Ninez Ponce 00:00

Good evening. Good evening, everyone and welcome to the Tamkin Auditorium at UCLA, which as a land-grant institution acknowledges the Gabrielino Tongva peoples as the traditional land caretakers of Tovangar - that is, the Los Angeles Basin and the South Channel Islands. Welcome. I am Ninez Ponce, the director of the UCLA Center for Health Policy Research and Professor and Wasserman-endowed chair at the Department of Health Policy and Management at the UCLA Fielding School of Public Health. I've sighted some students here from our department from the Fielding School. I welcome you to this special evening of thoughtful discussion and an important shift in thinking about the big challenges we face in the world. This big program is a result of efforts of many big thinkers here at UCLA, including the Center for Health Policy Research, and our event co-sponsors, the Burkle Center for International Relations, and you saw Alexandra, now handing out the cards, the Deputy Director there. The Fielding School of Public Health Department of Health Policy and Management, the WORLD Policy Analysis Center (and the director you will meet very soon), the Center for Health Care Management, and Laura Erskine is here with us. And the Luskin School of Public Affairs Department of Public Policy, and you'll meet Rob Fairlie, who is the chair; you'll see him, too. So collectively, our UCLA community of optimists contribute to the changes we want to see in the world, especially in health and well being. For example, at the UCLA Center for Health Policy Research, we produce high quality data and research to inform decision making and evidence-based policy. We help develop and evaluate local, state, national, and even international work to improve wellbeing and health outcomes. The WORLD Policy Analysis Center has a similar mission but on a much global scale. Well, we know that our data and research are only good if they are acted upon by policy leaders. So we appreciate partners like the Center for Health Care Management, which interrogates methods for improving service delivery and health policy, and the Burkle Center for International Relations, which fosters intelligent discourse in policy areas that builds sustainable change across the world. When we take all of these areas into consideration, the leaders of these centers know we can connect to systems that facilitate positive transformations. This has been at the heart of the work at the Center for Health Policy Research for 29 years. Yeah, we're 29 - we're going to be 30 next year. In fact, tonight's a kind of kickoff for the 29th year as the Center looks forward to our 30th anniversary in 2024, where we build on events such as this, where we envision our own future and the kind of thinking that we need to innovate approaches to solving complex problems. We hope you'll join us for events all year long and a big anniversary party in the fall to celebrate what we have accomplished and where we are going in the future. So I hope you will be there and join us in our celebration. So more than 20 years ago, we changed the policy landscape when we launched the California Health Interview Survey, the largest state-based population health survey in the country because data and analytics matter to inform good policy. This is a major theme in Dr. Rajiv Shah's book. This is so important. But over the years, we kept asking how can we do better? We knew there were blind spots, populations that were overlooked or stigmatized, and we needed to change our measurements and our approaches. So we seek out the collaborations to elevate our work - like working with our partners on tonight's event. This was a big collaboration. And we also regularly bring together those who can share new perspectives, perspectives that aren't necessarily voiced in the rooms of decision making. And it makes us think of how we can build better tools, better analytics, better democratization of the data. And that is what we invite you to do tonight. Open yourself to new possibilities, new ways of looking at a problem, new paths to finding solutions, and as the basic ground rule, always, please always, be respectful as we listen and learn from each other. Tonight we brought together thought leaders who invite you to frame your ways of thinking so you too can look at a new problem, understand it in new and different ways, and build a system that will find and implement - and implement, can't just let sit on a shelf - implement solutions. So now, I would like to welcome tonight's featured guest. Dr. Rajiv Shah is the president of the Rockefeller Foundation, a global institution with a mission to promote the well being of humanity around the world. The Rockefeller Foundation uses data, science and innovation to break down barriers, to improve health for women and children, create nutritious and sustainable food systems, end energy poverty worldwide, and enable meaningful economic mobility in the United States and around the world. Working with broad coalitions - this is a theme - and dedicated teams at the Rockefeller Foundation and elsewhere, Dr. Shah has helped vaccinate nearly a billion - a billion - children, has led high-pressure responses to the Haiti earthquake and against Ebola, dramatically expanded U.S. COVID-19 testing at the height of the pandemic, and began connecting a billion people to electricity for the first time. Your book have also been Billions - Billions and Big Bets. So, in 2009, President Barack Obama appointed Dr. Shah Administrator to the United States Agency for International Development. If you watch C-SPAN, you'll know that he was unanimously confirmed by the U.S. Senate. He reshaped the $20 billion agency's operations in more than 70 countries around the world by elevating the role of innovation, creating high-impact public-private partnerships, and focusing U.S. investments to deliver stronger results. He secured bipartisan support that included the passage of two significant laws, the Global Food Security Act and the Electrify Africa act. He has also served at the United States Department of Agriculture and at the Bill and Melinda Gates Foundation, which is prominent in the beginnings of his career in the book. There, he created international financing facility for immunization, which helped reshape the global vaccine industry and save nearly a billion lives. Dr. Shah has made big bets throughout his career. And three weeks ago, he published his new book - I hope you all will buy one or got one - we are giving 30 free books though to students. So don't pretend you're a student. And, how big bets, how large scale change really happens. It's a playbook. The playbook for transformational change; it's a playbook to get back that inner optimism that you may have lost from the feeling of hopelessness or helplessness in trying to solve the big problems that we have in the world today. We are so happy that you're here with us tonight, Raj, to share the power of your big bets mindset. Please join me in welcoming Dr. Rajiv Shah.

Rajiv Shah 08:34

Thank you, Dr. Ponce. And for the incredibly kind introduction, I just wish my mom was listening. I also want to thank Dr. Jody Heymann and Dr. Rob Fairlie for having me here today. I'm just so excited to be with all of you and respect so much what this great institution has done over generations of time working on issues like global health, domestic poverty and equity in health care access. I'm particularly excited that a good friend, Mayor Karen Bass, will join us a little bit later. She was somebody who, in addition to serving as mayor of Los Angeles, as you all know, was also the chair of important committees in foreign relations in her time in Congress and really did exceptional things to make sure America could project the best of our values, in particular, in our engagements in Africa over a long period of time and through some very difficult politics. I think most of our afternoon together, evening together, it's gonna be a conversation. So I'll try to keep my opening comments fairly, fairly short. I wrote this book, Big Bets, because I really do believe it is realistic to be optimistic about tackling the challenges we face, whether that is domestic or international. And frankly, I have three young kids. And I see that in the context of what, and they're not so young anymore, but they used to be young, they're still little. And what we see in our media, and in our news, and on our campuses, and in our high schools is, while some kids are optimistic about their capacity to make change in the world, I think we see a lot of pessimism, we see a lot of people being bombarded by social media messages that imply that it's difficult, it's challenging, that our own planet survival is at risk, all of which is true. But we have it within ourselves. And I feel like I've gotten the opportunity to learn from some household names. And, as you mentioned, Bill and Melinda Gates, or President Obama and his team, and so many others. But I've also learned just as much from people you've had not heard of that I write about in the book, whether it's a doctor who gave most of his professional career to serving a tribal community in a rainforest in South India, or a woman who created an NGO in West Africa that went tribal community by tribal community to convince tribal leaders to protect the interests of young girls, to prevent female genital cutting, and to promote efforts that would stop child marriage in that setting - an issue that Jody and others here have done so much on to make a difference around our planet. So, I wrote the book because I wanted those stories to help all of us and remind all of us that actually, even though the news can be tough, it is actually possible to make huge change happen. And I'm sure we'll talk about some of those examples in the discussion. The second thing I wanted to communicate in writing the book was that in order to actually make change happen at scale, we have to think bigger, we can't allow ourselves to be constrained by what's immediately in front of us. And we're here at UCLA, an institution that played such an instrumental role - some of you are here representing that role - in fighting HIV-AIDS in the United States and around the world. We know from those stories, that in the early days that those efforts a lot of people didn't think we could solve AIDS the way that has been addressed effectively on a planetary basis. People didn't expect the politics to come together to make that happen. I grew up in politics during the 2000 presidential campaign when there was an active debate about should we even make certain types of drugs available on a global basis in an affordable way. And yet, American leadership and your scientific contributions to that program and project have helped tens of millions of people survive and save entire nations from imploding, effectively, because of the commitment we've made based on science and vision and capacity and frankly, ambition. And so I wanted us to remind ourselves that we can be ambitious about immunizing every child on the planet, we can be ambitious about preventing the next pandemic, we can be ambitious about addressing hunger in an environment where climate pressures mean more people are likely to be hungry if we don't act now. And we can be ambitious about tackling child poverty in this country, based on what we know and what we've done and what is honestly still politically possible. The third and final reason I wrote the book is, as my wife keeps saying, "you should say this to every young group of young people you're with," is big bets start with betting on yourself. And I grew up in suburban Detroit. My parents are first-generation immigrants. My dad worked at Ford Motor Company, my mom had a Montessori school, of which I was apparently a student. And, you know, frankly, in case you can't tell as an Indian American in this community in suburban Detroit, I kind of thought that I'd either be a doctor or engineer; chose doctor because that's what was the option set. But you know, somewhere along the way, actually, I remember the moment and I write about it in the book, when I was a junior in high school, of all places, Nelson Mandela came to visit Detroit. And those of you in LA and these big fancy coastal cities, you're used to getting, you know, celebrity visitors and political leaders. If you're a kid in Detroit, you're not used to Nelson Mandela coming to town. So he was released after 27 years in prison. He comes to Detroit; he walks on the assembly line floor at a plant called the River Rouge auto plant, famous auto plant for auto kids in the crowd. And then later gives a speech at Tigers Stadium, and in the 80s the Tigers were actually like the Dodgers of today. Very good team. And Stevie Wonder opens for him, and he gives this speech. At every speech, he concluded his remarks by saying to the people of Detroit, the people of South Africa want to remind you that we respect you, we admire you, and above all, we love you. And I was blown away as a kid. And I thought, gosh, okay, I'll be a doctor, but I may also want to do something that is more around social impact and social justice. But honestly, I had no idea how. None. And I write in the book about various efforts to get started, most of which failed. Most famously, the Gore 2000 election campaign, which was supposed to be my road to the White House. And, and so I say that because in doing this book tour, I've gotten to meet a lot of young college kids or high school kids that, you know, want to make a difference with their careers and their work. But it's not always clear how to do so. And I just think it's okay to not know we'll all figure it out together. And big bets do in fact, start with giving yourself a chance to try. So with that, I look forward to this conversation. Thank you for giving me the opportunity.

Ninez Ponce 16:08

We're going to try to do this like cafe style here. I would like to welcome on Dr. Jody Heymann. Dr. Heymann is the founding director of the WORLD Policy Analysis Center, like I mentioned, and Distinguished Professor of Public Health and the former dean at the Fielding School of Public Health. As director of the WORLD Policy Analysis Center, Dr. Heymann leads an unprecedented effort to improve the level of quality of comparative policy data available to policymakers, researchers, and the public. WORLD examines health and social policies and outcomes in all 193 UN countries, and I have used that dataset and collaborated with Jody looking at child malnutrition. So earlier this year, WORLD launched new policy data in accelerating progress toward achieving gender equality in the economy with data from 193 countries on topics including girls' access to education, sexual harassment, and discrimination work and policies that support gender equality in work and caregiving across the life course. The WORLD's analyses of constitutions in all 193 UN member countries and their role in strengthening social and economic rights contributed to creating a partnership for advancing constitutional equal rights. She has worked with government leaders in North America, Europe, Africa, and Latin America, as well as a wide range of intergovernmental organizations, including the World Health Organization, the International Labor organization, UNICEF, UNESCO, and the U.S. Department of Economic and Social Affairs. She's helped develop legislation with the U.S. Congress. So, now impact at the home, as well as other UN agencies. So I'd like to invite Dr. Heymann to join us in the Tamkin cafe to have this conversation with Dr. Raj Shah. And I will be here. And stay tuned, there are other chairs. And you'll see more at this cafe and then the surprise, yes.

Jody Heymann 18:26

Thank you so much. Thank you all for being here. And wow, Raj. I mean, really, there couldn't be a more important topic right now. I mean, there are the enormity of the challenges we all face and willingness to take these on at scale. So I'm gonna say one thing about the book, then I'm gonna dive into the questions. So here's what I want to say about the book. For those of you who like me have 60 books on your phone? And you're like, do I really need another one? The answer is yes. And I was not asked to say this. I mean, really, it's a remarkable job at what's it really take. And so I'm going to assume you all are going to read it because it's worth it. And what I'd like to do, in the book, Dr. Shah goes through how they successfully took on these incredibly importantbig bets that you've heard about. I'd like you to talk with us today about another one that we are facing in increasing crises around the world. And that's climate change. And I know it's one that you're also taking on, and I hope we'll go through the steps you do in the book. So you open the book with first, you've got to ask the simple question. And it's very striking around climate change because it's complex topics. So my question for you is, is there a simple question or a set of simple questions for climate? What are they?

Rajiv Shah 20:24

Well, you know, the "ask a simple question" is the first lesson in the book. And I learned it from Bill Gates, frankly, because, back in the early days of the Gates Foundation, Bill and Melinda had read this article that said, 600,000 kids were dying of a disease called rotavirus. And there was a vaccine that was going to roll out but only in the United States and not in the countries where the kids were actually dying. And they said, this is wrong; how do we make sure every child on the planet has access to every vaccine that could possibly be used to help them save lives? And that started a 20 year journey. But in the first two years of that journey, we would gather almost weekly in Bill's conference room, and he would just hammer away at what does it take to vaccinate a child? And we're gonna multiply that by the 104 million kids that are born every year, understand the total costs, and then structure solutions at scale. And most of the experts would honestly say, well, it's very hard to think that way that's very reductionist, and this is complex, and you got to factor in human resource costs and refrigeration and electricity. All these things make it more complicated than that. But Bill just kept at it until we had an answer. And of course, our answer was wrong. But that almost didn't matter. What mattered was, we were forced to think about how do you solve the problem at scale. So if you apply that same thinking to, as Ninez pointed out, you know, if you look, 20 years later, the vaccine alliance that was established through all of that dialogue and collaboration, has allowed about 980 million kids worldwide to get vaccinated, who would not otherwise have been vaccinated, and 60 million child lives have been saved. So that, to me is a big bet that worked, it continues to work, it has some ups and downs, we could talk about. If you apply that thinking to climate, and Bill, frankly, wrote a great book that does exactly that. He basically takes the 52 billion tons of carbon emissions every year and breaks it down into its component pieces. And the question is, how quickly can you get to zero? And can you get there fast enough to save the planet effectively? And, you know, that's very interesting because a lot of the modeling and climate science, and I'm sure many of you have deep expertise in this kind of correlated temperature rise to these super bad ecosystem outcomes, like ice melt in the Antarctic, that then causes ocean acidification and you lose fisheries and a billion, a billion and a half people, lose their source of protein. And so the reality is, those estimates, overestimated how much temperature rise you need to get those bad climate system outcomes. So this summer, and, you know, ice the size of Alaska and Texas together fell off the Antarctic shelf - that's irrecoverable. And so we're hitting these tipping points, as the climate scientists call them, faster than people estimate. So the legit, it's a legitimate question of the policy process we're on. Can we take total emissions down fast enough? And what will we replace it with? And I'm happy to talk about some thoughts on that. But but the simple question is, you know, how much emissions are there? Where do they come from? How fast do they need to go to zero to save the planet? And what can we do to get there?

Jody Heymann 24:02

Fantastic. So in the book, you go from this simple question to "jump first." And I gotta say, I love that part, too. So why do I love that? So at WORLD, we started with a simple question, too. Our simple question was, why isn't there transparency and accountability for what every country does around policies that matter? And we, I might say, happily but foolishly jumped before we knew how big a challenge that was. We said, okay, well, it doesn't exist, we should just do it. And I think you do kind of have to jump with your eyes half closed for many of these big challenges. So I think that's a wonderful recommendation to everybody here. When you think climate change, how many want to jump first? You all are already jumping on the finance, tell us about the finance but other ways we need to jump first.

Rajiv Shah 25:11

Well, just to provide some context on why we call this the lesson learned from this effort "jump first," once we had figured out what the total resources needed were to enable large scale vaccination, we then understood that well, there wasn't even a supply base to vaccinate enough kids for a lot of different reasons. And so we put together, with some external partners, kind of invented this social impact bond. There really was an early global social impact bond that said, okay, if this vaccine alliance will issue all this debt, and the debt will be repaid by donor governments, if they go ahead and vaccinate hundreds of millions of kids. And to make a long story short, the only way that that bond was going to work was if European governments agreed to provide the full faith and credit backing of that security. And the only way that would happen was if they felt that the Gates Foundation was going to guarantee the viability of the bond. So late night, you know, at a bar, we sort of made that commitment. And I made that commitment while I was in the UK with the Chancellor of the Exchequer's kind of main advisor, a woman named Shriti Vadera. And I had, of course, no authority to make that commitment. I was a kid working at the Gates Foundation, right? When I was like, yeah, so but I was like, you know, it sort of makes sense. And if this whole thing works, as magically imagined, it will be so efficient, that that couldn't possibly cost us the billions of dollars it looks like it might cost us on paper. And I think I can sell it to Bill. And so I made the commitment, went back to Seattle, and realized very quickly, I wasn't going to sell that to anybody. It was well beyond what we could do. But the fact that we made the commitment got other partners to do things that they wouldn't have done, and the French, then the UK, then the Norwegians and the Germans, everyone jumped in. And at the end of the day, we issued a $6 billion social impact bond, used it to create a massive upgrade in the global supply chains for vaccines. And we were off to the races in terms of having a volume of supply, and it never needed a guarantee. So the reason I offer that is because we did this just a few years ago to jumpstart COVID antigen testing in the United States with Rockefeller's kind of "credit worthiness" standing behind. But 20 or 30 states had come together to buy antigen tests at a time when the American federal government led by President Trump was actually against testing overall, because if you remember, they were saying, he was saying, if you test and you find cases, that's a problem. And so, the bottom, so we jumped first in that context. And I'd say climate, we're trying to do the same thing, we have created an instrument that we call the Global Energy Alliance for People and Planet. And as Ninez mentioned, it's our effort to help a billion people who literally still live in the dark, they consume less power than one light bulb and one home appliance per person for the course of the year. And at that level of energy consumption, you basically are trapped in subsistence poverty, you can't really use your labor productivity increases to move your family out of poverty, and your community can't create jobs. So we've helped define a handful of solutions, including these solar micro grids, that can provide power at 20-22 cents per kilowatt hour. And we're scaling them across a dozen or almost 20 countries around the world, reaching about 20 million people. But to do that, we've had to do the same thing, like kind of guarantee the market. And so to guarantee the market, we put together a billion and a half dollar grant fund; Rockefeller made the largest single commitment we've made in 110 years, which was a $500 million grant to create this Energy Alliance. Thankfully, we got the Bezos Earth Fund and the IKEA Foundation to match it. And so that became a billion and a half dollars, and we raised about 10 billion on top of that in commercial capital. And so we have an 11 and a half billion dollar fund that's allowing for this to happen. But if someone doesn't go first, everybody just sits on the sidelines and says, gosh, is that possible? Let's study it more. Let's do more pilot projects. You know, we don't know if it works. We don't know if you can get the price down. And the truth is, you can't get the price down if you're sitting in your conference room talking about it. You get the price down by getting volume up and innovating in the systems and that's how the price came down. So that now in India, for example, Tata Power, a very big power company, is rolling these things is out and providing power probably at 15-20 cents a kilowatt hour in that range. So, you know, you can do amazing things, but you do have to take some risk. And in the private sector, we really admire and value those risk takers. Strangely, in philanthropy and public sector walks of life, we don't always take the risks; I think we should to make big change happen.

Jody Heymann 30:24

That's fantastic. And another totally remarkable story about getting the resources and scale and, you know, you make it sound so feasible, which is what's so important about it. I just want to remind everybody, though, what the world typically looks like, is assuming it's not feasible, right? So at the beginning of my career, most kids weren't being vaccinated around the world. The assumption was, maybe we wouldn't achieve that. I remember sitting in another university auditorium, this was on the such important work on AIDS and other areas. This was at Harvard. They brought in six African presidents, they had academics, they had everybody at that time, AIDS was getting pennies per person, you know, a couple 100 billion was a meeting where the idea was floated, that maybe the order of magnitude investment was off by 100. And we have to do something about it, so I think the fact you've accomplished this is extraordinary. Now, you talk in the book compellingly about having to take concerns as a challenge. And I hope you'll talk to us about that with climate change, both what you think are the biggest concerns we have to address, and one I hear repeatedly, which is, how do we advance equality between countries and within countries while tackling climate change?

Rajiv Shah 32:09

Well, I'm glad you asked that question. Because, you know, as a youth, the example you offer on HIV AIDS, I think is in part, the answer to the question. It's so often the case in doing this type of work, that when you try to set a big goal and try to articulate a path to actually solve, not just make incremental improvements, on some of the big hairy challenges we face. People tell you, your ideas are crazy. And that'll never work. And they might be right. Often they are. But it's so constant that it can, it can reduce your own sense of ambition to solve these problems. And, I learned early on, again, from Bill Gates, you know, the first one, we put that social impact bond together, I'd actually written it up as a proposal for Bill. And he was traveling in New York. And so they said, okay, go to New York and visit with Bill and his suite, you know, in his hotel. So I did, and I walk into the room. And it's just Bill and I, my first like, serious, one on one with him. And, he sits down, he pulls my memo out of his bag, and it's like, covered in ink. And he's like, this is a terrible idea. It's never gonna work, it's probably illegal. And then he just went into all the different reasons why it was, you know, stupid. And although he used much more colorful language. And, you know, and frankly, by then we were in the mode of just energetic debate. So instead of sort of thinking, okay, this is actually a bad idea, I was so excited about the idea that I just took a lot of his feedback as a roadmap that said, look, if you can solve these seven or eight reasons why he thinks this is a bad idea, if you solve all of them, then it's a good idea - that we could do it. And in fact, we spent the next two to three years doing that. And ultimately, he was the biggest champion, you know, taking me with him to meet Presidential Chirac of France or Gordon Brown in the UK or the leaders who actually made the decision to do the project. And then what I learned from that is take concerns as a roadmap. So when we started our climate program, and really focused on expanding renewable energy broadly, a lot of people say it doesn't work. They say, there are lots of reasons why local utilities are corrupt and inefficient in African countries and so it's hard to expand electrification. All of that is true. But if you if you take that those concerns as a roadmap and then systematically work to overcome them, you can deliver pretty meaningful results. And we just announced 1400 of these solar mini grids for Zambia that will reach a quarter of its rural population for the first time providing enough productive power to modernize its agriculture. You can do this in place after place after place, but you have to be willing to hear the concerns less as a vote of no confidence in your ideas and more as a roadmap for a set of challenges that then need to be overcome together.

Jody Heymann 35:16

Fantastic. I'm gonna ask one final question and then we're gonna invite people up. You have brought together incredible coalitions; that's clearly part of the solution. Who is not yet part of your Climate Coalition that you want on board?

Rajiv Shah 35:36

Well, that's a extremely timely question, because this year, the big climate meeting is being hosted by the UAE. And, you know, if you look at just the last two, two and a half years, given the huge run up in oil prices, there's been about two and a half trillion dollars of windfall profits that have gone to five petro-state countries. And to me, that profit came in part from a horrific conflict between Ukraine and Russia and a few other kind of global issues. You know, those are resources that, in my mind, should be deployed to help accelerate the climate transition, as opposed to reincentivize the use of fossil fuels at scale. And right now, where our political imagination is sort of narrow, in terms of seeking to unlock that. So I think I think the petro states and the oil majors that have been the largest beneficiaries, it's mostly the countries, the ones that just have had about 20% of that windfall, 80% have gone to the countries, it's only five countries. And you know, to me, there's deal space there. And we should have much higher expectations for genuine leadership, a little bit like Paris or Copenhagen here. There have only been a few of these global climate meetings that have become notable in the course of history. And I feel like we don't, we don't set our expectations high enough, when it seems pretty obvious where the resources need to come from, in order to accelerate, accelerate global progress.

Ninez Ponce 37:14

Thank you. So we're going to open the door for the cafe and invite Dr. Robert Fairlie, who is the new chair of the Department of Public Policy and a Professor of Public Policy at the UCLA Luskin School of Public Affairs. I saw him wandering around earlier today because he's so new. Welcome, welcome, Rob. So, you can come up as I brag about you. Before joining UCLA earlier this year, he spent nearly three decades at our fellow University of California school, UC Santa Cruz - so, banana slugs! let's Dr. Fairlie is a member of the National Bureau of Economic Research. If students who are here are unfamiliar with NBER, please look them up and look at some of the work that they've done on policy. He's published in leading economic and policy related journals. You have to have a lot econometrics, so just as a forewarning if you go to NBER research. Topics include public policy, entrepreneurship, education, information technology, labor economics, developing countries, and immigration, typically with close attention to the implications for racial, ethnic and gender inequality. Rob provided testimony before the California State Legislature on several occasions, again another fine example of academics making an impact, you know, beyond the peer review work, but actually making an impact in shaping and informing policy. He's also done this on a national stage. He has testified before the U.S. Senate, U.S. House of Representatives, and the U.S. Department of the Treasury. He also has a new book - did you bring it, Rob? - on entrepreneurial job creation and survival among U.S. startups titled, "The Promise and Peril of Entrepreneurship," which was recently published at MIT Press. So let's welcome Dr. Fairlie. And I look forward to your set of questions.

Robert Fairlie 37:58

It's pretty exciting to be at UCLA. I don't know if you know anything about Santa Cruz, but it's a much smaller, it's a bigger campus geographically, but it's smaller, of course, and doesn't have so many schools. So it's been really exciting to get involved in events like this and meet so many people. I feel like every day, I'm meeting five new people, right? That are doing research or doing policy that's related to what I'm doing. So let me just kind of jump in because you know, I, I want to hear more about the book. I feel like we haven't given you a lot of time to talk about it. So let me just give you a kind of real broad general question and then you can kind of do what you want with it. Why is now such a critical time for making big bets? Okay, so what have you learned from writing the book, of course, that can help us move forward. So, it's open for you to talk about anything you want.

Rajiv Shah 40:15

Well, thank you. And, you know, I think at the end of the day, I, you know, I define big bets as efforts to actually try to solve the big challenges we face. Child immunization is an example, the two major pandemics I discussed, the Ebola crisis and COVID, efforts to fight hunger at scale, in the aftermath, in particular, of the 2008 financial crisis that caused a tremendous 47 episodes of political violence and instability related to food insecurity. And I just, and the reason I think it's so important is because it's too easy for us to think that this work is about doing good. And so therefore doing, you know, incremental things that seem feasible, is good enough. And it's not good enough, like we should aspire to more. So I think that way of thinking is particularly needed right now. If you look at if you look across sort of global poverty and global health and hunger, and those types of statistics, just to take hunger as one example, between the mid 90s and 2017, global hunger went from about 14% of the global population to about 7%. And there were major efforts after big crises, one of which I read about the President Obama led truly in the aftermath of the 2008 food crisis. By the way, in the aftermath of 2008, there was an Economist cover story, with a young girl eating in Port au Prince, Haiti eating a mud cake, and a mud cake is exactly what you think it is, it is cereal grain mixed with mud, to allow her to be slightly more, have a little more satiety. And it was in the aftermath, and we had the big G20 Conference in, in Italy. And the President said, Look, if we're going to take these unique actions to protect the global financial system, we should also be protecting this young girl. And we should be lifting up those who are deeply vulnerable around the planet, both because it's the right thing to do, but it's also critical for our national security. And that kind of thinking, I think we need to reimagine again, because since 2017, the rate the global hunger rate, just as one indicator has gone from about 7% to almost 10%. And it's projected with climate change, which is causing as much as 30% reduction in agricultural output in lower income countries, that could go up again to 14/15% in just about a decade's time. So we are unwinding a lot of the progress we made, which is why I think it's important to reimagine some big bets and fighting hunger, fighting global health, for global health priorities and against disease, kind of in this moment now.

Robert Fairlie 43:09

Great, thank you. So there are a number of students here, it's nice to see them, you can always tell who your students are there, they have the cookies. Coming into the auditorium.

Rajiv Shah 43:22

By that standard, I would be a student. Just to be clear.

Robert Fairlie 43:26

I'm going to the cookies. What can you say to students about impostor syndrome? So this is one of the you know, big arguments you make? And I think it's, it's really helpful for them to kind of hear this from you. And all the success that you've had, and you talked about this in your book is being a huge barrier to making big bets. But it's also a barrier to making small bets right early in your career. So what can you say?

Rajiv Shah 43:52

It's also just terrifying. So I write in the book, a few different episodes, and just, you know, feeling like do I really belong? Doing X, Y, or Z. And one of my favorite examples is, after I when I was appointed to run USAID, which is America's development and humanitarian agency, about a week in after I was sworn in, the earthquake in Haiti happened, and it was really quite devastating. Like right away, we knew that 21 of 22 ministries had collapsed. The UN, which was providing both security through its security forces and humanitarian support, the building physically collapsed, and more than 100 UN people and leaders, some of whom we knew and worked with perished right away. And so it was it was really quite tragic. And in that moment, President Obama asked me to lead this response to the earthquake. And so the next morning, we go in, I was working all night and fielding phone calls and putting together this big effort in our operation center, and had all my data and it's going to the White House for meetings. But the next morning, we had an Oval Office briefing. And I get there first, because I certainly don't want to be late. So I get there a little early on first. And they let me in. And and so I'm in the Oval. And it's Obama and Biden are over by the window, with Obama kind of looking towards me and Biden looking out the other direction, but very close to the president. And he and I hear him say, as I'm walking in, "Hey, are you sure about this guy, Raj Shah, he's like 30, something he just got here and we have this other person, a gentleman named Craig Fugate," who is an amazing American, public servant and leader and a good friend who runs FEMA, the Federal Emergency Management Agency, and he's got so much more experience. And right as Biden saying that I walk in, Obama sees me. So he comes over, he's like, "Raj, come in, come in and sit down." And you know, and I'm like, Where is everybody no one else is there yet. And I was doing that quickly. Everybody got there. But I was, you know, like, Oh, my goodness. And, and at the end of the meeting, Craig Fugate was in the meeting, as was Hillary Clinton, and Janet Napolitano and all these folks. And on the way out, I grabbed Craig, and I'm like, Craig, I need your help. I just need your help. And he, he's like, absolutely, anything you need. And so he spent the next three weeks basically working out of the USAID operation center. And the lesson in the book is called Open the turnstiles. Because when I got back to USAID at that time, from the White House, as a as a employee of USAID, we all had badges we could get through security, but the military officers and and personnel, the Homeland Security folks and Coast Guard folks, and the FEMA folks, including Craig had to stand in this long line to get badged in and go through security before they can come in. And so I in an effort to make that easier, I asked the security team to could they just open the gates, keep them open. This was a huge moral emergency, we were all working to save lives, just let people in and out of the building for a little while without badging them in. And they said they would. And it was an extraordinary moment. And it made a big difference. But that's why the lessons call it open the turnstiles.

Robert Fairlie 47:22

Sure, I'll ask one more quick question. As an economist, it was great to hear you talk about prices, right? I think that's kind of one of the most important lessons we've learned in history, right? Is if you don't lower prices enough, you're not going to see the change, right. And that's really important for electricity, for example, we can't get the price of alternative energy down, it's gonna be much harder to change. So I wanted you to just spend a couple of minutes talking about that.

Rajiv Shah 47:48

Well, so our big bet right now at the Rockefeller Foundation is to help bring renewable electricity to a billion people that live in the dark. A lot of this grows out of work that the Obama administration started back when now mayor Bass was the chair of the Africa committee of the Foreign Affairs Committee in the United States Congress. And thanks to her leadership, we've passed a bill called Electrify Africa, that allowed American government agencies to start really seriously bringing electrification and renewable electrification across the continent. And, and frankly, since that time, about a decade ago, nine, eight or nine years ago, the explosion of technology has brought the price down in accomplishing that task. So I told you earlier about the solar mini grids that we use to now serve about 20 million people. But when we first were starting that effort as the USAID, Rockefeller was doing some of that work in partnership with us. It cost about $1 $1.20, to provide power, one kilowatt hour of power, which is an extraordinarily high price as you could possibly imagine, not at all viable. Now, as I mentioned, it's under 20 cents. And the reason for that is solar panels are cheaper. Batteries are much, much better and and less expensive for what you get. We have we use artificial intelligence to run the emergency and battery of the energy and battery management system. So you don't need personnel in remote parts of the the world to operate these systems. You can use smart meters from they were invented in a company in Washington DC, actually, that allows you to meter only for use, and then people can pay on their phones. And you know, just about six weeks ago, we announced based on all these technologies, we're rolling out these larger metro grids to serve 7.1 million people in eastern Congo. And I write in the book about Eastern Congo because we both spend time there and the reality is if you've ever been in that environment that kids are, have been through hell and back, It's been a conflict and kids that have been drugged and abused in extraordinary and unspeakable ways. And to finally be able to bring electricity, energy, job creation and hope to that community at that scale is what we can now do because the price came down because a lot of people stuck their neck out eight or nine years ago and and helped start a process that just now is paying huge dividends.

Ninez Ponce 50:46

The 43rd mayor of Los Angeles is in the house. She is the first woman and is second African American to be elected as the city's chief executive with an agenda focused on bringing urgency, accountability and a new direction to Los Angeles. She has started her term in the focus on housing people immediately and increasing safety and opportunity in every part, every corner of Los Angeles. A daughter of our city, mayor Bass was raised with her three brothers in the Venice Fairfax neighborhood, and is a proud graduate of Hamilton High School. Anyone here from Hamilton here? Okay, after serving as a frontline health care provider as a nurse and as a physician assistant, mayor Bass founded a community coalition to organize the predominantly Black and Latino residents of South LA, against substance abuse, poverty and crime and to pioneer strategies to address the root causes behind the challenges faced by underserved neighborhoods. She then went on to represent Los Angeles in the State Assembly and was elected by your peers to serve as speaker, making her the first African American woman to ever lead a legislative body of a state in the history of the United States. Her time in leadership intersected with the Great Recession, and she was honored with the John F. Kennedy profile and Courage Award for reaching across party lines and making tough decisions to keep the state from bankruptcy while protecting vital services. Thank you. While representing Los Angeles in Culver City in Congress, which was in Congress, your best help protect small businesses during the pandemic, created policy to drive local jobs from federal infrastructure funding, and led the passage of what Los Angeles Times called the most significant child welfare policy reform in decades. Please join me in welcoming L.A. mayor, Karen Bess.

Robert Fairlie 53:03

Well, it's very exciting to have you here, I'm gonna ask both of you a question. One of the major issues of course, facing California right now is homelessness. Incremental solutions have mostly been effective, of course, what are some big bet solutions that are promising? And I'll let you two choose which order?

Rajiv Shah 53:24

Well, I'm going to defer to the Mayor. But before I do, I just want to say thank you so much for being such a huge fan is, as you know, and a lot of what we were talking about earlier, from our work on HIV Aids to vaccination, to bringing energy to difficult communities across the globe and in Africa, in particular, I was able to do with others in government thanks to your leadership. And, and so I know we don't, that's probably not what you're spending every day talking about these days in in town here, but so grateful for all that you've done. Thank you.

Karen Bass 54:01

Thank you. Thank you. Well, let me just say this. It is on. First of all, I'm glad to be here. It's been a while since I've seen you and just congratulations. And I just hope. I mean, I just heard a couple of minutes of it, but I just really hope that people get the significance and how profound the work that you did was: Ebola. Yeah, I mean, Ebola was going to, you know, we were worried it was gonna wipe out the continent of Africa. And it was able to be isolated to three countries because your leadership, the President's leadership, mobilized the entire world to stop it. And can you imagine if we have that kind of leadership when we faced COVID. So and I mean, that's just one of the things and I could go on and on and talk about you. Congratulations for being a Rockefeller and can't wait to get your book, because I want to recall many of the things that you did during the time that we worked together. So thank you for also for the invitation to be here. Homelessness. You know, the day I took office, I didn't go to City Hall, I went to the emergency management department and put the city in the state of emergency because to me, in Los Angeles, 46,000 people, that's the city, if you add in the county, we're talking about 70,000 people. And there's a generation that has grown up thinking that this is normal. And some of us who have been around for a while, know that Los Angeles didn't always look like this. So that's why I ran because I wanted to come home, I believe that we had an emergency here. But what we've been doing is, we don't accept people being on the street. And we get them off the street immediately. And we have them in motels. And I've been in obviously in a few weeks, it'll be a year, it feels like 10. But But what what we've been able to do that I think is significant is dispel a myth. There's two myths that are very common in our city that everybody's from someplace else. And what happens is if you talk to somebody who's on house, and you say, where are you from? You'll tell me Chicago? And I'll say, Well, how long have you lived in LA? And you'll tell me 30 years, okay. You're an Angeleno. Another thing is, we've dispelled the myth that people will not leave the streets. So when I started, people said, what are we going to do to the people who won't leave, we have the opposite problem. We go to housing encampment, and we've counted 20 people. And what happens is 30 show up, because the unhoused have telephones, and they're calling each other and they're saying, come here. So we've been able to reduce street homelessness. And I do believe that we could cut it down by 95%. If I had the motels, I do, I mean, because we just are not having the problems that everybody anticipated we're having. We're not because we're not putting people in shelters. We're putting people in motels, we have to come up with a better model financially. But we're working on that as well. So we're moving to acquiring motels, we're also moving to master lease motels for multiple years.

Rajiv Shah 57:17

I just said that's a great example of a big bet. And it's just so we saw this on our work internationally. And you see this here, it people tend to believe these problems are not solvable, until you go out and start solving. And they take time, and there'll be setbacks along the way. But, you know, you've shown in so many different aspects of your leadership, it's possible to solve those problems. And I think in the book I tried to write about, like I said, folks who are household names, people you've heard of, but a lot of folks who are you definitely not heard of that have just done the hard work in communities around the world, and achieved some extraordinary things on behalf of humanity as a result.

Jody Heymann 57:58

So I'll start just by saying Mayor Bass, we are so grateful as a city that you are taking on the big bets. Truly, you know that you have that kind of inspirational leadership to say, we can and have to solve this. So I want to raise another big bet for you both. And that's about access to quality education for everyone. So we have huge inequalities in our high schools, in our elementary schools have been the success rates, we're seeing now, the data post pandemic, that many of those inequalities have gotten greater. I'd love to hear how you would both take on really betting on the next generation so that we no longer have the level of inequalities in education that we have for Mayor Bass here in LA, and for Dr. Shah, across the country and around the world.

Rajiv Shah 59:12

Well, I'll just say we've our our foundation's work on education has was grounded in getting kids back to school during the COVID crisis. And with the leadership with some of my colleagues that are here in the room, we built a testing solutions group that included most major metropolitan areas across the country, with their mayors as mayor Garcetti, he was was a big part and LA County was the first place where we started expanding testing through a group called core which is Sean Penn's organization, and a number of others that came together with the city and with the county to actually figure out how can we expand access to testing at a time when people didn't know what the options were and at a time when frankly, would take 4 to 7 days, if you could get a PCR test in but to get a result, which is obviously we now know is completely inadequate to offering any kind of protection. The bottom line is over the course of about a year, we were able to help schools across the country use testing strategies to reopen, we created the antigen testing market. We did some, again with I think LA-based RAND corporation did these amazing studies to show that you could keep teachers safe, we partnered with the Randi Weingarten and the teachers unions to come out with joint protocols to help schools. And I'll tell you, I learned three things from that. The first is, if you want to get big social efforts done, you have to be a good partner with everyone. And it was a time when people were pitting the teachers unions against the parents groups, and some folks were trying to make electoral kind of progress based on splitting people apart. But actually bringing folks together and saying, Okay, tell me why your teachers are concerned and what we need to do to get over that together, became a big part of the solution. I write in the book a lot about building those kinds of unlikely partnerships and bridges. A second thing was, it was it's inexcusable, to see how the loss of educational opportunity for lower income kids, for black kids, for brown kids across this country is is right behind the excess mortality that we suffered as a nation is the big consequence of COVID. And we have gotten nowhere near making up for that. And even the money that we helped the federal government put in place $10 billion help schools hasn't even today been fully drawn down to help those schools actually upgrade their capabilities they have to offer. So that's that's the second thing is we don't take equity much more seriously, in the context of education system, we had no no chance. And I remember hearing from teachers in LA, but also Broward County, and just across the country, people had such different experiences with with getting losing kids to follow up and all and all of that. And then third, and I think most importantly, and this isn't Rockefellers work, necessarily, but but I look to other partners around the nation, there are so many examples of schools that are crushing it. I did my first book launch event in a school called Harlem Village Academies in New York, just up the street from where our headquarters are, seeing all these kids, they are first or second generation kids in this country, they are all minority kids, they are all going to college, they're all getting their IB degrees, and they are all the first in their family to go to college. And you sit in that circle and you talk to these kids. They're asked me about the book, they've read the chapters, they're like, what how did you feel when this happened? Or what do you tell your dad when you left medical school? They had the tightest questions. But those kids I would bet on those kids all day long. And so the idea that you can't provide an education to kids who are less fortunate and give them a path to the best schools and the best careers in this country is simply proven wrong all over this country. And if we don't, if we don't set the expectations higher for ourselves, we're simply not going to be successful.

Karen Bass 1:03:24

That's, that's great. And Harlem village has done such great work. We'll just answer that from a local perspective. And those of you that know LA Unified Schools, you know that the overwhelming majority of the students are students of color, with a very, very, very high number of students that qualify for free lunch. I think one of the things that we have done in our country that we have suffered from on so many different levels: systematically shredding the social safety net. And so school is not just school anymore, one of the things we learned in the pandemic is school was where families were getting food. And so in LA Unified, they went about passing out food every day, because they didn't really realize how families were depending on school for food, school for health care in some instances. And so we have to look at education holistically. And unfortunately, you shouldn't have to take care of your health care, your food and everything else in school. But until we rebuild a social safety net, the school has to be comprehensive. And one of the other things that we learned during the pandemic, we actually had known this in South LA, because we had done surveys years ago, of students of mental health was a huge issue. Everybody understands it now after going through the pandemic. And so even mental health or physical health, you shouldn't have to look at school for that. But now what is happening in LA Unified is the concept, it's not rocket science, but of a Community School, which means the school after hours and serves the community. So in addition to addressing the education needs, we have to address basic needs in our schools. And, and that is something that we have to do. I'm also a very big believer, as you know, in coalition building, and collaborating, because in a city like this, we have everything we need, really. But it's a question of accessing it, mobilizing the resources. And then a lot of times people in communities do not know the resources that exist, unhoused people don't realize that they actually might qualify for all sorts of social programs that they don't know exists. So it's the shredding of those programs. But it's also the difficulty in accessing what remains of our safety net.

Robert Fairlie 1:05:58

The book talks about how to solve major problems, it's important to build and maintain unlikely alliances. Can you provide some examples of diverse alliances that have been especially effective? Now, how do you address these issues, when Democrats and Republicans right now are probably more farther apart than they've ever been, ideologically? So what are some, you know, ideas, we can move forward on this?

Rajiv Shah 1:06:24

Alright, I'll start. But the mayor is the pro at this. So I'm gonna defer quickly. There's a chapter in the book called Make it personal because it is after the 2011 to 2010/2011 election, our Congress switched parties and a group of folks at the time called Tea Party colleagues had joined the team, so to speak. The team. And and one of the first bills that was put forward HR 1 would effectively zero out USAID when I was running USAID. And, and so our team got very worried about, the White House got very worried. They said you gotta go testify. So in my testimony, I had done all this math, and boldly proclaimed, although is accurate, that if you eliminated all these programs, 70,000 kids would die around the around the world, and I did it by malaria programming, vaccinations, HIV, Mother-Child transmission of HIV, very specific. And I got back to my office, and I got some congratulatory calls from mostly from White House. And they're like, good, that was tough, well done. And then I got a call from my friend Tom Vilsack, who was who was the secretary of agriculture. And Tom said, Raj I was just with Speaker Boehner, and he is very upset with you. And I'm like, Oh, I haven't met him yet. And he said, look, he's spent all this time building a conservative, faith-based Republican community of conservative political leaders who support the global humanitarian mission, but do it from a very different place. And he felt your comments were insensitive to all that. And so I went, and he's like, you should go meet with him. So I went and met with him, I apologized. He gave me a list of people to meet. And frankly, over about six months, I was able to get to know people I never otherwise would have gotten to know. And one of them was Senator Jim Inhofe of Oklahoma, who, you know, on face value, you'd say, okay, this was the senator who took a snowball onto the floor of the Senate to demonstrate that climate change wasn't a huge problem because it was still cold outside. That happened. And, but behind closed doors, he had a deep commitment to the kinds of issues we're working on, in particular food security. And together with now, Mayor Bass, but Karen and he and others, basically passed the Global Food Security Act, which was the second largest piece of global development legislation since PEPFAR was passed in decades. And it was a huge advance for America to be able to reestablish our role fighting hunger, it's been reauthorized twice on a bipartisan basis, including most recently, it was the legislation that enabled the Black Sea grain initiative to help alleviate hunger caused by the Russian aggression in Ukraine. So, you know, you can be successful, but a lot of that was about building deep personal relationships, traveling together, praying together, and engaging in a way that, you know, was new to me, but was important to build progress. And I will say whether if you see Mayor Bass here or in Washington or any setting, there are leaders like the mayor who are able to do this with all kinds of different people. And when people ask me, why are you optimistic in this current political environment? And the answer is behind closed doors I've seen what what your mayor has done, I've seen what others have done. And I believe, I believe in that kind of politics.

Karen Bass 1:10:07

You and several other people have said to me, well, how do you deal with the city council? They're so partisan. Right, frankly you know there's only 15 of them, it's not 435. I remember that I remember when you were there. So I was on Foreign Affairs I had just gotten there. And the Tea Party, by the way, liberal right now, yeah. Compared to the current crop, but I remember, you have to have fun, you have to have levity. So I remember we were going to introduce a bill that called for foreign aid to be cut so it will only be 10% of the national budget. How much is foreign aid?

Rajiv Shah 1:10:52

It's about 1%.

Karen Bass 1:10:53

What people did, you know, because they were so hysterical, they were sure it was 40% gotta bring it down to 10%. Well now I haven't read the book, but just knowing the title of that chapter is about making it personal. And so I will tell you, though, why do you see on TV coming out of Congress is only part of the story. Because some members of Congress are into theater, they should go into acting. And what they really want to do is they want to be clipped so they'll be on Fox, or MSNBC and CNN at night. So you see all of this bombastic behavior. But you know, people do actually work together and do pass bills and get things done. The big stuff is where you run into problems. But it doesn't mean that that legislation doesn't pass and you're not getting it done. It just doesn't get the spotlight. Because unfortunately, the media is not all that excited about talking about when we get together. So my number one partner, you remember Chris Smith, oh, yeah, Chris Smith from New Jersey. Number one issue in his life was abortion. Needless to say he was not pro abortion. And I worked with him for 12 years, he was my number one partner, and we worked on sex trafficking it is a really big issue. We have a major issue with sex trafficking here in the city, you should know that that the average age of a girl that has been trafficked is 12 years old, okay. And major, major problem, we're an international thoroughfare here, and the girls are domestic girls, most of them are, are from foster care. And so he was very interested in that issue. And his origin was religion. Mine was not. But we worked together on that we just didn't talk about a woman's right to choose. But I was not going to be so rigid that I wasn't going to talk to him about any issue that we had in common. So it's about one identifying a personal connection and two, it's about finding the issue that you can work on together, and then maybe avoiding some of the other issues. And it's about keeping your eyes on the prize and focus on what you need to get done.

Jody Heymann 1:13:01

Phenomenal, phenomenal. So I know Rob and I could ask questions all night. But I also know that in this audience are extraordinary people working on so many big bets. And they've questions for the Dream Team up here so I am gonna pass it to Ninez for that. Yeah.

Ninez Ponce 1:13:26

I'm gonna walk around behind here. Can you all hear me with this mic? Yes. Okay. All right. First of all, thank you so much for gracing the occasion and Mayor Bass for being here at UCLA. So thanks so much. So I'm a survey researcher. How many people here are students? How many people here are graduate students? Okay, undergrads? High school students? Not many come, no, we did. We reached out to students. Probably doing their homework. But, well thank you all for coming. And so I'm hoping this is this is how I can I can read this close. But overall words can't convey how I feel sitting here listening. What is your advice? This is to to Raj. I think it is also for you, Mayor Bass. What is your advice to folks early in their career to make impacts when across now to 2 Job sectors and public health I've been met with don't rock the boat. Oh, no. Rock the boat.

Rajiv Shah 1:14:49

Well, you start,

Karen Bass 1:14:51

I call myself a constructive disrupter. You absolutely have to rock the boat, but it's how you rock the boat. You know? And most of the times, it's not what you do, or what you say, it's how you go about it, and how you speak to others. I don't know what that was, in reference to was that in reference to public health? Or was that in reference to?

Ninez Ponce 1:15:12

I think it says, I'm going to add this to multiple sectors, multiple jobs.

Karen Bass 1:15:17

Well, I mean, I can just tell you the, I mean, I have to deal with the city as a whole. But in terms of homelessness, I have found so much status quo behavior. This is what we've been doing. It's been working, it's getting better. We just need to keep doing what we're doing. No, it's not getting better. The population has tripled in size. 2000 people dying on the streets of Los Angeles, last year, 50 people died, the first six months of this year on Metro. That's a crisis and emergency and I can't just go about it in the way it's always been dealt with. So I think it's important not to be afraid to question. But it's also real important to learn diplomatic skills. Because if you just go in and disrupt everything, that's what I said, a constructive disruptor. If you just go in and disrupt everything, especially institutions that all have bureaucracies, they'll just shut down. Or they'll just smile at you with very deep, passive aggressive behavior and say, okay, I'll just wait. I'll just frustrate this person until they go away. So you have to build alliances, build relationships, study, do your homework, know what it is you're trying to change. And don't act like no one ever had your idea before. Because sometimes people come in and they're new. I remember when a couple of new members of Congress came in, and they're on their first day in caucus, they wanted to walk in and lecture 200 people on climate change, like they just thought about it. And you have people in the room, who've been doing climate change legislation for decades. And so be humble, learn. And but don't be afraid to challenge otherwise, we will not have progress.

Rajiv Shah 1:17:05

I would add to that we talked about Ebola earlier and I'm write about Ebola in the book. You know, when President Obama made the big bet, to for the first time in US history, deploy American troops into a pandemic hot zone to fight a pandemic abroad. First time in American history. You could imagine it was a politically charged time, it was September October before an election, right? Donald Trump was starting to be the it was all on his birther movement at the time and and folks were saying, oh, we should cut off all flights to Africa, to Liberia, there are no flights, by the way to Liberia, we like looked at that. So that's not going to make sense. But but the bottom line was, the CDC was predicting 1.6 million cases, including a few hundred thousand in the United States, we beat Ebola back with 30,000 total cases, 11,000 deaths in West Africa, faster than anyone predicted. And when President Obama deployed those troops, the reason they went out there was to build something called Ebola treatment units because that's the standard operating protocol for fighting Ebola from decades back. It turns out, nobody went into those Ebola treatment units, they were empty. They were the wrong solution. And it was the disruptors on the ground and the folks on the ground and rock the boat and said, You know what, when people go in there, they don't come out, their ashes don't come out, their possessions don't come out, no one's ever going in. What we need to do is figure out how in communities to prevent transmission. And they invented a solution. They call it burial teams, which were fully garbed in protective equipment and with body bags, and they would go in and remove bodies before anyone would wash or kiss or dress the bodies of the deceased, which was part of the culture to pay respects. And that led to an immediate 70% reduction in transmission and throughout Liberia, then it was mimicked in Sierra Leone and Guinea. And I remember at the time, because you are not just rocking the boat, you're going against the CDC, you're going against all these experts. And you're and you have all these military personnel literally building these Ebola treatment units, which was why they were there, and some other solution entirely was the solution. So my advice much like the mayor is is don't be afraid to rock the boat, but be respectful, be an experimenter, data driven, and be thoughtful in how you advocate for your ideas.

Ninez Ponce 1:19:27

Yeah, I think in the book, you Raj you talk a lot about the math of malnutrition, the math of hunger, that come in doing a lot of your homework, to meetings and you you have all the analytics, but then the end, you get to a meeting but it's really about relationships, which kind of gets at this next question. When time and energy is limited, should leaders focus on improving technical solutions or aligning political assets?

Rajiv Shah 1:20:05

That's a That's a good question. That's a great question I, you know, the two go hand in hand, you make friendships, by doing things together. And, and so if you're open to that, you know, the things you're doing to get your learning together, you're changing the nature of the solutions and improving the solutions together. And, and you're listening to others. And I write about our big energy program in the chapter there. It's called give up control, because so much when I was earlier in my career, I wanted to really control everything. And you know, I would do all that math. And I thought I Well, the math is the always the answer. I learned quickly that math is not always the answer. It's building the team that is the answer. And building the team means effectively giving up a lot of control, and a lot of authority often in doing that.

Karen Bass 1:21:01

I think it's definitely both. And I think that there's a lot of times people say, Well, I don't get involved in politics, I don't want to be involved in that. Yeah you do. Because I don't think that people realize how much politics does control and impact your life. And I'll just give you an example. I lived many lives, one of those was in the medical field. And I worked in the emergency room. And a lot of times people in health care say, Well, I'm not involved in politics, but they didn't realize its elected officials that determine what you do in an examining room. You know, in terms of the policies, whether or not you have the funding, whether or not you're allowed to do that. And so you might not want to be involved in politics in terms of, you know, going to conventions or things like that. But policy impacts everything you do, and policy is driven by politics.

Ninez Ponce 1:21:57

So this next question is how can an individual deliver large scale changes, given we only have limited capacity, time, reasons and opportunities? And after you both answered, I'll give a plug to Center for Health Policy Research, because we have a health equity challenge for graduate students.

Karen Bass 1:22:19

I don't think I guess I don't see things. I don't believe we have limited resources. I don't believe we have limited time. I think we have it all. The question is how you organize and use it. So you as the individual can't do it all. But you as the individual can involve other people, and can access and collaborate with other resources. You know, a lot of what was happening in homelessness in LA is the city and the county were pointing fingers at each other and saying, well, the city does that. Well, the county does that. Well I said hey why don't we work together, we're both trying to deal with the same individual in the tent. But you have to be willing to give up give up the power in the sense of, you know, it's not just my turf here. A couple of weeks ago, I took a delegation of city council members to DC, apparently that hadn't been done before. But it was an opportunity for me to share with them the relationships that I had on a federal level in the administration and in Congress, so that they can go back and build those relationships too. We're far more powerful in getting things done if we build alliances with each other, that takes away the limits on resources, the limits on time.

Rajiv Shah 1:23:34

I'll come back to a comment I made on the front end, which is the big bet, start with betting on yourself. And when I see folks that don't want to be involved in politics or don't, you know, don't believe our public leadership can make a huge difference. I tried to make the case and I hope the book does make the case that these efforts actually have changed the lives of 10s of millions of people around the world and here at home. And that's just one person's observation of stories of others. And, you know, I am so much more optimistic and so much more hopeful, because I had the chance to serve in government. And because I saw and get to know and call a friend, someone like Mayor Bass, or I read a chapter in the book is about Mitch Landrieu when he was mayor of New Orleans and the work he did to build community engagement and support to remove four Confederate statues, risked his life, that were put in place, you know, long after the Civil War, to intimidate and to honor terrorist episodes of white supremacist groups, massacring the integrated police force in New Orleans and, you know, 130 years ago and so, I think when when I see those examples, I feel like, hey, community engagement makes a difference activism makes a difference. I love being here with you three, because you're very smart academics and you're appropriately awarded as such. But you're also each an activist. And as I read about the work you're doing, it's not just studying the issues. It's being an activist about it. I think, Tom Coates, others are here who've been part of this UCLA contribution to fighting HIV AIDS around the world. I mean, it's the activism that connects your extraordinary intellect and skill set to making a huge difference in the world. And we're just very grateful for that.

Ninez Ponce 1:25:34

Thank you. And y'all, thank you, UCLA. Yeah, I think that was shared with you, Raj? There's a time in the professional organization, it was out that you can't have scholarship and activism at the same time. Really? Yeah. Like you could be a scholar, you could be an activist, but you can't be both. So I think we're dismantling that here. So what I wanted to say also is new, both of you are superstars and also Jody and Robert, and, and opportunities come and you see students, I've seen in your book, Raj, amazing, like being at the start of the Gates Foundation, just like these amazing opportunities, USAID and and now the Rockefeller Foundation. I mean, you're, you're older than then our set of health policy researchers, but not so much to be the president. So I think some students are wondering, then what, like how these opportunities don't fall on everyday people's laps? And how can you make these big changes? Like what opportunities should you go after? Particularly if there's complex issues? You don't feel like you have kind of back to Rob's question, maybe you don't think you have the skills, you might have some impostor syndrome? How do you do this?

Rajiv Shah 1:27:00

Well, let me let me say, I think we're almost out of time. So I'll be very brief. But I don't know. I'll just say when I got started, I didn't know what I was doing. My wife and all three of my kids would say, I still don't know what I want to do. And I, you know, I think honestly, to me, it's been good fortune to get to meet people who made the next thing possible. So for example, I left medical school to join Al Gore's presidential campaign thinking, I was going to get a job in the White House after we won resoundingly. And then we didn't win, even though you could argue, many more, Floridians voted for Al Gore than George W. Bush. But nevertheless, and then I was distraught for a while. But it turns out, one of the folks on the campaign was helping Bill and Melinda kind of set up their foundation, and said, Oh, yeah, I kind of know an unemployed sort of health economist sort of Doctor, you know, I'll connect you guys. And that's how I got started there. And then I was there, there were a few people there that were very plugged into politics and said, hey, we know your dream is to be in an administration. And they, they basically encouraged me to join the Obama administration. And so and then just on and on. And when I was in service, I got to work with people like Karen Bass and Chris Coons and all these amazing leaders who are now friends who I just respect so much, and take such inspiration from and I, the lesson to me for young people is, you might spend a lot of time think about what your next job is, or what your career opportunity is, my advice to you is, think as much about who you're gonna get to meet and work with and learn from, because they'll shape the way you think they'll shape the way you are either optimistic or not about the future. And they'll probably shape what you do after.

Karen Bass 1:28:55

Absolutely. And I do think that opportunities like I've had, are there for everyday people, because that's who I am. I something special with the public schools, I had no idea what I was doing either That's never stopped me. I didn't know what I was doing. You know, in terms of homelessness, but you just jump in and solve the problem. And don't be afraid to take a risk. Don't be afraid to not know, don't be afraid to learn as you go. And one of the things that I'm a very big believer in is mentors, coaches, and somehow that gets associated with youth. I think that you can have mentors and coaches throughout your life. So I had by the way, three weeks ago from being a member of Congress to Mayor, I never worked in City Hall before. And but you know, you better believe that I was in contact with past mayors. Now. I work with a lot of different mayors, but, you know, it's about taking risk and being okay with sometimes if it doesn't work out. But I think the opportunities are out there and I agree with Raj 100%, it's all about relationships, get to know people, get to know people, if there's something that moves your heart find somebody that does that work. I think a lot of people, one of the things I pride myself in the most is working with young people turning someone else on to committing to fight for social and economic change. And I'm very, very committed and invested in the next generation because at some point I want to retire. And that fight continues on. It's not about the individual. It's about the issue.

Transcribed by https://otter.ai