From the narrative arc to the endless loop – and back!

Akiko Fujita @ Yahoo Finance and Esther Dyson @ Wellville
Main Stage
Ascent Conference 2020

Akiko Fujita [00:00:03] Good morning to all of you and welcome to day two of the Ascent Conference. I’m Akiko Fujita. I am an anchor and reporter with Yahoo finance and I am thrilled to be hosting this session. The theme is from the narrative arc to the Endless Loop and back and really excited to be speaking with Esther Dyson. A little background on Esther. Many of you may be familiar already. She is the executive founder of Wellsville. That is a 10 year nonprofit project focused on health and equity, looking specifically at five small communities in the US. In addition to that, Esther is an investor, a philanthropist. And I’m most curious about the she is an amateur cosmonaut, so we’ve got a lot to get through to today and it’s great to talk to you today.

Esther Dyson [00:00:51] Good morning. It’s wonderful to be here. I just went swimming for the first time in a long time. Why is reopening.

Akiko Fujita [00:00:59] Yeah,things we’re both in New York City today so that things are slowly starting to come back, although I guess there are some concerns about an uptick in covered cases. Let’s start by talking about where we are today, seven months into the pandemic, certainly being in the same city, having experienced this big wave of initial shutdowns and then this big transition, especially in the tech space of work from home. So, you know, as an investor, somebody who is familiar with both the health care space and the tech space, you’ve got a pretty unique perspective on some of the real changes we’ve seen over the past seven months. Walk me through what you have observed, what you have experienced in terms of the fundamental changes we’ve seen in the behavior of all of us over the last seven months.

Esther Dyson [00:01:51] OK, so I’m going to do something, things like I’m to just shift myself quickly because now I can look at you and I’m looking at the camera and that’s much better. So fundamentally, it’s like. Disruption is very if you look at a patient on the table in the operating room who has cancer, I mean, they are like, it’s horrible. There’s blood all over their sick. But at the same time, the purpose of that is to make them better, and if you if you actually are able to get the cancer out and you can sew them up. Right. And so forth, that descent into this huge disruption is actually necessary for the patient to be a much healthier patient thereafter. And our hope is that that’s what this disruption is, not the kind that makes you weaker forever. But the reality is it’s going to really help a lot of not just tech companies, but people using tech. We’re all becoming more efficient. We travel less. And I believe when the pandemic is over, we’re going to make much better trade offs around. Should I really bother to travel, which in some cases makes a lot of sense, or should I just stay home and be more efficient? People are finding they can cram more and more calls into their day and they’re they’re also realizing how exhausting this is. So I think what you’re really going to find afterwards is a much better understanding of the tradeoffs with a population that’s going to be much more tech savvy and also with employers who are going to be making those calculations much more effectively. How much does it cost to run this office? We can just have all these people remote. What are the tradeoffs in terms of creativity, in terms of, you know, I can imagine the people who’d been working at the company from before know each other. Well, if you’re trying to on board a new employee, how do you how you get the culture in? So we’re going to see a. A dip to some extent eventually, and one hopes a rise in travel. But this disruption is going to make things a lot more efficient. The challenge is it’s going to have a huge long term impact on a lot of poor people, on people who get sick, on kids who suffer both from missing school or domestic abuse. I mean, it’s. It’s really seeping into the poor and minority people who lack the resilience in the first place, and that’s going to have a long term impact on them and on our economy. But with luck, it’s also going to make it clear to the rich people, you know, people’s health is a public asset. It’s not just an individual thing. And we need a country and an environment and we need to start investing in human capital. And that’s what health is as opposed to health care.

Akiko Fujita [00:05:06] So, I mean, Esther, let’s try to connect those two. You’re talking about, on the one hand, that the trade offs that have been made, especially at the corporate level, but primarily in tech companies, the efficiencies that have been created. And yet it seems like that only creates a bigger divide between what we’ve seen as have and have not. So how do you. As an investor, look at that divide right now and how do you bring the two sides together.

Esther Dyson [00:05:36] As an investor? I see a huge and sad. But lucrative opportunity, especially for mental health of all kinds, and I see employers beginning to understand this more and more employers are you know, if the insurance company covers it, great. If not, we’ll just make it a benefit, understanding that they need to keep their people happy and productive and, you know, they need to keep them from committing suicide. Also, it’s not like a.. I see, obviously, a huge tech market, again, telehealth, also some telehealth, there’s still something about having a doctor who knows you and there’s telehealth where you just get a random doctor like Tinder every time until the health with the doctor that you know, again, that will. It’s it’s gone to extreme heights, it’s now coming back down a bit, but, you know, it doesn’t make sense for you to go to the office just to talk to the doctor. It makes sense for you to go to the office of the doctor needs to examine you and you can do some of that remotely. So there’s both remote monitoring in these sort of telehealth televises. I’m an investor in a company that offers medication assisted treatment. Remotely comes in a box and it’s electronic, you have to fill in a code and so forth and so on, they’re called Medika safe and they’re still in the final throes of FDA approval. So if stuff like that, there’s no reason someone should go to a clinic to pick up some medications. It’s crazy. And so those kinds of things will be much bigger. But as an investor also, I mean, I mostly invest in startups, but I would look really carefully at the culture of the company I invest in because. It’s keeping your culture together and keeping a good culture is going to become more and more important.

Akiko Fujita [00:07:46] I mean, is that part of the conversation that was happening even pre covid about this move to really look at values within the company over profits? Or do you see this as a different dynamic?

Esther Dyson [00:07:59] Well, over profits is probably overstating it. Along with profits, it was it was a lot of talk and also with racism, there’s a lot and a lot of talk and people are beginning to notice it, but it’s. Have noticed it forever and for white people. Oh, my gosh. And then. Can’t can we kick can we actually deliver on the promises these companies are making? It’s it’s going to be a challenge, but it. Just because we’re not perfect doesn’t mean I’m not glad we’re getting much, much better, but it’s not that easy and. There’s people talk about Tector all the time, there’s there’s there’s racism dead. There are so many people of color who have grown up in poverty, you know, bad food supply, bad education, you can’t you can’t just a race that it’s I mean, it’s like health itself. There’s also health debt. How do you get someone from a preexisting condition to healthy? And it’s all those preexisting conditions, whether mental, educational, social, economic or physical health that are it’s not like, OK, we’re going to start treating you equally. Now, how do we fix what happened to you and. You need to start thinking long term, because this is not a one year fix, and I would say the country’s biggest problem is short term thinking, whether it’s short term, thinking about short term, thinking about profits, I want exponential growth of politicians, short term thinking about votes and people short term thinking about investing in public health.

Akiko Fujita [00:09:55] So Estra, I want to get to what has really been the central focus for you over the last several years, and that’s Wellsville. You know, this hits on a lot of issues about health and equity. And you started this back in 2014. The goal here, achieving equitable, equitable well-being over a 10 year time period. What what prompted you to take on this project? But really, look at this 10 year span. That’s a pretty big commitment when you’re talking about focusing on five small communities.

Esther Dyson [00:10:29] Yeah. So first, it’s it’s not achieving equitable well-being because, again, it’s but moving dramatically towards it. So the the gradient is pretty clear. What caused. So I started investing in health care after. Twenty five years in the tech industry and after training as a cosmonaut and so forth. But if you look at. If you just so is also a journalist, if you just ask the most fundamental question, why are we spending so much money fixing people who shouldn’t have been broken in the first place? People, diabetes, most of asthma, hypertension. Obesity, mental health, some of this is genetic, but a very small part, most of it is the circumstances in which kids grow up and you can you can blame the parents. But those parents grew up in circumstances. So it’s it’s not like just how little bit of willpower and. Behave yourself and you’ll be fine. It’s how do you change the environment in which people live, which is what we pay for with our taxes, we need our taxes to be better, and then we won’t waste them on fixing people who were broken by a lack of investment previously anyway. I thought somebody should just, you know, I mean, what I’m telling you is not news, nobody is going to say, Oh. We shouldn’t I mean, they’ll they’ll start get worried about the taxes they pay, but nobody disagrees with the fundamental principle that people’s health is influenced by their childhoods. But the degree to which that is true and how much racial disparity there is. And how much disparity there is among poor communities and others, so I thought somebody should do this now is. Giving a talk somewhere and I was going to talk about how somebody should do this, and then I realized somebody else should do something that I’m telling them to do is not a great talk. And I also realize, yeah, I’ve actually decided to do this. I don’t have anything else. I’m investing in stuff, but nothing real on my plate. So I decided to do that. Looked for a CEO. I started learning a lot. And in the summer of. Twenty fourteen, my CEO and I are twenty thirteen. Anyway, we went in, we wanted five communities, sort of like a health X Prize versus a health care X Prize. We put out a call for applications that was Rick Brusher, CEO, who’s formerly with Cigna and very organized, and you had to be under two hundred thousand people. You had to have some cross-sector collaborative and you needed to be a discrete community because the whole idea was we’re not doing individuals. We’re helping the leadership of the community makes the community a place in which children grow up healthy. And it was originally four, five years after two or three years, I felt ready to commit for 10 years. I mean, it was it is a real commitment, money, time, everything. Anyway, we visited 10 communities of forty two who applied and picked with one change. The five that are there now, Muskegon, Michigan. Lake County, California. Clatsop County, Oregon. North Hartford, Connecticut. And Spartanburg, South Carolina.

Akiko Fujita [00:14:10] So you are six years into the program right now. You started in 2000, 2014. What kind of progress have you seen? Where where where are you compared to where you thought you’d be five, six years into this?

Esther Dyson [00:14:25] So. It’s kind of I mean, I never expected anything specific, I probably was hoping for a few more numbers that. With indications of reductions in diabetes and mental health and so forth, and in a sense, covid-19 has reset all that. But what is amazing is there is and it’s not just. Black Lives Matter, it’s it’s. More fundamental within the community, more recognition of not just racial and economic disparities, but their impact in so Muskegon is the community I work in. The the community organizations are beginning to collaborate rather than compete for short term grants, the goodwill in the YMCA or collaborating on adding child care, which is incredibly necessary right now, as opposed to child storage. Which is what you’ve got a lot of the YMCA also has a diabetes prevention program that’s beginning to scale in North Hartford. The collaborative is. In each place, so we don’t we’re not giving them fish, we’re not training them to fish, we’re helping them to build their own fishing skills because the last thing you want is a nice white lady from New York coming in with her progress. What you want is someone who will coach you to do what you’re trying to do better. And, yes, she’ll argue with you occasionally and give you some, I hope, interesting ideas. She will introduce you to other people in your community, which is an amazing sometimes it takes an outsider who doesn’t want your job to give you that sort of external advice. And. I am confident that by the end of the 10 years we will have more numbers, Muskegon has in fact gone up the county health rankings. But it’s it’s more than just diabetes prevention, it’s it’s this sense of community, it’s the school system. Being more integrated, the parents working through the school system.

Akiko Fujita [00:16:46] I think that no, I think that that gets to the question I had, which is if this isn’t just about wellness, but well-being, I mean, how do you how do you measure that?

Esther Dyson [00:16:58] The real way you measure it is you go and you sit and covid should be over. You sit in the real estate brokers office and you hear him say people want to move into town. They just they know this is a good place to raise their kids. I mean, somehow that word spreads you you walk down the street and it’s tidier. There is there are fewer incidents. Crime rate goes down, more kids graduate, unemployment rate goes down. These are all the things we’re watching and they are inextricably linked. Again, there’s all kinds of scientific studies about early childhood experiences and later incidents of everything from diabetes to incarceration, unemployment, addiction, whatever. And it takes a while. You can’t do 17 years in 10 years, but you can see that the third graders are doing better than the third graders five years ago. So that’s. Those are the kinds of things and the economy is better is the idea here to to create a template for other small towns to follow its Lycett template? I mean, it’s not do these three things and you will lose 50 pounds in the next two months. It’s. It’s more inspiration and stories, and we want to influence other communities, what we want to influence voters to understand that this is worth investing in, because if you don’t want your kids paying high taxes for other people to be sick. You should be happy to pay taxes now to create a much healthier society and every employer. Is incentivized to make their employees healthy. What they need to understand is at some point, they also need to pay taxes to keep their customers happy and healthy and able to spend money on what they’re selling rather than spending their money on repairing. Physical and mental damage.

Akiko Fujita [00:19:13] What is one of these six years and really focusing on these communities taught you No one about the small communities in the US and also what have you learned about the ability to break that cycle? We talk so much about the cycle of poverty and how less than half I mean, a dramatic number, less than half of the people who are born into poverty never get out of it. So well, you’re not just addressing poverty. There are the pieces that come together that allow for the next generation to to get out of this cycle. What is this taught you about that?

Esther Dyson [00:19:52] So there’s kind of this whole you fall into you might fall into it because of poverty or poor health or a parent who is addicted. And to get out is really, really hard. What have I learned, I’ve learned. Just the reality of it is so important to understand its and its the importance of role models, whether the role model is your blackboy and you have male black teacher or your community. And, you know, it’s those people who Muskegon, they’re like us. If they did it, we can, too. You need somebody who’s done it to inspire you. It’s it’s. So we teach kids statistics at school, but what really? What really influences people is stories of other people’s stories of other communities, examples, anecdotes. I mean, it may not be scientific, but if you want to change a voter’s mind or give a politician a story to talk about, to inspire people, you need real places with normal people. Not. Twenty thousand people in some fancy study somewhere, but a real community like yours and North Hartford is are one, you know, really urban subset and they’re another example. This is the poor part of town, so to speak. But the importance of that is, is. Getting much clearer. People don’t want I mean, you asked me about my numbers, I want to give you better numbers, but what people really want to hear is, so how’s it working out for these organizations actually working together? Are they reaching the Kids, Boys and Girls Club after school? The Muskegon School District is feeding all these kids.

Akiko Fujita [00:21:44] And Esther, I know we’ve only got a few minutes left here, but I want to get back to some of what your outlook is on investing right now and your investment thesis. I mean, we talked earlier about how things have shifted as a result of this pandemic, but what specifically are you looking at right now? What are the real opportunities for growth you see in the sectors that you really invest in?

Esther Dyson [00:22:10] Well, mine are unfortunately mostly about repairing damage and preventing damage. I’m doing a lot in mental health. Some general as a company called Supportive, which is working with Wal-Mart, others focused on communities of color, medical staff and also pocket naloxone around remediating addiction. I have another whole sector right now. My very first company I was involved with was Federal Express Logistics and I think insurance. In some areas, the business of insurance is thinking long term and rationally with the best insurance companies reduce the risk. They don’t just price it. So something like go, which is car insurance that actually helps drivers to drive more safely with their permission. And now I’m going to give you the one investment that is guaranteed to succeed, except I think we’re ending right now.

Akiko Fujita [00:23:12] OK, we’re going to end it on a cliffhanger there. Esther Dyson, it’s great to talk to you this morning.

Esther Dyson [00:23:17] Thank you so much. It was great.

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