J.P. MORGAN PRIVATE BANK

Philanthropy Field Guide: Global Health

Introduction

In 2000, the average life expectancy for the world’s population was 66.4 years. Just 15 years later, the global average life expectancy had risen to 71.4 years.1

Tremendous progress has been made in the past decade toward better health. However, there is more work to be done. This philanthropy field guide discusses trends in global health, offers a framework for understanding disease and other health issues, and outlines opportunities for philanthropists to make a difference.

COVER PHOTO: In central Malawi, a healthcare worker measures the height of a young girl. According to the World Health Organization, just over 42% of children under five in Malawi show signs of “stunting,” or impaired growth and development.INTERIOR: A woman and her children play on the beach at Hesketh Island in Alaska. As of 2016, an infant girl’s average life expectancy in the United States is 81 years.

This philanthropy field guide was developed by Geneva Global in partnership with The Philanthropy Centre at J.P. Morgan.

1 World Health Organization. Global Health Observatory (GHO) data: Life expectancy. January 2018. Available at: http://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends_text/en/

While infectious diseases, such as hepatitis, HIV/AIDS and tuberculosis, continue to be a priority in many low- and middle- income countries, chronic diseases, such as diabetes and cardiovascular disease, are on the rise around the world.

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THE VALUE OF GOOD HEALTH

Good health is critical to our quality of life, well-being and happiness as individuals. According to the World Health Organization, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”2 The many factors that influence people’s health status and quality of life include those that are:

• Social, such as income, status, sense of belonging, nutrition and education

• Biological, such as genetics, physiology and disabilities

• Environmental, such as pollution, urbanization, violence and working conditions

As Kofi Annan, former Secretary-General of the United Nations, observed, “The biggest enemy of health in the developing world is poverty.”3 Individuals living without decent shelter, good sanitation or sufficient food and clean water are at a higher risk for disease, injury and mental illness. Initiatives that aim to alleviate poverty recognize good health to be an asset and key to unlocking individuals’ ability to thrive. The relationship between health and economy is clear at the macro level, where, according to economists, every US$1 spent on health may result in up to US$20 in income growth within a single generation.4

INTRODUCTION

INCREDIBLE PROGRESS IN IMPROVING HEALTH WORLDWIDE

There have been tremendous global health gains over the past century, many of which have accelerated since the 1990s, thanks to concerted global efforts to address health as a key factor in reducing poverty. For example, child and maternal mortality have fallen by 53% and 44%, respectively, since 1990.5 In developed regions, coverage of women receiving the recommended course of antenatal care nearly doubled, while the birth rate among adolescent girls declined by 50%. In developing regions, the proportion of people who are undernourished decreased from 23% in 1990 to 13% in 2015.6

Reductions in poverty during the last few decades have contributed to an incredible shift in the types of diseases that have the greatest impact in terms of death and illness (also known as the global burden of disease).7 While infectious diseases, such as hepatitis, HIV/AIDS and tuberculosis, continue to be a priority in many low- and middle- income countries, chronic diseases, such as diabetes and cardiovascular disease, are on the rise around the world.8 In the United States alone, medical costs to treat chronic diseases are expected to average US$2 trillion per year between 2016 and 2030.9

2 World Health Organization. Frequently asked questions. December 2017. Available at: http://www.who.int/suggestions/faq/en/3 World Health Organization. Poverty and health. December 2017. Available at: http://www.who.int/hdp/poverty/en/ 4 Devex. Opinion: Building a shared future in a fractured world starts with education and health. January 28, 2018.

Available at: https://www.devex.com/news/opinion-building-a-shared-future-in-a-fractured-world-starts-with-education-and-health-91971 5 World Health Organization. Health in 2015: From the MDGs to the SDGs. December 2015. Available at: http://www.who.int/gho/publications/mdgs-sdgs/en/ 6 World Health Organization. Health in 2015: From the MDGs to the SDGs. December 2015. Available at: http://www.who.int/gho/publications/mdgs-sdgs/en/ 7 Institute for Health Metrics and Evaluation. Rethinking Development and Health: Findings from the Global Burden of Disease Study. 2016. Available at: http://www.healthdata.org/sites/default/files/files/policy_report/GBD/2016/IHME_GBD2015_report.pdf

8 Institute for Health Metrics and Evaluation. Rethinking Development and Health: Findings from the Global Burden of Disease Study. 2016. Available at: http://www.healthdata.org/sites/default/files/files/policy_report/GBD/2016/IHME_GBD2015_report.pdf

9 Partnership to Fight Chronic Disease. What is the impact of chronic disease in America? January 2018. Available at: http://www.fightchronicdisease.org/sites/default/files/pfcd_blocks/PFCD_US.FactSheet_FINAL1%20%282%29.pdf 22

Infectious diseases are on the decline, while chronic diseases are on the rise around the globe.

INTRODUCTION

Source: University of Washington. Rethinking Development and Health Findings from the Global Burden of Disease Study. Available at: http://www.healthdata.org/policy-report/rethinking-development-and-health-findings-global-burden-disease-study

Ischemic Heart Disease

Cerebrovascular Disease

Lower Respiratory Infections

Chronic Obstructive Pulmonary Disease

Diarrheal Diseases

Neonatal Preterm BirthComplications

Tuberculosis

7.2%

-1.8%

-19.5%

-13.8%

21.2%

-59.3%

-67.7%

-48.1%

1

2

3

1

2

4

4 3

5 9

6 18

7

Road Injuries

Tracheal, Bronchus and Lung Cancer

Malaria

Neonatal Encephalopathy

Alzheimer’s Disease and Other Dementias

Measles

Stomach Cancer

8

9

10

11

12

13

14

Congenital Anomalies

Self-Harm

Diabetes Mellitus

Hypertensive Heart Disease

Chronic Kidney Disease

Colon and Rectal Cancer

15

16

17

18

19

25

HIV/AIDS 39

12

8

6

20

19

5

87

16

21

15

7

13

10

14

11

-59.3%

-67.7%

-48.1%

-44%

-41.8%

54.8%

63.4%

-93.7%

-39.7%

-42.0%

-21.9%

-13.1%

4.8%

49.8%

22.7%

242.3%

1990 2015 RANKINGS

PERCENTAGE CHANGE

A GLOBAL SHIFT | RANKING THE TOP CAUSES OF DEATH IN 1990 AND 2015

Noncommunicable diseases

Injuries

Communicable, maternal, neonatal and nutritional disorders

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WHY HEALTH MATTERS

Julia Gillard, Board Chair of the Global Partnership for Education, and Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, explain why investments in health and education matter in their op-ed “Building a shared future in a fractured world starts with education and health.”

LEARN MORE ABOUT THE TRENDS

The Council on Foreign Relations began tracking vaccine-preventable outbreaks in 2008, a project that is now managed by Vaccines Work. Explore the map to learn whether there are outbreaks in your country.

Hear from two professors at the Harvard Chan School of Public Health as they discuss the role of mobile phones in health in the PLOS Blog titled “Empowering Community Health Workers with Telecommunications Tools: Lessons from the Savar Textile Building Collapse, the Ebola Epidemic, and Everyday Global Health Care Delivery.”

In the podcast “The Lancet Commission on Pollution and Health,” three leading experts discuss the relationship between pollution and health, and how to tackle this issue.

INTRODUCTION

LOOKING AHEAD: GLOBAL GOALS AND MILESTONES

As we look ahead, the global community continues to prioritize health as key to reducing poverty. The Sustainable Development Goals (SDGs), which were established by the United Nations and build upon the Millennium Development Goals, comprise one of the most influential frameworks for global development. The SDGs lay out 17 goals aimed at ending poverty, protecting the planet, and ensuring peace and prosperity. Sustainable Development Goal No. 3 includes milestones and targets on the path toward ensuring that every person can lead a healthy life. Other global initiatives target specific populations or health challenges, such as Every Woman Every Child and Family Planning 2020, which mobilize stakeholders to achieve goals set for women’s, children’s and adolescents’ health and well-being. Global compacts such as UHC2030, which brings together advocates for universal health coverage, aim to promote better access to healthcare.

IN THE NEWS: TRENDS IN GLOBAL HEALTH

Improving health through the use of technology is a dominant trend across the sector. Already in practice, but predicted to grow, is the use of smartphones to improve accessibility to medical care using text messaging and phone counseling. Smartphones will also increase the amount of data patients can record about their medical issues and lifestyle choices, and then share with medical professionals. Researchers are also looking at new technologies in terms of empowering patients and community health workers to deliver treatments.

Please see page 22 for resource links.

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INTRODUCTION

Increasingly and at the earliest stages of research and development, scientists and others are exploring the role of each individual’s genetic composition in order to develop precision therapies for specific diseases. However, in some cases, there has been pushback against health advances; for example, antivaccination movements based primarily in the United States and Europe have resulted in outbreaks of preventable diseases.

On a global scale, there is a large-scale investment in outbreak preparedness. The Coalition for Epidemic Preparedness Innovations is taking lessons learned from Ebola and Zika outbreaks to fast-track technologies and vaccine development for diseases that may cause future epidemics, including MERS-CoV, Lassa and Nipah—diseases unknown to many but which have the potential to disrupt health systems worldwide.

Linkages of health and the environment continue to be an important discussion in the sector. For example, smoke from traditional cook stoves in many low-income countries has been linked to premature births. Leaders in the health community are increasingly working with agricultural, environmental and sanitation experts, in addition to engineers and technology developers, to find holistic solutions to health challenges.

Health Education

Economic Empowerment

POVERTY ALLEVIATION

Health is one of the three levers for reducing and eventually ending poverty. Learn more about the relationship between health, education and economic empowerment in our Philanthropy Field Guide | Poverty Alleviation.

THE HARMFUL IMPACT OF DISCRIMINATION AND STIGMA

Across societies, individuals with poor health face discrimination because of their conditions. For example, in a study of 19 countries by UNAIDS, one in five people infected with HIV avoided going to a hospital or clinic—and ultimately delayed treatment—because they feared stigma.10 A 2016 study of people returning to work in the United Kingdom following a cancer diagnosis concluded that one out of five experienced discrimination in the workplace.11 And a significant number of people continue to believe that people with mental illnesses are more likely to be violent, despite evidence that these individuals are more likely to be the subjects of violence.12

POVERTY ALLEVIATION | ROLE OF EDUCATION IN ENDING POVERTY

10 UNAIDS. UNAIDS warns that HIV-related stigma and discrimination is preventing people from accessing HIV services. October 3, 2017. Available at: http://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2017/october/20171002_confronting-discrimination

11 Macmillan Cancer Support. 1 in 5 people who return to work after cancer face discrimination. November 7, 2016. Available at: https://www.macmillan.org.uk/aboutus/news/latest_news/1-in-5-people-who-return-to-work-after-cancer-face-discrimination.aspx

12 BBC. The myth of mental illness and violence. July 23, 2015. Available at: http://www.bbc.com/future/story/20150723-the-myth-of-mental-illness-and-violence; World Health Organization. Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group. 2010. Available at: http://www.who.int/mental_health/policy/development/mh_devel_targeting_summary_2010_en.pdf?ua=1 5

COMMUNICABLE DISEASES Infections caused by bacteria, viruses, parasites, fungi and other microorganisms. Also known as infectious diseases, these illnesses are transmitted between people directly, such as through sneezing, or indirectly through contact with vectors, such as mosquitoes or fleas, that carry the disease. HIV/AIDS, malaria and tuberculosis are global priorities because of the number of people at risk and affected. In 2016, more than 36.7 million people worldwide were living with HIV, 10.4 million people became sick with tuberculosis, and an estimated 216 million cases of malaria were reported.13 Recently, neglected tropical diseases—over 1.5 billion people worldwide have been infected with at least one—are receiving increased philanthropic support.14

INTRODUCTION

UNDERSTANDING DIFFERENT TYPES OF HEALTH ISSUES

Illnesses and other health issues can be broadly categorized in terms of how they are transmitted and how they affect the body.

SEXUAL AND REPRODUCTIVE HEALTHEncompasses all aspects, from physical to social issues, of reproductive health and freedom. According to the United Nations, successful management of sexual and reproductive health “implies that people are able to have a satisfying and safe sex life, the capability to reproduce, and the freedom to decide if, when and how often to do so.”18 This means addressing the spectrum of infectious (for example, syphilis) and chronic (for example, cervical cancer) diseases, mental illness and societal issues, including gender-based violence. Related and often included in sexual and reproductive health initiatives is maternal health.

CHRONIC DISEASES Diseases that tend to develop over the long term, as a result of a combination of biological, environmental and lifestyle factors. Also called noncommunicable diseases, these illnesses cause the deaths of more than 40 million people annually.15 The four main types of chronic diseases are cardiovascular diseases, cancer, chronic respiratory diseases and diabetes.16 Individuals who die from these diseases are more likely to be elderly. But, especially in Africa, South East Asia and the Eastern Mediterranean, deaths from chronic diseases are increasing in younger populations.17 Modern diets, high in sugar and fat, and sedentary lifestyles contribute to the development of some chronic diseases and to poor health more generally.

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MENTAL HEALTH A disease category that encompasses a state of well-being and is sometimes considered a type of chronic disease. As defined by the World Health Organization, mental health is “a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and contribute to his or her community.”19 There are many types of conditions that comprise mental health, ranging from cognitive disorders, such as Alzheimer’s, to addiction—many of which are highly stigmatized. People at high risk for poor mental health include those living in poverty, those forced from their homes because of violence, and marginalized individuals.

INJURY A health issue stemming from the environments in which people live. Globally, injuries resulting from road traffic incidents between motorists, cyclists and pedestrians are recognized as a global health priority. Other sources of accidental injury include drowning, poisoning, burns and falls. Intentional injury includes sexual violence, domestic violence and injury experienced during conflict.

13 World Health Organization. Malaria factsheet. November 2017. Available at: http://www.who.int/mediacentre/factsheets/fs094/en/; World Health Organization. Tuberculosis fact sheet. October 2017. Available at: http://www.who.int/mediacentre/factsheets/fs104/en/; World Health Organization. HIV/AIDS fact sheet. October 2017. Available at: http://www.who.int/mediacentre/factsheets/fs360/en/

14 The END Fund. NTD Overview: What are neglected tropical diseases? January 2018. Available at: http://www.end.org/whatwedo/ntdoverview15 World Health Organization. Noncommunicable diseases fact sheet. June 2017. Available at: http://www.who.int/mediacentre/factsheets/fs355/en/ 16 World Health Organization. Noncommunicable diseases fact sheet. June 2017. Available at: http://www.who.int/mediacentre/factsheets/fs355/en/ 17 World Health Organization. Probability of dying from any of CVD, cancer, diabetes, CRD between age 30 and exact age 70 (%), by WHO region, 2016.

December 2017. Available at: http://apps.who.int/gho/data/node.sdg.3-4-viz-1?lang=en18 United Nations Population Fund. Sexual & reproductive health. December 2017. Available at: http://www.unfpa.org/sexual-reproductive-health 19 World Health Organization. Mental health: Strengthening our response. April 2016. Available at: http://www.who.int/mediacentre/factsheets/fs220/en/

INTRODUCTION

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The relationship between health and economy is clear at the macro level, where, according to economists, every US$1 spent on health may result in up to US$20 in income growth within a single generation.20

Opportunities for Impact

Philanthropy has a long tradition of promoting good health in communities around the world.

There are many different opportunities for philanthropists to improve health, such as supporting the development of technologies that make it easier for individuals to access healthcare or responding to disasters or other humanitarian crises.

20 Devex. Opinion: Building a shared future in a fractured world starts with education and health. January 28, 2018. Available at: https://www.devex.com/news/opinion-building-a-shared-future-in-a-fractured-world-starts-with-education-and-health-91971

LEFT: A doctor administers a test for malaria in a nonprofit-run clinic in Tanzania’s capital city, Dar es Salaam. Just under half of the country’s population sleeps under an insecticide-treated bed net, which helps to protect against malaria.

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21 World Health Organization. Smallpox. January 2018. Available at: http://www.who.int/csr/disease/smallpox/en/; Polio Global Eradication Initiative. This Week. January 2017. Available at: http://polioeradication.org/polio-today/polio-now/this-week/

SUPPORT EFFORTS TO OVERCOME A DISEASE

Overcoming a disease requires a combination of interventions to ensure that the right tools are available, that those tools reach individuals who are at risk or need treatment, and that policies promote behaviors that reduce illness.

ADVANCE RESEARCH AND DEVELOPMENT OF BETTER TOOLS AND TECHNOLOGIES

The diagnostic tools that help determine if a patient has a disease, the drugs and medicines used to provide treatment, and the vaccines that protect children and adults are the results of intensive research and development (R&D) efforts. Philanthropists can make a difference in the early stages of R&D by supporting researchers in the process of scientific discovery, which may include work such as chemical analysis in a laboratory or data collection in the field. During the later stages, private philanthropy can support the testing of new technologies to see how they affect humans during the clinical trials process.

R&D efforts are high risk and high cost, and the process requires years of investment. However, technologies resulting from R&D can be game-changers for both infectious and chronic diseases. For example, because of a modern vaccine and global vaccination efforts, smallpox was eradicated in 1980 and polio is following a similar path, with only 22 cases of wild polio virus reported in 2017.21 Globally, as diseases evolve to withstand current treatments, the discovery of new drugs and vaccines is becoming increasingly critical to combating antimicrobial resistance.

OPPORTUNITIES FOR IMPACT

EXPLORING R&D FOR BETTER HEALTH

What is a clinical trial? Better understand the purpose and goals of the clinical trials process by watching this video by the pharmaceutical company Roche. (3:26)

From gene editing to a superglue inspired by slugs, read about “The 20 Most Life-Changing Medical Breakthroughs of 2017” in Prevention.

Discover how lab-made tiny tumors can provide scientists with a better tool to study specific types of cancer in an article from The Economist. Then, listen about how R&D is uncovering new treatments that target cancer cells without damaging healthy cells in a TED Talk by biomedical engineer Elizabeth Wayne. (5:33)

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OPPORTUNITIES FOR IMPACT

FILL CRITICAL GAPS IN THE DELIVERY OF HEALTH SERVICES

The many advances in R&D mean there are treatments, cures and, in some cases, vaccines for infectious and chronic diseases. However, tools alone are not enough; they need to reach the right individuals at the right time to make a difference. Delivery of healthcare for a specific disease often starts with training of health workers, including specialists, primary care doctors and nurses. Training ensures they are equipped to diagnose uncommon or unfamiliar illnesses, follow the most current treatment guidelines, use new technologies and educate patients on lifestyle choices that impact their health (a service critical to combating chronic diseases). From targeted training programs to centers of excellence, philanthropists can offer supplemental or complementary training to help prepare medical professionals to deliver quality care.

Access to care is also an essential component of healthcare delivery and increasingly performed through mobile apps and telemedicine platforms. Using technology, patients can receive counseling or talk with a trained healthcare worker without the added cost of transportation or long wait times at clinics. Similarly, philanthropists can provide critical resources for mobile clinics that go out into underserved or hard-to-reach communities for education, screening and treatment. These alternative delivery methods can be particularly impactful in populations that struggle to reach physical clinics, such as refugees, people with disabilities and those who are elderly.

ADVOCATE FOR BETTER POLICIES AND INCREASED FUNDING

Policy is critical to the overall health of a country and influences how individuals access and experience the health system. Technical experts, advocates from the medical professions and related fields, and civil society organizations all have a role in educating policymakers on health issues and providing the research that supports the development of evidence-based policies. Businesses, such as pharmaceutical companies and food manufacturers, contribute to the policy dialogue via lobbying—primarily for the economic interests of their shareholders.

INNOVATIONS IN HEALTHCARE DELIVERY

In this success story, read “How Mongolia Revolutionized Reproductive Health for Nomadic Women” using a combination of telemedicine, temporary housing for pregnant women, health reforms and advocacy.

The elderly have an increased need for a range of healthcare services. Learn how technology can help this population in “New technology for old age” by The Economist.

Stay on top of new approaches. Follow Fortune’s BRAINSTORM HEALTH and receive a daily email that synthesizes important health news.

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OPPORTUNITIES FOR IMPACT

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Philanthropy has a role in helping ensure the policy development process is informed by research, expert opinion and the experience of individuals, including patient advocates, who will be affected by new guidelines. Advocacy can take many forms, from the patient-led movement that influenced the U.S. government, in 1983, to allocate the first funding for HIV/AIDS research and treatment to the creation of fact sheets to educate policymakers on research findings. However, advocacy work is inherently risky in terms of certainty of return. Philanthropists supporting advocacy projects must be comfortable with ambiguity and willing to work in an environment that changes rapidly. It is also critical to understand any national or local laws that may regulate which types of advocacy charitable organizations may undertake.

ABOVE: A three-year-old child, who lost half of his right leg as an innocent victim of war, is fitted with a prosthesis.

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22 World Health Organization and World Bank. World Report on Disability. 2011. Available at: http://www.who.int/disabilities/world_report/2011/en/ 23 World Health Organization. Global Health Observatory (GHO) data: Under-five mortality. January 2018.

Available at: http://www.who.int/gho/child_health/mortality/mortality_under_five_text/en/ 24 World Health Organization. Global Health Observatory (GHO) data: Under-five mortality. January 2018.

Available at: http://www.who.int/gho/child_health/mortality/mortality_under_five_text/en/ 25 United Nations. Sustainable Development Knowledge Platform: Sustainable Development Goal 3. January 2018.

Available at: https://sustainabledevelopment.un.org/sdg3

OPPORTUNITIES FOR IMPACT

MEET THE HOLISTIC HEALTH NEEDS OF SPECIAL POPULATIONS

People with disabilities, children under five years of age, the elderly, and women and girls have a higher risk of poor health. These special populations are priorities under the Sustainable Development Goals.

IMPROVE THE HEALTH OF PEOPLE WITH DISABILITIES

Worldwide, people with disabilities are more likely to be in poor health compared to those without disabilities. Globally, the five most common obstacles to seeking and receiving medical care are: unaffordable services, unavailable or unaffordable transportation, inadequate healthcare equipment, inadequately trained health professionals and a negative experience at a previous visit with a healthcare professional.22 Those with disabilities may also need to overcome negative associations within a community or culture. Infrastructure improvements, such as adding ramps, are critical, as is support for programs that train medical professionals in the healthcare needs of people with disabilities. Transportation, communication and modes of service delivery (telemedicine, for example) are a few of the areas where philanthropists can help improve access and quality of care. Advocacy can also be an effective approach to addressing systemic issues, such as affordability and discrimination.

REDUCE THE RISK OF DEATH FOR CHILDREN UNDER FIVE YEARS OF AGE

Owing to concerted efforts by governments, philanthropists and the private sector, the rate of children dying before their fifth birthdays decreased 56% from 1990 to 2016.23 However, progress has been uneven. As of 2016, an average of one in 12 children died before his or her fifth birthday in Sub-Saharan Africa; the risk of child death in this region is nearly eight times higher than in Europe.24 The health of children under five years of age continues to be a priority under the Sustainable Development Goals, which include the ambitious target to “end preventable deaths of newborns and children under 5 years of age” by 2030. Many efforts focus on neonatal health, or the health of infants in their first 28 days of life, which accounts for almost 45% of deaths in young children.25 Movements, such as Every Woman Every Child, seek to ensure that children and women remain at the center of global development efforts by engaging with governments, private philanthropists, business and civil society.

MAKING HEALTHCARE ACCESSIBLE FOR PEOPLE WITH DISABILITIES

Explore the winning ideas of Google’s Impact Challenge: Disabilities, in which innovators use technology to map locations accessible to people with disabilities, create affordable prosthetics using 3-D printers, and develop a smartphone-based tool to diagnose hearing loss.

Access is a significant barrier to healthcare for people with disabilities. Learn about the role of urban planning in making cities more accessible in the article titled “City Planners Must Practice Everyone-Based Design” by Next City.

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THE GROWING SHARE OF THE POPULATION AGED 60 YEARS OR OVER BY REGION

26 Available at: http://www.undp.org/content/undp/en/home/librarypage/poverty-reduction/ageing--older-persons-and-the-2030-agenda-for-sustainable-develo.html27 United Nations Development Programme, HelpAge International, AARP. Ageing, Older Persons and the 2030 Agenda for Sustainable Development. July 2017.

Available at: http://www.undp.org/content/undp/en/home/librarypage/poverty-reduction/ageing--older-persons-and-the-2030-agenda-for-sustainable-develo.html

MEET THE SPECIAL HEALTH NEEDS OF WOMEN AND GIRLS

Women’s and girls’ health needs are unique. They require specialized care of their sexual and reproductive health; for those who have children, this includes their maternal health. Mental health is a key focus area for women and girls, who are more likely to experience marginalization, gender-based discrimination, and sexual and other forms of violence. Whether or not women and girls receive healthcare depends on their legal rights, the quality of their community’s healthcare infrastructure, and whether services exist and are accessible.

ENSURE THE GROWING POPULATION OF ELDERLY INDIVIDUALS REMAINS HEALTHY

As of 2015, 901 million people—or just over 12% of the world’s population—were 60 years of age or older.26 Over the next few decades, this segment is expected to become significantly larger in most regions.27 Maintaining health requires a combination of lifestyle and medical interventions aimed at effectively managing chronic conditions, sustaining mobility, ensuring good nutrition, promoting social engagement and retaining independence. Interventions may also tackle issues to which the elderly are prone, including poverty, domestic violence and neglect.

1980

5%

10%

15%

20%

25%

30%

35%

1990 2000 2010 2020 2030 2040 2050

World

Latin America and the Caribbean

OceaniaEurope

Northern America

Asia

Africa

Source: United Nations Development Programme, HelpAge International, AARP. Ageing, Older Persons and the 2030 Agenda for Sustainable Development. July 2017. Available at: http://www.undp.org/content/undp/en/home/librarypage/poverty-reduction/ageing--older-persons-and-the-2030-agenda-for-sustainable-develo.html

SPECIAL NEEDS OF WOMEN AND GIRLS

Women and girls have unique health needs. Learn more about how philanthropy can make a difference in our Philanthropy Field Guide: Women and Girls.

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OPPORTUNITIES FOR IMPACT

MEETING THE HEALTH NEEDS OF REFUGEES AND OTHER DISPLACED PEOPLE

Healthcare is critical to those who flee their homes because of violence. But, it can be difficult to access for many reasons. Learn more about the health needs of refugees in our Philanthropy Field Guide: Global Refugee Crisis.

28 World Health Organization. Nigeria is now free of Ebola virus transmission. October 20, 2014. Available at: http://www.who.int/mediacentre/news/ebola/20-october-2014/en/index2.html

HEALTH DURING HUMANITARIAN DISASTERS

Better understand the factors that contribute to a health emergency in the article titled “Yemen’s cholera outbreak now the worst in history as millionth case looms” by The Guardian.

Disease outbreaks are common where families flee their homes because of violence. Learn about the emergence of diphtheria among Rohingya refugees in Bangladesh in an article by ReliefWeb.

Can you guess which diseases are most likely to cause outbreaks? See if you recognize the World Health Organization’s list of eight emerging diseases likely to cause major epidemics in an article by the World Economic Forum.

OPPORTUNITIES FOR IMPACT

MAKE HEALTH A PRIORITY DURING A HUMANITARIAN CRISIS

Philanthropic support is crucial during humanitarian crises to ensure individuals have access to healthcare. No one healthcare need dominates during a crisis: Support is needed for chronic conditions, infections, mental health, and sexual and reproductive health.

RESPOND TO A DISEASE OUTBREAK AND SUPPORT RECOVERY EFFORTS

Philanthropists can support efforts to prepare for crises, to mount a response to an immediate crisis and to support recovery processes. In cases where disease is the primary driver of a humanitarian crisis, such as the Ebola crisis that primarily affected West Africa from 2013 to 2016, diagnosing and treating the illness is a priority, alongside efforts to reduce the rate of new infections. In the aftermath of the immediate crisis, support for recovery efforts is critical to address the long-term health needs of survivors and to encourage communities to reengage in social and economic activities. Learnings from recovery efforts—such as Nigeria’s use of existing polio surveillance systems to track and contain its 17 Ebola cases and connect each to a single traveler from Liberia28—can also help a country prepare for future crises.

SUPPORT REFUGEES AND OTHERS WHO HAVE FLED THEIR HOMES BECAUSE OF VIOLENCE

Violence is another driver of humanitarian crises, forcing families to flee their homes to other parts of the country or become refugees in another. People fleeing violence have increased exposure to new diseases, and poor hygiene and lack of clean water make it difficult to fight infections. Untreated chronic diseases may worsen. Women and girls may have little to no care during pregnancy, birth and in the period following. Newborns and young children also lack appropriate care. Philanthropy can make a difference by providing refugees and others fleeing violence with holistic medical care at every stage in their journeys. Recovery is equally important for this type of humanitarian crisis, and philanthropy can play a role in ensuring families regain their mental and physical health.

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TACKLE SYSTEMIC AND STRUCTURAL ISSUES AT THE LOCAL AND GLOBAL LEVELS

Addressing structural issues or those with systemic impact can benefit everyone by improving quality of care and individuals’ ability to make good decisions about their health.

IMPROVE INFRASTRUCTURE AND OPERATIONS IN HOSPITALS AND CLINICS

Philanthropy has historically played a leading role in supporting the building and renovation of hospitals and clinics. This work continues to be important, especially where facilities, such as operating rooms, may be outdated or inadequate. However, creating a sustainable, high-functioning hospital or clinic is a holistic effort. Capacity-building programs work to strengthen the management skills of leadership and administrative staff to solve operational issues that affect the quality of care. Skilled administrators are better able to manage for a range of issues, from stock-outs—where a facility runs out of oxygen, drugs or other medical supplies and, as a result, must suspend surgeries and other critical services—to hygiene issues that affect the spread of infection in a hospital.

EXTEND THE REACH OF LOCAL HEALTH SYSTEMS

In some countries, community health workers (who may be paid or unpaid) deliver basic health services and education to individuals who live beyond the immediate reach of a hospital or clinic. Training local workers can be critical to gaining the trust of a community, as well as to the sustainability of health programs. Providing community health workers with training to deepen their knowledge or provide care to newborn infants and mothers, administer malaria medications or deliver other medical care may have a positive impact on the health of people in remote areas.

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OPPORTUNITIES FOR IMPACT

Source: The World Health Organization. Tracking universal health coverage: 2017 Global Monitoring Report. Available at: http://www.who.int/healthinfo/universal_health_coverage/report/2017/en/

CATASTROPHIC PAYMENTS | WHERE HEALTH COSTS EXCEED 10% OR 25% OF A HOUSEHOLD BUDGET

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0

100

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300

400

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2005 2010 2000 2005 2010

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Africa

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In 2010, an estimated 808 million people had healthcare expenses that exceeded 10% of their household incomes. More than half of these individuals lived in Asia.

29 World Health Organization. Tracking universal health coverage: 2017 Global Monitoring Report. 2017. Available at: http://www.who.int/healthinfo/universal_health_coverage/report/2017/en/

ADDRESS ISSUES OF AFFORDABILITY AND ACCESS THROUGH SUPPORT FOR UNIVERSAL HEALTH COVERAGE

In a 2017 report, the World Health Organization estimated that at least half of the world’s population could not access essential health services, and 800 million people spent more than 10% of their household budgets on healthcare.29 Better policies and well-funded programs can streamline the process of receiving healthcare, improve its affordability and incentivize people to engage in healthy behaviors. UHC2030 is an example of a global initiative through which national governments, the United Nations, civil society organizations and philanthropic organizations come together to advance universal health coverage (UHC). UHC, or the concept that individuals can access the healthcare they need without financial hardship, is gaining momentum because better health has been key in achieving other economic, environmental and social targets outlined in the Sustainable Development Goals.

OPPORTUNITIES FOR IMPACT

Asia Europe Latin America and the Caribbean North America Oceania

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30 World Health Organization. Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks. February 2018. Available at: http://www.who.int/quantifying_ehimpacts/publications/preventing-disease/en/; World Health Organization. Environmental impacts on health [infographic]. February 2018. Available at: http://www.who.int/quantifying_ehimpacts/publications/PHE-prevention-diseases-infographic-EN.pdf?ua=1

31 World Health Organization. Sanitation. July 2017. Available at: http://www.who.int/mediacentre/factsheets/fs392/en/32 World Health Organization. Sanitation. July 2017. Available at: http://www.who.int/mediacentre/factsheets/fs392/en/33 IssueLab. Foundation Funding for Water, Sanitation, and Hygiene. March 2012.

Available at: http://foundationcenter.issuelab.org/resource/foundation-funding-for-water-sanitation-and-hygiene.html

THE IMPACT OF ENVIRONMENT ON HEALTH

An article by CNN summarizes a recent UNICEF report that estimates 17 million children, the majority of whom live in South Asia, are exposed to toxic levels of air pollution and are at risk for developmental impairments.

Read “Why World Toilet Day Should Matter To You” in Forbes Asia, then follow up by looking at the toilets of people around the world, at different income levels, using a tool by Dollar Street.

Road traffic accidents claim upward of a million lives annually. The Guardian explores what work is being done in Latin America—and how much more needs to be accomplished—in the article titled “Latin America struggling to meet 2020 road deaths target.”

WORK TO MITIGATE ENVIRONMENTAL RISK FACTORS FOR BETTER HEALTH

According to a 2016 report by the World Health Organization, 23% of global deaths, and 26% of deaths among children under five, were due to environmental factors that could be modified or changed.30 Starting in 2018, the World Health Organization and United Nations Environment are collaborating to take steps to mitigate environmental health risks.

INCREASE ACCESS TO CLEAN WATER AND SANITATION

Globally, 2.3 billion people do not have access to basic sanitation facilities.31 While the challenge is significant, the investment in increasing access to sanitation and clean water creates high returns: Every US$1 invested returns US$5.50 in lower health costs, fewer deaths and higher productivity.32 Philanthropic funds support this sector through several avenues, such as water sector policy and administrative management, research on and implementation of toilets and other hygiene interventions, water conservation and river basins development.33 Many interventions implement multi-prong solutions that integrate water, sanitation and hygiene into one program to achieve more sustainable impact.

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OPPORTUNITIES FOR IMPACT

OPPORTUNITIES FOR IMPACT

ENSURE THE AIR IS CLEAN INSIDE AND OUTSIDE OUR HOMES

Three million people die prematurely from outdoor air pollution in cities and rural communities, with 88% of those deaths occurring in low- and middle-income countries.34 Reducing common air contaminants, such as carbon dioxide, black carbon and methane, not only improves health outcomes, but has the added benefit of contributing to the mitigation of climate change.35 Many efforts focus on decreasing emissions, fostering uptake of clean energy sources, and supporting policies that enforce these goals.36

Indoor air pollution, in particular smoke, is also a major risk. Three billion people worldwide are exposed to black carbon, carbon monoxide and other harmful pollution generated by the fuels they use to heat their homes and cook for their families.37 Another source of indoor air pollution is secondhand smoke generated by the more than one billion individuals worldwide who use tobacco. Programs that mitigate tobacco use target individuals in low- and middle-income countries, where 80% of people who use tobacco live.38

UNDERSTANDING CLIMATE CHANGE AND HEALTH

Interested in learning more about how philanthropy can help improve the environment? Read our Philanthropy Field Guide: Climate Change and Conservation.

34 World Health Organization. Ambient (outdoor) air quality and health. September 2016. Available at: http://www.who.int/mediacentre/factsheets/fs313/en/35 World Health Organization. Ambient (outdoor) air quality and health. September 2016. Available at: http://www.who.int/mediacentre/factsheets/fs313/en/36 World Bank. Brief: Reducing Pollution. April 2017. Available at: http://www.worldbank.org/en/topic/environment/brief/pollution37 World Health Organization. Ambient (outdoor) air quality and health. September 2016. Available at: http://www.who.int/mediacentre/factsheets/fs313/en/;

World Health Organization. Health Effects of Black Carbon. 2012. Available at: http://www.euro.who.int/__data/assets/pdf_file/0004/162535/e96541.pdf 38 World Health Organization. Tobacco: Key facts. March 2018. Available at: http://www.who.int/en/news-room/fact-sheets/detail/tobacco

ABOVE: In Jinan, Shandong Province, students wear face masks to protect themselves from air pollution. According to state media reports, on the day this photo was taken, 10 Chinese cities were under high alert because of heavy smog.

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INCREASE THE SAFETY OF ROADWAYS AND PROMOTE APPROPRIATE INFRASTRUCTURE

Road traffic injuries are one of the leading causes of death for individuals ages 15–29 and were among the top 10 causes of death globally in 2015.39 An estimated 1.25 million people die from traffic accidents every year—the majority in Africa—and more than 20–50 million suffer injuries that may contribute to the development of a disease or a disability.40 Initiatives focus on improving policies related to road safety—specifically pursuing laws needed to promote safety—as well as changing behaviors to favor helmets, lower driving speeds and the use of seatbelts.41 Other interventions emphasize the need for improved infrastructure, such as crosswalks, lane marking, medians or barriers, and public transportation systems, in addition to better vehicle standards.42

ABOVE: According to recent data, road-related injuries are the third leading cause of premature death in South Africa.

39 World Health Organization. Road traffic injuries. May 2017. Available at: http://www.who.int/mediacentre/factsheets/fs358/en/; World Health Organization. The top 10 causes of death. January 2017. Available at: http://www.who.int/mediacentre/factsheets/fs310/en/

40 World Health Organization. Road traffic injuries. May 2017. Available at: http://www.who.int/mediacentre/factsheets/fs358/en/41 Bloomberg Philanthropies. Road Safety. Helping to Save Lives Through Proven Interventions That Reduce Road Traffic Fatalities. February 2018.

Available at: https://www.bloomberg.org/program/public-health/road-safety42 Bloomberg Philanthropies. Road Safety. Helping to Save Lives Through Proven Interventions That Reduce Road Traffic Fatalities. February 2018.

Available at: https://www.bloomberg.org/program/public-health/road-safety 20

OPPORTUNITIES FOR IMPACT

Addressing structural issues or those that have a systemic impact can benefit everyone by improving quality of care and individuals’ ability to make good decisions about their health.

Leading Private Funders

Governments, private foundations and philanthropists are working together to improve health worldwide.

The following private donors invest in a range of health interventions, research and development, and advocacy. Each offers a unique lens through which to view approaches to increase well-being.

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BILL & MELINDA GATES FOUNDATION gatesfoundation.orgThe foundation supports R&D, health service delivery and advocacy for better policy across a range of infectious diseases and for family planning and maternal health, with the aim of bringing evidence-based models to scale. In addition, the foundation tackles issues that contribute to health, such as clean water, nutrition and agriculture. The foundation is a vocal champion of global polio eradication efforts and makes significant investments in the development of vaccines to prevent other infectious diseases.

BLOOMBERG PHILANTHROPIESbloomberg.orgThe philanthropies’ public health initiatives focus on proven strategies that decrease preventable deaths and include strong commitments to mitigating the use of tobacco, improving road safety, preventing drowning and increasing access to family planning as a key driver to reducing maternal mortality. The philanthropies also invest in initiatives to improve health data to inform policy decisions, particularly in low-income and middle-income countries.

CARLOS SLIM FOUNDATIONfundacioncarlosslim.orgBased in Mexico, the foundation’s varied health portfolio addresses the needs of individuals of all ages through support for R&D, service delivery and capacity strengthening of medical personnel. The foundation’s work includes reducing chronic diseases; developing vaccines for diseases linked to poverty and promoting vaccine use; improving maternal and infant health; and ensuring quality care for the elderly and terminally ill. The foundation also aims to improve road safety. Initiatives primarily focus on people living in Latin America, with some programs, such as the foundation’s support for polio eradication, having global impact.

CONRAD N. HILTON FOUNDATION hiltonfoundation.orgThe foundation’s health programs focus on specific diseases as well as clean water—a key environmental factor for enabling good health. The foundation is deeply committed to children affected by HIV and AIDS. It also provides significant support to promote early childhood development as a component of health in five East and South African countries. Improving access to clean water for households, schools and health facilities is also a priority in these five countries. The foundation’s other disease-based initiatives target preventable blindness from cataracts and trachoma, multiple sclerosis and substance abuse in various geographies.

LEADING PRIVATE FUNDERS

DONOR COLLABORATIONS TACKLING INFECTIOUS DISEASES: TWO EXAMPLES

The Global Fund to Fight AIDS, Tuberculosis and Malaria is a financing mechanism dedicated to accelerating the end of the AIDS, tuberculosis and malaria epidemics. In partnership with governments, civil society and the private sector, the fund raises and invests nearly US$4 billion annually to locally run programs in countries and communities that are most in need.

The END Fund is a pooled funding mechanism dedicated to ending the five most common tropical diseases. The fund’s strategy includes mass drug administration: a community-based intervention in which entire schools are treated for multiple diseases during a single campaign, using drugs donated by pharmaceutical companies.

Philanthropy Field Guides with resource links: jpmorgan.com/philanthropyfieldguides

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DAVID AND LUCILE PACKARD FOUNDATION packard.orgThe promotion of reproductive health and rights is a key health initiative of the foundation. The program focuses on improving the quality of information and services available to women in four countries in Sub-Saharan Africa, three in South Asia, and the United States. The foundation also engages in global advocacy efforts around reproductive health and rights, especially those led by young people. In the United States, the foundation funds interventions to ensure families have access to affordable health insurance and social services that support their children’s healthy development.

ROCKEFELLER FOUNDATIONrockefellerfoundation.org Advancing health is one of the pillars under the foundation’s mission to promote the well-being and resilience of people around the world. The foundation focuses on advancing universal health coverage and fostering more equitable and resilient health systems. Other initiatives include pioneering disease surveillance networks to detect and respond to disease outbreaks, and developing innovations to meet the health needs of informal workers.

THE SUSAN THOMPSON BUFFETT FOUNDATIONbuffettscholarships.orgSupported by Warren Buffett, this highly private foundation is one of the world’s leading philanthropic funders of reproductive health and rights. Its geographic focus is global, and significant investments are made in the United States, Latin America and Sub-Saharan Africa. The foundation works with a broad range of academic and NGO partners to ensure women realize their right to reproductive health, and are able to access high-quality information and services. Note that the foundation’s minimalist website does not include information about its health programming.

TATA TRUSTStatatrusts.orgBased in India, the trusts’ investments aim to improve the lives of vulnerable populations. The health portfolio focuses on women’s and children’s health, particularly primary care and nutrition. The trusts also invest in chronic disease prevention and treatment, with a focus on mental health and cancer care. In communities with weak health facility infrastructure, the trusts invest in human resources for health, including staff training.

WELLCOME TRUSTwellcome.ac.uk Based in the United Kingdom, the trust improves health for everyone through medical R&D that aims to better understand health and disease, and to identify innovations that improve heath. Partnership is central to its mission; the trust collaborates with others to drive change in priority areas, such as vaccines, research on drug-resistant infections, developing research leaders in Africa and Asia, and science education.

LEADING PRIVATE FUNDERS

“ I envision a world in which everyone can live healthy, productive lives, regardless of who they are or where they live.”

— Dr. Tedros Adhanom

Ghebreyesus, Director-General of the World Health Organization

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Summary

Philanthropy can have a powerful impact by informing the policies that govern health, improving how health is delivered, supporting research for new technologies or tackling environmental factors that contribute to poor health. In finding the right path, we suggest you examine your personal goals:

REFLECT ON WHY YOU WERE DRAWN TO HEALTH

Health can be deeply personal, and many philanthropists find they are guided by their own experiences. Overcoming an illness, or watching a family member succumb to a disease, drives many individuals. For some, reading that millions of children die from diseases that can be prevented, or even seeing these children on their travels, will spark a passion about health. Yet other philanthropists will be drawn to health as it relates to other issues, such as climate change, the well-being of women and girls, or poverty.

CONSIDER GIVING AS ONE OF SEVERAL OPPORTUNITIES

Giving is one way to make an impact. Philanthropists can also consider initiatives, both through civic engagement and their businesses, to create healthy environments, encourage employees to live healthier lifestyles or ensure staff are able to access healthcare.

01

03

ASSESS YOUR APPETITE FOR RISK IN THE PROGRAMS YOU SUPPORT

The level of risk you are willing to accept in your giving will help determine which approaches are the best fit. For example, R&D and advocacy are both high-risk ventures that can, in some cases, offer high rewards in the form of new technologies or inclusive policies. Philanthropists who prefer a lower risk level may prefer to improve the delivery of services, educate communities on lifestyle choices or support other types of programs with similarly tangible outcomes.

02

RIGHT: A pharmacy in Essaouira, Morocco, provides medicines for the local community.

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