On the Couch with Dr Jack Chow

Our guest on this occasion was Dr Jack C. Chow, who was visiting Adelaide to deliver a seminar at Carnegie Mellon University (CMU) on Strategic Policy Design, A Guide to Statecraft, which is part of CMU’s advanced education program. Dr Chow is a Distinguished Service Professor at Carnegie Mellon’s Heinz College of Public Policy, and is a founding faculty member of CMU’s Washington DC program. By way of career background, Dr Chow was commissioned by Secretary of State Colin Powell as the United States Ambassador on Global HIV/AIDS and was the first Assistant Director-General of the World Health Organization on HIV/AIDS, Tuberculosis and Malaria.

Dr Chow has also held senior positions throughout the US Government, including in the State Department, the House and Senate Appropriations Committees, the White House Office of Science and Technology Policy, and the U.S. Department of Health and Human Services. He has also worked in the private sector as a management and policy consultant at the RAND Corporation, McKinsey and PricewaterhouseCoopers. His academic degrees include: MPA in international policy from Harvard’s Kennedy School of Government, an MBA from the University of Chicago, MS from Berkeley, MD from the University of California at San Francisco, and BA from the University of Pennsylvania.

Dr Chow was interviewed by Ms Nicki Dantalis, Acting Executive Director, Policy, Governance and Executive Services Division at the Department of Health and Aging. Previously Executive Director, Office of Chief Executive, Department of Health, she has worked in the South Australian health system for almost 30 years in a broad range of hospital, public health and government administration settings. She works at the senior executive level and has extensive experience in policy development, health system governance, inter-government relations and legislative reform. In her current role, she has been responsible for leading the negotiations for SA Health with the Commonwealth for the national health reforms and works closely with her Department of the Premier and Cabinet colleagues, especially in the lead up to the National Health Reform Agreement that was endorsed by COAG in August 2011.

The MC for the event was Ms Anna Cosentino, Chief Operating Officer, CMU, with whom IPAA has recently commenced developing a partnership alliance that will ensure that IPAA’s some 50,000 members receive the best benefits of CMU’s deep engagement with internationally noted and esteemed public sector leaders. The session with Dr Chow inaugurated the relationship and certainly represented a highly auspicious partnership launch. The session was pulled together virtually overnight and could never have happened without the immense support of Dr Chow, Ms Dantalis and Ms Consentino, along with equal support from our sponsor, Flinders University, which marketed the event to its many contacts, as well as from the Department of Health and Aging, which made sure that the opportunity to hear from Dr Chow was extended to its staff.

During the 40-minute interview, Dr Chow and Ms Dantalis covered much ground and it would have been terrific to have been able to provide a full report on all that they discussed here. For this article however, IPAA has elected to focus on the 3 questions that seemed to provide the greatest inspiration and instruction –

1. What have been some of your most fulfilling accomplishments in your public policy work, and are there recommendations from your reflections you wish to share?

Dr Chow’s response to this question attests to his empathetic nature and altruist outlook. He had two particularly fulfilling accomplishments to convey to us:

1. His role as the ‘policy architect’ of WHO, which was formed out of his conversations with George W Bush and that US President’s Secretary of State, Colin Powell, as well as with Kofi Annan and other notables. The fulfillment that arises for Dr Chow from his role of “policy architect”, he explained, is very similar to that of the architect who designs a building with the knowledge that – for a long time to come – the building will house and welcome a multitude of folk that will benefit from, enjoy and put to good use the building and its architectural refinements and innovations. Dr Chow knows that, so far, well more than 7 million people have received treatment and other substantial benefits from the WHO policy architecture;
2. Even while Chow only ever thought of WHO’s beneficiaries along with the other beneficiaries of his medical perspicacity, when formulating strategies and policies that will and do benefit us all, a single and ultimately personal achievement was a serendipitous outcome: a dear friend of his, who was suffering the radical effects of full-blown HIV/AIDs, ended up receiving the therapy that he needed to restore his life to a (relatively) healthy and enjoyable one; and
3. There are 8,000 extant rare diseases, some of which affect about 10% of the Aussie population, including some 400,000 children. What is the best way to approach this problem, given the issues?

This question was prompted by a brief article in the Weekend Australian (Leigh Dayton, 24-25 March, 2012), which reported that a consortium of Australian research and advocacy groups, led by the Mitochondrial Disease Foundation, convened in the week prior “to discuss new research, identify funding and medical issues and build on a preliminary work towards a national plan for rare diseases”‘. In posing the question, Ms Dantalis made the excellent point that – based on the statistics provided in the article – any single disease has an incidence of around 50 people within the Australian population – but collectively rare diseases affect a large portion of the Australian population, even without considering the issues that arise for these Australian’s families, friends and employers.

The first part of Dr Chow’s response was that the US is currently confronted by the same problem and the same issues, namely that educating medical practitioners in all of the diseases and their symptoms, and developing the requisite interventions and therapies, comes at great expense in terms of time, human resources and money. In light of this, fully addressing the issue could have thorny consequences: how do we justify these expenditures when only a relatively small proportion of the population would benefit, and this potentially at the cost of diminished expenditure on the diseases by which we are commonly afflicted?

The second stage of Dr Chow’s response involved his pointing out that this is a global issue and his proposal as to solutions relied to a great extent on his experience in addressing the global presence of prevalent diseases, such as HIV/AIDS, Tuberculosis and Malaria, through the WHO. The WHO approach is and was for medical practitioners, NGO’s and other not-for profits, and governments and communities, to form alliances and partnerships across the globe. This approach greatly diminished/es the time, human resource and financial expenses required and will no doubt do the same for the problem of rare diseases.

1. WHO is a huge, international organisation and yet it is consistently able to demonstrate prescient, probabilistically reasoned powers and solutions. How does it achieve this in light of its size and the fact that its leaders are distributed unevenly across the world? Given that SA is in strong period of public sector reform, with the focus on maximising service to its citizenry and residents, what can government organisations do to achieve comparable successes to WHO’s?

Dr Chow’s answer to this question was covered to some extent in our previous question, which concerned strategic problem solving around rare diseases, namely that WHO’s success ultimately relies and globally and locally formed alliances and partnerships. Essential to the success of these alliances and partnerships, stated Dr Chow, is that they are all formed by commonly held ethical and political principles: e.g. and to quote Dr Chow, “My mission is your mission”, a commonly held view that collegiality is essential and that solving the issues is “not about my country and certain prerogatives; it is about [effective] delivery”.

The problem that WHO faced at its inception some 10 years ago, continued Dr Chow, was that it “endured skepticism” just when it needed the support required to accelerate its strategies, policies and implementations and to maximise its “capacities and capabilities”, all of which are issues that affect and slow down governments and their agencies in their own efforts to maximise service excellence and delivery. Dr Chow’s advice was that, certainly with respect to WHO’s leadership and most active supporters and contributors, “It takes a vision, a gutsiness, a form of courage to have [the] confidence [required]’. Very importantly also, WHO, which currently services over 7 million people from around the globe, purposely set out to provide governments (its key alliance partners) with a viable and strategically devised policy, a “blue-book” of universal applicability and implementability that “shaped our product to be actionable”.

Of course, said Dr Chow in closing, the development of the requisite blue book relied tremendously on WHO leaders determining, via targeted community consultation, just what their target market actually required/es. Not only this, but WHO, and like organisations, need to be in the position to “give fortitude” to the front-liners directly engaged with and in communication with the victims of disease.

At the end of the highly informative and engaging interview, Dr Chow kindly extended his time with IPAA members, for some one-on-one chats, the food, venue and libations having been provided at no charge by CMU to IPAA. The feedback that IPAA has received so far firmly indicates that the On the Couch session with Dr Chow was an immense success.