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The Multinational Academic Health …
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Created: Thu Aug 16 14:45:54 2007
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The Multinational
Academic Health
T
he nation's academic health centers are
Center essentially idealistic institutions that seek to
"do good." Their primary goal is not to seek
By Steven A. Wartman, MD, PhD a profit where it can be had (although profits often
follow what they do), but rather to improve health
and well-being. This goal now needs to extend
beyond the nation's borders, where academic
health centers have a unique opportunity to work
in partnership with other academic health centers
worldwide. In doing so, these institutions can
come together as agents of change by serving the
global community and be among the critical forces
Modified from the Presidential Address shaping the 21st century.
2007 Spring Dialogues
Association of Academic Health Centers
CYCLES OF CHANGE
Much has been written about human history's
cyclical changes: the rise and fall of empires, the
waxing and waning of industries, and the ebb and
flow of ideologies. These occur with historical
regularity, and the time clock of cyclical change has
been accelerating.
The hegemony of European countries and
institutions from medieval times through the 19th
century is well known. The 20th century has been
called "the American Century," given the
spectacular growth and development of the United
States as an economic, industrial, and political
power. The 21st century's chapter is now being
written. What economic, intellectual and political
shifts will occur? And what role will academic
health centers play in defining this chapter?
Nations face a host of formidable issues: wars,
depletion of natural resources, climate change,
population growth, demographic shifts, poverty,
disease, terrorism, and more. Central to these
issues are healthcare, research and education ญญ
fields in which academic health centers excel and
are leaders. By working together in new alliances
and partnerships, academic health centers can, and
indeed must, play a positive and active role on the
world stage, and in no small measure serve as a
beacon of light for the public good.
Association of Academic Health Centers
Leading institutions that serve society
ASSOCIATION OF ACADEMIC HEALTH CENTERS
THE WORLD MARKET commercializing new technologies -- wherever
those technologies have been developed.
The rapid pace of globalization is increasingly Business analysts are quick to point out that
guided by worldwide economic forces and led by the U.S. economy used to support the world
technology. Arguably, one of the most powerful economy. But now the world is turning upside
forces unleashed in modern history is the free down. The old industrialized triad of the U.S.,
market economy, which is governed by one over- Japan and Western Europe no longer dominates to
riding interest: profit. A blind search for profit can the degree it once did. China is close to taking
take precedence over attention to "unprofitable" over the No. 3 slot from Germany on the list of the
concerns, such as poverty and social justice. world's largest economies.2,3 India and South Korea
The growing world market is a huge horizontal are set to join the top 10 within a decade.4,5
force slashing across the vertical forces of political According to the World Bank, developing nations
boundaries. In a sense, this "clash of the horizontal collectively grew about 7% last year -- more than
and the vertical" is familiar: a version of it is seen twice as fast as high-income countries. They now
every day in academic health centers, where efforts account for 49% of world economic output, up
to develop integrated programs in research, from 39% in 1990.6
teaching, clinical care, and administration intersect India presents a telling story. Despite
across the silos of schools, departments and special enormous economic and social challenges, this
interests. Reconciling what are often competing nation of 1 billion people has been transforming
interests is a significant everyday challenge of the world through ability, ideas, and ambition.
academic health center leadership. Similar tensions India is a new force in high-tech competition and
are playing out today on the world stage, where the health care built on young talent. Many U.S.,
horizontally driven global market is filtered Japanese, and other companies, including IBM,
through the lens of countries, politics and Dell, Siemens, Fujitsu, and Motorola, are actively
ideologies. This clash raises challenging questions: outsourcing to India. India's GDP has expanded by
What is meant by a nation-state? What constitutes $350 billion in the past six years.7,8
national interests in an increasingly globalized Singapore initiated a plan in 2000 to turn the
world? country into a global biomedical hub. Since then,
scores of the world's top companies and scientists
THE GLOBALIZED WORLD have been lured by promises of hassle-free funding,
and the freedom to follow their research interests,
The United States, once the source of unfettered by the conflicted ethical debates that, for
approximately 70 percent of the world's R&D, now example, surround stem cell research. The
generates only about one-third.1 In the past, U.S. biomedical industry has become a pillar of
firms often retained a competitive edge by virtue of Singapore's national economy. The government's
their technological superiority and the commercial centerpiece investment is Biopolis, a $300 million
depth of the U.S. economy. Now, U.S. firms must "science city."9,10
compete in a global arena with rivals from Elsewhere in Southeast Asia, countries such as
technologically sophisticated countries, rivals Malaysia are realizing the potential of engaging in
that often are equal, if not more practiced, in the biomedical industry, making significant
the art of acquiring, assimilating, and rapidly investments in this area.11 And the vast potential
that is being unleashed in China has implications
"Now, U.S. firms must compete in a for every aspect of the American economy and
global arena with rivals from standard of living. Among their many forward-
technologically sophisticated countries, looking programs under development, China is
rivals that often are equal, if not building 100 research universities, with the goal of
achieving the caliber of many of the best in the
THE more practiced, in the art of
U.S.12
MULTINATIONAL acquiring, assimilating, and rapidly
ACADEMIC commercializing new technologies."
HEALTH CENTER
2
ASSOCIATION OF ACADEMIC HEALTH CENTERS
THE VISION "Today, the needed intellectual capital
Most of the nation's academic health centers -- the knowledge workers -- do not
already are involved internationally. The depth
always come to America."
and level of their international activities vary, but
they are growing substantially and range from the
establishment of new schools or branches, to the professionals? Billions of dollars in government
development of clinical or public health programs, investment, brand new research equipment and
to the advancement of major research initiatives in facilities, and a certain sense of freedom and
a wide variety of scientific endeavors. adventure, along with the opportunity to conduct
A confluence of economic and technological research unfettered by social politics. In short,
advances, coupled with pressing worldwide health there is now an unprecedented flow of knowledge
needs, presents a convincing case for a new workers across international boundaries. The
paradigm of the academic health center. The vision worldwide ramifications of this must be addressed
for this paradigm is a new type of entity: the by forging new international alliances and
multinational academic health center, which has partnerships.14
the potential to be the signature multinational A large proportion of knowledge workers is or
corporation for the 21st century. will be in academic health centers. Other countries
are increasingly recognizing the scope and
significance of academic health centers, perhaps
THE KNOWLEDGE ECONOMY AND better than many American policymakers. Leaders
KNOWLEDGE WORKERS abroad realize these institutions contribute
enormously to the creation of knowledge workers,
Given these developments, it is essential to the generation of new ideas and technologies, and
remember that the root of innovation and success ญญ more importantly ญญ contribute to improving
is still people -- human capital. Knowledge has the health of the population. Perhaps one of the
always formed the basis for economic and social most vital ingredients for sustained economic
development. Now, with advances in information growth will be the knowledge and discovery that
technology and communication, the ground rules emerges from academic health centers to power the
for knowledge development have changed. There technology and innovation of the future.
is now a global knowledge economy where So it is no surprise that many countries are
productive, well paid work is based on ideas, establishing their own academic health centers and,
information, creative thinking, and analysis. in some cases, having U.S. academic health centers
Intellectual capital is what often differentiates locate branches there. There is also the growing
companies, and may well be the trump card in the impact of rapidly expanding affordable and high
global economy. quality health care, which some countries are now
Today, the needed intellectual capital -- the offering to patients from around the world.
knowledge workers -- do not always come to However, the preeminent academic health
America; in fact, some of U.S. knowledge workers center enterprise is in the U.S., which is especially
are leaving.13 For decades, American companies strong in the area of creative and out-of-the-box
shifted blue-collar manufacturing jobs to parts of thinking. This critical asset is in high demand
the world with low labor costs and acceptable around the world.
quality standards. Now, they are outsourcing
knowledge work -- engineering, software, and
product design and development -- to such THE POTENTIAL OF THE
countries as China, India, and Russia. These MULTINATIONAL ACADEMIC
workers represent the kind of highly educated, HEALTH CENTER
technologically skilled employees who can write
computer code, design sophisticated products, and At this critical juncture of need and opportunity, THE
manage high-end production processes. academic health centers must position themselves MULTINATIONAL
What attracts scientists and other talented as agents of change that embody and personify the ACADEMIC
HEALTH CENTER
3
ASSOCIATION OF ACADEMIC HEALTH CENTERS
ideals of equality and justice, as they work for both already started this process, either consciously or
economic and societal progress. reflexively. Their programs, students, professors,
They have much to contribute to growth and patients, businesses, researchers, partners, and
development worldwide, as academic health stakeholders must engage a far wider circle than
centers are increasingly recognized as major drivers most are used to. Taking the best ideas ญญ from
of the economy and international prestige. How wherever they may come ญญ and acting on them is
they choose to engage and participate in policy essential. The view needs to be changed from
debates will impact the actions of political leaders "protecting turf" to "adding turf." This means,
around the world. In this regard, it is essential that among other transitions, that international
policymakers fully understand their collective partnerships and alliances may come to dominate
strengths by first, not taking them for granted, and many of academic health center programs.
second, investing significantly in their enterprises. This is the moment when academic health
Academic health centers must take the lead in centers collectively can point the way toward
sending the message how their work serves to positive change around the world, including
enhance the global community's health and well- increasing access to knowledge, modern
being. technology, and health care. They can and must
To successfully do so, academic health centers join together to form international alliances and
need to be viewed, both nationally and partnerships, to develop programs that enhance
internationally, in the collective sense. They must health and well-being, and to advance the concept
promote their shared leadership, even as they seek of a global community. They must think
to enhance their individual institutions. The collectively and act internationally, as they work
nascent forays into international alliances by many together to develop a shared idea of how to foster a
academic health centers are commendable, and can world environment driven by the ideal of
be viewed as first steps towards new overarching improving the public good. By working closely
models and networks that join together multiple together with policymakers, they can seek to ensure
academic health centers in the United States with that the benefits of progress and economic growth
their neighbors overseas. As the traditional are spread throughout and among the populations
assumptions about the organization and around the globe. What better institutions to drive
management of academic health centers are re- this vision than redefined and fully engaged
thought, they must consider as a priority the work multinational academic health centers?
that they can do in the new global context.
This in large part will require a process of Steven A. Wartman is president and CEO of the
reorienting and restructuring academic health Association of Academic Health Centers.
centers into multinational institutions. Some have
"Academic health centers need
to be viewed, both nationally
and internationally, in the
collective sense. They must
promote their shared leadership,
even as they seek to enhance
their individual institutions. "
THE
MULTINATIONAL
ACADEMIC
HEALTH CENTER
4
ASSOCIATION OF ACADEMIC HEALTH CENTERS
References
1Office of the President, National Science and
Technology Council. Ensuring a Strong U.S. Scientific,
Technical and engineering Workforce in the 21st Century.
April 11, 2000.
2 China now 4th largest economy. China Daily, April 7,
2006 http://www.chinadaily.com.cn/home/2006-
07/04/content_632199.htm
3Barboza, D, Altman D. That blur? It's China, moving
up in the pack. New York Times, 21 December 2005.
4 Jafre, SA. India to be 3rd largest economy for 2020:
Pant. Rediff India Abroad, 7 January 2004.
rediff.com/money/2004/jan/07economy.htm.
5South Korea aims to be in world's 10 largest
economies by 2015. Asia Pulse News, 6 September
2005. World Development Indicators 2007, April 2005.
6World Bank, World Development Indicators 2007, April
2006.
7Loth R. India rising. Boston Globe, Editorial
Notebook, February 26, 2006.
8Goldman Sachs. Global Economics Paper #99.
www2.goldmansachs.com/insight/research/reports/99.pdf
9 Tong, D. Singapore's reply to offshoring -- build
Biopolis, create new jobs. San Francisco Chronicle, April
18, 2004 http://www.sfgate.com/cgi-bin/article.cgi?f=/
c/a/2004/04/18/BUGAI66EEK1.DTL
10 Agency for Science Technology and Research.
http://www.a-star.edu.sg/astar/biopolis/index.do
11 Malaysia offers millions into biotechnology
research, aims to become hub. International Herald
Tribune, Asia-Pacific. September 7, 2006.
http://www.iht.com/articles/ap/2006/09/07/asia/
AS_SCI_Malaysia_Biotechnology.php
12 China spending billions to better universities,
Howard W. French, The International Herald Tribune,
27 October 2005
http://yaleglobal.yale.edu/display.article?id=6422
13 See Institute of Medicine. Rising Above The Gathering
Storm: Energizing and Employing America for a Brighter
Economic Future. National Academies Press,
Washington, 2006; America The Uneducated,
November 21, 2005, Business Week.
14 See Bachman, SL. Silicon Valley dons a brave
face, despite worries: The birthplace of hi-tech
globalization frets about competition. YaleGlobal,
28 April 2004.
http://yaleglobal.yale.edu/display.article?id=3781
THE
MULTINATIONAL
ACADEMIC
HEALTH CENTER
5
Association of Academic Health Centers
Leading institutions that serve society
VISION
To advance the nation's well-being
through the vigorous leadership of
academic health centers.
MISSION
To improve the nation's health care
system by mobilizing and enhancing the
strengths and resources of the academic
health center enterprise in health
professions education, patient care,
and research.
1400 Sixteenth Street, NW Suite 720
,
Washington, DC 20036
202.265.9600
202.265.7514 fax
www.aahcdc.org
ฉ 2007 by the Association of Academic Health Centers