Pritpal Tamber

Each week Maria Franzoni, Speaker Bureau Director, invites one of her speakers to talk about their life, work, passions and leisure so that you can get to know the person who is the speaker behind the mic.

This week Maria’s guest on the show is Dr. Pritpal S. Tamber. Pritpal is the CEO and co-founder of Bridging Health & Community, a Seattle based non-profit dedicated to transforming how healthcare works with communities. At the heart of its work is the insight that our current approach to health, deploying technical solutions to biomedical problems, is failing in a world of circumstance related chronic conditions. Bridging Health & Community has gleaned 12 overarching principles for how healthcare can work with communities. These principles also have the potential to foster the agency of communities, their ability to make purposeful choices, something increasingly recognised as core to health. He is the former physician editor of TEDMED and began his career as an editor at the British Medical Journal.

Pritpal tells us how he became an editor at the British Medical Journal, what he learnt from working at Biomed, explains a bit about TED and TEDMED and talks about his work in Bridging Health & Community. He shares his thoughts on why healthcare systems are failing and why he is flexible on being a cat or a dog person!

More about Pritpal Tamber

More about Maria Franzoni Ltd

Connect with Maria on Linkedin

Connect with Maria on FaceBook

To book any of the speakers featured on the Speaking Business podcast, click here

You just have to start getting healthcare to look in the mirror and realise that it’s not as effective as it could be, and realise why.

Podcast Transcript

This week Maria’s guest on the show is Dr. Pritpal S. Tamber.  Pritpal is the CEO and co-founder of Bridging Health & Community, a Seattle based non-profit dedicated to transforming how healthcare works with communities. At the heart of its work is the insight that our current approach to health, deploying technical solutions to biomedical problems, is failing in a world of circumstance related chronic conditions. Bridging Health & Community has gleaned 12 overarching principles for how healthcare can work with communities. These principles also have the potential to foster the agency of communities, their ability to make purposeful choices, something increasingly recognised as core to health. He is the former physician editor of TEDMED and began his career as an editor at the British Medical Journal.

Maria:

Welcome, Pritpal, thank you for joining me on the Speaking Business podcast. How are you?

Pritpal Tamber:

I’m very well, interesting to go through this podcast.

Maria:

Yes, fantastic. Well let’s find out a bit more about you then, Pritpal. Let’s find out, what did you want to be when you were growing up?

Pritpal Tamber:

Great question. An astronaut. I thought I was going to be an astronaut, that was the idea, that was the hope. It didn’t last very long, I sort of realised how hard the sciences were so medicine was as far as I would take it but yes, it was an astronaut when I was a kid.

Maria:

But were you interested in medicine, per se?

Pritpal Tamber:

Not a huge amount, I actually wasn’t that bothered about medicine when I was a kid, it was more that I was a bit of a science nerd, so I just was very good at biology, physics and chemistry and then you’re sort of trying to ask yourself what a teacher, especially one quite influential teacher when I was a kid, encouraged me to be an engineer, but my family were a bit more interested in having a doctor in the family and so in the end, I went in that direction.

Maria:

Always good to have a doctor in the family, I think. So you became editor at the British Medical Journal, how did you get that particular job and how long were you there?

Pritpal Tamber:

Well, I became an editor there, so not the editor. When I was there, I first won a scholarship when I was a medical student, so at the end of my fourth year, they were doing eight week scholarships. So medical students quite often will go for six to eight weeks somewhere to study some branch of medicine in a way that is off curriculum but is educational in its own way, and I wanted to learn about publishing and editing and so I was interested in being a writer at the time and so I won a scholarship there, that was for six to eight weeks, and then proposed to them that they take a student, who I also then happened to propose it to be me, for a year to be a student editor in office.

So I did that, so I was there for 14 months before I went back to medical school, graduated and started my medical career. But yes, I was there for that 14 months and that job became a permanent job with they’ve recruited a student for every year for, I think that job lasted for 25 years before they finally closed it down, I’m not quite sure why they closed it down in the end, but that’s how it all started.

Maria:  

A very good start as well. You worked at Map of Medicine and if I’ve understood correctly, that mission there, at Map of Medicine, was to improve the flow of patients through the healthcare system, which is a great thing to be doing. Have you seen improvements in patient flow through healthcare do you think?

Pritpal Tamber:    

There might have been, it’s very difficult to know.  So the premise of Map of Medicine was that there’s this thing in healthcare, and I think probably in most industries, called the know-do gap. The difference between what we know from research and what is actually happening in practise. Map of Medicine’s premise was that if we can deliver knowledge at the point of care, in a way that is context sensitive, then you can improve decisions of doctors and therefore improve the flow of patients through healthcare systems, because they’re not bouncing around, they’re going in the right direction each time. In the end, and in hindsight, I was there for four years, in hindsight ultimately it was a naïve proposition because what you learn by trying to do that work is that knowledge, even when coupled with powerful technology, and even if surfaced in a context sensitive manner, cannot really influence what happens in the complex environment of health and actually so much more about how systems improve come down to people and culture.

So we were a technical solution in a world that needed a social solution. So, although it was a very good proposition and I think we did some really great work there, we weren’t enough, essentially, of an organisation trying to change the culture in healthcare delivery. We were really just trying to produce a technical solution.

You know, the shame of it is, is that we were not the first to learn the challenge wasn’t technical, the challenge was social, but when you look at what’s happening in the NHS and other healthcare systems, we continue to see solutions that are technical in nature and not social. So it’s amazing how we in healthcare, as a global industry, really just fail to learn that message over and over again.

Maria:     

Wow, yes, I wasn’t expecting that answer, that’s a really interesting answer, we’ll come back to that a bit later, I’m sure. Thank you for that. So I see you as a bit of a disrupter, and I hope you don’t mind me saying that about you, and one of the examples is when you were at BioMed Central, where there you made some great changes in academic publishing. I didn’t even know there was a need to disrupt academic publishing and make it more transparent. What was the need there?

Pritpal Tamber: 

I don’t know that I am a disrupter, I was just a staff member there but I learnt from the founder who himself was a serial disrupter. For me, it was just an interesting job. Really what happened was, was that what he perceived was the advent of the internet changed distribution of knowledge. So the distribution of knowledge is classically defined in academic publishing was really just subscription. You would buy a subscription to a journal and you would get it.

What the founder there realised and what lots of people were talking about at the time was that because the unit cost of delivery, i.e. what it takes for the person to receive a research article, was radically diminished almost to zero because you could just basically put it on the internet and that would deliver it to whoever wanted to be able to access it. And so actually, you could distribute knowledge a lot more effectively with the internet. That was really appealing, especially to funders, because so many research funders are essentially funded by tax and so we have a sort of odd situation where taxation funded research and in order for the researchers to get access to the fruit of research, they had to subscribe to private companies that were publishing journals.

Now don’t get me wrong, these private companies publishing journals were creating a good service, but that service became less required, or basically not required, once you had the internet. So there was a sort of an idea of the internet changes the distribution of knowledge, changes the business model, let’s work out how to do it, and that’s what BioMed Central was trying to do. The idea was especially just to democratise knowledge, so you make it more accessible and more people can process it and come up with new ideas, etc, etc. That was what BioMed Central sought to do, and achieved it, and it became, I think, was the first company in academic publishing that went into the black and then was eventually purchased by a corporate publisher.

For me, I think what I learnt from that process was that I learnt a bunch of things. First of all, just new technologies should enable you to think anew about existing solutions and come up with new ways of doing things. That certainly wasn’t a way in which I thought when I first went to work there, I sort of thought the world was the shape that it was and that’s it but working at BioMed Central kind of made me realise that you can question everything.

I think the second thing I learnt was no matter how daft the status quo is, there are so many vested interests in the status quo, that radical change is extraordinarily hard. That was actually quite eye-opening to me and I sort of assumed that people were always willing to make things better. You then realise actually people in systems, quite often do their best to keep things as they are, even if as they are is pretty bad and dumb, and not really creating the value that could be created. So those are sort of things that I learnt by working with a disruptor, whether some of that willingness to disrupt rubbed off on me, that would be a kind interpretation. I certainly learnt a lot by working with him for the six, seven years.

Maria:    

So Pritpal, in your intro, we heard that you were physician editor of TEDMED, for anyone who’s managed to miss it, and I can’t believe there’s anybody on the planet, but can you tell us about TED and tell us about TEDMED and your role there, please?

Pritpal Tamber:   

You know, it’s funny, I think in Europe, lots of people don’t really know that much about TED, which I always find interesting, and maybe not in your circles, but certainly in mine, I quite often mention TED and people look at me and wonder what that is. TED started, I think it’s about 35 years old now. TED stands for Technology, Entertainment and Design and the original idea was that those were three industries, there wasn’t really a space for them to get together and work out how they can cross-pollinate ideas, and so the first meeting, or the first event, was about bringing together leaders of those three industries to see if they could cross-pollinate with new ideas.

So that’s what TED tries to do, it still tries to do that. Of course, the worlds of technology, entertainment and design overlap a lot more these days than they did back then. If you look at companies like Pixar for instance, that’s an entertainment company that used technology with design at the forefront of how it works. So it’s become a business reality in many places.

TED carries that ethos on about how do you share ideas across sectors by creating an environment where people can rub shoulders, get out of the day job and hear about ideas from other sectors. I think the thing that people always misunderstand about TED, even though the strap line is very clear, the strap line is, “Ideas worth sharing.” People think it’s about innovation and there’s a significant difference between an innovation and an idea. An idea really is something that you can take from a sector and try to work out how you would apply it in your sector, or in the problem that you’re seeking to address, and those ideas are often personal ideas, or borne of personal experience, which is why classically TED talks are people often reflecting on their own life before they start speaking about their current work and that’s different to an innovation. An innovation usually is some kind of technical solution to something and those are quite often industry specific, or sector specific. So there’s a vast difference between an idea and an innovation.

So that’s what TED is, that’s why they talk about ideas worth sharing, etc. TEDMED is essentially its health spin off, they tried to use the same approach to think of big ideas that are going to improve health and my role there was to help them be a little bit more robust in how they were looking at the science underneath some of these ideas, and thinking very critically about whether those ideas were likely to be deployed in the healthcare system, if they were ideas for the healthcare system, were they likely to be deployed in healthcare.

One of the things about change in healthcare is,  and people don’t talk about this enough, is that any change essentially creates some kind of clinical risk, and the clinical risk is essentially hurting or killing someone. So healthcare innovates very slowly because of the caution around clinical risk. Actually, when you try to do something in healthcare, the biggest thing you have to think about is who’s indemnifying who, and that very rarely surfaces in these events because there’s a sort of fetishizing of ideas, or sometimes innovations, without sufficient thinking about, “Well actually, how might this actually roll out?” I was so obsessed by that that they eventually made me do a small talk on it myself.

Maria: 

Brilliant, fantastic. Is that how your speaking career started?

Pritpal Tamber: 

Yes, probably, that was probably the hardest one I’ve done. They made me do a four minute talk. So the short talks are very, very hard, much harder than trying to do the classic 17 minute talk, and takes a lot of practise to take an idea and package it into four minutes.

I think my talking started when I met Mark Stevenson, who’s the author of the Optimist’s Tour Of the Future, he was a friend of a friend and I think he actually eventually introduced me to you and then this sort of started off me doing talks more regularly. That was probably where it started. I never saw part of what I did as speaking, but it’s actually become a big part of what I do now. I’m not a great fan of talk, I’m much more interested in action but I speak in order to try to catalyse action, so that’s probably where it started.

Maria: 

Fantastic, we’ll come back to that a bit later, I sort of digressed a little bit because I actually wanted to go on to talk to you a little bit about the Health Service. Why do you think the Health Service is failing us?

Pritpal Tamber: 

It’s a difficult topic. I think it’s a topic that a lot of people don’t want to talk about because in the UK, and actually in lots of other countries, it all just becomes about it needs more money, but actually there’s something much more fundamental going on. So first of all, if you just look at the stats, people in difficult social circumstances, either low income or some form of exclusion, are getting sicker way earlier in their life, and are dying way earlier in their life. So sometimes that difference is 10 years. So two people born in the same year, the one that goes through difficult social circumstances will die 10 years earlier. Now, the health system isn’t able to respond to that because in many ways, the health system is a kind of one size fits all approach. Actually, I wanted to go and understand that, why is it that our health systems are struggling to meet those people? So that actually has underpinned my work.

So I’ve spent time with people working in difficult social environments, to understand what does it mean to work there. I think at the surface level, there’s a very obvious answer, which is there is a very significant lack of understanding of what it means to be in difficult social environments, so health systems are providing square pegs that don’t fit round holes. So that’s the surface level, pretty clear problem, that is not being responded to.

I think the other thing that became clear to me is that as I did this work more and more, it’s increasingly understood that what gives us our health, there’s about 70% of that comes down to our social circumstances, and people talk about that being kind of lifestyle, that’s actually a scientifically inaccurate term to use because when you use the term lifestyle, there’s an assumption it’s about choices that people make. Actually lots of people are in circumstances where they don’t have choices. A very obvious example of that is where people live in environments where they don’t have access to fresh food.

So you still hear it, you hear it even from government bodies who talk about lifestyle related, and health behaviours, and things like that which is sadly scientifically very poor use of words. If you think about people’s circumstances, and whether they’re able to stay healthy or otherwise, that’s really what matters more than how good a healthcare system is. The stats are really clear, about 75% of your health comes from your circumstances. Only about 20/25% comes from how good a healthcare system is and that could be based on if it’s the best healthcare system in the world. Most of your health comes from your circumstances and our healthcare systems are failing because we continue to think of healthcare, hospitals, primary care doctors, that kind of stuff, as the sources of our health, whereas actually the science is really clear that that is not the place that we should be playing, or at least only 25% of our efforts should be there, 75% of our efforts should be elsewhere.

Maria:  

That’s really fascinating actually, it’s a really different view. Is that what you’re trying to do with Bridging Health & Community, is that the message you’re trying to get across to governments and to organisations?

Pritpal Tamber:        

Yes, so Bridging Health & Community really came from my writing and my talking. So I was really just trying to understand this problem. I left TEDMED with a clear feeling that the ideas on stage were really not going to touch communities in difficult social circumstances and I wanted to understand why there was that big gap between where all the excitement in ideas and innovation was, compared to where all the need was. So that’s why I went to spend time with people working in difficult social circumstances and just work out what it meant to be there. That’s what made me really appreciate this 75% versus 25% stat, which is actually very well documented. It’s at least 30 years old, about 25, 30 years old, the science behind it is at least 25, 30 years old. So it’s interesting that it hasn’t yet penetrated policy in any real way, despite a lot of rhetoric.

Bridging Health & Community, what we’ve been trying to do in the US, is think about how can healthcare systems quite literally bridge better to communities in difficult social circumstances? What does that mean? In the US, the emergency departments there, they’re called emergency room, the ERs, so people turn up in ER with their sickness and then the healthcare system tried to do something about that but by then, it’s quite frankly too late. They’ve got ill for other reasons. So how can a healthcare system reach into a community and understand that they need to start working out how to influence the 75%, even though they don’t own 75%?

Part of the 75% are things like access to fresh food, that’s not something a healthcare system can directly own but how can it influence it? How can it influence the food delivery system, the commercial food industry, in order to try to help people have better health? So that’s what Bridging Health & Community is trying to do, but as you said in your intro, one of the things that I learnt by doing this work is that it’s also been pretty clear, at least since the late ’80s, that if we look at why people are getting sick, so we can say it’s because of diet, lack of exercise, living in environments that are toxic to the body in some manner, stress from life, etc, etc, those can account for illness but lower down the socioeconomic gradient, we actually realised that it still doesn’t really explain more than 50%.

It turns out that actually, the scientists in this field are called social epidemiologists, and it turns out that they’ve been struggling with this for a long time and realising that they can’t explain it. So we find more and more risk factors over and over again. Every day on the news, you hear something, “Burnt toast is going to give you cancer. Too many eggs are going to give you cancer.” You hear this stuff over and over again. This is epidemiology trying to find more reasons why we’re healthy or otherwise, and it’s a good and important science. The problem is, is that we have this gap in our knowledge and it’s been known, again, since at least the late ’80s. What it seems is that lower down that socioeconomic gradient, what really matters is that people do not have what the technical term is agency, the ability to make purposeful choices. It turns out as you go up the socioeconomic gradient, people have more agency, basically by how they’ve been brought up and the education they’ve received.

So what we’ve realised is that when you’re reaching into communities in difficult social circumstances, if you’re not being purposeful about how you foster the agency of those communities, you’re really not going to have a material impact. So what we’re trying to do is help healthcare work out how to show up in those environments, and be intentional about fostering agency, while also thinking about the more obvious things, like access to fresh food.

Maria:  

So Pritpal, tell me, why have you based the organisation in Seattle, when you’re based in London?

Pritpal Tamber:  

That’s a good question. So it started off because I started this work when I was just finishing off with TEDMED, so a lot of my network was American at the time, as I started to explore this topic, it was largely Americans I was reaching out to. That’s how it started. I then discovered in doing this work, that actually the fragmentation in the American healthcare system actually creates an interesting Petri dish of experimentation in different forms all around the country. So that also meant that it was a rich seam to follow. So that’s why it really got hold there and why we decided to incorporate there.

We do actually have work in the UK, the UK manifestation of what we’re calling in the US, Bridging Health & Community, and in the UK is actually called Beyond The Systems. The reason why we have a different shape to it is firstly, there’ve been different advisors and actually we all felt collectively that it needed to have its own identity. Secondly, the challenge here is different in the UK, because we’ve had this fully developed social welfare system since 1948, and actually it’s surfacing the same issues as we’re seeing in the US, but for different reasons and so the solutions that we should propose would be different. So actually, I do work in both countries but we’ve been going longer in the US through Bridging Health & Community.

Maria:

Pritpal, would you say then that education could play a huge part as well? We have to learn English and maths, basic English and maths at school, should we be learning more about health as well?

Pritpal Tamber:   

My answer is sort of yes but not entirely. So if we go back to this idea of agency and the ability to make purposeful choices, agency in many ways, it’s the ability to solve problems, can you work out what to do, can you overcome barriers in your own life? Actually education is really pivotal to that and it starts at home, it starts with how your parents bring you up, all that kind of stuff. We know that actually education and economic security are the two things that matter long-term to your health, more than anything else. More than how shiny your hospital is, more than the fresh food etc. Education and economic security are the two things that matter most.

I would say that education matters, but I wouldn’t say that the way in which we think about education is we have to sit people down and say, “Eat fruit, eat vegetables. Walk to work rather than just drive all the time,” etc, etc. I don’t think it’s that kind of education that really matters. In fact, we’ve got ample evidence that shows that when we try to provide education information to people, it has a very limited effect on their behaviours and so there’s something about working much more fundamentally on people’s ability to really just handle the obstacles in life, and education plays an incredibly important part of that, basic maths, basic English, all of that kind of stuff to enable you to overcome the obstacles in life and that is you essentially expressing agency.

As they say, at least from the late ’80s, it’s been clear that that matters to health and yet you won’t ever see it in health policy in many places. In fact, I don’t really see it intentionally either in the UK, the US or anywhere else I’ve been speaking or writing.

Maria:     

We touched earlier on the fact that you’ve started talking about this to business audiences, to corporate audiences, to all kinds of audiences actually,  all sorts of industries. What are you hoping when you speak to audiences, that they will do differently as a result of listening to you?

Pritpal Tamber:   

Well for me, it’s all about getting to action. I see my work as the kind of 20 year journey, and so right now it seems that that knowledge exists in the nerdy journals and actually what’s going on is, is that when we get to implementation, we take the stuff that is a little bit easier to get our heads around. So we can sort of understand food, exercise, that kind of stuff is easy to get our heads around. So we see that going into implementation but I’m not sure how much impact it’s having. It seems to me this much more fundamental problem is a little bit of a thorny issue and so feels to me like right now the challenge is just to get the message out there. I think the science is strong and I think my work defined the 12 principles for how you operate in these environments, which essentially are the principles for fostering agencies. What we’ve learnt by doing this work is really about getting the message out there and creating a framework that enables people to start thinking about how to act.

Now, I’m being really cautious about saying, “start thinking about how to act,” because you could imagine, healthcare’s a business, I think it’s about a seven trillion dollar industry across the world and people will start with those things where they’re very clear that they can have clear ROI and agency isn’t this thing that you can go and implement get an intervention around and then get a three to one ROI within a 12 month timeframe, which is how business strategy tends to work. This is a much more fundamental thing about the shape of society. The challenge, I think for now, is just to get the message out there and get people thinking about it.

When I talk to audiences, I always have this thing of if there’s 100 people in the room, there are really only two or three who are really going to want to come and have a deeper conversation about it. That doesn’t mean that the other 97 are not interested, but two or three are going to be the type of people who’ll say, “I really want to get into this,” and that usually is what happens. Afterwards you get two or three come up to the podium and ask a lot more deeper questions. Then usually one or two will really want to get into implementation, really start thinking about, “How do we change our thinking?”

I think that’s ultimately the fundamental thing and ultimately what Bridging Health & Community has to do, is you just have to start getting healthcare to look in the mirror and realise that it’s not as effective as it could be, and realise why. At the moment, there’s a misunderstanding because there’s a feeling of, “Well, we have to get the food system to change.” Yes, but that’s probably not going far enough. Yes, we have to think about transportation, yes we have to think about stress environments, yes we have to think about the environment and whether that’s polluting people’s health, etc, etc. All of those things, yes, but there are much more fundamental things we need to be working on and sensitising people to that and getting them to work out what their role is in that, is actually where I’m trying to take this work.

Maria:  

That’s an enormous challenge, Pritpal, it’s a huge thing you’re trying to do and it’s wonderful. So when you do get some time out, and you aren’t working, how do you relax?

Pritpal Tamber:                  

Football. Everything’s about football, me. So I’m 44 and somehow still playing, although I’m sure that saying that I play football is a crime against football, but I play as much as I can. I probably watch too much although I’m an Aston Villa fan, so they’re not on TV as much as they used to be and I no longer have my season ticket, so I don’t see them as much as I used to. Then I’m usually in a pub with mates, talking about football, so I’m sort of horribly uni-dimensional outside of work, I can assure you.

Maria:    

I didn’t know that about you Pritpal, I’ve learnt something new. You fortunately haven’t talked to me about football, because I know nothing about football, so that’s brilliant. Now listen, I’ve left my most controversial question till last here, and I need you to think long and hard about it because you know me and you know where I stand on this, this is the big one. Are you a dog or a cat person?

Pritpal Tamber:    

My answer is it depends on who’s my girlfriend at the time. So I guess I’ve had a girlfriend who’s been a cat person and for the sake of peace, I’ve entertained the idea of having a cat, and I’ve had a girlfriend who was a dog person and for the sake of peace, I’ve entertained getting a dog but on neither occasion did it actually ever happen. Yess, I am very flexible on that, I don’t think I particularly have an opinion, which probably is the worst thing to say.

Maria: 

But do you know what? I think pets help your health. Pritpal, listen, thank you so much for some really amazing, thought provoking ideas there and things that we really need to focus on. Thank you for your time.

Pritpal Tamber: 

Thanks a lot.

Post navigation

Other posts you may be interested in

What are most speakers missing that corporate clients look for? A killer showreel.

In my free guide to showreels that get you booked, I share with you the seven key elements to consider when making your showreel, and professional editing is only one of them!

Sign up to our newsletter and receive your free download straight to your inbox

Sign up to our newsletter and receive your free download

straight to your inbox

Sign up to our newsletter and receive your free download straight to your inbox

Sign up to our newsletter and receive your free download straight to your inbox