegrand sort of white structures that
we're used to associating with hospitals.
So yeah, maybe, maybe that'ssomething to.
It, but it's like a one undonekind of thing.
(38:04):
And then you can just be like,oh, well, you're paying this premium.
But it's not that much forpeople who actually have.
Yeah.
And you'll see the benefitrelatively straight away.
So you work for Fred Hollows Foundation.
I want to go into a little bitto talk about who Fred Hollows is
and the mission behind the foundation.
(38:28):
Sure.
So Fred Hollows was anophthalmologist in Australia.
Foundation's been going, Ithink, for about 32 years now, and
Fred Hollows has passed away.
But obviously we continue his legacy.
And he was sort of apersonification of altruism in some
respects, where he was.
And I think when there arethese health interventions and these
(38:50):
miraculous, literally healthinterventions such as cataract surgery,
there's no reason toprioritize people who are wealthy
versus people who might nothave as much money.
And so I think he's got aquote talking about, you know, doing
a cataract surgery on, youknow, a child or a person in Nepal
is the same as if you weredoing it on the Queen of England.
(39:12):
Very, very Australian thing torelate it to.
But that was that.
That was his whole purpose inlife, the thing that was making cataract
surgery a little bit moreexpensive with these intraocular
lenses.
And it still does, to behonest, in some.
Some regions.
But essentially, when you docataract surgery, you.
You have this clouded lens and you.
And you suck it out or you cutit out and then you put in a new
(39:33):
lens and so.
So you can see again.
It's not opaque anymore.
And these lenses were beingmanufactured by, you know, big pharmaceutical
companies, and they'recharging an arm and a leg for them.
But what sort of Fred did waswent to places like Nepal and Eritrea
and established literally,intraocular lens laboratories or
factories to make these onmass for extremely low cost.
(39:57):
So in that way, he kind ofrevolutionized cataract surgery in
terms of making it way cheaperand way more accessible.
And obviously, he.
He trained a lot ofophthalmologists everywhere, and
we try and continue thatlegacy as well.
For Fred Hollow's foundation,if, if we're talking about our mission,
I think it's pretty simple inthat, you know, we want to see a
(40:17):
world where no one lives withneedlessly or with avoidable blindness
or vision impairment.
A privilege and a challenge ofworking here is that these.
These treatments exist.
Right?
They're cost effective.
And whether it's from, youknow, failures of government resource
allocation or failures frompeople, the amount of training that
(40:38):
people need or prioritizationor equipment or whatever, whatever
is happening in the world, forsome reason, there's still 1.7 million
people who are.
Who are blind.
1.7 billion, sorry, who areblind or visually impaired throughout
the world.
And nine out of ten of thesepeople, they can be treated, right?
That's the crux of everything.
(40:58):
How do we get treatment tothese people?
And that's where I thinkhealth economics is coming in more
and more.
And that's why you see a lotof health economists working for
governments and things like that.
Because we're kind of past thepoint where it's this treatment,
this cost effective treatment exists.
But how do we work together tomake sure people can access this
treatment?
And that's kind of whereHollows has shifted a little bit
(41:20):
lately.
I kind of call it like the oldschool world of development was kind
of like flying in trainedsurgeons from Australia or something
like that, going and doing acamp for two weeks, doing how many
thousand cataract surgeries?
That's, that's awesome.
And that's for sure needed insome contexts.
But what we're moving towardsmore now is looking at, you know,
(41:41):
health system strengthening approaches.
Can we set up optometryschools in Vietnam?
Can we, you know, can we workwith governments on blended financing
mechanisms with guarantors anddonors to fund these things to show
you that it's worthwhile andthen slowly pull away our investment
over a period of five years sothat you keep doing it right?
So we're taking this sort ofhealth system strengthening approach
(42:04):
to development now, which inmy opinion is the way to go.
Because if a country isn'tfunding this themselves, if they're
always relying on externalresources, then how's that ever sustainable?
That's the key word, right?
Sustainability.
How do you make it so thatyou're working with the communities
and the governments to buildtheir, their system?
(42:25):
What do you hope to see inlike the next year when it comes
to eye health?
One year, what do I want tosee is an increased focus on eye
health and the impacts it hasas a development issue.
It appears that just showingthat these enormous improvements
(42:47):
in health, right from someonebeing able to go from sort of bilaterally
blind to be able to see again,that's not enough for people to prioritize
or invest in these things.
So I would like people to seeeye health much more broadly is a
development issue.
For instance, it's eye healthconditions are holding people back
at school is affecting howpeople interact at work.
(43:10):
Eye health is affectingdevelopment of countries, literal
economic development ofcountries as a whole.
And I think when peoplerealize and see it that way and see
how cost effective it is totreat these things, that that's a
point where iHealth will, willsort of be prioritized.
And I know I've talked like alot about economic impacts, about
(43:31):
sort of, you know, formalworkforces and productivity and stuff
like that, but I think, youknow, there's, there's a great quote
from I think Caroline Criado Perez.
I'm not sure if you've readthe book Invisible Women, Data Bias
in a World Designed for Men.
Really, really great book.
And she essentially saysthere's, there's no such thing as
a woman who doesn't work.
(43:51):
There's only such thing as awoman who isn't paid for her work.
And so this is a lot of what'ssort of driven some of the resource
research that we're doing now.
It's that in a lot ofcountries where we're working, these
eye health is not onlyaffecting, you know, formal labor
and you know, labor marketswhere people are working, you know,
(44:12):
an office job or a factory andthings like that.
There's so much unpaid workthat's often, you know, happening
to a woman at home.
And you look at things likemaybe, maybe an example of a woman
who has cataract and her wholejob is to look after her family.
Right.
This is what we would classifyas unpaid work as economists, but
(44:32):
you know, she's, she's doing80 hour weeks or whatever and not
getting paid for it.
And this is kind of themissing link in terms of what we've
looked at eye health in the past.
So we're now starting to lookmuch more into this unpaid work aspect
of research because we knowwe've done two trials now in Burundi
and in India showing that eyehealth has a significant impact on
(44:55):
a person's ability to lookafter a family and to care for their
loved ones.
And often in some extremecases, for instance, say if there's
an elderly woman at home whonormally looks after the family,
cares for others, etc.
Say she has, you know, reallypoor visual health from cataract.
She might need help fromsomeone else in the family to, to,
(45:16):
to do all this unpaid workwhich, which previously, you know,
sort of had gone, you know,unaccounted for because it's not
in this formal, formal work setting.
And you can picture whereyounger individuals of the family,
often the daughter, yeah.
Is the one who has to stayhome from school and look after this
person, look after this unpaidwork that previously isn't, isn't
(45:37):
really quantified.
And you can imagine the sortof intergenerational impacts of that
getting stuck in the povertycycle if you can't get an education
for these individuals.
So yeah, that's, I guess, kindof an example of what we're looking
at in terms of showing thatinterventions are cheap and the benefit
is beyond just the healthimpact of the individual.
(45:57):
The benefit to the family, tothe society, to the country is much
greater than the individual.
So yeah, if people can seethat and understand eye health as
a sort of development issuemore broadly in a year, I'd be happy.
(46:21):
Thanks for listening to this episode.
If you want to learn moreabout the Fred Hollows foundation,
go to Hollows Dot or click thelink in the show notes.
All of the resources will belinked in the show notes.
This episode was hosted,produced, edited and all of the above
by me and huge shout out to mycoach, Anna Xavier of the Podcast
Space, who continues to pushme to create meaningful content in
(46:45):
the field of global health.
If you'd like to support me,you can review the podcast on Spotify
or Apple, or you can click thesupport link in the description.
Your support means the worldto me.
Until next time.
Ever thought about how a quickcataract surgery or a new pair of
glasses might change not justsomeone's life, but an entire community's
future?
Imagine being in a world wheresomething as small as improved vision
unlocks work, learning andsocial connection, sparking economic
(00:23):
growth and personal independence.
Today we're diving into thatidea, exploring how the economics
of healthcare, especially eyehealth, can spark big changes globally.
Our guest today, JackHennessey, is a veteran in this field
with over 10 years ofexperience tackling big challenges
(00:44):
in health economics.
He's not only shaped policiesin Australia, but also steered eye
health projects across SouthAsia, Africa and the Pacific.
Jack's work shows us thatmaking eye care accessible isn't
just a health win.
It's a key to drivingdevelopment and lifting communities
(01:05):
out of hardship.
In this episode, we chat aboutthe real world impact of affordable
eye care.
How can a simple eye exam ortimely cataract surgery bring new
opportunities to individualsand economies alike?
Jack will share insights fromhis hands on work, demystifying how
(01:26):
small interventions in eyehealth can lead to significant, significant
benefits far beyond the clinic.
My name is Hetul Daman andyou're listening to the Global Health
Pursuit.
You've spent your last decadein the world of health economics.
(01:47):
I think that for our audience,what, in your own terms is health
economics?
Yeah, good question.
Economics is generally likethe study of how resources are allocated.
Essentially there's scarceresources in the world and economists
want to study how to optimizetheir allocation.
So when it comes to economics,obviously people think about money
(02:10):
straight away just because ithappens to be like sort of one of
the most important and scarceresources in the world.
But sort of more and morelately, economists have branched
out into other types of fields.
So things like healtheconomics, development economics,
environmental economics,because these are all sort of resources
that are scarce.
And we sort of study as healtheconomists, I guess, as a sort of
(02:32):
sub discipline of economics,how scarce resources such as health
services, such as money forhealth services, etc.
How they could be sort of, Iguess, optimally distributed.
Really for me, healtheconomics is really the study at
the moment or finding ways ofachieving universal health coverage.
So that's kind of the ideathat, you know, there should be healthcare
(02:54):
accessible for everyone, right?
And it shouldn't be thathealthcare is free for everyone.
Maybe if you have a bit moremoney, there are ways that mechanisms,
financing mechanisms thatcould allow you to pay for health
services.
But if you don't have as muchmoney, that for sure shouldn't mean
that you can't access thesehealth services.
So I guess as a whole, healtheconomics is about how we enable
(03:17):
universal health coverage andhow we enable everyone to access
services for health, no matterif they're rich or they don't have
as much money.
That's kind of how I woulddescribe it.
Give me an example of howhealth economics actually impacts
people.
An example is, say there's acountry where there's only 10 ophthalmologists
(03:37):
doing.
Doing cataract surgeries, right?
But if we just let things go,I guess as a free market, maybe,
maybe naturally we'd probablyfind that the only people that get
these types of services arepeople that have lots and lots of
money and they can afford topay these services and maybe skip
the line.
But what we want to do is, ashealthc economists, is make sure
(04:01):
that everyone can get these services.
And it doesn't matter if youhave lots of money or a little bit
of money.
We want to find ways to eitherif it's setting up sort of government
systems, whether it's throughtaxation or whether it's through
foundations like the FredHollows foundation, or through other
sort of financing mechanisms,set up innovative ways to increase
(04:24):
access to these services foreveryone, no matter how much money
you have.
So you help people accesshealthcare services no matter how
much money they have.
And in a previous conversationthat we had, you said that you actually
worked for the bad guys inthis realm, right?
Yeah, I think.
I'm not sure if I should everdescribe anyone I've worked for as
(04:45):
the bad guys, quote, unquote.
But, you know, so I think so,certainly more often than not, people
are trying to do the right thing.
I think economists sometimesget a little bit of a bad rap because,
you know, a lot of the timewhat we're doing is modeling costs
and benefits associated with aprogram that, that we might want
people to invest in.
(05:05):
And if it's for a private firmor if it's for a government with
a certain political agenda,often there's a bit of pressure to,
I guess, skew, skew theresults in certain ways.
And so we see this all thetime, right, with sort of any health
intervention, any biginfrastructure project, you know,
if they want a new.
If they want to build a newfootball stadium in Kansas City,
(05:25):
right?
They say the return oninvestment for the economy is going
to be, you know, $300 billion.
People do it the same withhealthcare, right?
So if there's a pharmaceuticalcompany that's really pushing for
FDA approval or Medicareapproval in Australia, there's these
cost effectiveness studies orreturn on investment studies that
say, hey, yeah, this is agreat investment, it's a great investment.
(05:46):
So that's when I was kind offraming individuals that there's
bad guys.
And it's certainly not thecase, but I guess with what I would
call the good guys at the FredHollows foundation, where I've been
for about five years now, it'scertainly not the case there because
we kind of have these verystringent approaches to cost effectiveness.
(06:06):
And there's a book by PeterSinger called the life you can save
and this philosopher, but heessentially talks about this sort
of concept.
You know, there's, there'sbasically every intervention gets
shown as being pretty costeffective or having a good return
on investment.
There's, there's not too manyeconomists who are doing these things
and saying, hey, you know,that's a, that's a really bad idea.
(06:26):
But there is when you followquite a scientific approach and you
know, I'm pretty privileged towork at the foundation where they,
they take that relativelyscientific approach to things.
And I'm not having to go outthere and justify interventions that
I know might not be best forthe population.
And the fact is that, youknow, it's, I always say it's like
kind of like a dream job forhealth economists working in eye
(06:49):
health because we havecataract surgery and refractive air
treatment for glasses are twoof the most cost effective interventions
on the planet.
So I'm not out there trying toprove the cost effectiveness that's
been done.
That's like a fact of science already.
I'm out there working withgovernments to see how we can get
these services to the peoplewho are most vulnerable.
I guess that's the sort ofdichotomy of maybe bad and good in
(07:10):
that respect.
Explain to me a little bitwhat cost effectiveness is and why
this pertains to eye health.
I think people throw it arounda lot.
It's got kind of like atechnical term which is like the
cost per health outcome inhealth economics is, is what you
look at.
So if you're talking aboutcost effectiveness of something,
(07:31):
it might be the cost pernumber of glasses distributed, the
cost per cataract, surgery, etc.
But the way to say somethingis cost effective compared to other
health interventions, etcetera, is to sort of standardize
this approach.
So health economists use athing called usually quality adjusted
life years.
(07:51):
It's essentially saying like aparticular health intervention, whether
it's, you know, cancer, a typeof cancer treatment, or whether it's
cataract surgery, this mightresult in X number of additional
life years live, so it mightenable you to live longer.
But what quality adjusted lifeyears do is they take into account
(08:12):
the quality of life livedduring those years.
So essentially we look athealth interventions as we judge
cost effectiveness by thedollar per qaly added.
So for instance, if you get ahealth treatment, say, say you get
some type of surgery and itenables you to stay alive longer,
(08:33):
but you extremely cognitively,like, you know, reduce cognitive
abilities and stuff like that,we can't just say, hey, it's the
same as living another fivelife years.
We might equate that to liketwo quality adjusted life years or
something like that.
And so that's what we talkabout when we talk about sort of
cost effectiveness from atechnical point of view.
(08:53):
It kind of allows us to assessand standardize and prioritize health
interventions based on a ratioof cost to qualities added.
That makes a lot of sensebecause I feel like with eye health
you can just throw on a pairof glasses or do a quick cataract
surgery and then you're ableto see and you're able to work and
(09:15):
all of that, right?
So your quality of life is wayhigher than say you have cancer and
you have to go throughchemotherapy and that chemotherapy
has a lot of different side effects.
Yeah, absolutely.
I think the main thing aboutwhy cataract surgery and refractive
air treatments areconsistently like top 10 in the world
(09:37):
amongst immunizations, etcetera, as being the most cost effective
interventions is becausecataract surgery, right, you do it
with minimal equipment, you doit in like eight minutes and someone
goes from bilaterally blind,like literally potentially hasn't
been able to see for 10 years,a decade or whatever, and suddenly
they can see again.
(09:57):
So the cost of this surgery isreally, really low.
But that effectiveness interms of the quality of life impact,
ability to hang out with yourfriends, look after your children,
you know, go back to work, iswhat a lot of governments care about
these days.
That's, that's why it's so, socost effective.
So it's not just because it'slow cost.
It's like a low cost plus it'sone of the most effective changes
(10:19):
that you see so quickly.
Some of the work that you doright now with the Fred Hollows foundation
is kind of negotiating withthe government and different public
health entities to fund eyehealth treatments.
Why is it, why is that such adifficult thing to do?
(10:39):
Like, why is that such ahurdle when like, like what you just
said?
You know, it's Just an eightminute procedure or you can throw
on some glasses.
Why is that so almost likedeprioritized in governments?
Yeah, that's a, it's a, it's agreat question.
And I guess like that is the,the, the challenge and the privilege
(11:02):
of being a health economist atthe Fred Hollis foundation.
Because you know, if youlooked back 100 years ago, right,
and you, and you say, hey,like someone who's completely, you
know, bilaterally blind, wesay in eight minutes you can see
again.
Like we would all be likecelebrating in the streets and be
like, we've got it, we've gotthe cure.
Like, that's awesome.
Like there's no reason really.
(11:22):
Like, you know, polio vaccinecame in the 50s or whatever, in 10
years, polio is essentially eradicated.
Like it's, this is the greatchallenge of what we do.
And my role is why isn't this prioritized?
So there's, there's a coupleof reasons, I guess.
In, in more resource heavysettings, in more developed countries,
sort of like Australia and theUS we have really stringent ways
(11:45):
that, that healthinterventions are prioritized for
public funding.
So in Australia, for instance,we've got Medicare and so this is
publicly funded health services.
So for anything to be fundedthrough that, essentially you have
to have quite a rigorous costeffectiveness study to be done.
And for instance, things likecataract, et cetera, they pass these
(12:07):
rigorous cost effectivenesstests and often they are publicly
funded.
So it's, it's, it's not asmuch of an issue in, in these countries,
but in low resource settings,especially countries with sort of
fledgling health financingsystems, you know, they don't have
necessarily universal healthcare set up.
They don't have things like,we call it Medicare in Australia,
(12:29):
but it's obviously a differentmeaning in the US but essentially
publicly funded health systemsfor people who need it.
And so a lot of theseresource, I guess, constrained settings,
they don't have huge teams of,you know, Ministry of Health health
economists who are doing allthese sort of studies and prioritizing
interventions.
And in fact that's where mostof our work is done.
(12:53):
So we'll work with governmentsand we'll say, hey, you know, what
do you need to, we'll show youthis intervention, we show you cataract
surgery, we show yourefractive error, we show you our
ability to scale servicedelivery throughout these countries
and treat large proportions ofthe population really, really cheaply.
We say, do you need a costeffectiveness study?
Do you need more evidence?
Like what's what's the thingstopping you from funding this?
(13:17):
And it might just be lack ofresources where we end up cost sharing
with them for a little bit.
There's, there's so manydifferent things, things that we
do to, to sort of advocatefor, for eye health to be prioritized.
One thing I'll just touch onand something.
One of like my big researchprojects is at the moment when I
was talking about thosequality adjusted life years, which
(13:38):
again, like the, a sillytechnical term, but something very
similar called a disabilityadjusted life.
Here it's kind of just the opposite.
So quality adjusted life yearswe want to add through an intervention,
disability adjusted lifeyears, we, we want to like, save.
So they're kind of like a bad thing.
So what happens is theInstitute of Health Metrics and Evaluation,
(14:01):
based in Seattle, they publishthese things called the Global Burden
of Disease Disability weights.
And essentially it weightslike all different qualities of life
between zero, which is like,like essentially full health, and,
and one, which is, which isdeath in this.
You know, it seems reallyarbitrary to do that, but it rates
(14:23):
this on this scale.
And so blindness, forinstance, used to be rated up at
like 0.6.
So that was sayingessentially, you know, again, very
arbitrary, but saying, youknow, being bilaterally blind is,
you know, you're 0.6 and, and1 is death.
It's really, really bad onyour quality of life.
(14:44):
But these got reviewed like 10years ago and that they assess these
in a number of different waysand that dropped right down to, I
think it's at 0.19 now.
So 0.2.
So essentially they're saying,you know, it's really not that bad
at all.
I think, you know, compared toother things like skin conditions
and like, you know, mildalcoholism is like higher than really
(15:08):
blindness, mild alcoholism,0.26, rheumatoid arthritis, 0.29.
So we are essentiallyundertaking a big sort of systematic
review to delve into like, themethods that we use to calculate
these weights.
And they do them in a bunch ofdifferent ways.
But this is, this is one of mymain projects this year, is working
with London School of Hygieneand Tropical Medicine to really challenge
(15:33):
why this happened, what'sgoing on.
Because to say that bilateralblindness is a 0.19, when a moderate
skin disfigurement with anitch or the pain, or a pain is 0.19
as well.
There's.
There's something going wrong.
So, so yeah, so this is when Iwas talking about how governments
use cost effectivenessanalysis to prioritize interventions
(15:54):
that cost effectivenessanalysis inherently has to use these
weights.
So that's why, despite so muchresearch showing that these are these
incredible cost effectiveinterventions, when they actually
take it to trial and they tryand prove this to a government, often
they'll come out aspotentially less cost effective when
they're using thesestandardized disability weights as
(16:15):
the metric.
Tell me if I'm wrong, but oneof these metrics is mortality as
well.
Does it cause death?
So, yeah, exactly.
That's the, the crux of it.
So those, those metrics don'tgo into the, the weight calculation
but for the quality or thedaily calculation for sure.
And that's again why when wewere talking about cancer treatments
(16:35):
before, obviously like a yearof extra life is weighted the most
like for, for, for everyone.
That's, that's the goal,right, to, for everyone working in
health economics, the goal isto, to live another year longer.
Right.
And so when it comes to eyehealth, there's a fair bit of evidence
showing that, you know, poorvision is related to increase of
(16:59):
risk of falls in, in olderpeople and this might contribute
to mortality, but essentiallythere's no mortality involved in
that calculation of thatdisability weight.
When you compare to thingslike, as we said before, cancer treatments,
where, you know, thesetreatments, although they might be
really expensive, they havethe potential to avoid mortality.
(17:20):
So that's, again, you're spot on.
That's the reason why perhapssome governments don't necessarily
prioritize these eye health interventions.
I think my question is why?
How did it reduce so much from0.6 to 0.2?
That's like a huge drop.
It's enormous.
There's been a number ofpeople in this sector that have sort
(17:40):
of challenged this over time.
Hugh Taylor, who's aresearcher at University of Melbourne
and great friend of thefoundation, has been pretty vocal
about challenging this.
And I think, you know, we'resort of taking that next step now,
trying to produce somerigorous evidence and really articulate
why it has been done.
These studies have arelatively consistent approach, but
(18:01):
estimating those weights can,can take a number of different, I
guess, experimental processes.
So there's things like healthstate preference surveys where they
go out to, you know, 10,000people in certain regions and they
say, would you rather livewith, you know, a range of comorbidities
of a health state or would yourather this health state?
(18:23):
And so within those that mighthave like poor vision, it's like,
would you.
Rather be blind or deaf?
Literally?
Quite literally, yeah.
Yeah.
So would you rather be, wouldyou rather be blind or Would you
rather have a limb amputationand things like this?
Right.
And they, it's, it's not as,it's not as coarse as that, but that's,
that's essentially how they do it.
Health state preference surveys.
So the methods of those canrange from, you know, smaller sample
(18:46):
sizes in discrete regions thatactually go up to this, you know,
this, this disability waythat's influencing health service
priority for literallybillions of people worldwide.
And some of these methodsaren't necessarily as robust as others.
That's insane behavior, I feellike, to do that.
I mean, like, it's becauselike, obviously.
(19:09):
I would say I don't want mylimb amputated, you know, so.
Yeah, yeah, yeah.
But I don't, yeah, I don'twant to be bilaterally blind either.
Like, can, can I havesomething else?
It's, it's, yeah, it's, it'sfraught with, it's fraught with measurement
error and it's a really hard thing.
Right, because clearly peoplearen't going to have those sort of
preferences.
That's why a lot of people aredoing importance on like outcome
(19:31):
related quality of life.
Right.
So would you rather be ableto, like not saying like about a
health state specifically, butyou know, would you rather be able
to.
How much do you value beingable to play outside with your children,
for instance?
And these types of sort ofoutcome based quality of life type
surveys are getting used moreand more.
And I think that's, that's,you know, we're only about a quarter
(19:53):
of the way through this study,but that's probably likely a method
that we're going to sort ofpush for including in disability
weights associated with eyehealth as well.
Also about how they, they askthe question, you know, would you
rather this one, would youwant to do this, et cetera, all that
can influence how these are measured.
And again these, these weightsare just used by, by governments
(20:15):
and decision makers all overthe world.
And sometimes, yeah, we thinkthey're very wrong.
That's so interesting.
I wonder, and I'm sure thishas been done, but I wonder if there's
been a study where they justfollow, you know, people who are
bilaterally blind and juststudy the way that they live.
(20:36):
Right.
And then do a study on that.
But it's just like that's, Ifeel like that's so much harder than
just asking the question.
It's, it's hard because like,I'm certainly not trying to knock
what the Global Burden ofDisease team have done because you're
estimating one Disabilityweight for the world.
(20:57):
Right.
And so being bilaterally blindin Australia, in living in Melbourne
is very different on myquality of life.
If I'm bilaterally blindliving in rural Cambodia, for instance.
And so there's, it's, it'svery hard to sort of standardize
these measures.
We've done lots of research onthe impact of eye health on quality
(21:20):
of life and obviously likeyou're saying, you know, these, when
we sort of follow people preand post cataract surgery or pre
and post refractive areatreatment, the benefits aren't limited
to just being able to see.
Right.
You know, it's all the socialinteractions that they can have.
They can return to work, theycan increase productivity, et cetera.
You know, all these benefitswe know, but measuring it on that
small scale in sort of moreprimary data collection research
(21:43):
studies with smallerpopulations, we always see the benefits.
But it's when you're trying tosort of aggregate these at a global
level, I think is where we runinto difficulties.
Right, that makes a lot of sense.
I think that, I think my nextquestion is really just all about
like investing in eye health.
Right.
As a health economist, why andhow would investing in eye health
(22:06):
actually boost the economy?
So how does, how does actuallyimproving somebody's eye health improve
the economy in terms of money,for sure.
Great, great question again.
I think.
Yeah.
You know, I still have friendswho ask me to like help with their
taxes so bad with that sort of stuff.
So that's what economics doesto you, I get.
But, but you're 100% right.
(22:27):
So kind of before when we weretalking about, you know, how do we
advocate to some, somegovernments about prioritizing eye
health?
Well, one of these methods isshowing that investing in iHealth
can actually impact theirbottom line.
So a lot of, you know, a lotof policymakers, a lot of governments,
maybe they're only in powerfor, you know, one to five years,
sometimes less.
(22:48):
And so they want to keeptheir, they want to manage their
budget and they want to getreturn on investment within their
budget for the intervention.
So this is kind of somethingwe started thinking about over the
last sort of three to four years.
And it's and it's by no meansa new idea, but the fact that after,
you know, so many decades andso many years of having these really
affordable life changingtreatments, why hasn't it been prioritized
(23:13):
by governments?
And is the, is the individualbenefit to someone going from, again,
from having really poor visionto full sight, isn't that enough
to, to get Governments toinvest, you would think.
Clearly it wasn't so.
Yeah, you think so?
So, so, yeah.
We did a study that wereleased about a year ago.
It's called our sort ofInvestment Case for Eye Health.
(23:34):
And, and what we did is weessentially went to sort of 19 countries
where the foundation works andwe did some pretty rigorous costing
around what each of theseinterventions might cost in, in each
country.
So we did it for cataractsurgery and for, and for refractive
error treatment, giving people glasses.
And we essentially collected awhole bunch of data.
(23:56):
So it was based on sort of ahealth systems cost.
So we, so we know that there'sthis, you know, eight minute cheap
surgery that we can do forlike 25 bucks in some places.
25 bucks?
That's like a, that's a reallysignificant number.
Yes, yeah, yeah.
For the direct medical cost,for sure.
But when we did this study, wetook a more sort of, I guess, holistic
(24:17):
approach to sort of healthsystem development.
So we were talking about, youknow, trying to factor in all the
things like, you know,surgical outcome monitoring, management
and monitoring and evaluation,case finding exercises within the
community to get like areally, I guess, real picture of,
hey, in donors, governments, etc.
If you actually want to fundthis, like, this is what it's, this
(24:37):
is what it's going to cost.
And we compared that to theestimated benefit in terms of three
sort of benefit pathways, I guess.
So.
The first was increasedreturns on investment for education.
So often children, if they'rein school in Southeast Asia and South
Asia as a whole, there's areal sort of epidemic of myopia,
(24:58):
which is what I have when youcan't see things far away that well.
And essentially there's lotsand lots of evidence saying that
children are not getting theright education.
And in fact, a lot of them aredropping out of school and entering
the workforce, et cetera,because they're experiencing these
learning difficulties whichcan manifest as, you know, it's,
it's not easy for a child tobe able to, you know, see the chalkboard,
(25:21):
say, oh, it's because I can'tsee the blackboard.
Yeah, that's, that's why I'm,that's why I'm messing up at school,
et cetera.
So that's one of the benefitpathways we modeled.
The second was an increase inlabor force participation.
So this is people often with,with more severe levels of visual
impairment who, you know,economists talk about the labor force
and essentially that's peoplewho are willing and able to work,
(25:43):
but there's a whole bunch ofother people who, for various reasons,
whether it's health conditionsor otherwise, they're not even considering
work.
So you know, I haven't appliedfor a job in 10 years because I'm
blind and I couldn't doanything in the region where I'm
working.
Say I'm in a agriculturalregion in India for instance.
Be very difficult for me toenter the labor force.
And the third was returns oninvestment for people who are already
(26:06):
in the labor force, but theycan increase their productivity while
they're at work.
So there's lots and lots ofresearch on this both for cataract
and refractive error.
If you think of people in, youknow, there's lots of manufacturing
in South Asia and in Africaand a lot of the continents and countries
where we work.
And some of this is, you know,really small tasks.
(26:26):
Some of these people, youknow, sort of 40 to 40 plus years
old and they might getpresbyopia where they can't see things
in front of them so well.
So there's been lots ofstudies in, you know, on tea pickers
in India for instance, thatshowed, you know, giving press biobic
glasses which are, you know,sort of reading glasses essentially
can really improvesignificantly productivity.
(26:47):
And so essentially that's,that's a summary of what, what the
sort of economic benefits welooked at in this study, but we found
with, with cataract surgery inparticular, it was about a 20.5 to
$1 return on investment.
So what we found in theparameters again were 19 countries
where hollows worked.
We said, okay, hypotheticallyif we increased cataract surgery
(27:12):
surgical coverage by 40percentage points and we increased
refractive area coverage by 30percentage points, which are World
Health Organization goals foruntil 2030.
If we did that, the economy inthese individual countries all, all
aggregated up would be anaverage of 20 to 1, which is an enormous
return on investment that'sreturned to the government's bottom
(27:35):
line.
Right?
That's, that's the economiccontribution that would happen as
a result.
And obviously the governmentwould have, you know, income taxes,
et cetera, in formalsituations that is, is returned at
this point.
So it's, it's really sort of ano brainer in investment from that
perspective.
Brad Wong from Saver and heworks at IPB as well, did a, did
a pretty similar model butlooked at India and found even, even
(27:58):
higher returns on investment.
When we looked at things like,you know, even zooming in on places
in our investment case studylooking at Laos for instance, had
an over $50 return oninvestment for refractive error treatment.
So essentially that's saying50 for every $1 that you put in for
(28:18):
refractive error treatment programs.
That's, that's because of thedemographic distribution.
In Laos there's lots and lotsof young people in school.
So we found that a lot more ofthem would, would be likely to stay
in school and have returns oninvestment to education later on.
That's enormous for these lowcost treatments.
And you know, I know it's,it's certainly not a competition
amongst, well unfortunatelysometimes it is a competition amongst
(28:40):
prioritization of eye health interventions.
But you know, things that havebeen modeled in similar studies.
Team we worked at, withVictoria University have written
a number of these types of papers.
World Health Organizationpublishes a lot of investment cases
and they're quite, quite rigorous.
But when we're Talking about a20 to 1 return on investment for
cataract.
Across the countries where weworked similar investment cases,
(29:02):
there's been one that'smodeled treatments for anxiety and
depression that was a 4 to 1return on investment.
Treatments on adolescenthealth and Wellbeing was about a
10 to 1.
And treatments oncardiovascular health, which obviously,
you know, hugely burdensome onthe economy and health around the
world was about 11 to 1 returnon investment as well.
And again that's not sayinglike one is, is better or worse than
(29:27):
the other, but it's just areflection of how cheap these interventions
are.
And kind of what we talkedabout earlier, that, that quality
of life impact and theeconomic return associated with that
is just so massive compared tothese, you know, broader sort of
wraparound treatments that aremore comprehensive.
For instance, cardiovascularhealth isn't just one little intervention.
(29:47):
And when you're measuring likethe return, are you estimating like
somebody's given salary orsomething like that, you know, over
the years and how much theyspend and feel like there's just
so many, so many nuancedthings that you have to estimate
and assume.
And this is my likeengineering brain working right now
because I'm like how would youdo a study like this and how would
(30:10):
you, what, what would be allthe factors that you have to assume
and what would be the controls?
Yeah, for sure.
So, so there's so many, youcan, you know, if anyone interested,
I'm always happy to chat to them.
But we've got the reportonline, our investment case for iHealth.
So, so things like,essentially it was a, it was a model.
So we incorporated a number ofassumptions from specific studies.
(30:32):
For instance, saying that achild who would be given glasses
is more likely to stay inschool for, for one more year.
And there's a number of otherstudies that say that staying in
school and they, and theydisaggregate by country.
Staying in school for an extrayear in this country increases their
potential earning by X amountof dollars.
Right.
And so we essentially bring ina number of these assumptions.
(30:54):
There's similar ones forproductivity improvements in eye
health and labor forceparticipation and where we could
be disaggregated by countryand used, you know, probabilistic
assumptions otherwise andessentially extrapolated that out.
And we had, you know, it was,it was quite a detailed model.
We looked at, you know, yourlifelong productivity curve.
(31:15):
You get sort of moreproductive up to the point where
you're about close to 40.
I'm not quite there yet, if,if my, if my manager's listening.
So it's a good time to investand then, then, then drop off afterwards.
So we incorporated all these,these assumptions within the model
and essentially extrapolatedthat out to a return on the GDP per
(31:35):
per capita per country.
And so that was the quote,unquote, economic return.
It's really, it's, it's alittle bit difficult.
And sometimes I've struggledto grapple with this.
You don't see economists toomuch saying, hey, this is the X percent
return that you're literallygoing to get in your pocket as a,
as a government budget holder.
(31:56):
It's like the equity kind of thing.
Yeah.
Or something like that.
Yeah, yeah.
Because.
Because what economists tryand do is, is bring this sort of
this economic cost togetherand say, because obviously, you know,
even if you're getting Xamount from income tax return, you're
investing in these interventions.
So you have to take out thecosts, you have to take out these
(32:17):
holistic treatments.
And so that's why we used GDPas this sort of proxy for economic
returns, because it's the mostconsistent way for us to estimate
the returns to the economy asa whole.
And GDP per capita is, youknow, if you ask most economists,
saying it's probably the bestindicator for economic wellbeing
and prosperity in a country.
(32:37):
So essentially the argumentextended is that, you know, investing
in eye health can't just.
Won't just help individualsand their families, but will increase
your country's gdp, you'llstart being more productive, you'll
become a larger player on theglobal scene, and eventually you'll
be able to fund theseinterventions yourself without the
need for foundations, etcetera, to step in, which is, which
(33:00):
is the ultimate goal.
You mentioned that there areplaces in the world that are tackling
this in the case of eye healthand you mentioned LV Prasad Eye Institute
and that it's like the goldstandard of eye treatment and it's
in India.
Like why do you think thatthat works so well?
(33:21):
This is, you know, this is, ifyou go to any eye health conference,
it's kind of the questionthat, that people seem to ask every
year.
And the, the LV Prasad modeland, and some other models in India
in particular are based onkind of like this, this almost fundamental
aspect of universal healthcare.
So individuals who can, canafford to pay for, for treatments
(33:44):
will, will pay for them or,and often pay a premium for a premium
service if they, if that'skind of what they're after.
And essentially these models,these, these eye clinics or eye hospitals
cross subsidize those feepaying patients to other individuals
who can't afford.
(34:06):
So they essentially arefunding, you know, paying a premium
for a service knowing thatthey'll both get a, they'll get a
great service, but also someof this will be used to fund those
who can't afford this serviceand truly deserve it.
So that model, in my, youknow, limited experience, I haven't
worked extensively in India,only a little bit.
(34:26):
But from what I've seen, thatsort of model of altruism works especially
well contextually in India.
And I think there's, you know,a number of different factors that,
that might contribute to thatperhaps that notion of altruism and
I guess charitable giving in asense is just more ingrained in some
cultures within or throughout India.
(34:47):
They've tried to replicatethis model and others have tried
to replicate this model in anumber of other countries and it
hasn't worked as successfully.
So that's something we'restill looking at.
You know, it's, it's, it's oneof many financing mechanisms that
we're looking at more and more.
There's things like largeinstitutional donors or large family
foundations, high net worthindividuals, et cetera, who are really
(35:11):
focused on impact investingand outcomes based financing, social
investment schemes, et cetera.
So we're certainly looking ata lot of those as well.
You know, there's things likesocial impact guarantees where a
big high net worth individualor a foundation or someone might
come along and say, hey, youknow, a cataract hospital in, in
(35:32):
Vietnam, we'll pay you Xamount of dollars as long as you
achieve a certain number ofoutputs and a certain amount of quality.
And so a donor might say that,then you have a guarantor who says,
okay, no matter what, ifthere's some months that you don't
achieve that quality, we'llwork with you to improve that, but
also we'll pay the donor backfor you for those things.
(35:55):
So there's all these sort of,I guess innovative financing mechanisms
these days that are beingexplored to sort of de risk the risk
of investing in iHealth forsome of these countries that might
be kind of on the fence aboutprioritizing it.
I just had a thought because,you know, my family's from India
and I, I know that in Indiait's a pay first model, right.
(36:16):
You have to go and you have toshow the money and then you get treated.
Right.
I just wonder why it's sodifferent when it comes to eye health.
You know, in this model.
And yes, in India there is a,there is a sense of altruism, but
then there's also a for likethe very poor, if they break a leg,
(36:40):
then they have to sell theircow and you know, get surgery like
that.
But I just wonder like how it,how could it be translated to like
all of these other conditions.
Right.
Whether it be cancer or trauma.
Yeah, I, I think, and I, and Ithink one of the things is again,
these, these interventions areso quick and low cost, right.
(37:02):
These hospitals, they, theychurn out cataract interventions.
So there's not this point of,you know, it's not a long like trauma
based service and we can'tsort of accurately predict demand
for paying for these things.
You know, they're based onliteral life events, cataract and
refractive error.
You can relatively easilypredict, you know, insulin incidence,
(37:23):
prevalence, etc.
And kind of develop thesebusiness models around treatment,
knowing that you'll get acertain proportion of the population
willing to pay X amount forthese services.
So I think maybe it's comesfrom the sort of the ease of planning
for these interventions andthe ease of setup.
You know, you don't need these gigantic.
(37:44):
Like a CR or anything like that.
Yeah, exactly.
The eye hospitals like that wevisit a lot of the time, you know,
it feels like you're in like aportable or in like a school or something
like that.
They're not necessarily thesegrand sort of white structures that
we're used to associating with hospitals.
So yeah, maybe, maybe that'ssomething to.
It, but it's like a one undonekind of thing.
(38:04):
And then you can just be like,oh, well, you're paying this premium.
But it's not that much forpeople who actually have.
Yeah.
And you'll see the benefitrelatively straight away.
So you work for Fred Hollows Foundation.
I want to go into a little bitto talk about who Fred Hollows is
and the mission behind the foundation.
(38:28):
Sure.
So Fred Hollows was anophthalmologist in Australia.
Foundation's been going, Ithink, for about 32 years now, and
Fred Hollows has passed away.
But obviously we continue his legacy.
And he was sort of apersonification of altruism in some
respects, where he was.
And I think when there arethese health interventions and these
(38:50):
miraculous, literally healthinterventions such as cataract surgery,
there's no reason toprioritize people who are wealthy
versus people who might nothave as much money.
And so I think he's got aquote talking about, you know, doing
a cataract surgery on, youknow, a child or a person in Nepal
is the same as if you weredoing it on the Queen of England.
(39:12):
Very, very Australian thing torelate it to.
But that was that.
That was his whole purpose inlife, the thing that was making cataract
surgery a little bit moreexpensive with these intraocular
lenses.
And it still does, to behonest, in some.
Some regions.
But essentially, when you docataract surgery, you.
You have this clouded lens and you.
And you suck it out or you cutit out and then you put in a new
(39:33):
lens and so.
So you can see again.
It's not opaque anymore.
And these lenses were beingmanufactured by, you know, big pharmaceutical
companies, and they'recharging an arm and a leg for them.
But what sort of Fred did waswent to places like Nepal and Eritrea
and established literally,intraocular lens laboratories or
factories to make these onmass for extremely low cost.
(39:57):
So in that way, he kind ofrevolutionized cataract surgery in
terms of making it way cheaperand way more accessible.
And obviously, he.
He trained a lot ofophthalmologists everywhere, and
we try and continue thatlegacy as well.
For Fred Hollow's foundation,if, if we're talking about our mission,
I think it's pretty simple inthat, you know, we want to see a
(40:17):
world where no one lives withneedlessly or with avoidable blindness
or vision impairment.
A privilege and a challenge ofworking here is that these.
These treatments exist.
Right?
They're cost effective.
And whether it's from, youknow, failures of government resource
allocation or failures frompeople, the amount of training that
(40:38):
people need or prioritizationor equipment or whatever, whatever
is happening in the world, forsome reason, there's still 1.7 million
people who are.
Who are blind.
1.7 billion, sorry, who areblind or visually impaired throughout
the world.
And nine out of ten of thesepeople, they can be treated, right?
That's the crux of everything.
(40:58):
How do we get treatment tothese people?
And that's where I thinkhealth economics is coming in more
and more.
And that's why you see a lotof health economists working for
governments and things like that.
Because we're kind of past thepoint where it's this treatment,
this cost effective treatment exists.
But how do we work together tomake sure people can access this
treatment?
And that's kind of whereHollows has shifted a little bit
(41:20):
lately.
I kind of call it like the oldschool world of development was kind
of like flying in trainedsurgeons from Australia or something
like that, going and doing acamp for two weeks, doing how many
thousand cataract surgeries?
That's, that's awesome.
And that's for sure needed insome contexts.
But what we're moving towardsmore now is looking at, you know,
(41:41):
health system strengthening approaches.
Can we set up optometryschools in Vietnam?
Can we, you know, can we workwith governments on blended financing
mechanisms with guarantors anddonors to fund these things to show
you that it's worthwhile andthen slowly pull away our investment
over a period of five years sothat you keep doing it right?
So we're taking this sort ofhealth system strengthening approach
(42:04):
to development now, which inmy opinion is the way to go.
Because if a country isn'tfunding this themselves, if they're
always relying on externalresources, then how's that ever sustainable?
That's the key word, right?
Sustainability.
How do you make it so thatyou're working with the communities
and the governments to buildtheir, their system?
(42:25):
What do you hope to see inlike the next year when it comes
to eye health?
One year, what do I want tosee is an increased focus on eye
health and the impacts it hasas a development issue.
It appears that just showingthat these enormous improvements
(42:47):
in health, right from someonebeing able to go from sort of bilaterally
blind to be able to see again,that's not enough for people to prioritize
or invest in these things.
So I would like people to seeeye health much more broadly is a
development issue.
For instance, it's eye healthconditions are holding people back
at school is affecting howpeople interact at work.
(43:10):
Eye health is affectingdevelopment of countries, literal
economic development ofcountries as a whole.
And I think when peoplerealize and see it that way and see
how cost effective it is totreat these things, that that's a
point where iHealth will, willsort of be prioritized.
And I know I've talked like alot about economic impacts, about
(43:31):
sort of, you know, formalworkforces and productivity and stuff
like that, but I think, youknow, there's, there's a great quote
from I think Caroline Criado Perez.
I'm not sure if you've readthe book Invisible Women, Data Bias
in a World Designed for Men.
Really, really great book.
And she essentially saysthere's, there's no such thing as
a woman who doesn't work.
(43:51):
There's only such thing as awoman who isn't paid for her work.
And so this is a lot of what'ssort of driven some of the resource
research that we're doing now.
It's that in a lot ofcountries where we're working, these
eye health is not onlyaffecting, you know, formal labor
and you know, labor marketswhere people are working, you know,
(44:12):
an office job or a factory andthings like that.
There's so much unpaid workthat's often, you know, happening
to a woman at home.
And you look at things likemaybe, maybe an example of a woman
who has cataract and her wholejob is to look after her family.
Right.
This is what we would classifyas unpaid work as economists, but
(44:32):
you know, she's, she's doing80 hour weeks or whatever and not
getting paid for it.
And this is kind of themissing link in terms of what we've
looked at eye health in the past.
So we're now starting to lookmuch more into this unpaid work aspect
of research because we knowwe've done two trials now in Burundi
and in India showing that eyehealth has a significant impact on
(44:55):
a person's ability to lookafter a family and to care for their
loved ones.
And often in some extremecases, for instance, say if there's
an elderly woman at home whonormally looks after the family,
cares for others, etc.
Say she has, you know, reallypoor visual health from cataract.
She might need help fromsomeone else in the family to, to,
(45:16):
to do all this unpaid workwhich, which previously, you know,
sort of had gone, you know,unaccounted for because it's not
in this formal, formal work setting.
And you can picture whereyounger individuals of the family,
often the daughter, yeah.
Is the one who has to stayhome from school and look after this
person, look after this unpaidwork that previously isn't, isn't
(45:37):
really quantified.
And you can imagine the sortof intergenerational impacts of that
getting stuck in the povertycycle if you can't get an education
for these individuals.
So yeah, that's, I guess, kindof an example of what we're looking
at in terms of showing thatinterventions are cheap and the benefit
is beyond just the healthimpact of the individual.
(45:57):
The benefit to the family, tothe society, to the country is much
greater than the individual.
So yeah, if people can seethat and understand eye health as
a sort of development issuemore broadly in a year, I'd be happy.
(46:21):
Thanks for listening to this episode.
If you want to learn moreabout the Fred Hollows foundation,
go to Hollows Dot or click thelink in the show notes.
All of the resources will belinked in the show notes.
This episode was hosted,produced, edited and all of the above
by me and huge shout out to mycoach, Anna Xavier of the Podcast
Space, who continues to pushme to create meaningful content in
(46:45):
the field of global health.
If you'd like to support me,you can review the podcast on Spotify
or Apple, or you can click thesupport link in the description.
Your support means the worldto me.
Until next time.
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