EP. 106: A MORAL DRIVE TO HEAL THE WORLD

WITH JIM YONG KIM

Apr 2

WITH JIM YONG KIM, MD, PHD

The 12th President of the World Bank shares how he has sustained a sense of moral purpose throughout a career marked with immense contributions to global health, poverty reduction, education, and sustainable development.

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Episode Summary

Soon after finishing his first semester of college, Jim Yong Kim, MD, PhD excitedly told his father that he'd dedicate his life to starting a social justice movement. In response, his father sternly reprimanded him, saying that the only career he'd support was one in medicine. Dr. Kim acquiesced, but over the subsequent decades would hold on to this passion for social justice and become one of the most influential individuals working in global health, poverty reduction, and sustainable development.

He co-founded Partners in Health, today a renowned medical humanitarian organization that operates in the poorest areas of developing countries. From there, he served as advisor to the Director-General of the World Health Organization and as Director of its HIV/Aids Department. He would then serve as the 17th President of Dartmouth College, before being selected as President of the World Bank, a position he would hold for seven years.

In this episode, Dr. Kim joins us to discuss his unique training combining medicine with anthropology, the cultural factors that shaped his understanding of international development, how he spearheaded radical efforts to treat millions of HIV and multidrug-resistant tuberculosis patients around the world, the inner mechanisms of the World Bank, the moral philosophy that drives his work, and more.

Jim Yong Kim, MD, PhD is a physician and anthropologist who has made significant contributions to global health and development. Born in Seoul, South Korea, Dr. Kim immigrated to the United States with his family at the age of five. He received his undergraduate degree in human biology from Brown University nd his MD and PhD in anthropology from Harvard University.
Dr. Kim co-founded Partners In Health (PIH), an NGO aimed at providing healthcare to impoverished communities, starting in Haiti and expanding globally, notably impacting the treatment of tuberculosis and HIV/AIDS.
His work led him to the World Health Organization as the Director of the HIV/AIDS Department, where he initiated a global antiretroviral treatment program. Kim's leadership skills were further recognized when he became the President of Dartmouth College, marking him as the first Asian-American to lead an Ivy League institution. In 2012, he ascended to one of the highest roles in global development as the President of the World Bank Group, focusing on poverty reduction, sustainable development, and tackling climate change issues. Throughout his career, Dr. Kim has been driven by a commitment to health equity and the belief in healthcare as a human right, leaving a lasting impact on global health initiatives and policy.
In this episode, you will hear about:
• 2:32 - Dr Kim’s motivation for pursuing both medicine and anthropology
• 8:04 - How Dr. Kim paired his clinical training with his passion for social justice
• 16:46 - How Dr. Kim stayed true to his moral convictions as he faced challenges in managing global crises such as the HIV epidemic in Africa
• 26:29 - The story of PEPFAR, one of the most ambitious initiatives to address the global HIV/AIDS pandemic pandemic
• 30:45 - How committing to moral justice can help people think outside of the box to meet the economic needs of a situation
• 33:36 - The history and goals of the World Bank
• 38:11 - How Dr. Kim prepared for his role at the World Bank, an organization that operates in many sectors in addition to global health
• 43:28 - How Dr. Kim maintains a sense of purpose and fulfillment throughout his career
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and health care executives those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging, and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:01] Soon after finishing his first semester of college, Jim Yong Kim excitedly told his father that he'd dedicate his life to starting a social justice movement. Immediately pulling the car over, his father sternly reprimanded him, saying that the only career he'd support was one in medicine. Jim acquiesced, but over the subsequent decades would hold on to this passion for social justice and become one of the most influential individuals in the realms of global health, poverty reduction, and sustainable development. He co-founded Partners in Health Today, a renowned medical humanitarian organization that operates in the poorest areas of developing countries. From there, he served as advisor to the Director General of the World Health Organization and as director of its HIV Aids department. He would then serve as the 17th President of Dartmouth College, before being selected as the president of the world Bank, a position he would hold for seven years. In this episode, Doctor Kim joins us to discuss his unique training combining medicine with anthropology, the cultural factors that shaped his understanding of international development, how he spearheaded radical efforts to treat millions of HIV and multi-drug resistant tuberculosis patients around the world. The inner mechanisms of the world Bank, the moral philosophy that drives his work, and more. Jim, it's an honor to have you here, and welcome to the show.
Dr. Jim Yong Kim: [00:02:29] Thanks for having me. It's great. Great to be with you.
Henry Bair: [00:02:32] So there's so much we can explore here, given how colorful and diverse your experiences have been, but take us all the way to the start and tell us what led you to a career in medicine, and then specifically, how did anthropology enter the picture?
Dr. Jim Yong Kim: [00:02:47] Well. So, Henry, you know, uh, my guess is that, uh, you had Asian parents, uh, as well as I did. I was really, uh, more interested in other things, you know, my mother and my brother and sister tell me that, uh, yeah. Ever since I was quite young, I was really moved by and just captivated by the various social justice movements that were around. So I was born in 1959. And so, you know, I think the very first sort of awakenings of, uh, consciousness about, uh, you know, politics and equality and justice was around the late 60s. And so, you know, I listened to Martin Luther King's speeches on TV. I was, you know, growing up in Iowa, right next to the University of Iowa, where, you know, all of these anti-war demonstrations were going on. And so I was very moved by the social upheaval of the 60s and early 70s. And so I kept that interest all the way through high school. I mean, you know, I grew up in Iowa. I mostly, you know, focused as a high schooler on things like sports and, uh, you know, studying. But, uh, but I was still always really interested in those issues. And so that really awakened in me after my first semester at Brown University.
Dr. Jim Yong Kim: [00:04:05] You know, I started my career, my undergraduate career at the University of Iowa, but then really was kind of dissatisfied with what I found there, transferred to Brown University. And I was just incredibly captivated by the various movements that were going on at Brown. So, you know, the students of color, um, called themselves Third world students of all things, a term that is something out of our distant history now. But I became very involved with Third World Center. I became very involved with Asian American students. At the time, identity politics was really huge. You know, being committed to your own community, being committed to, you know, the plight of, uh, African American, Latino and even Asian American students. There were a lot of poverty in the Asian American community as well. So an interest that started from listening to Martin Luther King's speeches, uh, really took hold in my first semester as a transfer student at Brown University. And I'll never forget, I came home from that first semester just sort of on fire. And my father picked me up at the airport, which was about 30 miles away. And, uh, as we were driving home, he said, so, Jim, what do you want to study? And I said, dad, you know what? I'm going to study philosophy and political science. I'm going to become part of a political movement. We're going to really do things for Asian Americans and literally pull the car off the side of the road, just pull the car off the side of the road, look back at me and said, look, you know, when you finish your residency, you can study anything you want. So he he was the most practical man. I mean, he's a dentist, right? The most practical profession of all the professions.
Dr. Jim Yong Kim: [00:05:39] But my mother was a philosopher. She did a PhD in philosophy, but she also did her masters in divinity at the Great Union Theological Seminary in the 1950s, where, you know, uh, Reinhold Niebuhr, the guy who said the famous thing, you know, God, give me the patience to know what I can change and what I can't change. The whole, you know, the greatest moral and intellectual leaders of the time were at Union Theological Seminary. So my mother did her, her her studies there, did her PhD in religion and philosophy at the University of Iowa. So I had these two very different influences. So I wasn't sure I was going to go to medical school. But, you know, I my father convinced me and he would say things to me like, oh, so you want to do politics and philosophy? You think you think someone's going to want to pay you a Chinaman? That's what he literally would say, that you, you know, you a Chinaman, someone's going to pay you to talk to them about your views on politics and philosophy. Get a skill, get something that they can never take away from you. And then after that, we can, you know, you can do whatever you want. So it turned out to be great advice. And so I was accepted into, I mean, the two that I was really interested in, I was accepted into the University of California, San Francisco and to Harvard Medical School. And I went back to my father and said, look, dad, you know, now, okay, I'm in medical school. I'm going to go to UCSF because that's where the Asian American community is really strong. He goes, okay, fine, go to UCSF. But you're going to have to pay for it on your own. So it's and again, you know, he was right because I went to Harvard and they had just started a new program, an Md-phd program that allowed you to study medicine and a social science discipline. And I met my lifelong mentor, Doctor Arthur Kleinman, who I think you've had on this show. Is that right?
Henry Bair: [00:07:28] We did. We did interview him about a month ago. Yeah.
Dr. Jim Yong Kim: [00:07:31] Arthur had an enormous influence on me. I had read him because he had he had done the definitive work on culture and health, uh, specifically about Asian people. So I had, you know, written papers about him when I was an undergraduate. And so. As it turned out to be the greatest stroke of luck, because two years later, my long time colleague, best friend, uh, partner in crime, Paul Farmer, came to Harvard as well, and we worked together for 40 years until his tragic passing in 2022.
Henry Bair: [00:08:04] Wow. Yeah. As you're telling me, all the, you know, the things your father would say to you, I feel it in my bones because I had the same conversations with my parents. For me, it wasn't necessarily political science and social justice. For me, it was music. I wanted to go to music school. My parents said, absolutely no, you can do it. You can do anything you want. We will pay for conservatory after medical school. So I was in the same boat, but I don't regret it. It was good advice to come here because I absolutely could not be more fulfilled in my choice to go into medicine. So then let me ask you. So you went into medical school from the very start, interested in anthropology and the social sciences. So initially I asked you what drew you to medicine and then how did anthropology play a part in that? Maybe we should flip it then, because now we know what drew you to anthropology. But then how did the medical training come into the picture? Like how have you thought about how to bring your clinical training into your work and interest in political science?
Henry Bair: [00:09:02] Yeah. So, you know, as I said, back in the late 70s, early 80s, the most powerful social movements were were related to identity politics. So, you know, the African American, Latino women's movements, I mean, these were all about, you know, being from a marginalized or one could even say oppressed group of people in, in mostly, you know, African Americans, Latinos and women. There was the Women's Center at Brown. There was the Third World Center coming from those areas, doing something for one's people, whether they be women, African American, Latino. That was a very popular kind of idea. And I went to Harvard Medical School thinking that I would do something like that. I would do something that would be of service to Asians, Asian Americans, even Koreans. I mean, I thought about that as well. And so, um, just out of just sheer dumb luck, Arthur had raised all this money from the MacArthur Foundation to start this Md-phd program, and he needed warm bodies. And I was I was one of the warm bodies, and I was trying to think about what I wanted to do.
Dr. Jim Yong Kim: [00:10:10] And, you know, on the one hand, I was really into sort of Asian American stuff, but I didn't speak a word of Korean. You know, my brother and I, I was five and my brother was seven when we came to the United States. We spoke fluent Korean, we spoke only Korean, and we both completely forgot every word. My brother, to this day still speaks no Korean. And I thought, if I'm going to really be serious about identity politics, I need to go back and learn about Korea and maybe I can even help Korea. So this was incredibly naive in retrospect because, you know, by the late 70s, early 80s, Korea was growing very rapidly, but still, you know, 20 years before, in 1962, for example, I graduated in 82, in 1962, Korea was still one of the poorest countries in the world. So just 20 years prior to my graduation, Korea didn't even qualify for a world Bank loan because they were thought to be too poor to pay back a loan. And so the first, um, uh, first loan to Creighton didn't wasn't made until 1963. And they only had one other loan in 1968, which was for education, which they were ridiculed by the world Bank. The world Bank said, this is idiotic. You guys should be focusing on roads and energy, not on education. So you know how wrong they were there. Uh, so, you know, 20 years out of this incredible poverty, I thought, you know, maybe I'll go back to Korea, I'll learn the language again, I'll become a physician, and I will, you know, help, you know, improve the health situation, especially of poor people in Korea. That's really what I thought. But I think, you know, there's another part of it, too, is that, um, you know, a lot of Asian Americans, um, and Henry will know this.
Dr. Jim Yong Kim: [00:11:50] A lot of Asian Americans have identity crisis. You know, we don't look like the standard American. I grew up in Iowa. Can you imagine? I mean, you know, we were the only Asian family in Iowa. You know, the only good thing about, uh, growing up in Iowa at that time was there was a television show called Kung Fu. Right. And so, um, I mean, it was incredibly, you know, racist Starr was a white guy because they didn't think Asians could actually play Asian characters. And and yet the other part of it was that that people knew so little about Asians, they they kind of thought that, hey, you got to be careful. Maybe he'll kick your ass. Maybe he knows kung fu. That was the only good thing about it. But I grew up in this place where there were no other Asians. And so, you know, the the identity crisis thing was real. I mean, my parents didn't have an identity crisis. They knew who they were. They were Koreans. They spoke Korean first and foremost. They knew that there was a homeland for them. And here we were, uh, people who look like nothing like. 99% of the people in Iowa. And yet we didn't have any other grounding. We didn't know any anything else. That was the only thing we knew.
Dr. Jim Yong Kim: [00:12:54] So I like to say that, you know, people, most people, um, Korean Americans, uh, Asian Americans, they resolve their identity crisis by going to, you know, China or Taiwan or Korea for a summer spending, you know, in college, spending the summer going to clubs and bars and learning a few words of the language, and they sort of think, oh, okay, I know what that is, and they're done with it. But for me, I tend to do things to the extreme. I had to do a PhD in anthropology to resolve my identity crisis, right. Luckily, you know, I did. I learned the language. I spent two and a half years doing a PhD dissertation on the health care system in Korea. And so it was a great experience. I mean, you know, the fact that I learned my Korean is not great, but but it's passable. And, you know, like when I was president of the world Bank, for most of that time, the secretary general of the United Nations was also Korean. Pan Ki-Moon. We became really, really good friends, and we spoke to each other almost always in Korean. And so it was great because no one else could understand what we were talking about, and we could have really great discussions.
Dr. Jim Yong Kim: [00:13:58] I, I never would, you know, have any regret about that time spent in Korea. But, um, very quickly I learned that I was not needed in Korea by the end of my time doing research in Korea. They were hosting the 1988 Olympics. Right? So from 1962, they were still not eligible for world Bank loan because they were so poor. 24 years later, they were hosting the Olympics, right? They were growing so quickly. I, I learned to love the country. I'm so glad I got to speak the language. I'm so glad I was able to resolve my identity crisis. But what came out of it was sort of a, you know, what do I do now? Now what? I mean, I the whole idea of, you know, being one with my people, being down with my people, speaking the language, helping my people, that sort of got thrown out the window because my people were doing fine.
Dr. Jim Yong Kim: [00:14:52] And, and so, uh, that's when I started talking to Paul Farmer and Paul. Um, we were so close. And he was very respectful of the kind of things I was talking about. But he would say things to me like, oh, really? So what are you going to do? You're going to spend all your life trying to break the glass ceiling for Asian Americans. Oh, yeah, or bamboo ceiling or whatever they call it. Oh, yeah. That sounds great. Why don't you come with me to Haiti? So I did. I went with him to Haiti, and, uh, he said, I bet you anything they're going to call you blank, which is just it's white person and blank is just white. The French term for white. I said, oh, come on, you know, they're not going to do that. And not only did they call me blank, they asked him questions like, is he your son? Is he your brother? Because, you know, for for from the perspective of a Haitian landless peasant living in the hills in abject poverty, I was not a quote unquote person of color. I was an incredibly privileged person who, to their eyes, looked much, much more like Paul Farmer than like one of them. Right. So, um, having this experience of saying, I'm going to use medicine to live out a destiny that we had concocted in the identity politics world of Brown University in the late 1970s to, well, okay, so now I'm an MD, PhD at Harvard. If the concern is not just sort of like my identity, but the concern is for some much broader notion of justice. What should I do? Paul used to say it this way. He said, you know, we were both doing my PhD at Harvard. He said, look, the the fundamental question is, given our ridiculously elaborate educations, what's the nature of our responsibility to the world? As we kept asking that over and over and over again, and that's when we decided that we were going to work together and build partners in health.
Tyler Johnson: [00:16:46] So I'm interested as I hear you tell your story, what I'm hearing is that you have many sort of miniature arcs going through your story, right? So you have the arc of the push and pull between your parents, different conceptions of what to do with your life. You have the idea of identity politics. You have the idea of justice. As you began to conceptualize it as a teenager, listening to Martin Luther King and all the rest of it, and then eventually you end up sort of pursuing what both of your parents would have told you with an MD and a PhD, right. An MD in quote unquote hard sciences and a PhD in social sciences. And then you end up then talking with Paul Farmer. But the the through line that I see through all of those back and forth, through all of those miniature arcs, is a concern for justice or for the capital G good, right? Doing something, as they say, to bend the moral arc of the universe toward justice a little bit more, right? Which you thought originally. Maybe you do that in Korea, then figured out that really was not what was needed, and so then ended up with Paul.
Tyler Johnson: [00:17:50] But I guess this may sound like a a question that's so obvious that it's not worth asking, but often I think those are the ones that are the most worth asking. What does that mean? I mean, you have sat in many influential positions where you're making decisions, whether it's making a decision as a president of a university or the president of the world Bank. You not that you do it yourself, but but nonetheless, you're the person you know, so to speak, where the buck stops in terms of very large amounts of money going to this place or to this place, or, you know, who gets appointed as the leader of this group within the university or whatever. And so I guess what I'm trying to get at is. As you have aged and matured, and as you have worked to refine your own sense of what it means to try to pursue justice, especially as a leader, what have you concluded about what that means? Like when you're sitting down to make one of those decisions? And I would imagine that most of the time, like it's easy if there's a bad decision and a good decision, right, that anybody can make the decision. But if there are multiple competing goods and you have to decide between them, how do you decide which one advances the cause of justice the most?
Dr. Jim Yong Kim: [00:19:08] It's a great question, Tyler, and it's really the fundamental question. And it's the one that that Paul and I asked ourselves from the very beginning. And we took it really, really seriously because in the course of the work that we did, there were a lot of arguments that we were involved in with people who said, what you guys are doing. You may think that social justice work, you may think that's the right thing to do, but you're wrong. Our perspective is really a much more important way of thinking about it. And just give you an example. Do you treat HIV in Africa? Do you treat drug resistant tuberculosis in the poorest countries in the world? And our argument was of course you do. You have to. Multi-drug-resistant tuberculosis is an airborne infectious disease. If we allow multidrug resistant tuberculosis to go unchecked, when it starts growing in the places where HIV is the highest. Hiv knocks out this the cell mediated immune system, which is exactly the part of the immune system that keeps tuberculosis in check. You can see explosions of outbreaks, and we use so many different ways of talking about we're really talking about our own patients that we were seeing with HIV and tuberculosis in Haiti and Peru and, and elsewhere. But what we faced was a global health community that was incredibly angry at us for even thinking that it's possible to do that. They would say no because those things are too expensive. Those are not cost effective. If you do cost effectiveness analysis, you should focus just on garden variety, drug sensitive tuberculosis. You should focus on vaccinations. You should focus on prevention of HIV. You cannot afford to do those other things. Our moral position is superior to yours because we're talking about the greatest good for the most number of people. Right. And so it's a it's a reasonable argument to be had.
Dr. Jim Yong Kim: [00:21:06] We spent so much time, you know, reading all the great things that we read, Marx and Engels and Durkheim and Weber. You know, this was what you do as an undergraduate student, and all of them have designs of what you should do in this world. Vladimir Ilyich Lenin wrote this book called What is to Be Done? And for him it was, you know, revolution of the proletariat taking back control of the means of production. There was a clear plan. And back in those days, early 80s, it was an open question. Right. Are you going to go with the market economies, or are you going to go with closed economies that just trade with each other, that redistribute everything? That was an open question. We were debating that. Right. And so we read all that stuff and said, okay, in all of this, what is most compelling to us as the moral, ethical and even philosophical foundation of the work we're going to do going forward?
Dr. Jim Yong Kim: [00:21:57] We found inspiration from a lot of different sources, but I think probably the most inspirational for us was the work of the liberation theologians. You know, the idea of of what they call making a preferential option for the poor. And it was a very specific language. You know, these Latin American priests, a good number of them who were killed for having these views. The great Oscar Romero was assassinated because, you know, he asked really hard questions. He said, okay, we are followers of Jesus. And if Jesus were alive today, would he do what most priests are doing, which is hang out with the wealthy, hang out with the the military leaders, and ignore the suffering of the poor? Or would he be living, working, serving the poor? And you know, our organization, Partners in Health, has never been of a particular religion. But, you know, one of the things that we knew about because we were social scientists, you know, every major religious tradition has deep ideas about the importance of social justice. You know, tikkun olam in Judaism, you know, heal the world in Islam, in Christianity, of course, but also, you know, even in Confucianism, there are very strong notions of social justice in Confucianism. So we took our inspiration from the liberation theologians, but then added to it all the social justice thinking that had been developed over decades and decades and decades.
Dr. Jim Yong Kim: [00:23:22] And we came to this conclusion. We we came to the conclusion that we are not going to accept facile notions of what is available for the health of the poor. That might be the number now. But that's not enough. And that's not right. When we were talking about treating HIV in Africa. And it's hard. I consider you a my younger generation. It's hard for the younger generation to get their heads around how much against HIV treatment in Africa. Everybody was right. I mean, literally every single person in the global health world was telling us HIV treatment in Africa is impossible, right? The head of USAID, Andrew Natsios. And, you know, I have great respect for Andrew. This was not something that he decided. He's not a medical doctor. But in testimony to Congress when they said, is it is it possible to treat HIV in Africa and should we be doing that? He said, you know, in Africa they have no concept of time. They don't wear watches. They know morning, they know noon. They know dark of night. But if you tell them you're going to have to take a medicine at 8:00 and 6:00, they don't know what you're talking about because they have no conception of time.
Dr. Jim Yong Kim: [00:24:31] Now, that was the worst example of, first of all, just incredibly ill informed and racist notions of what Africa is. But he was simply reflecting the overwhelming consensus at USAID at the time. The US agency for International Development, which is you cannot treat HIV in Africa. We took a very different approach. We thought, okay, 25 million people in Africa living with HIV. You know, when I was head of the HIV department at Who I gave this speech all the time, I said, you know, if we turn our backs on people living with HIV in Africa and let 25 million people die, we will be known forever as the generation who stood by as a genocide happened. And believe me, the the economic implications will be severe. I actually didn't know at the time I had not been hanging out with economists. I didn't know what the economic implications were. But now, looking back, if we had done that, if if those who were arguing against HIV treatment would have won. And again, let me tell you, 99.999% of people in global health were against HIV treatment. If we had accepted that, I think the African economy in the sub-Saharan African economy would have collapsed. I think there would be people on boats going everywhere trying to find HIV treatment, and I think it would have been one of the greatest tragedies in human history.
Dr. Jim Yong Kim: [00:25:51] But things changed and we played a very big role in making that change. Right? So in this particular case, we didn't worship at the altar of cost effectiveness analysis. We said, no, there are much deeper issues here. You can say to me, yeah, but if we spend all this money on HIV treatment, then we won't be able to spend money on vaccinations. And we said, no, this is just wrong. We have to convince the most powerful people. We have to continue to do whatever we can to convince the most powerful people that we have to treat HIV and also provide vaccinations, which is exactly what happened. And so late one evening in November of 2002, Tony Fauci, the great, great Tony Fauci took Paul Farmer to the white House and showed before and after pictures of people living, of people who took who we treated for HIV in very small numbers, took before and after pictures and showed them to people like Michael Gerson, the great, you know, speechwriter for George Bush, who was just, I mean, tragically passed away. But it was an amazing, wonderful man. And Josh Bolten, you know, who I don't know if he was the chief of staff at the time, but people like that just said, you know, hey, you can do this. And in fact, we can bring the price of the medicines down dramatically. They were moved. Mike Michael especially was just deeply moved. Showed the pictures to George W Bush and George W Bush, created PEPFAR, which has to be one of the greatest programs in the history of the United States. When you had the president of the United States agreeing with you on moral grounds, that's all you need, right?
Dr. Jim Yong Kim: [00:27:31] So all this to say, people in global health were not in favor of HIV treatment. Our allies were the people from Act-up, the people from the Treatment Action Coalition, a lot of gay white men who, um, were very involved in the in the Act-up movement, who said we put our bodies on the line to get these drugs in and, and damned if we're going to let them only be used for people who can afford to pay. It was the act-up folks, and then small, a small group of us who were saying, we have to treat HIV. It's a moral imperative to treat HIV. We need to do everything we can to find the money. And, you know, the great good fortune that we're able to experience is that we were able to convince George W Bush. Right. And then everything changed from there. It proved to us that knowing what your moral and ethical foundations were, you know, what the, the, the non-negotiables were, you know, were important in, in changing the course, certainly of HIV.
Tyler Johnson: [00:28:34] For those who are not familiar, PEPFAR was a national initiative spearheaded by the United States, where the federal government provided a really enormous amount of money. I mean, of course, we can talk about all of the, you know, second and third order economic effects and whatever that you were referring to earlier. But really, at its base, it was a gesture of generosity. And again, I'm not trying to lionize the United States, obviously, when it's the, you know, richest country in the world and all those things, there are ethical responsibilities that come with that. But the point is, even accounting for all of that, it stands out in the last. Really, it has probably been since the Marshall Plan at the end of World War Two, from then until 2002, or I don't remember when exactly it was enacted, but where the United States just stepped up and said, this is an enormous amount of money. And even though there is no obvious, immediate way that we're being paid back for it, we're going to use it to provide these medications to do what is, you know, whatever else you think about it, an incredibly logistically and and medically complicated thing of providing mass. Because if you know HIV treatments, as you were alluding to earlier, right, they have to usually be taken multiple times a day. And it's kind of complicated. And there are multiple pills involved. And it's just it's not a straightforward thing and was less straightforward 20 years ago.
Tyler Johnson: [00:29:49] But it's just to say that I entirely agree with you. Michael Gerson, after he finished being a speechwriter for George W Bush, became a decades long columnist for The Washington Post. And I think particularly during the first Trump presidency, became sort of the voice of conscience of the conservative movement in the United States. But he wrote really right up until his death, frequently about the power of moral persuasion that the United States all too rarely, but in that particular case, was able to harness by doing this thing that really they were just doing it because it was the right thing to do. It was not, as you say, because of a cost effectiveness analysis or because there was some sort of obvious economic gain, but it was just because of the power of moral persuasion. And I, you know, we don't talk that much on this show about sort of national initiatives and whatever. But I but I think that whether you're talking about a national initiative or the world Bank or the way that you live your own life, that's a really powerful and beautiful lesson, because even now, 20 something years later, I think that still stands out as a sort of shining example of something that we were collectively capable of when we decided to do things for the right reason.
Dr. Jim Yong Kim: [00:31:01] Absolutely. In fact, when we when we use moral arguments, the public health and global health people usually got really mad at us. Right? Because saying, you know, who the hell do you think you are accusing us of being, you know, morally bankrupt or whatever it is that you're saying? And we kept saying, no, we're not saying that you're morally bankrupt. We're just saying, look at the moral implications here. Right. And the other thing is, you know, we were always just really, um, uh, we really didn't like the fact that people could be so glib and so and sometimes sloppy in thinking about possibilities or, you know, in terms of having ambition for the health of the poorest people. Right? So, you know, for for MDR-TB, they kept saying, no, you can't do even if you can successfully treat them, you can't because it's too expensive. And I asked them, you know, these were the leaders of tuberculosis in W.H.O.. Very simple question. I said, well, are these medicines generic, you know, off patent or are they still on patent? And at the time where they were saying, you can't do this because it's too expensive? Their answer was, we don't know. So they never they never bothered to check to see if these expensive medicines were actually still on patent. They were all off patent. And I said to them, well, do you know what happens to medicines usually when they go off patent? No, we don't know.
Dr. Jim Yong Kim: [00:32:20] Well, the first year they dropped 50% in price. And then after that, if you have three or more produce I had studied, you know, my Ph.D. dissertation was on the pharmaceutical industry. So I knew this. And then after three years or so, when you have three or more producers, the price drops 90%, right? And so same thing. They didn't know that an MDR-TB and with with HIV drugs, they kept saying it's $12,000 a year. How are you going to how are you going to pay $12,000 a year and treat 25 million people in Africa? I said, okay, well, HIV medicines are they were actually getting very simple about that time. And their pills, tuberculosis medicines are injectables. They're very much more complicated. Uh, these are just pills. And I told them, I think we can get that price down to less than $100. And with the support of another US president, president Bill Clinton, we got the price per year for drug from $12,000 down to $70 a year. Right. And so, you know, when people were saying it's too expensive, they just they hadn't done the homework to say, okay, if you believe it's a moral imperative to treat people living with HIV in Africa, don't you have to, like, knock down every wall and look at every possibility to see if, in fact, you can make it? Affordable and we we were able to do it.
Henry Bair: [00:33:36] Thank you so much for taking us through that inspiring story. You know, talking about the moral imperative you felt in addressing global challenges and health care and beyond brings us to your time at the world Bank. Before we get into the specifics there, however, most people might not even have a firm idea of what exactly the world Bank does. Can you give us an overview of the mission and activities of the world Bank?
Dr. Jim Yong Kim: [00:34:00] So the world Bank was founded along with the IMF in 1940. I think the year we use is 1944, and there was a conference with representatives from 50 countries or so in Bretton Woods, New Hampshire, and that's why they've been called the Bretton Woods institutions from the beginning. The International Monetary Fund was started because they wanted to bring some stability to currency exchange rates, the adoption of the gold standard, a bunch of things that, you know, economists know all about. But the IMF was about, you know, global financial stability. And they continued to do that today. Uh, the world Bank, the very first part of the world Bank was called the international Bank for Reconstruction and Development, so called IBRD. And the world Bank was created to rebuild Europe. The world Bank would utilize the credit ratings of all the member countries. And so, you know, if you want a really good credit rating and triple A is a good credit rating, if you can combine the credit ratings of all the countries that are part of the world Bank, that gives you a very, very firm foundation that all of these countries are saying we will back this institution. So, um, the idea was that these countries would come together, have a really, really good credit rating and be able to borrow money at very low interest rates. I mean, you know, uh, if you if you gave a loan, uh, or if you bought a bond from the world Bank, that was like the safest bond ever, because that bond would be backed by, you know, basically every rich country in the world.
Dr. Jim Yong Kim: [00:35:37] And so, um, every bank needs some capital. And so all of the countries that were part of the world Bank put a bunch of capital into the institution. And then with the foundation of that capital, the world Bank would go out and raise bonds and say, okay, you know, we're going to pay a very low interest rate, but because it's so safe for the world Bank, could get away with paying a very low interest rate, and we're going to go out and we're going to raise $1 billion at an extremely low interest rate, lower than anyone else could pay. And then we're going to take that money, and we're going to loan it out to our member countries that need it at rates that they would never be able to get themselves. Right. So let's say, you know, today IBRD still works and it's mostly for middle income countries. But we can go to a country like, say Nigeria needs, um, money for building a bridge. If they went to the capital markets themselves, they would have to pay very high interest rates just based on their own credit rating. And the length of the loan would be very short. So it'd be they'd get money that they'd have to pay back in 3 or 4 years at, you know, 8%, 9% interest.
Dr. Jim Yong Kim: [00:36:45] But if they come to the world Bank because they're part of a kind of cooperative, they can get money at a much lower interest rate, maybe a third of the interest rate, and they can pay it back over 30 years. So it's basically a bank that makes use of the fact that all these countries have come together and are supporting the bank and are passing the savings, the lower cost of capital on to their member countries. Now, also, every year the world Bank raises money for something called the International Development Association, and that you have to raise money every year because that money is given to the poorest countries. And it's like the best money that anyone can possibly provide. It's it's 0% interest. You pay it back over 30 years and you get a ten year grace period where you don't have to pay back anything. So it's basically a 40 year loan at 0%, right? The world Bank, in being able to provide countries with such good terms on, uh, capital for their most critical projects, the world Bank can also have an influence on how they spend it, what they build, how they monitor the building of it, how they assess whether they've done what they're supposed to do. So the world Bank was for many, many years by far the largest presence in terms of like infrastructure, but also, you know, health care, education, etc. it was just a fantastic idea.
Henry Bair: [00:38:11] So, as you just told us, the world Bank operates in sectors far beyond global health. It also deals in infrastructure development, environmental protection and sustainability, education and economic policy advice. Coming from a background in medical anthropology, how did you learn all the things you needed to know to lead this massive organization?
Dr. Jim Yong Kim: [00:38:35] Uh, I've done I've done lots of different jobs where I had to really quickly, um, you know, get up to speed on, on, you know, various issues. I never became a macroeconomist, but I learned a lot. I hung around with them a lot. I learned a lot about what they do and how they do things. And there's really no human being that I know of who can walk right in and be an expert on all the different sectors of the world Bank plays, and they play in so many different ones. So I was I was an expert in health care. I was an expert in education, not in infrastructure. But of course it was so important. I learned a ton about it. This was a case where I had just had intensive tutorials from people inside the bank on any number of issues, and one of the one of the first tutorials I got was actually not from a world Bank person, but, uh, maybe a month into my time at the world Bank, uh, al Gore showed up at the office and he took me through a three hour tutorial on climate change. That was unbelievable. It was just it was stunning. And up to that point, the world Bank was really not very involved in climate change. During the Copenhagen, um, the fateful Copenhagen meeting that failed, uh, the COP, the conference of the parties meeting, the world Bank was not even allowed in the main rooms where the negotiations were happening.
Dr. Jim Yong Kim: [00:39:51] Uh, but, you know, he and Rachel Kyte, who was the head of, uh, the climate change group at the world Bank, they gave me intensive tutorials, and I realized sustainability and climate change had to be at the center of what the world Bank did. And so we went from being non-players and in fact, you know, sort of outcasts in the climate change world to the point where we were the we were the largest funders of climate change related activities in developing countries by far. So in 2015, just before the famous Cop 21, where we came to the agreement, uh, arguably a lot of people will agree with this.
Dr. Jim Yong Kim: [00:40:34] Uh, arguably the most important meeting prior to Cop 21 was a world Bank IMF meeting that was being held in, uh, in Lima, Peru, in 2015. This was a few months before Cop 21. And the issue on the table was that the developing countries were saying, why should we agree to conference of the parties agreement? Why should we agree? There's nothing in it for us. They said, again and again and again, and especially the African leaders would say, look, the boot of climate change is on our necks. Flooding and drought, flooding and drought. Our roads are not climate resilient. You know, our infrastructure falls apart every time we have these cycles of climate and drought. We're the ones who are suffering most from actual climate change, and we put almost none of the carbon in the air. It's all you folks who put the carbon in the air, and now you're telling us that we have to sign on to this agreement where we're not even going to get access to energy? You're telling us that while you had baseload energy, you know, continuous energy from using, you know, coal and gas and oil for so many years? You're telling us now that we can only have intermittent energy with solar and wind? How does that make sense for us? So the deal was that at Copenhagen, uh, Hillary Clinton promised that the rich world would provide $100 billion a year to poor countries for both mitigation and adaptation to climate change. But the problem was that going into Cop 21, we were nowhere near that number. So the French were hosting, of course, the Cop 21. And in 2015, the Minister of Foreign Affairs, Laurent Fabius, the Minister of Finance, Michel Sapin, were all over me saying, world Bank, you guys have to step up and declare a big number.
Dr. Jim Yong Kim: [00:42:23] And so, um, on that fateful day when we had the meeting where everyone had to come to the table, we pledged that we would provide $30 billion a year for climate change related activities. And so anyway, the question was, how do I get up to speed? Well, you have to get up to speed quickly because you know, what you do. In this case, what we did at the bank, uh, led to, uh, getting, you know, closer to that $100 billion figure than ever. Because when we when we stretched, we were doing about 8 or 9 billion at the time. And I pledged that we'd get to 30. Uh, when we did that, everyone else had to step up. You know, the Inter-American development Bank had to step up the Asian Development Bank. Everyone had to just increase their number. The rich countries had to increase their numbers. And we stretched and stretched and we got to Cop 21, which was really important. But there's no lag time. You've got to get up to speed quickly to respond to the exigencies of the time. And I guess the real answer is I was just very lucky that I had great tutors, you know, everyone from our own teams at the world Bank to people like al Gore.
Tyler Johnson: [00:43:28] So I want to ask a question that is in a dramatically different direction than what we've just been talking about, but that I think is really, really important. And I want to set it up a little bit first. You know, so Henry and I met because Henry was a medical student at Stanford, and I'm on faculty at Stanford. And as a person who's been teaching at Stanford for a long time in the medical school, I have witnessed, I mean, to be clear, the students at Stanford are incredible, right? They have already done they've already achieved much more at, you know, 25 or whatever than I probably ever will. And I recognize that greatness in them. At the same time, I also recognize this almost perpetual need to accomplish more and achieve the next rung on the ladder. And this it's this insatiable desire, right? One of the speeches that I have most appreciated was a speech that was given at the graduation of the Stanford Law School a number of years ago by the person who used to be no longer is the head of the admissions at the law school there, who's a law professor named Rob Daines. The speech is called Why You Should Not Let Your Desire to Matter Harm the Things That Really Matter. And in that speech he tells this story of which will sound unrelated. But let me get to why.
Tyler Johnson: [00:44:45] So he tells this story of Microsoft trying to buy Yahoo back when Yahoo was like the hottest thing on the block, and Microsoft offered an enormous amount of money, and all the Yahoo board of directors had to do was sign on the dotted line, and then they would have gotten a zillion dollars and Yahoo would have been bought by Microsoft. But they refused. And there's some speculation as to why they refused. But in the in this speech, Rob Daines and that's what he studies is corporate mergers and that kind of stuff. He speculates that at least one of the reasons they may have refused is that they wanted to still matter. And as long as Yahoo was its own thing, then they were the board of directors. They were making the decisions. But if they sold themselves to Microsoft, they would all presumably be let go because Microsoft would have no need of them. And so then they wouldn't matter anymore. And so in reflecting on that, he says, I'm going to read briefly from this. He says, I think the mistake those people made is not that they put their own wealth over duty. I think it's more likely they rejected the offer because they liked being involved in something important and because they wanted to make a difference, to be consequential in charge and in the inner ring.
Tyler Johnson: [00:45:51] Perhaps they rejected Microsoft's valuable offer because they wanted to matter personally and to make a contribution. Obviously, this desire to matter and make a difference is laudable and noble. But just as boards do real harm to shareholders when they focus on their own role and job satisfaction instead of the welfare of shareholders, you may find he's speaking to the graduates. You may find along the way that your desire to contribute and be consequential can lead you to neglect valuable, but less immediately urgent goals, relationships, friends and family. And this will leave you and your loved ones unhappy in the long run. So all of this is by way of saying, you know, your CV is unimpeachable, right? It would be hard to imagine a more accomplished person, right? President of a university, president of the world Bank, partners in health, university positions, and on and on and on and on and on. But in the midst of pursuing all of those visible, shiny, very obviously laudable things, how do you also not neglect the things that are the most important when you go home at night and, you know, people are not looking at your CV anymore?
Dr. Jim Yong Kim: [00:47:10] You know, uh, um, it's a great question. It's a hard question. Uh, there's no question that my wife and two sons have suffered from, you know, the all the moves that we've made. I'm still, you know, close to all of them. So we're still all living together. And, uh, you know, I'm in a very different place now. And, you know, we decided together that it was time for me to leave the bank. You know, I left early and and so let me put it this way. Here's how I've tried to think about, you know, this kind of question. The first is I've tried to take a really rational and in many ways, hard headed view of whether or not I'm still adding value in whatever position I'm in. So to go back to the examples that I gave Multi-drug-resistant tuberculosis, I did that full time, you know, triple full time for about 4 or 5 years. And then we got a Gates Foundation grant, $45 million, which was the largest grant ever given for tuberculosis control. And it became really clear to me that I just wasn't needed. You know, there was not a lot of value that I was providing to this particular effort. And I started getting involved in HIV because it seemed to me that the experience I had with, uh, with tuberculosis was just exactly what was needed in the HIV world. And so we went, you know, the, uh, my wife and my older son and I, we went and lived in Geneva for three years. So Geneva is not a terrible experience. It was it was a it was a good experience of living there for a while. But then, uh, and we started this movement to get 3 million people in HIV treatment. And, um, after the deadline in 2005, we didn't reach the target, but we got a million people on treatment and everyone was saying, wow, we couldn't have believed that we would have done that. So right at that point, I realized again, you know, I don't have a lot to do now because, you know, I needed to sort of be in the middle of everything to get the movement started. But then when we got to a million, it was really maintenance. My family was ready to move back to Boston, and if I had wanted to remain relevant, I probably would have stayed there, you know, because it's I was the head of HIV of of the World Health Organization, and it was a very visible position. I was in the news a lot, but I came back and a good part of it was because my family was ready to come back.
Dr. Jim Yong Kim: [00:49:33] You know, the Dartmouth thing came out of the blue. I had no idea. The the head hunter, who remains a very close friend. After he interviewed me, he said, well, you know, you're a really interesting guy, but there's no way you're going to get this job. There's no way you're going to get this job. If you want to be a university president, I suggest that, you know, you go and be a dean or a provost somewhere. And so I thought, okay, thank you. Thank you for I mean, it was great to be able to be interviewed. I'm very happy without being with not being a university president. But then again, something happened and they wanted to meet with me. And then I started really intensively looking into Dartmouth, and they offered me the job. And again, it was another conversation that we had and we decided, well, you know, it'll it'll be quiet for the next period of time, 5 to 10 years. But, um, uh, you know, it's probably a good place. We're just having our second child. We made a decision to go to Dartmouth.
Dr. Jim Yong Kim: [00:50:27] Then out of the blue, you know, I get a call from, uh, from Tim Geithner, who was secretary of the Treasury at the time, asking me if I wanted to be president of the world Bank. It was completely unexpected. I was only three years at Dartmouth. I tried to talk him out of it. I said, Tim, you know, I edited a book calling for the closing of the world Bank on its 50th anniversary. But yeah, we know I said that doesn't disqualify me. No, no it doesn't. So what do you want me to do? Is come talk to President Obama, right. And again, you know, um, I walked into the room two days later, you know, the Oval Office sat down, President Obama, and, you know, he was trying to talk himself out of offering me the job. He said, Jim, why should I why should I nominate you an anthropologist and physician when people are telling me I should nominate a macroeconomist for the job? Right. You know, he called me on a Monday. I was down there on a Wednesday, so there was no preparing for it. Right? I just said to him, I said, well, President Obama, have you ever read your mother's PhD dissertation? He looked at me and he said, well, yes, I have. And I still I still don't know if he ever read his mother's PhD dissertation, but I had because his mother was an anthropologist, and she wrote about the metal sculptors artisanal industry in Indonesia. And, you know, it was just completely untrue. I said, well, you know, you will then remember President Obama, that your mother showed that while the macro economists argued that globalization was going to destroy the artisanal industry in Indonesia, she showed that globalization actually made it explode. And they started selling Indonesian metal sculptures all over the world. So, you know, I'm not going to be able to tell you what the world looks like from 30,000ft, like a macro economist, but. Redmond on the ground doing this work of development for my whole life. I'm going to be able to tell you if these things are working on the ground, right? And so, you know it.
Dr. Jim Yong Kim: [00:52:19] All this to say, yeah, you know, it's hard. I've very grateful to my family for moving around. My my son went to Sidwell Friends School, had a great experience in, in D.C. my younger son was growing up during that period. Now, you know, we're we're in Westchester County. You know, I've always lived with my family. And although I travel a lot and everything else, I do my best to be a good father and husband. But, I mean, look, the way I look at it is I've had these crazy opportunities basically thrown in my lap. The headhunter for Dartmouth was absolutely right. I had no business being in the running to be president of university. I did not, you know, quote unquote, have the qualifications of having done previous jobs like that. But, you know, in each instance, I try to think of myself, to think to myself, okay, I've never lived my life to be something, you know, I want to be a senator. I want to be this. I want to be president. I would never did that. I've always lived my life trying to do things. I want to do global health. I want to make sure that we would treat MDR-TB. I want to make sure that we have HIV treatment. They were things to accomplish on behalf of others that were always in front of me. Not never. I want to be in this position or that position. And so it gave me a freedom because I went there and I did everything I could to get that stuff done. But then after I was done doing those things and if I felt that, okay, now things are going there, I'm not really needed anymore. I went on and did something else that if I have any advice, it would be that right. If you're focused on trying to be something, a dean, a president, that's really hard and I think that can take you down very dangerous paths. But if you're clear and you're clear with your own family, in my case, it was, you know, health and social justice, education and social justice, access to infrastructure and social justice. You know, those are the things that I've done my entire life. And, you know, all I can do to my family is just apologize for all the time I've taken away.
Henry Bair: [00:54:26] Well, you know, with that, we want to thank you so much for taking the time to join us for sharing your life story. We've talked about pretty much your entire life, from your childhood and applying to college all the way to, you know, your time at the world Bank and after. There's such a clear thread that ties it all together, this thread of social justice, even though your father might have told you, you know you probably shouldn't be doing this at least early on in your life. You end up coming back to this over and over again in various different positions, in various different capacities, you know, but whether you are working at the W.H.O. or you're working at the world Bank, it's never not obvious that your dedication to justice and helping those in need is the fundamental driving force behind everything that you do. So thank you again for all the work that you've engaged in. And yeah, we look forward to sharing your story with our listeners.
Dr. Jim Yong Kim: [00:55:19] Thanks for having me.
Henry Bair: [00:55:23] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at www.theDoctorsArt.com. If you enjoyed the episode, please subscribe, rate and review our show available for free on Spotify, Apple Podcasts or wherever you get your podcasts.
Tyler Johnson: [00:55:42] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor or patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:55:56] I'm Henry Bair
Tyler Johnson: [00:55:57] and I'm Tyler Johnson. We hope you can join us next time. Until then, be well.