Dr. Alex Cahana: Positive Impact, Healthcare and Technology
This week, the TTI Interview Series covers our member Dr. Alex Cahana. Alex is the founder of BTblock Health Group, the blockchain-focused technical development firm. He’s also a board member at AdaLab Africa and a strategic advisor at ConsenSys Health, bringing 25 years in clinical practice, 15 years in medtech and 6 years in blockchain technology.
In this interview, Alex talks about how his experience across different sectors has shaped his world views and about the positive power of technology for creating equality in the world.
Healthcare and blockchain technology for positive impact
Alex, you like to say that you lived 4 lives in 1. Tell us more about how your work intersects with the impact investing space.
It means not only that I'm old, but also that I know the dirty little secrets of each life. I’m a soldier, a physician, a philosopher and a “blockchanger”. I’m on a quest to empower people to transform from health service consumers into health and wealth producers. A soldier - sticking to his mission and understanding that “none of us is as good as all of us”. A physician - dedicating his life to alleviate pain and suffering. A philosopher - interested in understanding one’s unique voice and trying to discover a method to investigate our rich subjective worlds. A “blockchanger” - applying the unique combination of computational trust, game theory and behavioral economics.
My passion is to listen, diagnose and heal the pain of individuals, companies, communities and society. I help organizations, local governments and policy makers understand their vulnerabilities and risks. I guide them on a journey to design, discover and deploy sustainable solutions. As an entrepreneur and investor, I help early stage ventures refine their approach and connect them to sources of social and financial capital.
Alex Cahana: impact as your personal footprint
What is your own definition of impact?
For most of us, we hear about impact when we study Newtonian physics in high school. We think of impact as a force applied to a body. We also learn that when one body exerts a force on another, the second body exerts an equal and opposite force. So we graduate thinking of impact as an action that must be measured and will be naturally resisted. In medicine, we associate impact with damage or trauma and try to mitigate or prevent its effects.
We also start to think of impact as the effect we exert on our patients. How our knowledge can translate to advice and actionable information, which can protect our patients from injury and disease. We learn not only about the physical but also the psychological, social and economic impact we have on other lives. And with that experience comes research and discovery, which brings the infamous ‘impact factor’, or the way physicians measure their academic prowess, that translates to prestige and fame.
However, our impact is the footprint we impress around us. For it to be a halo rather than a shadow, we must remember that although it is important to “do things right”, it’s fundamental to “do the right thing”.
Let’s avoid centralization in areas like healthcare
When you think about your experience across different sectors, what do you believe is one of the most important issues that need to be solved over the next 10 years?
COVID-19 has shown how vulnerable we are. An invisible virus has infected to date 50M, killed 1.25M, halted economic activity and has thrown 150M people into extreme poverty. In developed and developing economies, local and state governments have seen the limitations of lack of preparation, uncoordinated just-in-time supply chain and paucity of data that can translate into real-time, actionable information - but the conclusions on how to tackle and solve this and other future outbreaks have been erroneous.
National and international organizations continue to centralize information in national databases and enforce public health measures, like track and tracing, creating de-facto surveillance states. Governments are ignoring that these centralized structures are attack-, censor- and collusion- vulnerable and are behind our failing response.
“The intent to continue to centralize information will create data monopolies that can and will be exploited for political and financial gain, under the guise of public health.” Alex Cahana
It is therefore imperative to invest in decentralized and privacy preserving technologies, like blockchain, verifiable computing and federated learning to create cyber-resilient systems. We need to invest in providing self-sovereign digital identities (DID) to all (SDG 16.9), because without an identity we are invisible. We are unable to access healthcare, vote, open a bank account, get employment and at risk for exploitation and trafficking. Owning our digital identity provides accurate population data, while governments and organizations can monitor key demographics, public health indicators and deliver basic human services and socio-economic planning without the risk of surveillance and exclusion.
From denial to acceptance
On that note, what do you think are some of the biggest challenges in the impact space? What stands on the way of change-makers being able to provide solutions faster?
Change is hard and the world is changing fast. Be it the Fourth Industrial Revolution or Web 3.0, we are fundamentally changing the way we live, learn, work and interact with each other. These changes are not merely technological, but challenge our fundamental beliefs on how our world works. The idea of ‘going back to normal’ is gone, because it is the ‘normal’ that brought us this non-sustainable reality.
Yet, change has been here before and robust methodologies on how to change are implemented regularly in the impact space. Mapping out “outcomes pathways” has proven to be a clear way to monitor every step of change. But often programs do not achieve their goals. The reason is simple, change is not an organizational challenge. It is an emotional one. We are our own biggest obstacle to change.
Therefore to understand change, it might be instructive to follow Dr. Kubler Ross’ stages of grief and loss. First is denial. Many do not see the change. “Climate change is a hoax”, “we have the best healthcare system in the world”. Then comes anger. “COVID is not our fault”, “financial meltdown was a black swan event”. Stage 3 is bargaining, “maybe we don’t need to wear masks all the time”, “let’s open businesses”. Next is depression. We are overwhelmed by a reality that seems unrelenting and unforgiving.
Finally comes acceptance. Only when acceptance arrives, true change and true impact can occur.
The impact of owning your health data
Tell us more about the long-term vision you have for your work and how you measure & quantify your impact.
Imagine a world where you own your health data and you access it as easily as ordering on Amazon. Imagine a world where health information is like money. Personal, private, valuable, and safe inside a secure wallet. Like money you access your data whenever, wherever, for whatever reason and being of value, you invest in it. You treat your health like wealth, and you can inherit it to your nears or donate it to society. Until that world arrives I continue to work and leapfrog healthcare in Africa. Not by measuring impact through morbidity and mortality, or disability and quality-adjusted-life-years.
I measure impact by the number of lives we touch.
Are people actively engaging with their health platform? Are they achieving their wellness goals? Are they earning money and tokens, through healthy behavior (Universal Health Income)? Impact is measured by commitment. Establishing networks and relationships with users, providing them active roles in knowledge exchange and research, developing good understanding of policy and practice, involving the community as translators, amplifiers and ambassadors are all signs of creating a ‘new realty.
Health, wellbeing and financial inclusion are one and solutions to encourage micro-lending, micro-savings and micro-influencing are all part of our community health. The opposite of health is not disease but isolation, and by reconnecting to community we achieve health or as I say often:
If we take out the ‘I’ in illness and replace it with ‘we’, we get wellness, and that is quite the impact!Alex Cahana’s positive impact and “response-ability”
In the work you do within healthcare and blockchain technology, what are some of the misconceptions you’ve noticed regarding what impact is all about?
Impact is not objective. It is not even subjective. Impact is an inter-subjective, bi-directional experience. It is not something we do on someone or something, but rather a response, to quote the french philosopher Emmanuel Levinas: ‘to the call of the other’ (l’appel de l’autre). Our responsibility is actually a response-ability to the other. Once we understand that acquiring this -ability is key, then we will be truly impactful.
