I was encouraged to see that just across the Causeway in neighboring Malaysia, public-private partnerships to tackle disease are taking off and one good example is the one between the Malaysian Ministry of Health and Novo Nordisk with partners.
There will always be skeptics and credit to the Malaysian officials for disregarding the inertia and negativity to at least try. I’ve looked at the opening speech reported by Thomson Reuters and thought it easiest to insert my comments into an extract as below.
A focused partnership is born
Since the UNHLM in 2011, Novo Nordisk, the Steno Diabetes Center in Denmark, the University of Southampton in the UK, the University of Witwatersrand in South Africa and the Malaysian Ministry of Health have been working to develop the Jom Mama initiative, our joint effort to implement a life course approach to preventing diabetes. [The United National High Level Meeting in Sept 2011 was a unique, never-before gathering of world leaders to come together and commit to addressing what is probably the greatest scourge of modern times- not economic crises, not wars but disease, and specifically the chronic or non-communicable diseases which collectively account for more than half of all deaths in the world today. Many agencies have leveraged on the political attention and momentum to initiate programs including public private partnerships such as this one.]
The name ‘Jom Mama’ is an encouraging and motivating slogan in Malay. An English literal translation might be ‘Come on, Mama!’ and a contextual translation might be ‘Let’s do it, Mama!”. As an initiative, Jom Mama is a way to operationalize the life course approach, targeting at young couples who are planning to start a family.
Mounting evidence shows that supporting health early in the life course offers an opportunity to make a real difference in preventing type 2 diabetes (see video). Already, Jom Mama has gathered insights into the barriers young couples face when trying to improve their health. These insights will form the basis for a health intervention delivered initially as a three-year study. Young newly married couples will receive the intervention in a community setting and we will follow the couples through pregnancy and the birth of their child to monitor changes in their health.
It is a complex task and requires that we work in partnerships. We have been working together for more than a year and in June Jom Mama was officially established as a public-private partnership between Novo Nordisk and the Malaysian Ministry of Health to prevent type 2 diabetes in future generations.
The curious, the sceptics and the supporters
Needless to say, we have been met with a range of reactions. Curiosity from the open minded, scepticism from those who wonder why a pharmaceutical company would be preventing the disease its products treat, and support from those who have an understanding of the research. Research that continues to show that promoting health prior to conception holds a promising opportunity to reverse the rising prevalence of obesity and type 2 diabetes. [It would have been lovely if Novo Nordisk’s interests and rationale had been clearly explained. I would imagine that as a company, Novo Nordisk is somewhat unique in its size and single-minded focus on diabetes. I am familiar with the World Diabetes Foundation which is effectively the philanthropic arm of Novo Nordisk, and it does much good work in supporting preventive and therapeutic efforts around the world. The motivations of the company remain unspoken here but I would speculate that doing so embeds the company even more firmly in the diabetes space, the research provides it with new insights useful to its commercial strategies, the relationships built up through this partnership can only help, and finally companies evolve and there is no reason Novo Nordisk would not in later years move laterally across the diabetes spectrum into other facets of prevention and treatment.]
We want to tell the curious how Jom Mama is built on a fascinating field of science, the Developmental Origins of Health and Disease, which increasingly shows that scientists today can predict the individual risk of a new-born baby for developing diabetes later in life. The mechanisms of obesity and diabetes risk transfer from mother to child have been proven in research and Jom Mama represents the first health intervention of its kind of translating the science into action. With the focus on newly married couples in Malaysia, we will promote healthy pregnancies by helping them consume a nutritious diet, improve their physical activity and strengthen their health literacy. [Singapore has a mulit-million dollar research effort DevOS or Development Origins: Singapore which is government-funded and one flagship program GUSTO (http://gusto.sg/about/aboutGusto.html) seeks to study how mothers’ diet and lifestyle impact pregnancy and future risk of disease amongst children. I guess one of the key differences is Singapore’s wealth allows her to do so on her own which gives flexibility and independence but potentially deprives of opportunities in tapping expertise across a wide range of sectors and interests.]
We want to assure the sceptics that Jom Mama is a partnership driven by aligned intentions to put a stop to raising rates of obesity and type 2 diabetes that threaten the health of both the current and future generation. The time for action is now and it is that sense of urgency that has created the platform for the Jom Mama partnership. According to the WHO, 347 million people worldwide have diabetes. Current estimates put the number of overweight adults at 1.4 billion and of these more than 300 million are obese women. Numbers from 2011 show that more than 40 million children under the age of five were overweight.
Investing ahead of the curve
In Malaysia, the number of people living with diabetes will increase to almost one in four adults by 2020. The recent National Health and Morbidity survey done by the Ministry of Health in Malaysia shows a significant increase in prevalence among the economically productive younger age group (18-35 years) with a three-fold increase over the last 15 years!
Already, diabetes costs are estimated to account for 16% of the national Malaysian healthcare budget. The urgency to invest now to jump ahead of the diabetes curve is very clear. Neither the public nor private sector can stand by and watch as, for the first time in human history, we face a situation where children will live shorter lives than their parents. This is not acceptable and we will never be forgiven if we do not do our part to ensure this does not happen. [It is very clever to frame the partnership as a moral endeavor, one that brings together public and private interests and importantly sets aside commercial and partisan needs, because “we will never be forgiven if we do not do our part”.]
Our hope with Jom Mama is to rally support and inspire the committed to explore a life course approach to preventing obesity and diabetes in programmes, projects and policy. Together we can truly make a difference. Already, we have received encouragement and support from academic partners, the University of Southampton in the UK and the University of Witwatersrand in South Africa as well shared knowledge with researchers at Harvard Medical School. Their commitment to work alongside us is a testimony of the innovation potential that can be unleashed by cross-sector collaborations or private-public partnerships through research. [The ‘dilution’ of the private sector presence is clever and bringing in reputable academic partners helps deflect any criticism that Malaysia is ‘selling out’. For the academic partners, the appeal is clear- Ready access to a fairly large population with good data collection and probably the opportunity to conduct interesting clinical trials supported by the host country’s government.]
Some of the lessons in structuring public-private partnerships which can be gleaned from this short extract?
1. Time is needed to nurture and mature the relationships and trust
2. Start with a specific, contained and doable project that will enable all partners to be comfortable with each other and learn to work together
3. Show high level commitment and address upfront skeptics’ concerns and doubts
4. Leave the money out of public communications
5. Bring in other partners so that the coalition resulting is ‘politically’ more robust and acceptable to the majority
All in, I am impressed by the ‘can-do’ spirit of our Malaysian counterparts and the willingness of civil servants to be bold and try new things. There is no assurance this or any other collaborative will be successful but as the great Canadian ice hockey player Wayne Gretzky put it, “You miss 100 per cent of the shots you don’t take.
Just as importantly, the learning from this public-private partnership puts Malaysia in good stead for future such efforts. Ultimately, especially for the chronic diseases where so much is dependent on behavior and lifestyle choices, there is so much to learn from the private sector’s savvy in influencing and shaping consumer preferences, choices and actual spending. Can governments ever hope to achieve the same levels of sophistication? Very unlikely and hence the role and need for partnerships has never been more urgent.