Skip to main content

Remarks of Harvard President Lawrence H. Summers, Panel discussion: ‘Public Health Crisis in Africa: How May Harvard Help?’

Harvard School of Public Health, Boston, Massachusetts

It is great to be at the Public Health School and it is great to have a chance to talk about a profoundly important issue. And I want to thank very much all of those who have been involved in organizing this program. Deborah Prothrow-Stith, for your moderating this program, Professor Akyeampong for his leadership of the University’s efforts in African studies. You know, for the first time, we now have a department in the Faculty of Arts and Sciences that is in part a Department of African Studies and that is an important milestone in the history of the University. I want to thank Dean Bloom for his leadership of the Public Health School and I want to acknowledge especially Max Essex’s work on AIDS. For a distinguished scientist to work on AIDS today, because it is a profoundly important problem, is something that can be quite easily anticipated and there are many who are doing it. When Max Essex started working on AIDS, when he focused his career on AIDS, when he began doing things in Africa, it was a courageous and it was an important choice. And there are many thousands of people who are alive today, who would not be alive today, if Max Essex had not made that choice. And Max’s example is a very powerful one for all of us of the moral accomplishment that can come from the pursuit of knowledge. Max, thank you for your example.

I want to talk for a few minutes about why I think the study of health in Africa is at the center of what a university like this ought to be about. And then talk a little bit about some of the things that I hope we’ll accomplish at the University over the next few years. And then I want to respond to your questions and comments because ultimately in a university what happens is not what administrators decide. It is what students and faculty accomplish.

I am convinced that the public health of the developing world and especially Africa is the single issue that has the greatest significance for humanity over the next half century. More people will live or die based on our success in addressing AIDS, malaria, and other diseases than will live or die based on our success in creating prosperity, based on our success in advancing freedom, or based on our success in keeping the world at peace.

There is no other issue of comparable significance for humanity.

I am also convinced that there is no other issue that is as amenable to Africa, that the challenge of protecting public health is amenable to effort, through increased resources and human commitment. There are literally millions of lives a year that could be saved with today’s knowledge, today’s resources, if we simply were able to make the requisite commitments in the countries. And there are yet millions of people whose lives could be saved each year with advances in knowledge that are within our reach, that do not involve miracle cures but involve the steady and sustained application of research protocols that we know. That is not true with respect to many of the world’s other great problems. Someone may have an inspiration for how to promote peace. Someone may have an inspiration as to how to promote economic growth everywhere that hasn’t been found yet. In public health we have the knowledge of today and we have the pathways to the knowledge of tomorrow. And when there is a situation in which the greatest problem and challenge facing humanity is also one of the more tractable challenges facing humanity, it behooves us to be seriously engaged. It behooves us to be seriously engaged all the more because in a way that is quite unique, this challenge of disease in the developing world and especially in Africa seems to me to engage all four of the things that I think are central to what the University is about in the years ahead.

You know, as Deborah said, I’m the 27th person to become President of Harvard since 1636. I’m also only the seventh person to become President since the end of America’s Civil War, and that inclines one to take a long view.

And you know, if I think about what will be in history books about the time when we were alive 200 years from now, it won’t be that many things. You know, you don’t remember that much about 200 years ago and not that much will be in history books 200 years from now. But there will be a few things. The first will be how does the coming together of developing and developed countries work out? We’re in an unprecedented period when the communication, the transportation, the extent of interaction between the developing world and the industrial world is far greater than it has ever been before in our history. That can work out splendidly. Look at the way in parts of East Asia standards of living have doubled in a decade, doubled in a decade and doubled in yet a third decade. Look at the fantastic emancipation of women that has taken place in parts of China where a generation-and-a-half ago women could expect to have their feet bound at birth. Look at the fact that in a city like Seoul, Korea, there were a million child prostitutes a generation ago and today there are almost none.

There are staggering opportunities for progress and if this progress is realized it has the potential to be an event that would rank in the history of the last millennium, in terms of really changing the conditions of mankind, only with the Renaissance and the Industrial Revolution.

But equally and in the same world within a 14-hour airplane flight, within the distance of a picture that can be transmitted in a matter of seconds, there is an entire continent in large parts of which a child is more likely to be malnourished than to learn to read, and more likely to die before the age of five than to enter secondary school. A continent where two teachers die of AIDS for each teacher who is trained. A continent where something is happening that has not happened, did not happen in Europe during World War I or in Europe during World War II, and that is the life expectancy is substantially declining. A continent in parts of which life expectancy is declining back to the Biblical norms of one score and ten years and it is part of the same planet. And that difference, that progress that is possible, and that disaster that is looming, will be part of how our generation is judged.

There’s a second thing that is happening and it’s happening right here. It’s happening all over the world but the epicenter of what is happening is actually, probably within a few hundred yards of where we are right now and that is that there is a revolution underway in the life sciences.

For the first time in all of human history we are coming to a fundamental scientific understanding of human nature. And that fundamental scientific understanding is an operational understanding in which we can influence human beings, in which we can in scientific and planned ways interfere with disease processes. I’m told that it’s not unreasonable to expect, given the progress that we are making, that my 12-year-old daughters, and if not my 12-year-old daughters, surely their daughters, will live to be a hundred.

But you know something? If you look at the American pharmaceutical industry it is spending more on pet disease than on tropical disease. Less than 1 percent of the patents that have been given in recent years have gone to address the diseases of tropical countries. And yet those diseases can be addressed by this scientific revolution, as well. We in the City of Boston have the highest fraction of concentrated talent in the life sciences that exists anywhere on the planet earth. You look at the five institutions in all the world who are able to attract the most peer reviewed scientific funding. Institution number one, institution number two, institution number three, institution number four, and institution number five are all here in Boston. And no small part of that funding through the City of Boston comes to people like Dyann Wirth for her very important research on malaria, to people like Michael Reich for his very important research on death due to accidents, his very important research on schistosomiasis. Surely, if we at Harvard are in possession of the most significant life science concentration of talent that there has ever been, we have an obligation to this problem.

There’s a third thing that’s important about this time and it’s something that I believe in very strongly, perhaps reflecting my background as an economist, and it’s something that’s really at the center of a great deal of what goes on in the Public Health School and that is that a far wider range of human phenomena, of challenges and of problems, are becoming amenable to analysis, can be confronted using the data. People can have not just hunches and superstitions but they can actually have evidence and they can approach truth in ever-closer ways.

A facetious example comes from the book that some of you may have seen, Moneyball. That book shows how a very smart guy who hires some very smart statisticians was able to produce the best baseball team in the American League at a third of the payroll of the other teams by drafting the right players based on statistical analysis.

A different kind of example is provided by the people who advertise on television who don’t just figure out what would be a fun advertisement but look very carefully and with very carefully controlled experiments at which advertisements work. None of this is new to the traditional medical field. If you wrote a history of medicine within the 20th century and you had to list all the important innovations, penicillin would be there, transplant surgery would be there, cancer chemotherapy would be there, but you know what is probably the equal of all three? The idea of the double blind clinical trials, which permitted us, actually, to know and not just to guess what worked and what didn’t work.

Those same techniques of analysis are possible with respect to what types of interventions work to promote public health. What is the best way to interfere with sexually transmitted disease? Which regimens do and do not work with respect to AIDS? What are the optimal strategies in an environment where blasting a disease is important but where avoiding the creation of resistant strains is important? What are the optimal strategies for using drugs? These are questions we don’t have to guess about any more. We have critiques of rigorous analysis for figuring out the answer and that is not just socially important. It is an enormous practical intellectual challenge and it one that is within our reach and it is one that is at the center of a great many people’s research here at the Public Health School and in other parts of the world.

And finally, a university like this is very fortunate. All of us who have a chance to be part of this university community are very fortunate. I was reminded of that this morning when I was a visitor to a public school in Boston and spent time with many of the children, many of whom don’t have a chance to grow up in a family background like the one I was fortunate enough to grow up in and the most disadvantaged of those children lives in an enormously fortunate environment, compared to most of the children who are alive on this planet today.

We are fortunate to spend our lives studying problems that we find fascinating, being compensated in a way that enables us to live comfortably, to do work that we love, surely we have an obligation to make a contribution in what we do to the broader mass of humanity. And make no mistake: the failure to address global disease in as effective a way as we can would be a moral failure. It would be failing to be a Good Samaritan. It would be walking past a sick person and not giving assistance. This is something that is truly important.

I’ve been reminded in recent weeks of a moral dimension of these problems that I didn’t previously appreciate by the work of the only Center on Human Rights and Health that exists in the world, the Center here, and its counterpart centers at Harvard’s Kennedy School that have emphasized that what is happening in South Africa, the denial of treatments, the misleading of people with respect to treatments that work, is a human rights violation. It is a human rights violation to not tell people the truth about what will work and will not work, in just the same way that it is a human rights violation to withhold their food or to withhold their education and as tragic as it is, there is no one among us who would not rather have the right to vote withheld than to have the right to an available treatment for AIDS withheld.

There is a moral dimension to all of this, as well. All of these are reasons why this work is so very important to the University and we’re doing many, many things, many of which Barry will detail. I just want to comment on what the three broad areas are in which I hope we will substantially expand our efforts in the years ahead: the first is training of students for positions of leadership in this area. I hope that an increasing fraction of those who do research in the life sciences at Harvard will do research in the life sciences connected to the problems of the diseases of the developing world. I hope and I expect that we will provide instruction to our undergraduates in issues relating to global health that will bring together in an interdisciplinary way their thinking in the social sciences and in the sciences in much the same way that we do with issues like environmental science. I hope that we will succeed in making it possible for more of the very best students to come and study public health. You know, the “every tub on its own bottom” system that we have at Harvard has many virtues. But it is a grave mistake to ever suppose that the importance of a professional activity is measured by the average income of those who go into that profession. One of Barry’s predecessors told him that public health was a distinctive field. It was the only post-graduate degree that you could earn that reduced your salary. Well, it may reduce your salary, but it sure increases your contribution to society and that’s why people go into it.

But we have an obligation at the University to make it possible for the things we say about assuring that everyone can come who is excellent, to come. That needs to be true in every part of this University. That’s why we started providing increased financial aid for public health education, other fields like it, and we need to do a great deal more to build on those efforts. And it would be my hope also that as we have our Program in African Studies that we will assure that not just those students who are going to specialize in the area but that a much wider range of our students become familiar with these basic ideas, the importance of what it is that is happening in the developing world.

The fundamental insight that Dean Bloom says so well, that not one person in 50 in America appreciates that with respect to many problems it is not about your behavior. It is about the way the society functions. We had American automobile accidents; the number of people who died from automobile accidents increased by 3 percent a year for five decades. And for all of those five decades, America had a plan with respect to automobile fatalities. It was to tell people to drive more safely. It was a plan and we talked about it and we talked about it, I don’t know who did but really it was a plan and global automobile companies advocated it. It was a really very serious plan. And then we decided, well, people are kind of people and maybe what we should do is have safer cars and have safer roads and suggest systems like seatbelts that would make them safer and today we’ve got twice as many people driving as we did when I was a kid and we’ve got a third fewer fatalities. That is the fundamental lesson of public health — that the system matters — and we need to make sure that a larger fraction of educated people know it.

All of that is about education and training, which is a fundamental thing we do at Harvard. There’s a second thing we do at Harvard and it’s something that we are very fortunate to be able to do because of the standing of this university and that is the tremendous convening power that this university has. We’re very lucky, people come to Harvard, people are invited to come to Harvard, they have a way of deciding if they want to come and discuss these issues. When the food industries wanted to discuss the set of questions having anything to do with people who are overweight and their contribution to the obesity epidemic in America, and they wanted to have the people who market foods get together with the other people who market foods, get together with the health experts, get together with the regulators, it could have happened in many places but, because there was a place called Harvard with the reputation that Harvard has, it happened to take place at Harvard.

We need to use that convening power to bring together people who are in a position to make decisions, people who are in a position to influence the global debate on public health. We’ve done it in important respects. There’s a major project at the Kennedy School that’s underway, in which I know people from the Public Health School are engaged, that is around the AIDS epidemic, that is around working with businesses to talk about how they can make a difference in reducing AIDS by working with their employees in Africa through the things that they do in their education. But there are many, many more groups that need to come together and need to be sensitized if we’re going to do everything we can with respect to this problem.

Timing, convening power, and dissemination — development and dissemination of new knowledge. You know, a really tremendous thing happened in the last year that most people take for granted, or more accurately, a really tremendous thing was a thing that didn’t happen in the last year. In 1918, about 3 percent of the people on planet Earth died of the flu. Think about that: 3 percent of the people on planet Earth. Today that would be 180 million people. SARS had some of the same kind of virulent potential that the flu had, and less than 1,000 people died. That is because of what we understand now that people didn’t understand then.

The research that we do, sometimes in ways that are predictable what Dyann will discover with respect to malaria — sometimes in ways that are completely unpredictable — what a mathematician, now working in FAS, thinking about strains of mutations, discovered with respect to the nature of the AIDS process.

New knowledge makes a huge difference in our ability to prevent, to contain and to treat disease. And we need to make sure that we are bringing here to Harvard the people who have the greatest potential to contribute to this knowledge, to contribute to the scientific knowledge, to contribute to the social scientific knowledge that is necessary if the world is going to make the fullest possible effort. If we’re able to bring more and more of the greatest scholars to join the remarkable community we now have, if we’re able to use our convening power and our voice in the world with respect to this problem, and if we are able to train a yet larger and greater next generation of leaders, we will have done our part with respect to what is both the greatest and the most tractable moral problem facing humanity.

Thank you very much.