Perspectives
Profile David Evans: putting universal health coverage on the agenda There have always been doubters when it comes to universal health coverage (UHC). But David Evans has always been a dreamer. Before WHO’s 2010 World Health Report Health Systems Financing: the Path to Universal Coverage changed the policy landscape at a stroke, the argument for UHC looked like it might never be won. “When we first put out the idea of UHC as a guiding principle of health financing, we had a big meeting outside Geneva. One of the big donors stood up, and he said this is a pipe dream, it’s too far-fetched”, Evans, an economist by training, recalls. “But I’m pleased we did have that dream and that he was wrong.” UHC is now firmly on the post-2015 health agenda, and this year sees the first Universal Health Coverage Day on Dec 12. The years since that 2010 report have been some of Evans’s most fruitful as Director of the Department of Health Systems Governance and Financing at WHO, an organisation he joined in 1990. I met him in his temporary office at WHO’s headquarters in Geneva, after his old space was requisitioned for a new Ebola operations centre. The turmoil, though, is nothing new to Evans, a veteran of five WHO Director-Generals and all the shifting politics and priorities that come with each new administration. “In this organisation, understanding how to get things done is critical”, he says. “I had a supervisor in my honours year [at the Flinders University of South Australia, Adelaide] who had worked at the International Labour Organization, and I asked him what it was like. He said any UN organisation is a political organisation, but a good director can get things done even if they are in a sea of mediocrity. I don’t say WHO is a sea of mediocrity”, he laughs, “but there are ways of getting things done. You’ve got to adapt to the organisation. You’re always going to have turf wars, political issues, financial problems, and the quicker people understand that the quicker they can get on with what they have to do instead of dreaming of reforms.” Evans’s ability to get things done at WHO is valued by colleagues. “It’s not easy to survive in an international bureaucratic and political organisation like WHO and maintain your intellectual integrity”, says Suwit Wibulpolprasert, of Thailand’s Ministry of Public Health. “David is one of the few who has been extremely successful.” On meeting Evans it’s not hard to see why, with his tinder-dry humour keeping the conversation light and hinting at a healthy non-conformist streak. There was always an expectation that he would follow in his father’s footsteps and go into medicine, but Evans had other ideas. “I had a fairly fractious relationship with my father in my teens”, he recalls. “I didn’t know what I wanted to do, but I knew it wasn’t going to be medicine”. An aptitude for maths and a passion for history led him to economics, and after graduating with a PhD in 1980 he spent a decade as an www.thelancet.com Vol 384 December 13, 2014
academic economist. “Academic economics is intellectually challenging and interesting, but it’s all going in circles with models and there’s rarely any sense that it’s useful for anything”, he says. “I enjoyed teaching…But after a while I started finding the questions around health more and more interesting.” In 1986, he became probably the first academic appointment of a health economist to a medical faculty in Australia when he took a position in the clinical epidemiology unit at the University of Newcastle, but keen to make more of an impact on policy he moved to WHO’s Special Programme for Research and Training in Tropical Diseases (TDR) in 1990. His 8 years with TDR helped Evans learn the political ropes before his promotion to Director of the Global Programme on Evidence for Health Policy in 2000, midway through the term of then Director-General Gro Harlem Brundtland. “Under Julio Frenk and Chris Murray, we were Dr Brundtland’s favoured part of WHO, so suddenly money wasn’t as much of a problem and we were able to do a good mix of the technical, academic, and political work that makes the organisation so interesting”, he says, among which was the World Health Report 2000 Health Systems: Improving Performance. However, there’s no doubt that Evans’s “crowning achievement” is the World Health Report 2010 on financing for UHC, says Tim Evans, the World Bank’s Senior Director for the Health, Nutrition and Population Global Practice. “The report has managed to draw attention to the core financing functions of progressive equitable and efficient financing of health systems that hitherto have escaped policy makers’ attention”, he says. That work will now be taken forward by Evans’s as-yet unnamed successor, as he prepares for a typically unconventional retirement in 2015. With a 5-year-old son, another child unexpectedly on the way, and a new academic position at the Swiss Tropical and Public Health Institute in Basel, his will be retirement in name only. “For me personally I’d like to start thinking about some fundamental things for low-income and middle-income countries that haven’t really been looked at. I’m particularly interested in the fiscal incentives and disincentives for changing people’s behaviours. I think fiscal and regulatory controls are very important but we haven’t done anything on that apart from in very rich countries”, he says. And Evans will keep a watchful eye on how the UHC agenda is taken forward. “I don’t think UHC has run its course yet for WHO”, he says. “In 10 or 15 years someone’s going to come up with something else to keep up this momentum for equity, and in the next 5 years we’ll see where the new Director-General wants to go. But this push to UHC is here for another 5 years at least.”
See Editorial page 2083
David Holmes 2101
Profile David Evans: putting universal health coverage on the agenda There have always been doubters when it comes to universal health coverage (UHC). But David Evans has always been a dreamer. Before WHO’s 2010 World Health Report Health Systems Financing: the Path to Universal Coverage changed the policy landscape at a stroke, the argument for UHC looked like it might never be won. “When we first put out the idea of UHC as a guiding principle of health financing, we had a big meeting outside Geneva. One of the big donors stood up, and he said this is a pipe dream, it’s too far-fetched”, Evans, an economist by training, recalls. “But I’m pleased we did have that dream and that he was wrong.” UHC is now firmly on the post-2015 health agenda, and this year sees the first Universal Health Coverage Day on Dec 12. The years since that 2010 report have been some of Evans’s most fruitful as Director of the Department of Health Systems Governance and Financing at WHO, an organisation he joined in 1990. I met him in his temporary office at WHO’s headquarters in Geneva, after his old space was requisitioned for a new Ebola operations centre. The turmoil, though, is nothing new to Evans, a veteran of five WHO Director-Generals and all the shifting politics and priorities that come with each new administration. “In this organisation, understanding how to get things done is critical”, he says. “I had a supervisor in my honours year [at the Flinders University of South Australia, Adelaide] who had worked at the International Labour Organization, and I asked him what it was like. He said any UN organisation is a political organisation, but a good director can get things done even if they are in a sea of mediocrity. I don’t say WHO is a sea of mediocrity”, he laughs, “but there are ways of getting things done. You’ve got to adapt to the organisation. You’re always going to have turf wars, political issues, financial problems, and the quicker people understand that the quicker they can get on with what they have to do instead of dreaming of reforms.” Evans’s ability to get things done at WHO is valued by colleagues. “It’s not easy to survive in an international bureaucratic and political organisation like WHO and maintain your intellectual integrity”, says Suwit Wibulpolprasert, of Thailand’s Ministry of Public Health. “David is one of the few who has been extremely successful.” On meeting Evans it’s not hard to see why, with his tinder-dry humour keeping the conversation light and hinting at a healthy non-conformist streak. There was always an expectation that he would follow in his father’s footsteps and go into medicine, but Evans had other ideas. “I had a fairly fractious relationship with my father in my teens”, he recalls. “I didn’t know what I wanted to do, but I knew it wasn’t going to be medicine”. An aptitude for maths and a passion for history led him to economics, and after graduating with a PhD in 1980 he spent a decade as an www.thelancet.com Vol 384 December 13, 2014
academic economist. “Academic economics is intellectually challenging and interesting, but it’s all going in circles with models and there’s rarely any sense that it’s useful for anything”, he says. “I enjoyed teaching…But after a while I started finding the questions around health more and more interesting.” In 1986, he became probably the first academic appointment of a health economist to a medical faculty in Australia when he took a position in the clinical epidemiology unit at the University of Newcastle, but keen to make more of an impact on policy he moved to WHO’s Special Programme for Research and Training in Tropical Diseases (TDR) in 1990. His 8 years with TDR helped Evans learn the political ropes before his promotion to Director of the Global Programme on Evidence for Health Policy in 2000, midway through the term of then Director-General Gro Harlem Brundtland. “Under Julio Frenk and Chris Murray, we were Dr Brundtland’s favoured part of WHO, so suddenly money wasn’t as much of a problem and we were able to do a good mix of the technical, academic, and political work that makes the organisation so interesting”, he says, among which was the World Health Report 2000 Health Systems: Improving Performance. However, there’s no doubt that Evans’s “crowning achievement” is the World Health Report 2010 on financing for UHC, says Tim Evans, the World Bank’s Senior Director for the Health, Nutrition and Population Global Practice. “The report has managed to draw attention to the core financing functions of progressive equitable and efficient financing of health systems that hitherto have escaped policy makers’ attention”, he says. That work will now be taken forward by Evans’s as-yet unnamed successor, as he prepares for a typically unconventional retirement in 2015. With a 5-year-old son, another child unexpectedly on the way, and a new academic position at the Swiss Tropical and Public Health Institute in Basel, his will be retirement in name only. “For me personally I’d like to start thinking about some fundamental things for low-income and middle-income countries that haven’t really been looked at. I’m particularly interested in the fiscal incentives and disincentives for changing people’s behaviours. I think fiscal and regulatory controls are very important but we haven’t done anything on that apart from in very rich countries”, he says. And Evans will keep a watchful eye on how the UHC agenda is taken forward. “I don’t think UHC has run its course yet for WHO”, he says. “In 10 or 15 years someone’s going to come up with something else to keep up this momentum for equity, and in the next 5 years we’ll see where the new Director-General wants to go. But this push to UHC is here for another 5 years at least.”
See Editorial page 2083
David Holmes 2101
