On the 19th of June 2019, I landed in the middle of the United States, in a place called Aspen. I never heard of this city before but I knew that Colorado State was well known by its wild landscapes and its beautiful mountains. The taxi driver who picked me up from the Airport did not know much about Aspen or the region as himself was there from California only to work a few months in the hotel where I would be staying. Soon after arriving, I started reading and learning about Aspen and its famous Aspen Ideas Festival, founded by Walter Isaacson in 2005, and hosted at the Aspen Institute. I was about to embark on an exciting five day exchange of ideas on global challenges such as health, climate change and sustainability with people from the more diverse backgrounds – local practitioners, governmental and non-governmental officers, journalists, academics, innovators, musicians and billionaires.
On the first day, I heard Imran Khan, head of public engagement of the Wellcome Trust, presenting the results of the Wellcome Global Monitor 2018 report. The study surveyed over 140,000 people from more than 140 countries in order to find out how people around the world think and feel about science and major health challenges. The study showed that globally, 72% of people trust scientists, which seems good news for scientists. Curiously, the study also showed that men are 11% more likely to claim they know something about science than women. This obviously caused a good laugh from the people in the room. On the very hot topic of vaccination, the study found out that, globally, 79% of the people believed that vaccines are safe, but at least 95% vaccination coverage is needed for the global population to be protected, and therefore a dangerous gap seems to exist between implementation and health safety. People from countries that do not observe the positive impact of vaccines on their day-to-day life anymore seem to be more sceptical about their benefits, as for example, the French people. One speaker highlighted that it is crucial to involve communities, including indigenous people without being paternalistic. He insisted that scientists lost the capacity to work with communities and that this is contributing for the lack of trust in scientists.
What was more exciting about the Aspen Ideas Festival is the diversity of people that we meet during the festival. On the second day, I caught, by chance, a lift from the small electric car that delivered participants to their sessions in the Aspen Institute campus and started a conversation with the only passenger in the car. This was a woman of Latino origin and we talked about Portugal and vegan food. I was later to find out that she was the awarded journalist Maria Hinojosa, the anchor and executive producer of Latino USA, who was going to facilitate the seminar “The Influence of Housing on Health”. This seminar underlined the discrimination that existed in terms of access to housing and how this affects people’s health. Social housing have been so badly built that it is almost a punishment on poor people, black people have been excluded from accessing mortgages, and disadvantaged people have been spending more money in housing than on their children’s education and healthy food. This is obviously having harmful effects on stress, mental health, life expectancy, and as these problems cross generations, they lead to transgenerational stress inheritance. Even though this is slowly changing for the better, experts thought we are living in a period of dehumanisation where the more advantaged consider that deprived communities choose to be deprived communities. Several quests were thrown at the audience: For when entering in a neighbourhood without being able to guess the social background of the community living there? And When will the residents of these disadvantaged communities take the lead and come up with the ideas and the solutions to rejuvenate their deprived neighbourhoods?
Other seminars reflected on the usefulness of big data, artificial intelligence, machine learning and deep learning as well as their limits. While there are now lots of data collected and stored, there are still many patients not treated accordingly to their illness. Problems occur during data collection that restricts its benefits and for these to be fully accomplished much better quality data has to be collected and databases harmonised. However, some advantages in the health sector are showing up now. For example, lung cancer is one of the most deadly cancers in the USA but in some parts of the country, there is only one radiologist per 10,000 people. Artificial intelligence could replace radiologists and diagnose the problem much earlier on, as well as its treatment, with higher chance of cure. The main concepts associated to the theme, were defined in a follow-up seminar. Big data is a very large and complex dataset, which challenges are transportation and analysis. Artificial intelligence help people to perform tasks using human speech and has the ability to understand the content of an image and recognise patterns. Machine learning trains machines to use methods and deep learning is a type of machine learning where there are transformations from simple to complex features. Experts agreed that everyone would benefit from a larger, global datasets but recognised we still have a long way to go before machines can do the work for us. Unfortunately, there was hardly any time left to discuss ethics, identity, privacy, fairness and safety, all big issues related to big data.
The Wellcome Trust hosted an interesting round table around “The Planetary Health Diet” believed to save lives and the planet, according to the Lancet Commission report. This diet consists of vegetables and fruits, wholegrains, dairy products (milk, cheese), protein sourced from plants (e.g. lentils, peas, nuts, and soy foods), small quantities of fish, chicken and red meat, eggs and small quantities of fats. Even though this diet would contribute less to greenhouse gas emissions, not everyone connects this with climate change. Shifting to this diet would also reduce water footprint, and nitrogen and phosphorous usage and runoff. Once again, poorer, disadvantaged people might have difficulty to access the planetary health diet as they usually go for street or processed food that are more fast filling. Vegetables are expensive and insects, which are another potential source of protein, are already luxury meal in some countries (e.g. Thailand). On the other hand, impossible burgers, without meat, seem to be now fashionable among young kids in the USA, and this could mean the next generation would adhere more easily to the “Planetary Health Diet”.
In the Aspen festival there was really a bit of everything and in between seminars, there was time for a musical seminar. In this, music and mental health were in put in harmony through a beautiful piano performance of a Schumann piece by the host of the seminar.
After this relaxing moment, I chose to attend a discussion on people’s right to health. I found out that even though the ordinary American citizen does not have the right to healthcare, the native Indians do. This was agreed and written in treaties between the government and the Indians but health programs for Indians have never been properly funded. One indicator of this lack of implementation is low life expectancy, which is only around 50 in the poorest Indian communities. Fortunately, the Indians take care of the members of their extended family and not only their direct relatives. In the Uganda, the government signed all the international agreements on health but it did not establish a national policy that guarantee people’s right to healthcare. People die if they have no money to pay for the necessary treatments and materials such as gloves, even in emergency cases. The burden on vulnerable people aggravated when the blood transfusion system lost its USAID funding with the arrival of the Trump administration and the Ugandan government did not replace the funding. Parallel healthcare systems have appeared in the country like mushrooms due to the tax breaks given on people bringing medicines and healthcare materials from the outside world. This can help but in some cases, it spurs fraud and fake health providers. People’s dignity need should be respected and people should feel that healthcare is a right they have, not a privilege. Pathways to universal health coverage were discussed in another session and these include: 1) Building capacity; 2) Transparency; 3) Monitoring results; 4) Fighting corruption. Experts express several quests, from governments to recognise that health is more important than grey infrastructure, to the fact that more young people and women should be involved in program design and should make sure that mechanisms to fund community-based organisations to implement health projects in the USA are claimed.
The #MeToo movement was also represented at the Aspen Festival of Ideas. Four inspirational women described their links with the movement and their activism directed to eradicate sexual harassment in their working sectors. Even though the movement started with Hollywood stars, sexual harassment cuts across several sectors of the society. The National Academies of Sciences, Engineering, and Medicine (NASEM) recently released a comprehensive report on Sexual Harassment of Women in Academic Sciences, Engineering, and Medicine revealing that 50% of medical students experience sexual harassment, and that medical organisations are men dominated. It highlights that “academic institutions as they exist today are either unwilling to or fundamentally incapable of addressing sexual harassment.” The message left by the women presenters was not to fight against men but to request their support, especially asking white, privileged men to use their privilege to change the system.
Learning about the Wonderful Company was my next experience. This company grows, harvests, bottles, packages, and markets a diverse range of healthy products, including fruits, nuts, flowers, water, wines and juices. The co-founder and co-owner Lynda Resnick presented a video about the work undertaken by the company to support health and education of their workers their children, mostly migrants from Latin America. She claimed they have spent $50 million in far-reaching community development, education, and health and wellness programs across California’s Central Valley and beyond, all with the goal of enriching and enhancing the lives of her employees, their families and their communities. Even though the implementation of the program is at its infant state (only 6.5 years), one main economic benefit already observed is the steep drop of staff turnover. The company has also observed a spill over effect of their programs to neighbouring companies.
Due to my work on climate change adaptation and sustainability in Guatemala I found very interesting to listen the medical director of the non-governmental organisation WINGS (Women’s International Network for Guatemala Solutions), Dr Michelle Dubon, talking about her work with young mothers in Guatemala. The priority of WINGS is to serve the low-income, rural and indigenous population in Guatemala, but they also offer reproductive health information and services to the public. They believe in reproductive rights and health education and have a tough job in a country where one out of three indigenous women have no access to health or family planning services, and where 80% of the indigenous population lives in poverty. The most emotional moment was when this doctor described that young women usually come to her practice asking for contraceptives because they know they will be raped during the harsh journey as migrants to the border with the USA. Dr Michelle, who is also a 2019 Aspen Institute New Voices Fellow, believes that training indigenous nurses is essential to reach women in indigenous communities in Guatemala.
My prize seminar was that of Professor Mariana Mazzucato on her recent book “The value of everything”. After listening her on the BBC programme Desert Island Discs, reading about her and browse some of her books at the Blackwell’s bookshop in Aberdeen, I was lucky enough to attend her seminar in Aspen, buy her book and even have a chat with her. Professor Mariana is one of the most important thinkers about innovation of our times. She defends that we should not allow governments to come and fix the market when these fail but to avoid these to fail in the first place. She argues that market failure policies do not achieve radical innovation and very unlikely will succeed in the accomplishment of the Sustainable Development Goals. She criticises the governments for investing money in the private sector, for example in the health sector, and not claiming for a share of the profits when these occur, only bailing it out when there are losses. She challenged the audience to rethink capitalism, rethink the role of public policy and the importance of the public sector, and to redefine how we measure value in our society.
The closing session was on a topic close to my heart: climate change and climate action. Maria Hinojosa, the Latino-USA journalist talked to a group of young climate activists to understand what they are doing to change the rhetoric around climate change in the USA, including the legal action they are undertaken to sue the government for not doing enough and damaging their future and the that of future generations. I thought that there was not much happening in terms of climate action in the USA but I was wrong. A lawsuit filed in 2015, called Juliana et al. versus United States of America et al., puts claimants, represented by the non-profit organisation Our Children’s Trust, and on behalf of future generations, against the United States and several of its executive branch positions and officers, including President Donald Trump and former President Barack Obama. The claimants, some of them present in the session, also want to call the attention for the migration problem, as they believe people are leaving Latin America to the USA because of the impact of overexploitation of resources by developed nations and of climate change on their livelihoods.
In general, I came back from Aspen mentally and intellectually rejuvenated!