Thursday, April 28, 2011

Dan Pallotta's inspiring vision of nonprofits achieving Apollo-like aspirations

At Harvard’s Center for Public Leadership my guest presenter on Wednesday was Dan Pallotta, author of UNCHARITABLE and founder of Pallotta Team Works that created the multi-day AIDS rides and the 3 day breast cancer walks. His talk was about “why can’t nonprofits achieve Apollo like aspirations?”

As part of his presentation about the various factors that hold back nonprofits, Dan cited as evidence, that since 1970 there have been 46,136 businesses that have crossed the $50 million annual revenue barrier, but only 144 nonprofits that have done so.
Dan argues that there were two distinct rulebooks: one for nonprofits and one for the rest of the economic world and he used vivid examples to make his provocative points about how the nonprofit sector is discriminated against in the following ways:

- Compensation: If you re CEO of a $50 million a year business that sells violent video games to kids, you are deemed worthy of making $1 million a year. If you work to feed hungry kids and are paid $500,000 a year you are considered a parasite. Talented people who want to have a nice lifestyle feel like they have to go into the for-profit world and make their difference by contributing money once they are wealthy, rather than by contributing their talent.

- Advertising and marketing: Charitable giving has remained stuck at 2% of GDP, not because human beings are wired to give only 2% but because nonprofits can’t build demand and take market share. Budweiser can buy Superbowl ads in a business culture that believes you can spend down to the last dollar that yields value, but AIDS and Darfur are left with no way to build retail demand for their needs. In the business world it would be malfeasance to build a great product or service but not then invest in a great advertising and marketing campaign, as Apple does for example, to create desire and demand for it

- Risk taking for new donors: Hollywood execs almost always have a mix of hits and flops, and the risk taking makes them better over time, but launch a big event in the nonprofit sector and losing a lot of money on it, and you’re finished.

- Time horizons: Nonprofits are judged on an annual basis, thanks to tradition and the IRS form 990. lost money for six years, before becoming wildly profitable, because it understood the need to invest in capacity for long-term return. A nonprofit that began with six years of projected losses would find little donor or foundation support. And so nonprofits keep making only incremental gains.

Dan founded Pallotta Team Works and created the AIDS rides and breast cancer walks after bicycling across country as a Harvard student to raise money for hunger relief. He really gets the power of asking people to share their strength. And in an era of activism in the form of on-line petitions and clicks, etc. he believes “people are tired of being asked to do the least that they can do, people want to be asked and challenged to do the most they can do.”

Monday, April 25, 2011

On World Malaria Day: A Fatal Case of Political Laryngitis

In the run-up to the fourth annual World Malaria Day there are have been a flurry of new reports documenting scientific breakthroughs, progress, and the on-going need. In the past few days for example The Institute for One World Health announced that it is ready to enter the production and distribution phase of developing a semi-synthetic form of artemisinin, the most effective anti-malarial drug.

The problem is that while the focus will be on scientific developments, the obstacles to eradicating malaria are as much political as they are scientific.

Malaria is both preventable and curable, and it is has essentially been eliminated from the developed world. But 300-500 million people continue to get infected with malaria around the globe each year and there are more than 800,000 deaths, mostly of children whose less mature immune systems make them the most vulnerable.

Of course they are not only vulnerable, they are so poor and marginalized that they are also voiceless – and therefore there are literally no economic or political incentives and therefore no markets for serving them. They might as easily be considered victims of a fatal case of political laryngitis.

This is true for more than just those who are victims of malaria. There are other so-called neglected diseases, often parasitic, like schistosomiasis lesihmaniasis and Chagas disease. And there is also hunger, malnutrition,

This would be an equally proper focus for World Malaria Day - with special attention to those who are working to create alternative market mechanisms to compensate for the lack of economic and political markets.

As I’ve tried to chronicle in The Imaginations of Unreasonable Men, some of the most unlikely but most promising entrepreneurship and innovations are coming out of labs like those of Steve Hoffman, Jay Keasling, and Stephan Kappe.

But some of the most promising innovations are also coming from outside of science: from economists, activists, and advocates. These include organizations like Nothing but Nets, Imagine No Malaria, the Bill and Melinda Gates Foundation which are also trying to build political will.

Friday, April 22, 2011

Five pieces worth reading before World Malaria Day on Monday

Top five pieces to read this World Malaria Day

Ray Chambers and Dr. Tachi Yamada have an column in the Financial Times: Our resolve must not waver as resurgence can be swift and devastating. The link is @

Sonia Shaw’s book The Fever: How Malaria Has Rules Mankind for 500,000 Years, @

The magazine of the Johns Hopkins University Bloomberg School of Public Health provides this panel of six experts and six answers @

Jay Winston and Wendy Woods have this piece in the FT on Resetting the Roll Back Malaria campaign has had powerful lessons and results @

My Tumblr page provides links to a variety of interviews and article about my new book: The Imaginations of Unreasonable Men @

What Americans may be telling us about our values

In today’s NY Times two journalists implicitly poses a question on the front page and another, on the op-ed page answers it. The Times lead story is headlined “New Poll Shows Darkening Mood Across America”. It is about the number of Americans who believe things are getting worse – a jump of 13% in just one month, but posed against the encouraging signs of renewed growth since last fall. The question implicit is: why such gloom amid signs of improvement.

In an op-ed about health care that is not intentionally related, but I think may be directly so, Paul Krugman writes about “How did it become normal, or for that matter acceptable, to refer to medical patients as “consumers”? In his concluding paragraph he writes: “The idea that all this can be reduced to money — that doctors are just “providers” selling services to health care “consumers” — is, well, sickening. And the prevalence of this kind of language is a sign that something has gone very wrong not just with this discussion, but with our society’s values.”

So maybe that’s what’s behind the depressing poll numbers. Voters are often smarter and ahead of the politicians trying to figure them out. Maybe they are responding to the pollsters as they are not based just on economic statistics but on a gut feeling about how our values have gone astray.

Wednesday, April 20, 2011

"We Know the Solutions, But How Do We Deliver Them"

I came across this TED Talk via a Gates Foundation tweet that read: “Saving newborn lives in India: We know the solutions, but how do we deliver them? @”

It’s a theme very similar to the first thing I learned about malaria, a curable and preventable disease, from vaccine developer Steve Hoffman in researching The Imaginations of Unreasonable Men. We know the solutions. We don’t know how to make them affordable and how to distribute them to all who need them. The challenges are as much political as they are scientific, for the problems affect those who are so voiceless that there are no markets for solving them.

In this talk Vishwajeet Kumar explains the interventions that reduced neonatal mortality and laif the foundation for other spheres of community development.

Monday, April 18, 2011

When "everything is on the table" in budget battles, does that include the truth? Or our principles?

Massachusetts has long had a reputation for being one of the most liberal states in the nation. So over the weekend, when I posted the Boston Globe’s front page story about Democratic Governor Duval Patrick’s proposal to cut 20% of state funding from the Women, Infants and Children’s program of supplemental nutritional assistance, the response on my Facebook page was swift and biting: “disgusting, disgraceful”, “sickening”, “is there any humanity left among politicians?”   (The Globe story is @

State officials made the usual excuses about having no choice but to make the cuts because of the state’s budget cuts – an argument consistent with the prevailing national view that when it comes to eliminating deficits everything should be on the table. But fortunately facts are stubborn things and they are finally beginning to emerge. Because it turns out that not everything is on the table in budget debates that have been mostly one-dimensional. As the New York Times explains in its lead editorial this morning about last week’s House passage of Budget Committee Chairman Ryan’s budget cutting proposal: “Fully two thirds of his $4.3 trillion in budget cuts would come from low-income programs.”

Here are some additional facts courtesy of the Center on Budget and Policy Priorities:

 The House-passed budget would cut SNAP funding by $127 billion or 20%. This could cut as many as 8 million people from the program. It is an amount equal to the funding projected to go to the 30 smallest states over a ten year period.

 Three-quarters of SNAP participants are in families with children; one-third are in households that include senior citizens or people with disabilities.

 Eighty-six percent of SNAP households have incomes below the poverty line (about $22,350 for a family of four in 2011). Such households receive 93 percent of SNAP benefits. Two of every five SNAP households have incomes below half the poverty line.

 SNAP lifted 4.6 million Americans above the poverty line in 2009, including 2.1 million children and 200,000 seniors. No benefit program kept more children from falling below half the poverty line in 2009 than SNAP — 1.1 million

The House budget cuts spending by an amount almost identical to the amount needed to pay for its proposed tax cuts (as opposed to deficit reduction). So when politicians say that everything must “be on the table” when it comes to balancing the budget, one might ask: Even the truth? Even our principles?

Tuesday, April 12, 2011

Countdown to World Malaria Day, April 25: failure to imagine or failure to care?

One of the insights at Share Our Strength that has fueled our growth is that most failures are failures of imagination, more so than the excuses we tend to latch onto regarding failures of financial support or planning or execution. Indeed this is a central point of my new book The Imaginations of Unreasonable Men which is about those who have made the leap to embrace the possibility of not just treating malaria but eradicating it.

In the Washington Post last week, Michael Gerson who worked in the White House for President George W. Bush writes compelling about a different kind of failure of imagination – the failure to imagine the very real life or death consequences from budget decisions, like those reflected in the proposed cuts in global health programs that could lead to 70,000 African children dying from malaria and other preventable maladies.

As Gerson explains: Fiscal conservatives tend to justify these reductions as shared sacrifice. But not all sacrifices are shared equally. Some get a pay freeze. Some get a benefit adjustment. Others get a fever and a small coffin. This is not fiscal prudence. It is the prioritization of the most problematic spending cuts — a disproportionate emphasis on the least justifiable reductions. One can be a budget cutter and still take exception to cuts at the expense of the most vulnerable people on earth. In Britain, Prime Minister David Cameron is pursuing even greater austerity while increasing funding for development. The full column can be found at

Moral imagination is supposed to be what differentiates us from other species. But our boast is bigger than our bite. We remain only partially evolved, a work in progress to be both admired and resisted. As proposed cuts in the most effective global health programs show, we are at times as Bruce Springsteen sings “halfway to heaven and just a mile outta hell.”

Monday, April 11, 2011

Countdown to World Malaria Day: at the intersection of imagination and malaria

There’s been another fascinating development at the intersection of imagination and malaria – and it goes right to the heart of trying to solve problems that affect those so poor that there are no markets for solving them. A group of students from UC Davis, Harvard, UCLA and several other schools have developed an application that enables a smart phone to diagnose malaria by taking a picture of a blood sample and then process the data to detect malaria parasites.

The students are participating in the annual Imagine Cup contest sponsored by Microsoft, which this year has as its theme: “imagine a world where technology helps solve the toughest problems.” Their application is called LifeLens and uses a microscope attachment on a Samsung Smart Phone. You can read about it at

This overcomes the obstacle of needing to have an expensive laboratory in remote areas that are malaria endemic. It would enable a doctor or nurse working, for example, in an African village lacking Internet access to make a diagnosis without having to upload data for processing elsewhere. The same diagnostic technology may work for Sickle Cell and other diseases.

What the students have really done is use imagination and technology to find a way to address a market failure. Those affected the most by malaria are so poor and economically marginalized that there simply is no market to serve them. There are no financial incentives or rewards for creating the diagnostic labs or tools necessary. So instead the students have found a way around that market failure with an application that could reduce the complexity and cost of diagnosis.

I begin The Imaginations of Unreasonable Men ( recounting the death of my thirteen year old Ethiopian friend Alima Dari, who was misdiagnosed with tuberculosis but actually had cerebral malaria. By the time they got her to a hospital hours away it was too late. Her death might have been prevented by LifeLens. And the deaths of nearly 800,000 children from malaria each year will only be prevented when global health entrepreneurs better understand and adapt to both the constraints and the potential that market forces offer.

Sunday, April 10, 2011

My pathetic effort to fast in protest of budget cuts

Like many of our colleagues in the anti-hunger community I committed to participate last week in the “rolling fast” being organized to protest budget cuts that would affect those most dependent on public food and nutrition programs. Two of my all time heroes are Gandhi and Cesar Chavez, both of whom used fasting to powerfully advance social change. So you can imagine how disappointed I was to discover how bad I am at fasting.

First of all I had trouble finding a time to do it. I was supposed to fast on Wednesday but my older son Zach and his girlfriend Daniela, decided to get married that morning in a civil ceremony at the Rockville Court House. A celebratory lunch followed and it would obviously have been bad form not to partake in such an important and joyful event.

Since I hadn’t realized I would need Thursday as a back-up I’d already packed it with a breakfast meeting at the Mayflower Hotel, a lunch with a Community Wealth Ventures alum, and dinner with my father-in-law. Since he’s 82 we eat early to take advantage of blue plate specials and so by 6:30 on Thursday evening, I was ready to commence my fast. By 9:00 p.m. I was already irritable because I always have a few cookies with tea as I try to do some evening writing and I have convinced myself that the better the cookies the better I write.

The next morning was chaotic because I was up by 5:00 a.m. responding to emails, then taking Nate to school, then busy and distracted with meetings in Boston until noon. By lunchtime, even having so far only missed one meal and the previous evening’s snack, I was feeling sufficiently unfocused and unproductive to be questioning the wisdom of my participation in the fast. After lunch I hurried to a 1:00 meeting at which I kept looking at my watch and contributed nothing. It’s always amazed me that evolution has not changed the fact that our species needs to munch on something as frequently as every few hours.

Needless to say I made it through the 24 hours, but not with confidence that I could have gone much farther. As a result, I took away a few observations I thought might be worth sharing:

First, from the trouble I had finding the time to fast, I realized that aside from the obvious fact that most of our lives are so privileged that we never have to worry about where our next meal is coming from, our lives are actually so privileged that it can be hard to find a time when food is not literally being pushed at us! I’m not even sure what to call that level of disparity.

Second, as closely as I follow the budget deliberations on Capitol Hill, I followed even more closely during this period while fasting, which kept reminding me of the plight of those who will feel the cuts the most. The weekend’s press coverage of the averted government shutdown was astonishing in its focus on who was hurt politically (Boehner? Obama?) but with virtually no mention of who would be hurt in terms of the impact of devastating budget cuts on their bodies and lives: women, children, the elderly.

Third, the political climate is as dangerous as it could be to those who are hungry or poor, and with both parties and the President agreeing to a record $38 billion in cuts it is difficult to find many influential policymakers with the requisite fight in them to protect those most voiceless and vulnerable. As fasting symbolizes, we will truly have to put ourselves on the line in the months ahead, take risks, be willing to sacrifice, and use every strategy at our disposal, if we are to restore some sense of sanity and humanity to the effort to ensure that we achieve the goal of No Kid Hungry.

Monday, April 4, 2011

Countdown to World Malaria Day: Who is using market forces to scale their work?

With World Malaria Day only a few weeks away, it merits asking who in the malaria community is committed to utilizing market forces to scale and sustain their work?

At the beginning of 2011 The Scientist magazine wrote about entrepreneurs who are “breaching the barrier between profit and nonprofit” and using as a prime example the story of Victoria Hale who I wrote about in The Imaginations of Unreasonable Men. Hale imagined and created The Institute for One World Health, and more recently Medicines360, because “Big Pharma makes drugs for Westerners. She, on the other hand, wanted to make drugs for all of humanity—drugs that don’t necessarily pull a profit.” See

The article explores new ventures ranging from the Acumen Fund’s investments in Tanzania to the Pacific Northwest Diabetes Research Institute in Seattle. But the common theme is nonprofits leveraging their assets, and using market forces to get their proven ideas to scale.

It’s a concept very much at the heart of our work at Community Wealth Ventures. And I’ve also had the opportunity to witness firsthand how it is aligned with the strategy of the for-profit biotech company Sanaria which is developing a vaccine to eradicate malaria. Let’s hope other entrepreneurs embrace it as well.

Sunday, April 3, 2011

Share Our Strength's unprecedented growth: secrets of success, lesson #10

I recently used a Community Wealth Ventures convening of leading nonprofits in Cincinnati, and then a lecture at the Kennedy School in Boston, as an opportunity to discuss Share Our Strength’s unprecedented growth over the past two years. Specifically I sought to tease out and understand the key ingredients of that growth, almost as if presenting a case study. This is a unique moment in our 25 year history. And our recent experience is all but unique across the broader nonprofit sector. That makes it a valuable learning opportunity that could help others, whether within or outside the hunger field.

At Share Our Strength our revenues hovered around $13 million annually in the years between 2004-2008. We were a classic case of the nonprofit whose growth had reached a plateau. We were stuck. Then we sharpened our strategy and made investments in capacity – including a few we could not afford. Our revenues grew to about $19 million in 2009, $26 million in 2010 and they will be $34 million this year. We added 30 staff to a base of 65 in 2010 and we are hiring for 20 more now. Though improbable it was not accidental or coincidental. The specific reasons follow below.

Lesson #10 Pay attention to what matters most, not to what others think matters most.

Because nonprofits are typically insecure about the impact they are having – because impact is hard to have and even harder to measure and communicate – they often are seduced into paying attention to what others think is important: press coverage, brand awareness, efficiency ratings of GuideStar and Charity Navigator, etc. And some of these may in fact be important. But ascertain that for yourself rather than assuming it. These may all be nice to have but not necessary to achieving mission. In fact Share Our Strength made many investments that impacted our “overhead to grant making” ratio in ways that hurt us with the ratings organizations, but had almost no negative impact on our donors or reputation, and actually helped our growth.

Donors, partners, foundations, and media all have strong biases about the way nonprofits should work. But they will not have your expertise in solving the specific set of social problems your organization was created to solve. So work to respectfully educate them but don’t let their own interests cause you to detour from your strategy.
Tomorrow: Lesson 12: Create Community Wealth

Countdown to World Malaria Day: "Mission Accomplished"? (Why I cringe at the words)

          On April 1 the New York Times reported that “A few nonprofit groups have recently announced plans to wind down, not over financial problems but because their missions are nearly finished. Most notable, perhaps, is Malaria No More, a popular nonprofit that supplies bed nets in malaria zones. Its goal is to end deaths from malaria, a target it sees fast approaching.”

The article was published under the headline “Mission Accomplished” which for me immediately evoked unfortunate associations with President George W. Bush’s now infamously premature press conference on an aircraft carrier announcing the end of major combat operations in Iraq.  I wonder how whether the intent of the headline writers was that mischievous.
Indeed on the same day Scientific American ran this bold headline: “Malaria on the Rise as East African Climate Heats Up: In East Africa, warming as a result of climate change is paving the way for the spread of malaria.”

Malaria No More is a first-rate organization that has helped to both showcase and inspire incredible progress in reducing malaria deaths in Africa.   But both science and history offer compelling evidence that we need to steel ourselves for a longer fight to succeed in eradicating malaria’s deadly toll.

The organization’s vice chairman Scott Case is quoted as saying: “We never planned to be around forever. We have thought of this more as a project than as an institution-building exercise, and the project is nearing its completion.”  But one might argue that against a foe as formidable as the malaria parasite, long-term institution building is exactly what is needed most.
            One of the lessons I took away from researching THE IMAGINATIONS OF UNREASONABLE MEN , ,  was to aim high, but to bring as cold-eyed and realistic assessment as possible to the talk of battling malaria.   As we approach World Malaria Day a debate about how to strike the right balance could be of great value.

Looking Beyond the Conventional Wisdom on Unemployment

Bob Greenstein, the president of the Center on Budget and Policy Priorities, is a long time member of the Share Our Strength board and can always be counted on to dig deep beyond the conventional wisdom to explain economic developments impacting the most vulnerable and voiceless. And so I turned to the Center’s website after the release of the March statistics on the drop in unemployment. Sure enough, their analysis, by chief economist Chad Stone, provides a more sober view, including these points taken verbatim from his statement:

 We have to create over 7.2 million jobs just to get payroll employment back to its level at the start of the recession in December 2007. At March’s rate of 216,000 jobs a month, that would take almost three years.

 Unfortunately, the economy seems to be losing momentum, not gaining it. We need economic growth of 3½ to 4 percent a year to close the jobs deficit in any reasonable amount of time. The economy grew at a 3.1 percent annual rate in the fourth quarter and likely grew less than that in the first quarter of this year.

 The recession and lack of job opportunities drove many people out of the labor force, and we have yet to see the return to labor force participation (working or actively looking for work) that marks a strong jobs recovery. The labor force participation rate (the share of the population aged 16 and over working or looking for work) remained depressed at 64.2 percent, the lowest it has been since 1984. Recent declines in the unemployment rate would be more encouraging if they were accompanied by a rising labor force participation rate.

 The share of the population with a job, which plummeted in the recession to levels last seen in the mid-1980s, was 58.5 percent in March. Prior to the current slump, the last time it was lower was October 1983.

 It remains very difficult to find a job. The Labor Department’s most comprehensive alternative unemployment rate measure — which includes people who want to work but are discouraged from looking and people working part time because they can’t find full-time jobs — was 15.7 percent in March, not much below its all-time high of 17.4 percent in October 2009 in data that go back to 1994. By that measure, more than 24 million people are unemployed or underemployed.

Hopeful news can play an important role in economic recovery and the most recent unemployment stats provide some. But the clear-eyed view provided by the Center shows how far we still have to go.

Saturday, April 2, 2011

Are "neglected infections of poverty" taking their toll on Washington DC?

The approach of our annual Taste of the Nation event in Washington DC on Monday, April 4 seems like a particularly relevant time to look in on Peter Hotez, who in a just published editorial writes powerfully about the healthy disparities between rich and poor in our society, and especially right here in our hometown of Washington: “Washington, D.C., rivals Louisiana, Mississippi, and Alabama as among the worst in terms of life expectancy and health index [2]; with respect to poverty indices, a recent report entitled “DC’s Two Economies” revealed that in terms of employment status, income, and poverty levels, Washington, D.C., currently exhibits some of the greatest disparities between whites and blacks of any city in the US”

As Share Our Strength’s national footprint continues to rapidly expand with the support of governors, corporate partners and celebrities, it never hurts to have a reminder of just how much our efforts are needed right here, on behalf of our own neighbors, just a few minutes away and in some cases living in hardship as great as anything our nation knows.

Hotez is a George Washington University professor and researcher who has devoted much of his career to developing a vaccine for hookworm and was featured prominently in THE IMAGINATIONS OF UNREASONABLE MEN. (

The editorial was published in the Public Library of Science Journal NEGLECTED TROPICAL DISEASES, and focused on what Hotez calls “neglected infections of poverty”. He explains that “In previous papers I have noted high rates of parasitic and related neglected infections among the poorest Americans living in distressed areas, but especially in inner cities, the American South, the border with Mexico, and Appalachia [3]–[5]. Indeed, the rates of some of these neglected infections of poverty among African Americans are comparable to the rates found in Nigeria”

About Washington DC specifically, he writes: “Although the District of Columbia does not have statehood, as a unique federal district it is often treated as an autonomous region and compared in rankings with the 50 US states. Today, Washington, D.C., rivals Louisiana, Mississippi, and Alabama as among the worst in terms of life expectancy and health index [2]; with respect to poverty indices, a recent report entitled “DC’s Two Economies” revealed that in terms of employment status, income, and poverty levels, Washington, D.C., currently exhibits some of the greatest disparities between whites and blacks of any city in the US [29]. An astonishing 6.5% of African American males in the District of Columbia are also HIV positive [30] (Table 1). Data for neglected infections of poverty in Washington, D.C., are practically non-existent, although some information from neighboring Baltimore indicates that trichomoniasis is extremely common [31]. Thus, we urgently need a program for active surveillance for the most common neglected infections of poverty in the District of Columbia.”

The entire editorial can be found at