Four strands, one question

Twenty-five years at the World Health Organization, working across health-system performance, economic evaluation, fiscal policy and health taxes, health-workforce economics, macroeconomics and health, and health-system governance. The work ran through programmes including WHO-CHOICE, chronic-disease prevention modelling and the economic evaluation of cancer control. I led country-implementation teams on resource allocation in Ghana, Costa Rica, Colombia, Peru, Mexico and Brazil. It combined quantitative analysis with the political realities of international organizations and field operations: seven years as an Assistant Secretary of Committee A of the World Health Assembly, and experience in Guinea during the West African Ebola response. The latter two taught me more about how decisions actually get made than any model could.

How do societies decide what is valuable, and how do institutions convert knowledge, resources and preferences into collective action? This strand takes in priority setting, equity and efficiency, public goods, institutional design, governance, and the relationship between evidence and decision-making. The central observation comes as much from experience as from analysis: important problems persist not because knowledge or resources are lacking, but because actors, incentives, mandates and funding are poorly coordinated.

My interest in technology begins with an older interest in models: not simply what they predict, but what underlying processes might generate the patterns we observe. More recently, I have become interested in artificial intelligence and the consequences of making certain forms of cognitive capability radically cheaper. I am also exploring how distributed ledgers, smart contracts and related technologies can represent intangible assets, encode agreements and track the creation of impact and public value. What happens to economies, institutions and societies as new capabilities emerge and relative scarcity changes? Which constraints become more important, how are the gains distributed, and what determines whether new capabilities translate into human flourishing?

Most recently, I've been fully engaged in translating ideas about economics, evidence, public value and coordination into working systems and institutions, currently through United Health Futures and Unexia. Their work spans impact measurement, public-value representation, policy implementation, financing, institutional design and technology-enabled decision support. We are actively building viable enterprises while learning how these ideas evolve through contact with practice.