Philanthropy 3.0

For my birthday this year, my daughter bought me a copy of Peter Attia’s book, “Outlive: The Science and Art of Longevity.” Attia uses both innovative science and practical advice to help his readers live a longer, healthier, and more fulfilling life.

What stuck with me the most, however, were his insights in chapter two. In the chapter, “Medicine 3.0,” Attia explains that the first era of medicine (Medicine 1.0) began with the ancient Greek philosopher, Hippocrates: “First, do no harm.” This period lasted 2,000 years in which medical practitioners would observe and guess what the best treatments were for people. This brought about, to nobody’s surprise, mixed results. Diet and exercise improved many people’s lives but the concept of “bodily humors” as well as the practices of bloodletting and leaches did not yield particularly good outcomes. Intuition and anecdotal observations were shown to be unfruitful strategies.

Medicine 2.0 began in the mid-nineteenth Century with the arrival of germ theory. Change was slow but thanks to Sir Francis Bacon, the scientific method had been normalized. Medicine was now focused less on throwing solutions at things and hoping for the best and instead focused on experiments that measured outcomes with randomized controlled trials. This shift changed our world with the advent of things like penicillin, the eradication of polio and smallpox, and even the remarkable rapid development of COVID19 vaccines.

While Medicine 2.0 has made our lifespans longer, almost all that progress has stemmed from antibiotics and improved sanitation. Attia notes that if you exclude infectious diseases and accidents (or “fast deaths”), humanity’s mortality rate has declined little since 1930. Assuming you don’t participate in high-risk behavior like skydiving or motorcycle racing, more than likely, you will die from one of four “slow death” causes: heart disease, cancer, neurodegenerative diseases, or type 2 diabetes.

Medicine 2.0 has not been effective against these “slow death” factors because Medicine 2.0 is focused around finding cures to acute illnesses and injuries. Instead, Peter Attia argues that we are at the dawn of Medicine 3.0: not focusing on fixing things that are broken in people’s bodies but preventing the bad things from happening in the first place. For example, preventing the strain that causes the first heart attack or preventing cancer tumors from appearing. Prevention is much easier and less expensive than treatments, but our healthcare system is still stuck in medicine 2.0: focused mostly on fixing what is broken rather than preventing it from breaking in the first place.

The Social Sector

As I read “Outlive,” of course I thought about my own health. But I also recognized the parallels to what we are doing at Azura. Philanthropy began, like medicine, from a place of noble intentions: to make the world a better place. Early philanthropy 1.0 would see social problems and guess as to the best way to solve them. Usually this meant throwing money at the problem. The results were mixed.

For example, while governmental agencies and foundations have dumped billions of dollars into the continent of Africa over the years, many speculate that it would have been better to do nothing than to employ the solutions we tried. Likewise, our country has spent over $20 Trillion on treating the symptoms of domestic poverty since 1965. Yet, we have seen minimal improvement in the number of impoverished people.

This frustration brought about the advent of Philanthropy 2.0: we began to measure outcomes more and ask better questions about the effectiveness of social programs. People asked, “what sort of ROI will my philanthropic dollars bring?” Philanthropy 2.0 was a substantial improvement to social services, and we can see a measurable dent in social problems that have plagued us for centuries.

In a similar fashion to the world of medicine, Philanthropy 2.0 has been good at fixing acute and “fast” problems but not as effective at dealing with “slow” stubborn problems that have deep-seated causes that do not go away with a short intervention.

Why is This So Hard?

Prevention of social problems, like preventative medicine, is much easier and less expensive than treating symptoms of a long-developed disorder.

There are reasons why it is difficult for people to make the mental shift to Medicine 3.0 and Philanthropy 3.0: The problems that are in front of us and causing pain or anguish will always get more attention than the potential for a problem down the road. In public policy, global climate change is a notable example of how we kick the can down the road because we do not yet feel the pain of a future problem.

We also kick the can down the road with medical and social issues. The steps towards type 2 diabetes are very predictable and easy to prevent. Yet, most medical efforts and dollars focus on palliative care. The steps toward homelessness are also predictable and easy to prevent. However, we focus most of our efforts on the chronically homeless who are the most difficult to get off the streets. The easiest way to prevent homelessness is to keep people from being homeless in the first place.

Part of the problem with making a shift to a 3.0 way of thinking is that it is exceedingly difficult, if not impossible, to “measure” prevention. We do not know for sure the outcomes of our actions if we take a particular action. Often, there is no way to tell if an intervention “A” would have a causal effect on “B” for many years, if ever. We all have heard of medical statistical outliers who smoked, drank, had terrible diets, and lived to be 105 years old. This makes it easy for cynics and skeptics to cast doubt on preventative measures.

Because we can be so short-sighted, we are fighting against human nature when it comes to solving some of the deepest problems of our day.

Two Mindsets 

Years ago, I heard a fascinating talk about how a person’s socioeconomic status affects the way they view time in relation to money. The sociologist giving the lecture cited research that demonstrated that people who live in poverty have a very short-sighted view of money: they are worried about their next meal, making the next rent payment, and finding a way to get to work. People who are poor are paid frequently (weekly and sometimes even daily) because they are “hand to mouth” – they need the money now, not some time in the future.

Those who do not live in poverty sometimes find their behavior baffling. If people in poverty have the money in the bank, they will spend it – often on frivolous purchases like designer clothes or a large TV. But their behavior makes sense to them: I have the money now; I might not have it tomorrow. Getting something now is better than the potential of getting something in an uncertain future.

Wealthy people, on the other hand, have a much longer-term view of money. Wealthy people are not worried about their next meal and have the luxury of thinking about questions other than survival. Wealthy people are usually paid monthly and have annual bonuses. Some wealthy people, like CEO’s, are even paid annually. Wealthy people can think about the long-term results of their financial decisions and, as a result, can usually generate much better financial outcomes over time.

The sociologist then said something that has always stuck with me: “The correlation between wealth and a person’s view of time is so tightly correlated, researchers are unclear about which factor is causal.”  In other words, are people rich because they have a longer-term view of money, or do they have a longer-term view of money because they are rich? Which comes first, the chicken or the egg?

I observed these two mindsets play out when I read about an American nonprofit that was doing work in Haiti. Haiti’s ecosystem was ravaged by human exploitation through the deforestation of its lush forests. The lack of trees meant extreme soil erosion. Because of the frequency of tropical storms, Haiti found itself constantly trying to keep up with constant natural disasters like mudslides.

The nonprofit had a great idea – they would re-plant the deforested rolling hills and provide stability for the soil on the hills as well as enable a shift from cooking with charcoal to cooking with wood. The nonprofit bought thousands of tree saplings, plotted out an 18-year plan to turn the rolling hills of Haiti green, and hired locals to plant the saplings.

The Haitians worked hard the first day and made great progress in planting all the new trees. The nonprofit workers felt great about their work as they headed back to their hotel for the night.

But when the Americans came back the next morning, they were surprised to discover that most of the saplings planted the previous day had been uprooted and taken. It didn’t take them long to realize that after they went back to the hotel the previous night, the Haitians needed firewood to cook their dinner. The promise of a potential tree in 18 years does not do much good when you need dinner tonight.

This may sound incredulous to our first-world ears, but it is the same mindset that nonprofits and government agencies have used for decades in the battle against poverty. We are fighting poverty with a poverty mindset: looking for the quick fix to long-term problems.

Azura

If you can understand this shift in mindsets, you can understand what drives Azura. In the Summer of 2023, we formed Azura, building on the foundation of over 100 years of the blood, sweat, and tears of the Mesa United Way. We have learned a few things in those 100 years as we fought for the people in poverty in our city. Today we are moving into the future with a new and innovative mindset: to make a dent in poverty using 3.0 solutions.

Here are a couple of examples of what that looks like:

·         Around 50% of young adults become homeless after they leave foster care. 65% of our current homeless population has spent time in foster care. So, our Foster360 program is preventing homelessness 15 years from now by working with at-risk kids who are graduating from the Foster-care system. From the outside it may seem like a relatively expensive program, but it is an absolute baragin compared to what it would cost taxpayers to get them off the street if they become chronically homeless.

·         People who drop out of high school are twice as likely to live in poverty. 80% of the US prison population dropped out of high school. But high school dropout rates do not happen overnight – they begin in the third grade. Children not reading at grade level in third grade are 13 times more likely to drop out of high school. So, Azura’s Literacy program provides reading tutoring to at-risk third graders to get them to reading level.

To be frank, we were tired of pulling up the saplings. We want to find better solutions. We are looking for people to collaborate with us on this bold new venture.