Working towards global health equity by combatting misinformation, avoiding vaccine nationalism, and strengthening self-reliance
The Salzburg Global Health and Health Care Innovation program "Better Preparedness for the Next Pandemic: Developing Vaccine Access Models with Low- and Middle-Income Countries" convened nearly thirty Fellows, including healthcare practitioners, policymakers, researchers, and representatives from health ministries in several African countries. They engaged in crucial discussions on access to suitable and affordable vaccines in low- and middle-income countries (LMICs), and several key points emerged related to misinformation, vaccine nationalism, and self-reliance.
In a discussion moderated by Lisa Adams, Associate Dean for Global Health and Director of Dartmouth’s Center for Health Equity, Salzburg Global Fellows sought to answer: “How can ‘infodemic’ – misinformation and vaccine hesitancy – be better managed, and what are the implications for procurement?” Drawing from their experiences of the COVID-19 pandemic, Fellows mentioned the ineffectiveness of a top-down approach that tells the public what they should know, rather than listening to their needs and concerns. “If facts were enough to motivate people, we would have solved all of the healthcare problems,” noted a Fellow.
Another challenge is the speed of misinformation on social media, unfortunately targeting not only the wider public, but also healthcare workers, letting their own fears and misconceptions cloud their judgements. The group talked about a “multi-pronged approach” involving not just politicians or healthcare workers. “It really comes down to the issue of trust, and whom you trust or listen to. Is it our politicians, our healthcare leaders, is it religious leaders or our star athletes, who will be the spokesperson to mobilize the community?”, reflected a Fellow.
Fellows suggested involving people who interact with the community on a more personal level, such as social workers or primary care practitioners, also pre-pandemic. When addressing procurement, Fellows touched on the need to factor in vaccine hesitancy. In their experience, there was a significant mismatch between the supply of the COVID-19 vaccine and its demand. A possible solution shared amongst the group was to survey the public to determine acceptance of vaccines to forecast demand, rather than using the number of individuals eligible for them.
When trying to summarize the issue, they came back to trust. “We need to map where trust is; who is trusted and who are the influencers spreading misinformation? There is a displacement of trust and if you start with that, you can start to make change.”
In the aftermath of the COVID-19 pandemic, the imperative to confront vaccine nationalism has become evident. Disparities in vaccine access highlight the need for collective action to safeguard global health. As storytelling contributes to vaccine nationalism, countries should shift their perspectives to view vaccine access as a global matter rather than relying on nationalist narratives.
Patrick Amoth, Director General for Health in Kenya’s Ministry of Health, commented, “We are talking about a global problem that has no boundaries. If we do not protect all of us, then even you will not be protected… How do we change that narrative and ensure that we as a global community are tied together in this?” The group reached a consensus that “solving for vaccine nationalism is solving for a collective action problem”.
Fellows suggested several ideas that can serve as an antidote. The first proposal is an “intercontinental buddy system”, a term coined by the group to refer to countries partnering bilaterally across continents that have common needs but distributed risk. Countries like Brazil and Kenya are already cooperating in a similar framework, and this kind of bilateral partnership could be expanded into global cooperation. The second suggestion is a clearing house in the Africa CDC for countries to better manage the vaccine donations they are given. There would be great value in sharing cross-country data through the Africa CDC platform so that surplus vaccines can be shared with neighbors based on need.
The group suggested that countries start with cooperation through organized regional or economic blocks, especially in Africa. By implementing strategies like these that foster global solidarity in addressing public health challenges, countries can pave the way for a more equitable and resilient future for all.
“Self-reliance is about empowerment, not exclusion.” This was the defining idea contributed by a Fellow during a discussion seeking to answer: “How far can local manufacturing and research be developed in Africa, and what would
its impacts be?” Fellows focused on the challenges behind these questions.
They highlighted that the conversation around African self-reliance needs to evolve beyond considering vaccines as a finished product. It needs to strengthen numerous components, such as diagnostics, pharmaceuticals, and education to foster self-reliance. It also needs to consider all aspects of vaccine development, such as the pharmaceutical ecosystem, the research and development sector, the market, and the political environment.
One of the solutions that Fellows considered is increased coordination in procurement and regional manufacturing. As every country cannot build vaccine centers for every disease, it would be ideal to have specialized centers for specialized diseases. Biotech startups need to be supported, as they can bear the increased risks accompanying vaccine development. Universities are also often neglected spaces of tertiary education which must be supported to develop a talent pool for the research and development sector.
A unique vaccine financing model that can keep up with changes in demand and supply was suggested by Fellows. They proposed a combination of a subscription and variable model, where vaccine centers are paid a subscription cost to support their operations, with additional costs levied in cases of increased demand. Additionally, local and specialized manufacturing must be incentivized, which would also increase supply chain resilience.
Fellows emphasized that African self-reliance in vaccine manufacturing is not about excluding the rest of the world, as 100% self-reliance is neither feasible nor desirable. Instead, African countries seek to be more independant in a health emergency and to better prepare for the next potential pandemic.
African perspectives on lessons learned from the COVID-19 pandemic about vaccine procurement
From syringes to storage facilities, vials to funding strategies, every detail matters in a pandemic. The COVID-19 pandemic exposed the inequalities in healthcare around the world and the pressing need to address them before the next pandemic. This begins with identifying the challenges that low- and middle- income countries (LMICs) faced during the pandemic. During a health program on "Better Preparedness for the Next Pandemic: Developing Vaccine Access Models with Low- and Middle-income Countries", Salzburg Global Fellows Henry Mwebesa and Patrick Amoth elaborated on the experiences of two African countries and the lessons the world can learn from this.
Securing vaccines was a pressing priority for all, but for many African countries, it was a long and delayed process layered with obstacles. After initially receiving one million doses of COVID-19 vaccines in March 2021, Dr. Henry Mwebesa, Director of General Health Services at the Ministry of Health of Uganda, revealed that it took another three months for the next batch of vaccines to arrive. As the pandemic progressed and Uganda received more philanthropic funds, securing vaccines in time remained difficult, as “we made orders, but they did not supply in time,” Henry recalled. To make matters worse, rigid contractual terms forced upon LMICs made it impossible for them to penalize untimely deliveries.
Lacking bargaining power and the financial means to access vaccines, most of the vaccines for LMICs came from donations. However, they often came with a very short shelf life and did not consider the needs of LMICs. Patrick Amoth, Director General for Health at the Ministry of Health in Kenya, alluded to one donation where the packaging was so voluminous, that it overwhelmed the storage capacity at the national vaccine depot and crowded out routine vaccinations. Patrick referred to this as “dumping vaccines”. LMICs often receive vaccines that are near expiration, which inadvertently creates more burdens than benefits, as the cost of destroying these vaccines is borne by LMICs.
Equitable access to vaccines will be crucial in the next pandemic. Reflecting on the COVID-19 pandemic, Henry believes that COVAX has the potential to be strengthened into a more equitable arrangement for the future. During the pandemic, the price for vaccines rocketed as high-income countries hoarded doses. COVAX should continue to pool vaccines, but Henry added that the key was to ensure adequate stock levels and strengthen COVAX as an “arbiter” and a “more genuine engine”.
A strengthened COVAX would also efficiently allocate vaccines, allowing individual countries to apply and buy from the pooled stock according to their own needs. This corresponds with Patrick’s takeaway that “requests should actually come from the receiving countries”. Patrick explained, “we should be able to customize based on our own individual context”. LMICs differ significantly in infrastructure, and it is necessary to develop solutions adapted to the regional needs and capacities of LMICs.
Despite facing challenges in vaccine access, African countries fared better against COVID-19 than the world expected. Learning from the HIV pandemic in the 80s and 90s, Kenya institutionalized “home-based care” where people who were not severely ill were treated at home by professional healthcare providers and community health workers. “This platform worked very well during the pandemic,” Patrick explained, “not on a single day was our healthcare system stretched to the limit”. The solidarity and communal support demonstrated by Kenyans is a testament to a recurring message of the program, the need for a bottom-up approach. As has been the case in COVID-19, when one region cannot gain access to healthcare, every country is at risk. Such is the importance of global solidarity in the next pandemic. As Patrick concludes, “No one should be left behind.”
The Salzburg Global Fellows featured in this article attended the Salzburg Global Health and Health Care Innovation program "Better Preparedness for the Next Pandemic: Developing Vaccine Access Models with Low- and Middle-income Countries" from March 11 to 16, 2024. This program convened nearly thirty Fellows, including healthcare practitioners, policymakers, researchers, and representatives from health ministries in several African countries, for crucial discussions on access to suitable and affordable vaccines in low- and middle-income countries (LMICs). Central to the discussions was a focus on understanding end-user needs and constraints to inform the design of a new model for multilateral vaccine procurement.
Representatives from global organizations agree that care and caregiving requires universal commitment reflected in public policies
In July 2023, the United Nations General Assembly designated October 29 as the International Day of Care and Support. To celebrate this milestone Salzburg Global Seminar has joined the World Health Organization (WHO) Europe in a much-anticipated discussion on recognizing the invisible value and contribution of unpaid care worldwide. The message from a panel of leaders in the field was clear that addressing and overcoming gender inequality and measuring the data gap of unpaid care is fundamental to building resilient and sustainable care systems that ultimately contribute to thriving and inclusive societies.
The online discussion took place last October and included representatives from international organizations, such as the United Nations Partnership for the Rights of People with Disabilities (UNPRPD), American University in Cairo, the European Institute for Gender Equality (EIGE), Eurocarers, the London School of Economics (LSE) and the International Labour Organization (ILO) Europe Office.
Stefania Ilinca, Technical Advisor for Long-Term Care at WHO Europe moderated the discussion. Stefania is one of the leaders behind the development in October 2022 of the “Salzburg Statement on the Value of Care and Caregiving”, a call to action ignited by the Salzburg Global Fellows, who identified priorities and specific recommendations for policy changes and actions needed to ensure fairness, inclusion, and equity in care systems. This statement was a result of a program led by Salzburg Global Seminar and supported by the Robert Wood Johnson Foundation on the topic of Health and Economic Well-being: Gender Equity in Post-Pandemic Rebuilding. Following endorsements by representatives from key international organizations, research institutions and public health associations, the Statement currently serves as a roadmap for global movement towards recognition of unpaid caregivers.
Mary Helen Pombo, Program Director for Health at Salzburg Global Seminar, echoing the Statement went on to stress that the COVID-19 pandemic particularly reflected inequality in caregiving as responsibilities of unpaid care for sick family members or staying at home with children primarily fell to women. Pombo emphasized that the Salzburg Statement and the UN’s recognition of care and caregivers is an opportunity to unite, accelerate, and expand cross-system collaborations that place gender equity at the center.
Dr. Hania Sholkamy, Co-chair of the Care Work Taskforce of the National Council for Women of Egypt, Associate Professor at The American University in Cairo, and a co-leader of the Salzburg Statement emphasized the importance of recognizing care and caregiving as a moral and intellectual responsibility. She pointed out that care is difficult to define and since it is an act of selflessness, it is affected by the lack of dignity, social welfare, and protection.
According to data published by the International Labour Organization, women around the world perform three-quarters of unpaid care work. Jolanta Reingarde from the European Institute for Gender Equality pointed out that closing the gap in statistical data of unpaid care is fundamental to recognition of gender disparity in care and addressing the social and economic benefits of care. Reingarde continued that women bear the economic price since they dominate the care workforce and informal care.
The need for using scientific data in enhancing quality and recognition of care was also emphasized by Adelina Comas-Herrera, Director at Global Observatory of Long-term Care (GoLTC) at the Care Policy and Evaluation Centre at London School of Economics and Political Science. Adelina stressed that, in the context of the current global landscape of rapid demographic change and challenging events linked to pandemics, conflicts and climate change, it is particularly important to have resilient long-term care systems. She went to emphasize that supporting cross-national learning and sharing experiences is key to strengthening care systems. “The COVID-19 pandemic showed that few countries have resilient Long-Term Care systems able to respond to emergencies, and that in most cases what went wrong was linked to structural problems in governance, financing and workforce capacity. It is urgent that countries ensure that they have Long-Term Care systems able to respond not just to unexpected events, but also to the well-known reality that more people are living longer with needs for care and support. International collaboration is vital to support countries in this process,” said Adelina.
As over 70 participants shared information about initiatives and efforts in driving the agenda for the recognition of unpaid care forward, it was clear that the International Day of Care and Support is a milestone step and it will require continued attention, investment, and collaborative effort.
Salzburg Global Fellows call for policy change to promote fairness, sustainability and resilience of care systems
Every individual will need care at some point in their lives; every individual will give care at some point in their lives. Care for self and others is fundamental to building and maintaining social relations and its value to individuals, families and societies is truly incalculable. Care is also a productive activity, deserving of appropriate compensation, and a crucial resource for human and economic development.
From October 17 to 22, 2022, Salzburg Global Seminar, with support from the Robert Wood Johnson Foundation, held Health and Economic Well-being: Gender Equity in Post-Pandemic Rebuilding.
For four days, the program brought together 60 participants from around the world, representing different sectors that can influence gender equity at all levels, from citizens, to communities, civil society organizations to policymakers.
Together they explored what it would look like to place the health and economic well-being of women at the center of COVID-19 recovery, with a focus on economic participation, opportunity and inclusion, as well as working conditions and culture.
Following this session, program participants drafted a Salzburg Statement on the Value of Care and Caregiving. Led by Stefania Ilinca, Technical advisor for long-term care at WHO Europe, and Hania Sholkamy, Co-chair of the Care Work Taskforce of the National Council for Women of Egypt. They set out priorities and recommendations to appropriately recognize, value and support care and caregivers and promote fairness, sustainability and resilience of care systems. Through this statement, Salzburg Global Fellows are calling for policies and actions that will help achieve that goal.
"In the face of global ageing and persistent social inequities, the Salzburg Global Statement on the Value of Care and Caregiving is a paramount call to action. The role of care and caregiving has long been underrecognized, but it is truly the foundation upon which societies are built. We’re proud of this work and look forward to supporting this statement to be more than an expression of intent, but a commitment to shape a more compassionate and equitable future for all”, stated Mary Helen Pombo, Salzburg Global’s Program Director for Health.
Download the Salzburg Statement as a PDF
On Tuesday, October 31st at 15:00 CET, WHO Europe will celebrate care and caregivers in honor of the first International Day of Care and Support and will dive further into the statement and how international, cross-sectoral and multi-disciplinary partnerships can help accelerate progress towards a shared vision of gender equality and caring societies.
Stefania Ilinca will be one of many to speak on the Statement and the topic of care during the webinar: “Care is a universally shared human experience and deeply woven in the social fabric. Families, communities, economies are built on and rely on the provision of care and support. Care benefits everyone but it is not equally shared and it is not adequately valued. As traditional care and support structures shift and fray, there is a role for every government, every organization and every individual to join the conversation and participate in the effort to recognize, reward and enhance the value of care and caregiving in modern and gender equal societies."
To hear more, you can register at the following link: https://who.zoom.us/meeting/register/tJwoce6trjouHNGYhgPGbgj2EKKhM8kDp7Jb
Read the full Salzburg Statement below:
To further the reach and impact of the Statement, we encourage you to share it with your network. If you or your organization would like to collaborate to amplify this Statement and its mission, send an email to Mary Helen Pombo, Program Director for health at Salzburg Global at mpombo@salzburgglobal.org.
Current endorsements:
Ankita Bose and Kelley Buhles reflect on the discussions at Salzburg Global's latest Health and Health Care Innovations session
A relentless challenge remains when investing in community and essential social infrastructure – and that’s the gap between the goals of funders and the needs of communities whom the investments initiatives should most serve.
In June, more than 45 leaders contemplated this challenge at the Salzburg Global program Connecting Capital to Communities: How Investors Harness Financial Markets for Essential Social Infrastructure. Participants explored ways communities around the world are gaining more control over capital, and investors are better integrating the voices of community into regenerative investment decisions. During this group discussion, some of the more challenging nuances of community-led processes were discussed. Fellows named common concerns held about community-led processes, as well as shared examples of practices being used to mitigate those concerns.
The belief that communities always know what is best for them was challenged during the discussion. As an example, Tee Thomas, former State Water Finance Director at Quantified Ventures, recounted an experience with a US Midwestern community that had a cluster of cancer occurrences in young people that are highly associated with exposure to agricultural chemicals via water, air, and food. While at the funeral of a 21-year-old who died from this aggressive cancer, she noted that many people in attendance were wearing hats or clothing of the local fertilizer distributor. She felt that the community was unable or unwilling to see the impact of the industrial agriculture system on the health of their families. Even if they could be convinced that exposure to these dangerous chemicals was killing their children, it would require them to put their livelihood at risk by having to seek alternative employment in an extremely economically depressed area.
Another concern raised by the group was that sometimes communities don’t have the expertise they need. As Abrar Chaudhury, Research Fellow and Climate Expert at the University of Oxford, shared. In his native Pakistan, traditional knowledge of suitability for growing a particular crop (like cotton) in a region is challenged due to climate change. This burdens the community with a lot of technical decisions, sometimes leading to suboptimal outcomes.
The needs and interests of groups within communities often vary– sometimes they directly conflict. During the conversation, distinct groups within communities came to the forefront. An example of rural communities in South Asian countries like Bangladesh and India came up, which portray bifurcated structures between groups who hold power and those who do not. Distinctions can be based on landholding, monetary resources, gender, historical factors like caste hierarchy, and other social dynamics. What might appear as a homogeneous community to an outsider actually comprises these distinct sets of people who have their own expectations and varying authority within the community.
To be clear, the conversation wasn't advocating for eliminating community engagement, there was general consensus that community input is critical, and that top-down approaches are often more likely to fail and/or cause more damage. However, by naming some of the challenges and questions that come with community-led processes, the group was able to share practices that can help those processes be more successful.
For example, in Tee Thomas’s story, she felt that external interventions play a critical role in promoting a common understanding of community needs and supporting community mobilization. Without these capacities, the lack of social cohesion can be exploited by companies harboring extractive practices.
Building a solid foundation of communication, awareness and collaboration within a community is essential for investment partnership that truly meets the long-term, sustainable needs of those most marginalized. Monica Altamirano, Director of Climate Impact at WaterEquity cautioned that “external experts shouldn’t tell the community what to do; but instead, we should have expert facilitators that facilitate a participatory system analysis process. These need to work with community members to clear [up] any misconceptions, and by bringing external expertise into these processes at the right time and way support communities in zooming out from the symptoms they experience, connect the dots and gain insights about the mechanisms and root causes for the problems they face. It is from this shared understanding that they can then themselves propose effective plans and strategies”.
In working with marginalized rural communities in India, we would aim for “enabling external interventions” for the successful implementation of community empowerment programs. A predominant focus was getting the voices of the community involved right from the project building stage, with inputs from the community in program design. Once the project rolls out, feedback loops are a vital component - going back to the community and getting feedback at every stage helps in modifying the program as per the evolving needs of the community.
A similar example in the African context came up during the panel discussion. Chanda Banda, Government Relations and Policy Manager at the One Acre Fund, shared that their work on carbon agro-forestry with communities in Zambia depends upon building a strong channel of communication with all stakeholders involved, including the community, traditional leadership, and government officials. For example, spending the initial two years on community conversations before starting the project helps in building the trust of communities and avoid skepticism about the project. Maintaining a high level of engagement throughout is crucial to ensure that the project is informed by community voices, thus facilitating capital absorption within the communities.
Creating feedback loops as a theme also emerged among the social enterprises that shared about their community engagement practices. Michaela Kauer, Director of the Brussels Liaison Office for the City of Vienna who promotes Vienna’s uniquely successful model of social and affordable housing, pointed out: “It is important to keep revisiting the decisions made to ensure true empowerment and transparency, keeping in mind human and women rights, a long-term perspective and a high quality of living for all citizens.”
An enabling external intervention, when it respects and engages a community’s knowledge, wisdom, and expertise, can work with the community to highlight factors of influence that can lead to greater communal freedoms. Bi-directional knowledge flows help to “grow expertise within the community by bringing together multiple forms of non-financial capital like social or relational capital, as opposed to “experts” coming in and telling the community what they should do.” as Cathy-Mae Karelse, Systems Change Lead at Resilience Capital Ventures highlighted.
External experts also should appreciate the multiple ecosystems that exist within a community. It is the interaction between both external and internal players that helps in collaborative decision-making towards greater capital absorption where it is needed most.
Building long-term relationships, creating feedback loops, capacity building, and collaborative decision making are practices that we also see in the growing movements of Trust-based Philanthropy and participatory methodologies, such as Participatory Action Research, Participatory Grantmaking, Participatory Budgeting, etc.
They point to a trend towards re-thinking some of the assumptions that underpin our typical investment processes, such as hierarchical power structures, qualitative measurements, and profit driven decision making. With trust-based and participatory processes, the process is the point. The empowerment of communities is one of the returns on investment.
Community-led doesn’t need to mean that communities need to be the experts or even have a clear understanding of their situation from the start - community-led means that communities have a voice, as well as decision-making authority over decisions that affect their livelihoods and wellbeing.
Ultimately, community needs are best understood by members of the community themselves. External experts need to keep an open mind to appreciate the multiple ecosystems that exist within a community. Interaction between external and internal players can help in collaborative decision-making that results in greater capital absorption capacity by communities.
Ankita Bose has worked extensively in social impact for more than 8 years. She is currently pursuing her Masters in Public Policy at the Lee Kuan Yew School of National University of Singapore. Prior to this, Ankita worked to provide access to water for marginalized communities in inherently dry areas in India. She attended the UNLEASH global lab 2022 to curate innovative solutions for addressing sustainability challenges related to water and sanitation. Earlier in her career, Ankita was a documenter for UNICEF project and worked towards the elimination of communicable diseases in India. Ankita has a holistic outlook, having engaged directly with communities at the grassroots level and in strategy as part of a corporate donor team. She holds a bachelor's degree in Economics from St. Xavier's College, India, and a Master's in Social Work from the Tata Institute of Social Sciences, India.
Kelley Buhles is a consultant working at the intersection of philanthropy and community governance. She is passionate about liberating charitable money to provide non-extractive capital to entrepreneurs and movements, and to create economic models that build and retain power and wealth in communities. She has over 12 years of experience with participatory grantmaking, has designed and led over 20 participatory processes, and is a founder of the Participatory Grantmaking Community. Kelley also has 15+ years of expertise working with integrated capital, Donor Advised Funds, and philanthropy. She is a fellow of the Just Economy Institute and sat on the Transformative 25 2023 review committee. Previously, she was a Senior Director at RSF Social Finance, where she co-created the integrated capital approach to financing, ran the philanthropic programs, facilitated community pricing conversations, and supported organizational culture. She volunteered with Showing Up for Racial Justice and enjoys sketch comedy writing. Kelley holds a B.A. in anthropology from San Diego State University.
ImpactAlpha's Editor and CEO David Bank writes about Salzburg Global's latest health program
This article was originally published in ImpactAlpha.
There is no such thing as a single-issue struggle because we do not live single-issue lives, as the poet Audre Lorde once said.
Likewise, the challenges of providing for basic human needs such as food, water and housing are deeply interconnected. The search for solutions is made even more complex by the sometimes conflicting demands of between and even among capital providers, communities – and other stakeholders.
“I found myself wondering if financial instruments are the best way to address the root cause of some of the problems,” Murray Gray of the Netherlands-based impact consultancy Metabolic wrote in his reflections on the recent “Connecting Capital to Communities” gathering at the Salzburg Global Seminar in Austria. “Maybe financial intervention is not the thing. Instead, maybe the intervention is something else entirely.”
The gathering, sponsored by the Robert Wood Johnson Foundation, brought together nearly 50 changemakers across issue areas and geographies to “harness financial markets for essential social infrastructure.”
ImpactAlpha, the media partner for the convening, is producing a series of podcast conversations with delegates (the first two featured Vienna’s Michaela Kauer on that city’s affordable housing model and FarMart’s Samridhi Singh on connecting Indian farmers to global markets).
In the U.S., thanks to recent legislation, there is in many cases a healthy supply of capital to fund physical and even social infrastructure. But a shortage of “absorptive capacity” on the part of communities means that capital can sometimes resemble a plane with nowhere to land.
“We see the capital is not getting to the communities where it needs to go,” said Robert Wood Johnson’s Kimberlee Cornett. She cited the “capital absorption” framework developed by Robin Hacke of the Center for Community Investment in Cambridge, Mass. The reasons for such lack of capacity include policy failures, readiness gaps, risk perceptions and access to and the price of capital.
And even the refrain of “too much money, not enough projects” rang hollow to many delegates, particularly those from the global South.
“Where we come from, there isn’t capital. It isn’t there. It doesn’t want to come there,” said Empowa’s Glen Jordan, who is working on affordable housing solutions. Empowa is developing a rent-to-own model to tackle the challenges of affordable housing in emerging markets, starting in Mozambique, a country of 32 million people with a total of only 600 outstanding mortgage loans. Empowa’s blockchain-based approach lets renters build equity over time and assures developers with the cash flows they need to finance their projects.
“When there’s no formality, there’s no identification. Income is informal. The mortgage product just doesn’t work,” Jordan said. “So we have to turn it around and create products that meet the needs of the informal market.”
Barring a back-ended surge before the 2030 deadline, the global Sustainable Development Goals are looking like a utopian pipe-dream. Only 12% of the 169 specific goals are on track, 50% are off track, and for 30-40% of the goals, the world is actually getting worse off. And it’s not just COVID and the war in Ukraine – even in 2019, the world was not on track to meet SDG No. 1: End poverty in all its forms everywhere.
Bottom-up solutions will be key to any progress. Most of the world’s food is grown by smallholder farmers, for example, who also represent the bulk of the world’s poor.
“Think about that paradox: the hungry farmer,” said One Acre Farm’s Chanda Banda. “It doesn’t make sense.”
One Acre supplies inputs, advice and credit, and has a global repayment average of 98%, Banda said. “They pay back loans because their livelihood depends on getting the inputs from us,” he said. Banda borrowed a phrase from another delegate that became a mantra of the seminar: “Capital moves in the direction of trust.”
One of the seminar’s working groups produced a draft framework for a bond based on the “true value of food,” modeled on other green and sustainability bonds, to lower capital costs for producers transitioning to healthy, sustainable food production and distribution.
The global food system produces negative externalities that are not accounted for in the cost structure, said Suzanne van Tilburg of Rabobank, the Dutch lender that has focused heavily on food and agriculture. That includes an estimated $12 trillion annually in hidden health costs and $7 trillion in environmental damage, more than double the value of food consumption itself.
“How can it be that we have a food system where unhealthy, unsustainable food is the norm and is affordable,” van Tilburg asked, “while healthy, sustainable food is expensive and unaffordable?”
The word “community” has almost talismanic power in social-change discussions. Yet even the most well-intentioned advocates have to accept that communities may have different, or conflicting priorities.
In New York City for example, Local Law 97 enacted in 2019, pitted some affordable housing proponents against climate advocates when affordable housing projects were exempted from the law’s greenhouse gas reduction targets. In another city, a series of community meetings determined that locals prioritized soccer fields over affordable housing.
“That challenged everything that I have been trained in,” Cornett recalled. “How do we get comfortable when communities make different choices?”
How do communities see themselves? “Beneficiaries,” or customers, for example, may see themselves differently than do the social enterprises or impact investors seeking to serve them. Many farmers and shopkeepers do not identify themselves by their roles or their crops, said FarMart’s Singh, but by their families, their children, their villages and their ethnicities.
And communities exist in cities, states and nations. “We are reliant on government to help us,” said Habitat for Humanity International’s Patrick Canagasingham. “When institutional structures are weak, it’s hard to make sure outcomes are consistent with what communities are seeking.”
Salzburg Global Seminar, a 75-year-old nonprofit that operates from a storied “schloss,” or palace, on a picturesque lake (made famous as a setting for the movie, “The Sound of Music”), emphasizes hands-on solution-building. Delegates worked in small groups to develop concrete proposals to take forward after the gathering.
That process was not without its own power dynamics. “Despite the inspiring, thoughtful, talented, motivated group we had, I observed the very issues we are looking to address,” said Metabolic’s Gray. “I also observed that the larger the group, the more Europeans and Americans spoke. Those from Africa and Asia more needed to be ‘invited in.’”
He noted the group slanted towards the technical and mechanistic, rather than holistic solutions, suggesting the need for Inner Development Goals to complement the global Sustainable Development Goals.
Resilience Capital’s Triple B framework attempts to tackle such power dynamics, identifying bottlenecks and blind spots as well as blended capital solutions.
“How much do we value nonfinancial capital?” asked Resilience Capital’s Cathy-Mae Karelse. “How much do we attach value to the fact that our communities have knowledge and wisdom?”
Community knowledge and wisdom can provide ways to measure impact as well.
“Not everything can be told through numbers,” Gray said. “We are feeling, storytelling beings. Culture can be the soil for change. This soil is made up of narratives and stories. We can cultivate that soil.”
Salzburg Global Fellow Murray Gray reflects on (re)connecting capital(s) to communities
In June 2023, Salzburg Global Seminar curated a group of around 50 participants from around the world with a shared question: how do we better connect capital to communities to fund essential social infrastructure in the form of food, housing, and water?
The group spanned participants from a range of contexts. From global institutions like the IMF and OECD in New York and Paris, to entrepreneurs on the ground building affordable houses in Mozambique or building the infrastructure to connect smallholders farmers to markets across India. From funders at global institutions in Seattle, Amsterdam and Nairobi to nonprofits supporting direct action on the ground in Mexico to the Philippines.
There was an overwhelming depth and breadth of experience, expertise, and wisdom in the room. I stepped in as someone with less technical finance expertise than most. Here are some of the key (non-technical) lessons that emerged for me that I hope can trigger some thoughts for those working on directing finance to community-led solutions.
To change the world, change yourself, then change how you work in small groups before you enact big change. Patterns scale upward and downward.
It is said that change is fractal: the micro reflects the macro, the macro reflects the micro. The issues outlined above are ones we face globally. These are reflected in smaller groups. They are reflected deep within ourselves. Reshaping global power dynamics, relationships, and collaboration requires us to start with inner transformation.
Despite the inspiring, thoughtful, talented, motivated group we had, we fractally reflected the macro challenge we were tackling. We experienced certain power dynamics. We found it difficult to coordinate and collaborate cross-boundary. We found it hard to deeply listen to each other. We found it difficult to hold space so that everyone could contribute. We found it hard to sensemake together based on the different frames, perspectives, and experiences people brought in.
The larger the group we had, the more Europeans and Americans spoke and those from Africa and Asia more needed to be "invited in". Elsewhere, some of us felt judged by others based on the institutions we worked for that maybe were seen as "part of the problem".
Did we come in with the mindset that our role was to harness the maximal collective power of the group? To cultivate the collective genius (scenius)? Step back to observe our thoughts and behavior, reserving judgment, challenging our mindset? Optimizing for the dynamic of the bigger whole rather than ourselves? Ultimately, be the change we want to see?
We face the same overarching challenge and tension between goals, but they manifest very differently context-to-context. We can learn from each other, but to do that we will equally need to be comfortable adapting.
It seems to me that when we zoom out fully, we have shared goals. Social infrastructure that might have the following characteristics:
There are tensions between these characteristics. Finding a way to manage these tensions is the challenge we all face no matter where we are.
Yet how we manifest this goal is different in every context. Historically, richer and extractive countries have experienced development that has been linked to the destruction of nature and global inequality. These wealthier countries need a just transition within what is now a tight ecological margin – their carbon budgets are close to depleted. Countries who have development ahead of them are trying to not repeat the ecological destruction and issues of inequality created by these richer countries.
The more you zoom in to specific communities, the more the “how” of the change differs. What we “know” in one context starts to get challenged when exploring another context. How we communicate, frame, engage has to evolve too.
Universalism can be dangerous. The United Nations' Sustainable Development Goals are a useful starting point, but not the be-all and end-all.
We can undoubtedly learn from each other. Yet every context will need differently adapted solutions, rather than ones off-the-shelf. We need to find ways for connective language and discourse, but we also need to sit with differences and adapt to specific contexts.
We need both technical, political solutions and cultural solutions. We need to work to bring those to the table who can create the culture for change.
We talked about three key ingredients to connect more capital to communities: 1) shared priorities, 2) creating an investable pipeline of projects, and 3) developing the enabling environment. For all of these, I see that we need cultural approaches as well as technical ones.
We talked about the need to "build the piping". There is a detachment between where funding sits and where funding is needed. We need to build the connective tissue cross-boundary. Given the contextual differences, this tissue is not just structural – it is also cultural tissue that we need.
As outlined by Cathy-Mae Karelse, we need to shift deeper mental models, we need a multi-capital approach beyond finance (culture, social, spiritual, relational and so on), and we need catalysts and ecosystem builders.
While there is space for more intellectual and technical innovation, there is a huge space to fill for soft skills, translators, facilitators, and storytellers in the transformation we seek. We will need to invest in these more intangible roles in local communities, changemaker organizations, funds, governments, in multilateral organizations. When we zoom out to the macro global scale of connecting capital to communities, this seems critical.
It would have been helpful to have more of these skills in our group.
We talked a lot about impact measurement. Not everything can be told through numbers. We are feeling, storytelling beings. Farmers may ‘just know’ whether the soil is healthy if they are working in harmony with nature. Stories from communities may act as an impact measurement. There is emerging energy to explore this method. What is a citizen's story, their feelings before and after they own their first home? Or easily access clean safe water? Eat healthy local sustainable food and support their local community in the process?
Culture can be the soil for change. This soil is made up of narratives and stories. We can cultivate that soil. We need to find connective stories, connective language, connective common ground that connects people who are operating in quite different contexts. Not necessarily the same story or language.
We need to challenge ourselves to get into depth around problems, mechanisms of change, but also iterating our way through signal from the real world.
The scale of the issues is so big that it's hard to connect this to the very tangible things on the ground. We need to find ways of zooming between all the scales and contexts and leverage people who are great at that.
Our group leaned more towards technical and mechanistic thinking – the details of the "how". Sometimes we missed the deeper "what" and "why" of what we are solving and missed addressing a deeper root cause.
To get to powerful solutions, it is helpful to spend time understanding the true dynamics of the problems. In the startup world, where there is the ability to iterate and adapt to information quickly, this is less vital. You can iterate towards the solution that works. With infrastructure like houses, water and farms – and with more complex financial instruments – it is harder to just iterate and work things out.
When we immerse more in the dynamics of the challenge and the status quo we are looking to shift, we can better get into the roots of challenges and the systemic lock-ins that prevent change. I found myself wondering in some cases if improved financial instruments are the best way to address the root cause of some of these big problems. They may be treating symptoms of problems.
When we dug into the mechanics of "how", we missed out a bit on really understanding what our theory of change or impact thesis is for a given solution. Why is this the solution to drive change? What is the intended result? What are the critical assumptions in our model that will make or break whether this will work in the way intended? We might also consider ways we can prototype and iterate to learn from real life.
Combining these different approaches can help us come up with more effective solutions.
Catalytic organizations embody our best hopes to break the reinforcing feedback loops and lock-ins to the existing degenerative system we find ourselves in.
What we need to drive change are what we might call “catalytic organizations”.
Organizations may drive both direct change (building houses) and enable wider change (creating the conditions for more houses and wider development) such as Casa Real. Elsewhere, they may act as the critical piping between sources of finance and projects. Or they may break reinforcing feedback loops that prevent change, where each vital resource is dependent on the existence of another resource. Or they may kickstart more transformative change in richer countries to widen the ‘path of progress’ which has become quite narrow. So narrow, in fact, that current innovation efforts risk merely optimizing the current degenerative extractive system rather than changing it.
We need to work out which critical catalytic role(s) are needed in each context. Then we need to get the resources (not just money) to the catalytic organizations playing these roles.
When I zoom out, I see that what Salzburg Global did was find these catalysers from across the world. Then create the environment for them to engage while guiding them through a collaborative and emergent process.
I also see that these are five ways we can enact change better, to articulate shared priorities, create and execute an investable pipeline of projects, and improve the enabling environment for funding to land impactfully. I thank Salzburg Global, Robert Wood Johnson Foundation and all the fellows for the experience. And I look forward to the cross-cutting collaborations that emerge from this group: hopefully marrying structural and cultural approaches to system change.
As Co-Director of Metabolic Ventures, Murray Gray specializes in enabling early-stage entrepreneurs achieve their business and impact objectives, helping them succeed in realizing their system change vision. After tinkering in entrepreneurial endeavours in his teens, Murray started his career in finance, before spending most of his 20s in entrepreneurship within the creative industries. Upon moving into the world of sustainability and social impact, Murray developed a strong view on the role of enterprise in driving a new sustainability agenda across a variety of life cycles: from impact-focused startups to SMEs within the B Corp movement and large-scale enterprises evolving their business models. Metabolic Ventures' work focusing on enabling entrepreneurs to design and develop ventures that aim for system change. A key part of this is building the enabling environments that empower them to succeed: through finance, expertise, networks and policy.