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Getting the Global Perspective: An Interview with Richard Klausner of the Bill & Melinda Gates Foundation

Dr. Richard Klausner has a big job. As executive director of the Bill & Melinda Gates Foundation's Global Health Program, Klausner oversees the foundation's effort to improve global health equity by accelerating the development, deployment and sustainability of tools and technologies that will save lives and dramatically reduce the disease burden in the developing world. Klausner brings nearly three decades of medical and scientific leadership to the foundation's global health program. Under Klausner's direction, the global health program staff, in collaboration with grantees and partners in both the public and private sectors, focuses on projects addressing HIV, tuberculosis, malaria, and other infectious diseases, in addition to projects that aim to improve reproductive health, maternal health, child health, and nutrition.

In an interview conducted in April, Klausner commented on a variety of global health issues, the Gates Foundation's funding priorities, and the challenges and opportunities facing today's nursing professionals.

Americans used to think of global health issues as "developing country" issues. With the SARS virus in the headlines, many of us now think differently. What's your assessment of public opinion?

Global health issues must be the concern of people everywhere. We are all morally and ethically part of one world-a world without walls to protect us from the diseases or the consequences of diseases of developing countries. The AIDS epidemic, the West Nile virus and now the SARS virus have shifted our thinking. Sept. 11 was a critical part of our waking up to the fact that we're not isolated-that we're vulnerable.

There's no moat around us keeping us from the rest of the world's health problems. However, there is a huge divide that separates us from finding solutions to them. Today, only 10 percent of medical research is devoted to the diseases that cause 90 percent of the health burden. To help address this disparity, the Bill & Melinda Gates Foundation, in partnership with the National Institutes of Health, has issued a global call to the research community to identify "grand challenges" in global health. These grand challenges are problems that, if solved, could lead to important advances against diseases of the developing world, such as AIDS, TB, and malaria. The initiative's international scientific board is announcing the first round of challenges in September and will be soliciting proposals to solve these problems this fall.

The Gates Foundation has received a lot of publicity for its support of AIDS research and its work in other countries. Is the foundation doing anything to address local health inequities?

One of the sad and interesting things about our wealthy society is that the problems we associate with the developing world are problems we face here. There are many sources to the problem of our dropping vaccine levels, such as finding culturally sensitive ways to deliver health care. The Bill & Melinda Gates Foundation is not working on domestic health disparities.

Our focus is global because few other organizations are working on the problem of health disparities on a global level-that's where the resources are needed most. The United States doesn't lack financial resources. What we do lack is the political will and social conscience required to address the problem.

The U.S. has a reputation for recruiting nurses from other countries- often countries that can't afford to lose trained nurses. What's the solution to the nursing shortage crisis?

The U.S. has a long tradition of solving labor shortages by looking outside its borders. It's a practice that has enriched our country. Our recruitment of nurses and nursing students isn't the reason for the world's nursing shortage. There's a lack of resources to train and retain nurses. We need a free market. Opportunities are needed in the developing world to foster competition. Developing countries need to create incentives to keep their nurses from leaving home. The answer to the nursing shortage is not to inhibit free movement but for other countries to find a way to fulfill their nurses' aspirations.

How do you see the role of nursing changing? Where is the profession headed in the coming years?

Nursing challenges remain at the center of three health care issues in the U.S. The first is the constant tug between generalists and specialists and the issue of who uses and oversees new technology. Second is the changing demographics of the U.S. and the resulting health issues. The number of older individuals with special health problems is growing. There's been a shift from needing nurses to treat acute illness to needing nurses trained to help people with chronic diseases. This new dynamic provides a great opportunity for the field. Lastly, the financing of the health care system will always be a part of the mix of challenges for nursing.

How might nursing students train to have more of a worldview?

It's essential that nurses and nursing students train to become more globally aware. Nurses and nursing students should seek out direct experiences around the world at all points in their careers. They need to be provided with opportunities and information on the many ways they can expose themselves to and become involved in global health issues.

Prior to assuming his post at the Bill & Melinda Gates Foundation, Dr. Richard Klausner was director of the National Cancer Institute (NCI), where he led one of the world's largest research and health agencies. Klausner has been a senior fellow at the National Academies of Science, advisor to the Presidents of the Academies for counter-terrorism, and liaison to the White House Office of Science and Technology Policy. Klausner served as chief of the cell biology and metabolism branch of the National Institute of Child Health and Human Development and on numerous advisory committees and is the past president of the American Society for Clinical Investigation. Klausner received his undergraduate degree from Yale University and his medical degree from Duke University. After postgraduate medical training at Harvard, he began his research career at the National Institutes of Health.

For more information about the Grand Challenges in Global Health initiative, visit