Washington Global Health Landscape Study 2015 Final Report

Landscape StudyAUGUST 2015

Washington State Global Health

2 | Washington Global Health Alliance | Landscape Study | August 2015

CONTENTS

Letter from the Executive Director 4

Executive Summary 6

Introduction 7

Washington state has a distinct, diverse and collaborative global health sector 9

Global health contributes to Washington state’s economy through investment, innovation and employment 14

This vibrant sector will continue to grow by proactively seeking new funding models and methods of collaboration 17

WGHA Online Survey Results 20

1809 7th Avenue

Suite 901

Seattle, WA 98101

www.wghalliance.org

WGHA Contributors Lisa Cohen, Executive Director

Stephanie Grow, Program Manager

Community Attributes tells data rich stories

about communities that are important to

decision-makers.

1411 Fourth Avenue

Suite 1401

Seattle, WA 98101

www.communityattributes.com

President & CEO Chris Mefford

Analysts Spencer Cohen

Michaela Jellicoe

Alison Peters

Eric Viola

Design Maeve Edstrom

Funding for this report was provided by JPMorgan Chase & Co.

151Washington’s global health

organizations support projects in

COUNTRIES 1,959Washington’s global health organizations have

PARTNERSHIPSWORLDWIDE

12,620includes estimates for global health jobs in

large organizations, such as the University

of Washington and others (2013)

GLOBAL HEALTH JOBS

$71,129

32,800

in global health (excludes benefits),

compared to $55,100 across all jobs

statewide (2013)

Statewide, global health supports the following (2013):

The global health sector provided

paid to global health jobs statewide (2013)

AVERAGE WAGE

$2.3BIN LABOR INCOME

JOBS

$1.2B WAGES & BENEFITS

(2013)

$45.9MSTATE TAX REVENUES

Every job in global health supports a total of

(inclusive of the global health job, 2013)

2.6 JobsSTATEWIDE

Global health jobs have grown by

compared to 1.1% annual growth for all jobs

statewide (2013)

4.4% PER YEAR SINCE 2009

$9.4BIN BUSINESS REVENUES

168 GLOBAL HEALTH ORGANIZATIONS

WASHINGTON STATE GLOBAL HEALTH FACTS 2013

$5.8B FUNDING & REVENUES

in global health (2013)

$7.1B GRANTS

funding received since 2001 (2001-2013)

includes nonprofits, biotech companies,

research institutions, philanthropies,

government agencies and other

organizations (2013)

Millions of lives saved worldwide

Direct Impacts Overall Economic Impact

Global Reach


“Washington state has the talent, innovative spirit and unique concentration of organizations to lead the way for global health discovery, development and delivery in the world.”

– Lisa Cohen, Executive Director

LETTER FROM LISA COHEN, EXECUTIVE DIRECTOR

Millions of lives saved worldwide. Millions.

That is the legacy of Washington state’s

remarkable collection of global health

organizations. When we talk about “global

health” we mean addressing the needs of

the world’s most vulnerable people – both at

home and abroad.

Seattle-based organizations like Fred

Hutchinson Cancer Research Center, Center

for Infectious Disease Research and PATH,

have been pioneering global health solutions

for forty years. Their work in the Seattle

community, along with dozens of others such

as the Infectious Disease Research Institute,

SightLife and World Vision, has created a

fertile environment for starting and growing

global health organizations. Undoubtedly the

Bill & Melinda Gates Foundation, now fifteen

years old, is at the center of Seattle’s global

health community, contributing more to fight

neglected diseases and entrenched cultural

stereotypes than any one philanthropic entity

around the world.

When we founded the Washington Global

Health Alliance in 2007, the University of

Washington had just formed the Department

of Global Health and Washington State

University’s Paul G. Allen School for Global

Animal Health was formed, signaling a

growing field. Passionate interest among

the next generation coupled with a surge

in late-career professionals looking for

meaningful employment meant that global

health organizations were fielding hundreds

of applicants for a single job. In addition,

Washington state attracted unprecedented

levels of federal funding and private

philanthropy. Global health, like coffee,

aerospace and software, was becoming

a magnet for talent from other states

and countries.

This meteoric growth also has implications

for our state’s economy. Put plainly, our state

benefits from so many organizations focused

on global health research and delivery. Back

in 2007, then Governor Christine Gregoire

prompted the UW to study the economic

impact of Washington’s global health work.

WGHA has since mapped Washington’s

global health reach in 2009 and 2011. We are

grateful to the JP Morgan Chase Foundation

for providing support for the 2015 study which

integrates both the geographic reach and

economic impact of what we now call the

“global health sector.”

This study illustrates that Washington’s most

important export is, in fact, ideas that benefit

humanity. Our inspiration today is rooted in

the legacy they are creating.

Washington state has the talent, innovative

spirit and unique concentration of

organizations to lead the way for global health

discovery, development and delivery in the

world. In the future, as we work with other

regions to identify global health clusters, we

hope that similar data will be collected to

educate regional leaders and policymakers

about the contributions and importance of this

often overlooked sector.

Best wishes,

Lisa Cohen

5Washington Global Health Alliance | Landscape Study | August 2015 |

GLOBAL HEALTH

TRAINING

TALENT

Community Colleges

University of Washington

Washington State University

Other Colleges and Universities

Research Assistants

Grant Managers Business Development

Scientists and Postdocs

Software and Web Development

GLOBAL HEALTH ACTIVITIES

FundingResearch

Metrics & EvaluationProduct DevelopmentDelivery & Distribution

U.S. or International Policy & AdvocacyEducation, Outreach and Training

Philanthropy

Biotechs

Universities

Research Institutes

Governmental Organizations

PARTNERS

FUNDERS

International Agencies

International Agencies

National Agencies and Departments

Nonprofits

Multinational Organizations

Philanthropies

Federal Agencies

State Agencies

Private Foundations

Individual Donors


EXECUTIVE SUMMARY

Washington-based global health initiatives

have an enormous social impact worldwide

and economic impact in Washington state. By

focusing on interdisciplinary approaches to

complex problems, bringing outside investment

and attracting world-class talent to our region,

this sector contributes to Washington’s

innovation ecosystem. Nowhere is this more

evident than in the realm of developing products

for limited resource settings.

This report combines new and existing data to

measure and quantify the economic significance

of global health to Washington state including

employment figures and fiscal impacts. Global

health refers to the area of research and practice

to improve health and achieve equity in health

for all people worldwide.

Washington state has a distinct, diverse and collaborative global health sector.

The global health ecosystem includes

168 global health organizations (nonprofits,

biotech companies, research institutions,

philanthropies, government agencies and

other organizations).

Partnerships and collaboration are a part of

Seattle’s business and nonprofit culture, and

global health is no exception with 1,959 total

partnerships worldwide. Washington’s global

health organizations have 5,100 projects in

151 countries.

The high level of strategic collaboration

from research to program delivery, makes

organizations more effective, reduces

redundancy and increases impact ultimately

improving the lives of more people around

the world. Demonstrating its leadership,

Washington is the first state to formally

organize an alliance to further collaboration

and increase connectivity among global

health organizations.

Strategic Opportunities:

1. Provide new opportunities to connect

organizations to each other to leverage

expertise and foster new partnerships.

2. Build a stronger infrastructure for

bringing global health technologies to

the marketplace.

Global health contributes to Washington State’s economy through investment, innovation, and employment.

Washington’s global health sector accounts

for a growing portion of the state’s total

economic activity. Global health organizations

in Washington state directly accounted for

$5.8 billion in output in 2013, composed of

grant funding, product and service revenues,

private contributions and other sources. The

interdisciplinary nature of the work makes it an

important source of innovation for the state.

Expertise in designing for limited- or low-

resource settings positions the global health

community to constantly innovate in the name

of reaching customers at the bottom of the

economic pyramid.

In addition, global health organizations’

missions are a magnet for job seekers and an

educated, permanent workforce with spending

power for local goods and services. There

were an estimated 12,620 direct global

health jobs in Washington with average

wages of $71,129 per worker in 2013.


3. Promote global health as an important part

of Washington’s economy to attract the best

talent, new collaborators and new funding.

4. Apply lessons-learned in global health to

health challenges at home to explore cost-

savings in related healthcare settings.

This vibrant sector will continue to grow by proactively seeking new funding models and methods of collaboration.

Between 2009 and 2013 global health

employment grew at a compound annual

growth rate (CAGR) of 4.4% representing an

absolute gain of almost 2,000 jobs over five

years. In Washington state, total employment

increased at a CAGR of 1.1% during the same

period, meaning that global health jobs grew

at four times the rate of state employment.

Government funding has declined since 2012

with no immediate indication for increases

in the future. Global health leaders say new

funding models are essential to continue

making the kind of significant progress we

have seen in the last decade. The social

returns in global health make it well-aligned

with socially responsible, impact investing,

though the community has yet to build

appropriate investment vehicles.


5. Create new business models through new

partnerships with aligned corporate and

government entities to develop new revenue-

generating opportunities in the development

and delivery of global health solutions.

6. Focus on new training and education

programs to keep the talent pool competitive.


Summary of Strategic Opportunities






the marketplace.







5. Create new business models through

new partnerships with aligned corporate

and government entities to develop new

revenue-generating opportunities in the

development and delivery of global

health solutions.



INTRODUCTION

Background and Purpose

Washington-based global health initiatives

have had an enormous social impact

worldwide and economic impact in Washington

state. The significance of this growing sector

extends into many aspects of the statewide

economy and international economies.

This report leverages new and existing data

to measure and quantify the significance of

global health to Washington state. The study

leverages partners of the Washington Global

Health Alliance (WGHA) to tell the story of the

presence of Washington’s global health work

worldwide along with its economic impact

at home.

Research Methods

The analysis makes use of economic

data collected through several sources,

including state government-collected data on

employment, wages and other indicators. Data

gathered through interviews and an online

survey of leading global health organizations

in Washington also contributed to the

understanding of the global health economy.

The global health sector is complex in that

many organizations drive global health

activities along with focus areas outside of

global health. Therefore, the challenge is to

determine which portion of the jobs, wages

and operating budgets of these organizations

are dedicated to global health activities. Data

provided by surveys and interviews enabled

allocation of state-published data to arrive at

refined estimates of economic activity related

to global health.

The primary tool for analyzing economic

impacts is the Washington State Input-Output

Model, published by the Washington State

Office of Financial Management. The Input-

Output Model provides a rendering of the

state economy across distinct sectors, and

captures transactions and spending flows

across industries and through employee

spending. The Input-Output Model estimates

the impacts of economic activities when

output, employment, and wages are known for

a given industry or economic event.


Bothell and South Lake Union are regional hubs for life sciences and global health innovation

Demand for college-level global health programs is growing; fields becoming more specialized- UW started the Department of Global Health in 2007

- More global health jobs

in Washington

- Global health impact is increasing

- More reported collaboration

with partners

- More global health organizations

- More projects per organization

Global health is recognized as a distinct economic sector

New global health partnerships foster innovation in manufacturing and product development

WHAT’S NEW in WASHINGTON’S GLOBAL HEALTH SECTOR

Examples of Global Health

Expansion

Growth in Gates Foundation grant-making – $1.5B in Global Health & Global Development grants in 2007 vs. $2.8B in 2014

Infectious Disease Research Institute opens South Africa biotech

PATH had 199 technologies and products in the development pipeline. Three were licensed and two were prequalified by the World Health Organization (2011)

Uganda Cancer Institute – Fred Hutch Cancer Centre opens in Uganda

Global health organizations are training more in-country workers

Local Evolutions in Global Health

Trends


0 20 40 60 80 100

Nonprofits

For-profits

Colleges & Universities

Research Institutes

Governmental Organizations

Other

94

48

9

8

4

5

ESTABLISHMENTSSEGMENTS

TOTAL: 168

WASHINGTON STATE HAS A DISTINCT, DIVERSE, AND COLLABORATIVE GLOBAL HEALTH SECTOR

Washington’s global health industry represents

a diverse set of activities, spanning research,

grant-making, and health care delivery,

extending across for-profit and nonprofit

businesses and organizations. Washington’s

global health organizations are leaders in the

innovation economy, driving advancements that

by their very nature are global in reach, saving

lives throughout the world.

An extensive innovation ecosystem

Global health refers to the area of research

and practice to improve health and achieve

equity in health for all people worldwide.

Global health emphasizes health issues,

causes, and solutions that cross international

boundaries. It involves collaboration among

many disciplines within and beyond health

sciences and combines population-based

prevention with individual-level clinical care. In

Washington state, this is a rich ecosystem of

168 organizations, as shown in Exhibit 1.

Exhibit 1. Global Health Organizations in Washington State, 2013

Note: Data was from 2013 and accessed in 2015. Source: Washington Global Health Alliance, 2015; Community Attributes Inc., 2015.

Nonprofits represent the largest segment of

global health organizations with more than

90 entities in Washington. The nonprofit

group includes small and large organizations

such as SightLife and Med25 International.

Nonprofits design and implement global health

programs, and can also include philanthropies

and non-governmental funding partners.

For-profit entities include almost 50

businesses in the life sciences and biotech

space, such as Kineta. Manufacturing,

research and product development

companies like MSR Global Health are

also represented.

Colleges & Universities are an integral

asset within the global health sector. The

contributions by faculty, research staff and

students keep Washington at the forefront of

innovative scientific discovery. UW and WSU

are included in this count, along with Seattle

University, Northeastern University and

several community colleges.

Research Institutes, including Fred

Hutchinson Cancer Research Center, Battelle,

and Center for Infectious Disease Research,

are examples of organizations that employ a

diverse local workforce in applied research,

academic research, project management and

grant development.

Government partners in global health refer

to the Washington State Department of

Health, Public Health – Seattle & King County

and public health entities around the state

that contribute to global health research, data

analytics and health systems strengthening.

The Other category contains distinct global

health programs that don’t neatly fall into

existing subgroupings. This group also

includes global health programs that serve

veterans and active duty personnel at Joint

Base Lewis-McChord and Madigan Army

Medical Center.

Nearly 2,000 partnerships globally

Partnerships and collaboration are a part of

the region’s business and nonprofit culture,

and global health is no exception. Partnerships

are a critical and defining feature of global

health in Washington and include research,

programs, funding and advocacy.

In the last few years, the number of

partnerships named by global health

organizations has increased. In the 2009

Mapping Study by WGHA, 600 partners

were identified by global health organizations.

This 2015 study identified 1,959 partnerships

worldwide (Exhibit 2).1

1 The total of 1,959 partnerships does not include

worldwide grantees receiving funding from the Bill

& Melinda Gates Foundation. Within the foundation,

there are more than 1,000 active grantees within the

Global Health and Global Development department.

Data provided by the Bill & Melinda Gates

Foundation to Community Attributes Inc., 2015.


United States941

Canada35

United Kingdom

Sweden

212

India

China

Australia

New Zealand

Ireland

169

121

Kenya

Ethiopia

Niger

Switzerland

SpainFrance

Germany

Italy

Rwanda

Nigeria

GhanaBurkina

Faso

Malawi

MozambiqueSouth Africa

320Sudan15

72

51Nepal

Brazil42

Mexico24

183

Tanzania138

120

Georgia

70

Liberia11

62

49

Zambia47

Zimbabwe20

Mali49

Colombia18

Peru20

Argentina10

96

3233

Belgium 23

16

16

36

217

Denmark

Netherlands

217

48

Uganda

Cameroon

142

148 Congo31

Benin19

Togo 11

Gambia13

Bangladesh

Pakistan

91

Thailand35

Cambodia21

Indonesia27

Philippines31

45

69

112

Guatemala11

25

29

22

28

75-119120-1000Color Key

40-74

20-39 10-19 0-9

Exhibit 2. Washington Global Health Worldwide Partnerships, 2015

Source: Washington Global Health Organizations Survey, 2015.


Respondents (n=71) Share

Technologies and Devices 38 54%

Infectious Disease 37 53%

Maternal, Child and Newborn Health 32 46%

Health Systems Strengthening 30 43%

Other 30 43%

Non-Communicable Disease 26 37%

Surgical or Clinical Interventions 17 24%

Environment 16 23%

Agriculture 13 19%

Animal Health 10 14%

The high level of strategic collaborations

from research to program delivery, makes

organizations more effective, reduces

redundancy and increases impact ultimately

improving the lives of people around the world.

Washington is home to the first-of-its kind

formal body that increases connectivity and

furthers collaboration—the Washington Global

Health Alliance. WGHA’s strategic connections

strengthen the global health network and

improve the effectiveness and impact of global

health organizations while creating a platform to

influence critical practices that impact the sector.

In some examples, such as Global to

Local, the partnership involves a coalition

of nonprofits, local governments and public

health supporters, along with corporate

entities. Global to Local coalition partners

work to bring best practices from low-resource

settings to underserved communities in the

U.S. Partners include Providence and Swedish

Health Systems, Public Health – Seattle &

King County, the cities of Tukwila and SeaTac,

HealthPoint and WGHA. Washington State

University and Starbucks are also supporters.

For-profit partnerships connect for-profit

businesses that have expertise in product

design, manufacturing or production, with

nonprofit delivery and implementation

entities. Washington’s established industries

in biotechnology, medical devices and

health science research provide a

wealth of collaborative opportunities for

nonprofit ventures.

Depth of expertise

Because of the nature of global health,

organizations in Washington work to address

complex issues across a variety of disciplines.

The intersection of these areas of expertise

provides a distinct competitive advantage for

collaboration in Washington. Other regional

hubs like Washington DC or the Bay Area may

specialize in infectious disease or technology,

for example, but Washington is known for the

number of leading organizations from almost

every area of the global health ecosystem.

The work disciplines include the following:

• Infectious Disease. Activities and vaccines

related to the prevention and control of

communicable diseases, both emerging

and epidemic

• Technology and Devices. Includes

the development and manufacturing of

devices, diagnostics and tools, including

mobile devices and IT, used to improve

health outcomes

• Maternal, Child and Newborn

Health. Includes provision of ongoing,

comprehensive health care and nutrition

services for individuals and families

• Health Systems Strengthening.

Promotes health systems that integrate

service delivery, health workforce,

information, medical products/technologies,

financing and leadership or governance in

restoring or maintaining health

• Non-Communicable Diseases.

Activities related to the prevention and

control of diseases that continue for a

long time or constantly recur, including

cardiovascular diseases, diabetes,

hypertension, mental health and cancer

• Surgical or Clinical Interventions.

Direct treatment of individuals for specific

ailments, injuries (including traffic or

traumatic) or other conditions

• Environment. Addresses natural and

man-made environmental factors that

impact health (e.g. clean water, air quality,

sanitation) including initiatives addressing

the impact of climate change

• Agriculture. Initiatives to increase crop

yields or increase food security

• Animal Health. Detection of pathogens,

control of disease transmission and

vaccine development

All of the global health organizations that

participated in the online survey conducted

for this study responded with the disciplines

in which they work. More than 50% of these

Washington state organizations reported

work in infectious disease (and vaccine) and

technology and devices, as shown in Exhibit

3. While less than 25% of organizations

indicated current work or projects in

environment or agriculture, the growth

in funding from the Bill & Melinda Gates

Foundation suggests these two areas may be

opportunities for innovation in the near future.

Exhibit 3. Work Disciplines among Washington’s

Global Health Organizations, 2015



Well Funded

Communicable Diseases,including HIV, malaria, TB and enteric diseases

Ebola

Maternal and Newborn Health, including contraceptive health

Diagnostics

Underfunded

Non-communicable Diseases, including cancer, TB and the relationship between those diseases

Mental Health

Tropical Diseases such as river blindness

Alzheimers and other diseases effecting aging populations

Respondents (n=57) Share

5 or fewer projects 30 53%

6-10 projects 6 11%

11-20 projects 8 14%

More than 20 projects 13 23%

“Washington state has the potential to drive new technologies and new approaches to solve massive health problems.”

– excerpt from WGHA leadership interview

Exhibit 4. Global Health Perceptions on Funding Availability, 2015

Source: WGHA Leadership Interviews, 2015.

Thousands of projects in hundreds of countries

The projects designed and overseen by

global health entities in Washington state are

as diverse as the organizations themselves

and their partners. Survey participants

reported 5,100 current global health projects,

with some organizations such as Splash

and World Vision reporting hundreds of

projects underway each year.2 Most survey

respondents reported working on five or

fewer projects per year; the median number

of projects per organization was five for 2014

(Exhibit 5).

2 It is important to note that funds from the Gates

Foundation are not counted as projects. Rather,

Gates Foundation grants support organizations that

implement projects.

Exhibit 5. Organizations by Number of Projects, 2014


Survey participants had projects in 151

countries worldwide. Kenya was the top-

ranking country with 17 survey participants

that have active global health projects there.

Fifteen survey organizations had projects in

Uganda, 13 had projects in South Africa, and

13 had projects in India. (Exhibit 6).







the marketplace.

What drives an organization to focus on

some areas within global health and not

others is complex and can change to address

or respond to needs across the world. In

interviews with global health leaders, senior

executives highlighted the constraints of

market conditions and funding models that

impact the decision to work in different areas.

Their comments and perceptions confirm that

infectious disease projects are a strong area

of focus among Washington organizations

compared to research being done in non-

communicable diseases. Exhibit 4 presents

those areas of specialty that are well funded and

underfunded, as reported by industry leaders.


Canada

United Kingdom

India

China

Australia

Kenya

Ethiopia

Niger

Switzerland

France

Germany

RwandaNigeria

Ghana

Malawi

Mozambique

South Africa

Sudan

Nepal

Brazil

Mexico

17

Tanzania

Zambia

Zimbabwe

Peru

Uganda

BangladeshPakistan

Thailand

Cambodia

Philippines

Vietnam

Guatemala 15

13

11

11

Haiti6

Dominican Republic5

Honduras 5

Nicaragua5

5

5

5

5

5Ecuador5

10

109

9

9

9

9

8

6

66

6

8

8

7

Malaysia5

7

7

7

8

9

10

11

13

9-1213-17Color Key

3-8

1-2 0

Exhibit 6. Number of Washington Global Health Organizations with Active Projects, 2014

Source: Washington Global Health Organizations Survey, 2015. Countries with fewer than 5 organizations are not labeled.


0

100

200

300

400

500

600

700

800

2010 2011 2012 2013 2014

Millions,2013$

$704

$749 $741$719

$790OtherUSAIDCDC

Gates Foundation

NIH

0

100

200

300

400

500

600

700

800

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

YEAR

AWARDS

0 800400

Washington’s global health sector accounts

for a growing portion of the state’s

total economic activity. Global health

organizations in Washington state attract

external investments composed of grant

funding, product and service revenues,

private contributions and other sources. The

interdisciplinary nature of the work makes

it an important source of innovation for the

state. Expertise in designing for limited- or

low-resource settings positions the global

health community to constantly innovate in

the name of reaching customers at the bottom

of the economic pyramid. In addition, global

health organizations’ missions are a magnet

for job seekers and an educated, permanent

workforce with spending power for local goods

and services.

Funding sources and trends

Between 2010 and 2014, global health

organizations in Washington state received

more than $3.7 billion in grant funding, with

55% in funds from the National Institutes of

Health (NIH).

Awards from federal entities to global health

have steadily declined since 2011. During this

time period grants in global health and global

development to Washington global health

organizations from the Gates Foundation

have increased by almost 42%.

In 2014, Washington organizations involved in

global health received more than $790 million

from various sources, not including business

income (Exhibit 7).

Exhibit 7. Grant Funding for Global Health Activities, Washington State, 2010-2014, Millions of 2013 Dollars

Note: Bill & Melinda Gates Foundation funding includes grants for Washington global health organizations in both the global health and global development program areas. “Other” includes the Life Sciences Discovery Fund, NSF and the Department of State. Source: National Institutes of Health, 2015; Centers for Disease Control, 2015; USAID, 2015; Gates Foundation, 2015; Life Sciences Discovery Fund, 2015; Department of State, 2015; National Science Foundation, 2015; Community Attributes Inc., 2015.

The NIH is the top funding source for

Washington’s global health organizations,

On average, between 2005 and 2014, 644

grants per year were awarded to global health

organizations in Washington state (Exhibit

8). This includes federal grants as well as

grants from the Gates Foundation. NIH

grants to Washington state organizations,

and organizations across the country, have

steadily declined since 2012.

Exhibit 8. Grant Awards for Global Health Activities, Washington State, 2005-2014

Source: National Institutes of Health, 2015; Centers for Disease Control, 2015; USAID, 2015; Gates Foundation, 2015; Life Sciences Discovery Fund, 2015; Department of State, 2015; National Science Foundation, 2015; Community Attributes Inc., 2015.

GLOBAL HEALTH CONTRIBUTES TO WASHINGTON STATE’S ECONOMY THROUGH INVESTMENT, INNOVATION AND EMPLOYMENT

followed by the Gates Foundation, USAID and

the Centers for Disease Control. Compared

to the total funding from federal sources since

2010, grants from the Gates Foundation

are a relatively small piece of all funding for

Washington state organizations.


0

$500

$1000

$1500

$2000

$2500

$3000

$3500

2007

Millions

$1781

$2550

$1510

$975

$3270

$1724

$2487

$2853

2008 2009 2010 2011 2012 2013 2014

“Washington is the epicenter of global health research, but there is a need to recruit more people to Seattle. It would be ideal to attract younger talent at the peak of their career.”


Year Global Health Employment

Global Health Year-Over-Year

GrowthWashington State

EmploymentWashington

Year-Over-Year Growth

2009 10,630 2,836,354

2010 10,970 3.2% 2,808,445 -1.0%

2011 11,570 5.5% 2,844,391 1.3%

2012 12,060 4.2% 2,894,394 1.8%

2013 12,620 4.6% 2,960,071 2.3%

2009 - 2013 4.4% 1.1%

Bill & Melinda Gates Foundation Grants

The Bill & Melinda Gates Foundation

granted $2.9 billion for global health and

global development projects and programs in

2014 (Exhibit 9). Global health research and

development work from 66 Gates Foundation

grants is currently underway in Washington state.

Exhibit 9. Gates Foundation Global Development and Global Health Grants Value by Project Start Year, 2007-2014, Millions of 2014 Dollars

Source: Gates Foundation, 2015; Federal Reserve Economic Data, 2015.

Organization spending is growing

Global health spending activities involve

grant-making, payroll, and other expenses, of

which a large share accrue within Washington

state. Together these activities make up the

operating budgets of organizations involved in

global health.

Spending by global health organizations

brings money into the state and contributes to

the innovation economy. While current project

spending totaled $318 million, global health

leaders point out that this investment does not

begin to address the growing need for product

development research.

Global health benefits Washington’s economy

Global health job impacts are counted in three

distinct categories: direct, indirect and induced.

Direct jobs (12,620 in 2013) includes the

actual jobs in global health at an organization

or business. Jobs in global health have grown

each year since 2009, from 10,630 in 2009 to

12,620 in 2013. Jobs in global health have

grown at 4.4% per year since 2009, four

times the rate of Washington state’s overall

employment (Exhibit 10).

Indirect jobs (8,200 in 2013) are created

by the business-to-business transactions

that come into existence due to the output

of workers in direct jobs. Additionally,

global health organizations in Washington

supported an estimated 12,000 jobs through

induced impacts, which are the jobs that

are supported by the spending of wages

throughout the Washington state economy

from the direct and indirectly supported jobs.

Exhibit 10. Global Health Employment and Growth Rate Compared to Washington state Employment and Growth Rate, 2009-2013

Source: Washington State Employment Security Department, 2014; Washington Global Health Organizations Survey, 2015.


Tax Category Direct Payments Secondary Tax Impacts

Total Fiscal Impacts

B&O 1.0 15.0 15.9

Sales Tax 0.4 26.2 26.6

Other 0.0 3.3 3.4

Total 1.4 44.6 45.9

Direct Indirect Induced TotalJobs 12,600 8,200 12,000 32,800

Labor Income 1,164.0 424.6 661.8 2,250.4

Operating Budget 5,845.8 1,317.9 2,265.4 9,429.1

State business and occupation (B&O) taxes

and sales taxes are generated, however,

from business-to-business spending from

sector activities. The sector and its indirect

and induced impacts provided $45.9 million in

state tax revenues in 2013.








Exhibit 12. Washington State Tax Revenues from Global Health Activities in Washington, 2013, Millions of 2013 Dollars

Source: Washington State Employment Security Department, 2014; Washington State Office of Financial Management, 2014; Washington Global Health Organizations Survey, 2015.

Economic multipliers help demonstrate

how direct output or revenues, wages

and jobs support and generate economic

impact throughout the Washington state

economy. For every million dollars in

global health output in Washington, a total

of 5.6 jobs are supported throughout the

Washington economy. For every dollar in

direct labor income an additional $0.93 is

generated throughout Washington state. As a

comparison, the apple industry in Washington

supports 3.95 jobs for every direct job and

$0.67 in labor income for every dollar of direct

labor income throughout the Washington

economy. This comparison shows how direct

job growth in global health is an excellent return

on investment, spurring both above-average

indirect and induced jobs and labor income.

Valuable fiscal impacts

Global health is important to Washington

because of the global good provided by

the sector, the jobs created locally and

the industry spending in-state. Fiscal

contributions provide another layer of

benefit, with the sector paying their share

of state provided services.

Nonprofits and philanthropies are exempt

from many taxes or do not generate taxable

income, so the direct taxes paid by the sector

are limited to primarily the for-profit entities.

Exhibit 11. Economic Impacts of Global Health, Washington, 2013, Millions of 2013 Dollars

Source: Washington State Employment Security Department, 2014; Washington State Office of Financial Management, 2014; Washington Global Health Organizations Survey, 2015.

Combining direct, indirect and induced

jobs, the global health sector supported an

estimated total of approximately 32,800 jobs

in 2013, including 20,200 jobs supported

by both inter-industry purchases and wage

expenditures purchases. These 32,800 jobs

produced an estimated $2.3 billion in total

labor income in 2013 (Exhibit 11).

Throughout the Washington state economy,

global health organizations directly accounted

for an estimated $5.8 billion in output in 2013.

Through the supply chain interactions and

wage spending from direct and indirectly

supported jobs, these direct impacts have

a multiplier impact of 1.6, generating an

estimated $9.4 billion throughout the

Washington economy.3 Average wages paid to

global health workers were $71,129 in 2013;

precisely 29% higher than the average wage

in Washington state for all jobs ($55,100).

While not a primary driver of Washington’s

economy, these data document global health

as an economic sector with an impact and

contribution worth recognizing and nurturing

as a part of the innovation ecosystem.

3 These numbers have been rounded. More

accurate figures are $5.85 billion in output, 1.61 as

a multiplier, and $9.42 billion in state-wide indirect

business revenues.


THIS VIBRANT SECTOR WILL CONTINUE TO GROW BY PROACTIVELY SEEKING NEW FUNDING MODELS AND METHODS OF COLLABORATION.

Global health organizations and state

leaders in Washington have much reason for

optimism. There are opportunities to enhance

the state’s influence on the global stage,

collaborate with new and talented partners

and advance new solutions. A few challenges

are looming locally as the global health

community tackles the most complex health

challenges across the world. As global health

organizations think about their changing

strategies around staffing and the sector

competes for talent with other innovative

sectors (such as software development),

new trends will emerge. Success will be

measured by the degree to which Washington

organizations can make room for new,

more flexible funding to support continuous

innovation, manage its skilled workforce, and

add new training and education programs to

keep the talent pool competitive.

Global health growth areas

Areas of focus and need among specific

global health disciplines are difficult to predict

in the case of epidemics (the Ebola outbreak

and response, for example). Washington

organizations are uniquely tooled to address

both outbreaks and pandemics like HIV/

AIDS. In addition, the global health community

anticipates increased international focus and

spending around the United Nation’s newly-

created Sustainable Development Goals.

One measure to determine the future focus

of global health is hiring. When asked about

how the sector will grow, local HR directors

reported increased funding for projects in

several disciplines:

• Diagnostics

• Nutrition innovation (i.e. fermentation and

insects as food sources)

• Vaccine development

• Biotech

• Digital health

• Global development and agriculture research

In citing anticipated growth of these

disciplines, HR directors specifically call

out the increased need for inexpensive and

quick testing to diagnose and rapidly treat

communicable diseases. The University

of Washington and the Infectious Disease

Research Institute, among others, are working

in this space already.

Washington state’s global health community

needs to further support the emerging

research needs within agriculture and

environment. Projects in these categories

address natural and man-made environmental

factors that impact health. More and more,

organizations find health outcomes can

be improved in rural and urban areas with

breakthroughs in water, sanitation and hygiene

(WASH). Targeted investments in WASH

behavior modification and product innovation,

particularly from the Bill & Melinda Gates

Foundation, are yielding life-changing solutions

around the world.

New funding models

Important changes have occurred recently that

affect global health spending in Washington

state, including new sources of funding as

well as constraints placed on how funds are

disbursed. Current sources of funding include

government agencies, private foundations,

private coalitions and individual donors,

however, these sources are not adequate to

sustain progress in future years. In response,

many global health organizations in Washington

choose to turn to private donors who give

unrestricted gifts.

The following trends have affected funding models:

• Overall federal grant funding has slowed

• Competition for grants has increased

• Requirements for grant funding have become

more intricate

• Caps on so-called “indirect spending” limit

innovation and stifle interest in pursuing

some grants

• Grants are tied more to specific projects

versus outcomes that limit funding for new

innovations or basic science discovery

• Philanthropies defer to the Gates Foundation

to fund all global health activities

• A disconnect between funding cycles and

the time needed to implement programs

with measurable impact

• A “silo” mentality about diseases reinforced

by funding structures; organizations are not

financially incented to study how different

diseases relate to each other

• Diverse and complex granting bodies

require more specialized attention

Global health organizations were asked to

describe their biggest changes in funding.

Among them, a majority said they now solicit

funding from individuals, as well as private

foundations. This also provides increased

opportunities for individual donors to influence

programmatic focus and requires global

health organizations to mature fundraising

practices with appropriate hires.


32+68+MAre hiring now: 68%

Are not hiring now: 32%

RESPONDENTS (n=68)Are hiring now: 46 Are not hiring now: 22

“Global health is becoming part of Washington state’s brand, particularly around innovation, and WGHA is making the case to start working together. It’s a legacy of collaboration”


Key global health challenges

Washington’s global health leaders see a

number of challenges facing global health

effectiveness. Leaders expressed urgency to

address the following barriers:

• Improving infrastructure in low- and

medium-income countries—especially

transportation, energy and communications

• Scaling and capacity building in-country

• Identification and training of

in-country partners

• Empowering women and reducing

gender inequity

The challenge most discussed among global

health leaders is matching the appropriate

levels, duration and flexibility of funding to

appropriately address complex global health

problems. Looking forward, new funding

approaches are needed to help global health

research and organizations meet the ever-

changing needs of the world’s most vulnerable

people. One recommendation from many local

organizations was to move out of a 3-5 year

project cycle to a longer-term funding model to

achieve community sustainability. In addition,

organizations are increasingly aware that

projects need to move from focusing on specific

diseases to more interdisciplinary programs with

funding-based outcomes. There is a heightened

need to generate sustainable revenue sources

for global health organizations and partner

directly with the private sector on research and

program delivery.

Government funding has declined since 2012

with no immediate indication for increases.

Global health leaders say new funding models

are essential to continue making significant

progress as seen in the last decade. The

social returns in global health make it well-

aligned with socially responsible, impact

investing, though the community has yet to

build appropriate investment vehicles.

The variety of funding has to match the

activities across the spectrum of discovery,

development and delivery. The kind of

funding available has to have flexibility and

risk tolerance to allow for innovation and the

development of new business models.

Forecasted job growth in Washington and abroad

Washington’s global health community is

growing. Global health workers in Washington

are in high demand both within the sector and

from other industries separate from health

care. Among online survey respondents, 68%

indicated, as of 2015, they were hiring new

employees (Exhibit 13).

Exhibit 13. Washington Global Health Organizations by Hiring Status


Not all organizations hire global health

workers based in Washington. A recent pivot

in hiring practices has organizations exploring

and hiring in-country employees to reflect

their focus on building local capacity. With

constant emphasis on reducing administrative

overhead, employers may decide they can

reduce costs and deliver services or products

more effectively by placing workers directly

in low-resource settings or building personal

relationships with in-country partners.

How to maintain the pipeline of global health workers

Washington state’s quality of life, coupled

with high wages and mission-driven work are

drivers for attracting a strong global health

workforce. Also important is the influx of talent

associated with the state’s universities and

colleges. Additional programs like internships

and postdoc programs further develop

existing talent. Not only do Washington’s

universities produce undergraduates and

graduates in research and technical fields,

but many schools also provide programs

in communications, public administration,

entrepreneurship and finance, which

provide education for global-health-related

occupations. Washington State University has

just created a position titled Senior Director

of Global Health to centralize its many global

health activities. The influence of large

employers such as the Gates Foundation

and Fred Hutchinson Cancer Research

Center are undeniable.


Management

Software and Web Development

Research and Technical Assistants

Professors and Faculty

Scientists

Finance and Grant Managers

Manufacturing

Business Development

Evaluation and Metrics

Sales

Even so, recruiting challenges persist.

Washington state may not be top of mind

among graduate students and schools on

the East Coast, thereby limiting the pool

of applicants. Most global health positions

require a high and/or specialized level of

education and training, which means there

are fewer candidates who meet the minimum

qualifications. There is an outsized demand

for global health programs that the state’s

universities are not currently set up to meet

due to state funding constraints. For example,

the University of Washington’s School of

Nursing is exploring creating global health

emphases due to a demand from students.

Finally, the cost of living in the Seattle area

can be a negative factor among candidates

coming from less expensive geographies.

Even when a candidate wants to work in

global health in Washington state, his or her

skills or salary expectations might not be

appropriate for the jobs that exist; alas some

occupations in global health remain more

difficult to fill than others (Exhibit 14).

What makes a global health job difficult to fill?

• Increasing specialty roles such as program

managers and engineers

• Increasing demand for workers with upper-

level management experience

• Increasing competition from local software

development companies

• Wage gaps between nonprofits and the

private sector

• Increasing need for candidates to live or

work abroad

Exhibit 14. Most Difficult-to-Fill Positions, as Indicated by Survey Participants


Growing the talent pool of qualified candidates

will increase Washington’s impact in solving

global challenges like HIV/AIDS, tuberculosis

and malaria. Many organizations have a role

to play—universities, nonprofits, the private

sector, and convening groups like WGHA.


5. Create new business models through

new partnerships with aligned corporate

and government entities to develop new

revenue-generating opportunities in the

development and delivery of global

health solutions.



Conclusion

Washington state has the talent, innovative

spirit and unique concentration of

organizations to lead the world in global

health discovery, development and delivery.

To realize the potential of this sector, strategic

investments and new partners are needed.

Through organizations dedicated to improving

and saving lives around the world, the global

health community drives awareness of

Washington state as an economy focused on

improving lives at home and abroad.


Responding Organizations

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Agros International X X X X

Aseptico X X

AttoDX X X X

Battelle X X X X X X X X X X X X X X X

Benaroya Research Institute at Virginia Mason

X X X

Bethany Community Church X X

Big Water Consulting X X

Bill & Melinda Gates Foundation X X X X X X X X X

Burn Manufacturing X X X X

Camber Collective X X X X X X

Center for Infectious Disease Research

X X X X X X X

Centurion Medical Products X X X

CRISTA/World Concern X X X X X

Critical Practices LLC X X X X

Day for Girls International X X X X X X X

EG Walker Associates X X

First Presbyterian Church of Spokane

X X X X X

Fred Hutchinson Cancer Research Center

X X X

Gambia Health Education Liaison Project

X X X X X X X

Geneva Foundation X X X X X X X X X

Global Health Activities Global Health Focus Areas

WGHA ONLINE SURVEY RESULTS

WGHA Member



Fund

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Global Alliance to Prevent Prematurity and Stillbirth – an initiative of Seattle Children’s

X X X X

Intellectual Ventures (Global Good)

X X X X X X X X X X X X X

global HELP X X X X

Greater Spokane Incorporated X X X X X X X X X

HDR X X X X X X X X X X X

Health Alliance International X X X X X X X X

Infectious Disease Research Institute X X X X X X

Institute for Health Metrics and Evaluation

X X X X X X X X X

International Training and Education Center for Health

X X X X X X X X X X

JBLM 84th Civil Affairs Battalion X X X X X

Just. X X X X X X

Kineta X X X X X

Life Sciences Discovery Fund X X X

Limbs For U X X

MalarVx, Inc. X X

Max Foundation X X X X X X

MED25 International X X X X X X

Medical Teams International X X X X X X X X

Micronics X X X

Microsoft X X X X X X

Mobility Outreach International X X X X X X X X X X

Mobisante X X


WGHA Member



Fund

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Mountain Safety Research (MSR Global Health)

X X X X X X X

Northeastern University X X X X X X X X X

Oasis Diagnostics X X X X X X X

One by One X X X X X X X X

PATH X X X X X X X X X X X X

Philips Healthcare X X X X X X X

Pilgrim Africa X X X X X

Planned Parenthood of the Great Northwest

X X X X

Sherris Consutling X X X X X X X X X

SightLife X X X X X X X X X

SIGN Fracture Care International X X X X

Splash X X X X

SpringStar Inc. X X X X

Stratos Product Development X X X X X

Strengthening Care Opportunities through Partnership in Ethiopia

X X X X X X

University of Washington X X X X X X

University of Washington Department of Global Health

X X X X X X X X X X X X X X X

UW Bioengineering Lab (Paul Yager)

X X

Village Reach X X X X X X X X X

Washington Research Foundation/WRF Capital

X X X X X X

Washington State University X X X X X X X X X X X X X X X


WGHA Member



Fund

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Washington State University – Spokane campus

X X X X X X X X

Water for Humans X X X X X X

Weber Shandwick X X X X X X X X X X X X X X

World Concern X X X X X X

World Vision X X X X X X X X X X X X X X


WGHA Member

Documents

Washington Global Health Landscape Study 2015 Final Report