Washington Global Health Landscape Study 2015 Final Report

Landscape
Study
AUGUST 2015
Washington State Global Health

2 | Washington Global Health Alliance | Landscape Study | August 2015
CONTENTS
Letter from the Executive Director 4
Executive Summary 6
Introduction 7
Washington state has a distinct, diverse and collaborative
global health sector 9
Global health contributes to Washington state’s economy
through investment, innovation and employment 14
This vibrant sector will continue to grow by proactively seeking
new funding models and methods of collaboration 17
WGHA Online Survey Results 20
1809 7th Avenue
Suite 901
Seattle, WA 98101
www.wghalliance.org
WGHA Contributors Lisa Cohen, Executive Director
Stephanie Grow, Program Manager
Community Attributes tells data rich stories
about communities that are important to
decision-makers.
1411 Fourth Avenue
Suite 1401
Seattle, WA 98101
www.communityattributes.com
President & CEO Chris Mefford
Analysts Spencer Cohen
Michaela Jellicoe
Alison Peters
Eric Viola
Design Maeve Edstrom
Funding for this report was provided by JPMorgan Chase & Co.

151
Washington’s global health
organizations support projects in
COUNTRIES
1,959
Washington’s global health organizations have
PARTNERSHIPS
WORLDWIDE
12,620
includes estimates for global health jobs in
large organizations, such as the University
of Washington and others (2013)
GLOBAL
HEALTH JOBS
$71,129
32,800
in global health (excludes benefits),
compared to $55,100 across all jobs
statewide (2013)
Statewide, global health supports the following (2013):
The global health sector provided
paid to global health jobs statewide (2013)
AVERAGE WAGE
$2.3B
IN LABOR
INCOME
JOBS
$1.2B
WAGES &
BENEFITS
(2013)
$45.9M
STATE TAX REVENUES
Every job in global health supports a total of
(inclusive of the global health job, 2013)
2.6 Jobs
STATEWIDE
Global health jobs have grown by
compared to 1.1% annual growth for all jobs
statewide (2013)
4.4%
PER YEAR
SINCE 2009
$9.4B
IN BUSINESS
REVENUES
168 GLOBAL HEALTH
ORGANIZATIONS
WASHINGTON STATE GLOBAL HEALTH FACTS 2013
$5.8B FUNDING &
REVENUES
in global health (2013)
$7.1B GRANTS
funding received since 2001 (2001-2013)
includes nonprofits, biotech companies,
research institutions, philanthropies,
government agencies and other
organizations (2013)
Millions of lives
saved worldwide
Direct Impacts Overall Economic Impact
Global Reach

“Washington state has
the talent, innovative
spirit and unique
concentration of
organizations to lead
the way for global
health discovery,
development and
delivery in the world.”
– Lisa Cohen, Executive Director
LETTER FROM LISA COHEN, EXECUTIVE DIRECTOR
Millions of lives saved worldwide. Millions.
That is the legacy of Washington state’s
remarkable collection of global health
organizations. When we talk about “global
health” we mean addressing the needs of
the world’s most vulnerable people – both at
home and abroad.
Seattle-based organizations like Fred
Hutchinson Cancer Research Center, Center
for Infectious Disease Research and PATH,
have been pioneering global health solutions
for forty years. Their work in the Seattle
community, along with dozens of others such
as the Infectious Disease Research Institute,
SightLife and World Vision, has created a
fertile environment for starting and growing
global health organizations. Undoubtedly the
Bill & Melinda Gates Foundation, now fifteen
years old, is at the center of Seattle’s global
health community, contributing more to fight
neglected diseases and entrenched cultural
stereotypes than any one philanthropic entity
around the world.
When we founded the Washington Global
Health Alliance in 2007, the University of
Washington had just formed the Department
of Global Health and Washington State
University’s Paul G. Allen School for Global
Animal Health was formed, signaling a
growing field. Passionate interest among
the next generation coupled with a surge
in late-career professionals looking for
meaningful employment meant that global
health organizations were fielding hundreds
of applicants for a single job. In addition,
Washington state attracted unprecedented
levels of federal funding and private
philanthropy. Global health, like coffee,
aerospace and software, was becoming
a magnet for talent from other states
and countries.
This meteoric growth also has implications
for our state’s economy. Put plainly, our state
benefits from so many organizations focused
on global health research and delivery. Back
in 2007, then Governor Christine Gregoire
prompted the UW to study the economic
impact of Washington’s global health work.
WGHA has since mapped Washington’s
global health reach in 2009 and 2011. We are
grateful to the JP Morgan Chase Foundation
for providing support for the 2015 study which
integrates both the geographic reach and
economic impact of what we now call the
“global health sector.”
This study illustrates that Washington’s most
important export is, in fact, ideas that benefit
humanity. Our inspiration today is rooted in
the legacy they are creating.
Washington state has the talent, innovative
spirit and unique concentration of
organizations to lead the way for global health
discovery, development and delivery in the
world. In the future, as we work with other
regions to identify global health clusters, we
hope that similar data will be collected to
educate regional leaders and policymakers
about the contributions and importance of this
often overlooked sector.
Best wishes,
Lisa Cohen

5Washington Global Health Alliance | Landscape Study | August 2015 |
GLOBAL HEALTH
TRAINING
TALENT
Community
Colleges
University of
Washington
Washington State
University
Other Colleges and
Universities
Research
Assistants
Grant Managers Business Development
Scientists and
Postdocs
Software and Web
Development
GLOBAL HEALTH
ACTIVITIES
Funding
Research
Metrics & Evaluation
Product Development
Delivery & Distribution
U.S. or International Policy & Advocacy
Education, Outreach and Training
Philanthropy
Biotechs
Universities
Research
Institutes
Governmental
Organizations
PARTNERS
FUNDERS
International
Agencies
International
Agencies
National Agencies
and Departments
Nonprofits
Multinational
Organizations
Philanthropies
Federal
Agencies
State
Agencies
Private
Foundations
Individual
Donors

EXECUTIVE SUMMARY
Washington-based global health initiatives
have an enormous social impact worldwide
and economic impact in Washington state. By
focusing on interdisciplinary approaches to
complex problems, bringing outside investment
and attracting world-class talent to our region,
this sector contributes to Washington’s
innovation ecosystem. Nowhere is this more
evident than in the realm of developing products
for limited resource settings.
This report combines new and existing data to
measure and quantify the economic significance
of global health to Washington state including
employment figures and fiscal impacts. Global
health refers to the area of research and practice
to improve health and achieve equity in health
for all people worldwide.
Washington state has a distinct,
diverse and collaborative global
health sector.
The global health ecosystem includes
168 global health organizations (nonprofits,
biotech companies, research institutions,
philanthropies, government agencies and
other organizations).
Partnerships and collaboration are a part of
Seattle’s business and nonprofit culture, and
global health is no exception with 1,959 total
partnerships worldwide. Washington’s global
health organizations have 5,100 projects in
151 countries.
The high level of strategic collaboration
from research to program delivery, makes
organizations more effective, reduces
redundancy and increases impact ultimately
improving the lives of more people around
the world. Demonstrating its leadership,
Washington is the first state to formally
organize an alliance to further collaboration
and increase connectivity among global
health organizations.
Strategic Opportunities:
1. Provide new opportunities to connect
organizations to each other to leverage
expertise and foster new partnerships.
2. Build a stronger infrastructure for
bringing global health technologies to
the marketplace.
Global health contributes to
Washington State’s economy
through investment, innovation,
and employment.
Washington’s global health sector accounts
for a growing portion of the state’s total
economic activity. Global health organizations
in Washington state directly accounted for
$5.8 billion in output in 2013, composed of
grant funding, product and service revenues,
private contributions and other sources. The
interdisciplinary nature of the work makes it an
important source of innovation for the state.
Expertise in designing for limited- or low-
resource settings positions the global health
community to constantly innovate in the name
of reaching customers at the bottom of the
economic pyramid.
In addition, global health organizations’
missions are a magnet for job seekers and an
educated, permanent workforce with spending
power for local goods and services. There
were an estimated 12,620 direct global
health jobs in Washington with average
wages of $71,129 per worker in 2013.
3. Promote global health as an important part
of Washington’s economy to attract the best
talent, new collaborators and new funding.
4. Apply lessons-learned in global health to
health challenges at home to explore cost-
savings in related healthcare settings.
This vibrant sector will continue
to grow by proactively seeking
new funding models and methods
of collaboration.
Between 2009 and 2013 global health
employment grew at a compound annual
growth rate (CAGR) of 4.4% representing an
absolute gain of almost 2,000 jobs over five
years. In Washington state, total employment
increased at a CAGR of 1.1% during the same
period, meaning that global health jobs grew
at four times the rate of state employment.
Government funding has declined since 2012
with no immediate indication for increases
in the future. Global health leaders say new
funding models are essential to continue
making the kind of significant progress we
have seen in the last decade. The social
returns in global health make it well-aligned
with socially responsible, impact investing,
though the community has yet to build
appropriate investment vehicles.
5. Create new business models through new
partnerships with aligned corporate and
government entities to develop new revenue-
generating opportunities in the development
and delivery of global health solutions.
6. Focus on new training and education
programs to keep the talent pool competitive.

Summary of
Strategic Opportunities
the marketplace.
5. Create new business models through
new partnerships with aligned corporate
and government entities to develop new
revenue-generating opportunities in the
development and delivery of global
health solutions.
INTRODUCTION
Background and Purpose
Washington-based global health initiatives
have had an enormous social impact
worldwide and economic impact in Washington
state. The significance of this growing sector
extends into many aspects of the statewide
economy and international economies.
This report leverages new and existing data
to measure and quantify the significance of
global health to Washington state. The study
leverages partners of the Washington Global
Health Alliance (WGHA) to tell the story of the
presence of Washington’s global health work
worldwide along with its economic impact
at home.
Research Methods
The analysis makes use of economic
data collected through several sources,
including state government-collected data on
employment, wages and other indicators. Data
gathered through interviews and an online
survey of leading global health organizations
in Washington also contributed to the
understanding of the global health economy.
The global health sector is complex in that
many organizations drive global health
activities along with focus areas outside of
global health. Therefore, the challenge is to
determine which portion of the jobs, wages
and operating budgets of these organizations
are dedicated to global health activities. Data
provided by surveys and interviews enabled
allocation of state-published data to arrive at
refined estimates of economic activity related
to global health.
The primary tool for analyzing economic
impacts is the Washington State Input-Output
Model, published by the Washington State
Office of Financial Management. The Input-
Output Model provides a rendering of the
state economy across distinct sectors, and
captures transactions and spending flows
across industries and through employee
spending. The Input-Output Model estimates
the impacts of economic activities when
output, employment, and wages are known for
a given industry or economic event.

Bothell and South Lake
Union are regional hubs
for life sciences and global
health innovation
Demand for college-level global
health programs is growing; fields
becoming more specialized
- UW started the Department of
Global Health in 2007
- More global health jobs
in Washington
- Global health impact is increasing
- More reported collaboration
with partners
- More global health organizations
- More projects per organization
Global health is recognized
as a distinct economic sector
New global health partnerships
foster innovation in manufacturing
and product development
WHAT’S NEW in WASHINGTON’S GLOBAL HEALTH SECTOR
Examples of
Global Health
Expansion
Growth in Gates
Foundation grant-making –
$1.5B in Global Health &
Global Development grants
in 2007 vs. $2.8B in 2014
Infectious Disease
Research Institute opens
South Africa biotech
PATH had 199 technologies
and products in the
development pipeline.
Three were licensed and
two were prequalified by
the World Health
Organization (2011)
Uganda Cancer Institute –
Fred Hutch Cancer Centre
opens in Uganda
Global health
organizations are training
more in-country workers
Local Evolutions in Global Health
Trends

0 20 40 60 80 100
Nonprofits
For-profits
Colleges &
Universities
Research Institutes
Governmental
Organizations
Other
94
48
9
8
4
5
ESTABLISHMENTSSEGMENTS
TOTAL: 168
WASHINGTON STATE HAS A DISTINCT, DIVERSE, AND COLLABORATIVE GLOBAL HEALTH SECTOR
Washington’s global health industry represents
a diverse set of activities, spanning research,
grant-making, and health care delivery,
extending across for-profit and nonprofit
businesses and organizations. Washington’s
global health organizations are leaders in the
innovation economy, driving advancements that
by their very nature are global in reach, saving
lives throughout the world.
An extensive innovation ecosystem
Global health refers to the area of research
and practice to improve health and achieve
equity in health for all people worldwide.
Global health emphasizes health issues,
causes, and solutions that cross international
boundaries. It involves collaboration among
many disciplines within and beyond health
sciences and combines population-based
prevention with individual-level clinical care. In
Washington state, this is a rich ecosystem of
168 organizations, as shown in Exhibit 1.
Exhibit 1. Global Health Organizations in Washington State, 2013
Note: Data was from 2013 and accessed in 2015. Source: Washington Global Health Alliance, 2015;
Community Attributes Inc., 2015.
Nonprofits represent the largest segment of
global health organizations with more than
90 entities in Washington. The nonprofit
group includes small and large organizations
such as SightLife and Med25 International.
Nonprofits design and implement global health
programs, and can also include philanthropies
and non-governmental funding partners.
For-profit entities include almost 50
businesses in the life sciences and biotech
space, such as Kineta. Manufacturing,
research and product development
companies like MSR Global Health are
also represented.
Colleges & Universities are an integral
asset within the global health sector. The
contributions by faculty, research staff and
students keep Washington at the forefront of
innovative scientific discovery. UW and WSU
are included in this count, along with Seattle
University, Northeastern University and
several community colleges.
Research Institutes, including Fred
Hutchinson Cancer Research Center, Battelle,
and Center for Infectious Disease Research,
are examples of organizations that employ a
diverse local workforce in applied research,
academic research, project management and
grant development.
Government partners in global health refer
to the Washington State Department of
Health, Public Health – Seattle & King County
and public health entities around the state
that contribute to global health research, data
analytics and health systems strengthening.
The Other category contains distinct global
health programs that don’t neatly fall into
existing subgroupings. This group also
includes global health programs that serve
veterans and active duty personnel at Joint
Base Lewis-McChord and Madigan Army
Medical Center.
Nearly 2,000 partnerships globally
Partnerships and collaboration are a part of
the region’s business and nonprofit culture,
and global health is no exception. Partnerships
are a critical and defining feature of global
health in Washington and include research,
programs, funding and advocacy.
In the last few years, the number of
partnerships named by global health
organizations has increased. In the 2009
Mapping Study by WGHA, 600 partners
were identified by global health organizations.
This 2015 study identified 1,959 partnerships
worldwide (Exhibit 2).1
1 The total of 1,959 partnerships does not include
worldwide grantees receiving funding from the Bill
& Melinda Gates Foundation. Within the foundation,
there are more than 1,000 active grantees within the
Global Health and Global Development department.
Data provided by the Bill & Melinda Gates
Foundation to Community Attributes Inc., 2015.

United States
941
Canada
35
United
Kingdom
Sweden
212
India
China
Australia
New
Zealand
Ireland
169
121
Kenya
Ethiopia
Niger
Switzerland
Spain
France
Germany
Italy
Rwanda
Nigeria
Ghana
Burkina
Faso
Malawi
Mozambique
South Africa
320Sudan
15
72
51
Nepal
Brazil
42
Mexico24
183
Tanzania138
120
Georgia
70
Liberia
11
62
49
Zambia47
Zimbabwe20
Mali
49
Colombia
18
Peru
20
Argentina
10
96
32
33
Belgium 23
16
16
36
217
Denmark
Netherlands
217
48
Uganda
Cameroon
142
148 Congo
31
Benin
19
Togo 11
Gambia
13
Bangladesh
Pakistan
91
Thailand
35
Cambodia
21
Indonesia
27
Philippines
31
45
69
112
Guatemala
11
25
29
22
28
75-119120-1000Color
Key
40-74
20-39 10-19 0-9
Exhibit 2. Washington Global Health Worldwide Partnerships, 2015
Source: Washington Global Health Organizations Survey, 2015.

Respondents
(n=71)
Share
Technologies and
Devices
38 54%
Infectious Disease 37 53%
Maternal, Child and
Newborn Health
32 46%
Health Systems
Strengthening
30 43%
Other 30 43%
Non-Communicable
Disease
26 37%
Surgical or Clinical
Interventions
17 24%
Environment 16 23%
Agriculture 13 19%
Animal Health 10 14%
The high level of strategic collaborations
from research to program delivery, makes
organizations more effective, reduces
redundancy and increases impact ultimately
improving the lives of people around the world.
Washington is home to the first-of-its kind
formal body that increases connectivity and
furthers collaboration—the Washington Global
Health Alliance. WGHA’s strategic connections
strengthen the global health network and
improve the effectiveness and impact of global
health organizations while creating a platform to
influence critical practices that impact the sector.
In some examples, such as Global to
Local, the partnership involves a coalition
of nonprofits, local governments and public
health supporters, along with corporate
entities. Global to Local coalition partners
work to bring best practices from low-resource
settings to underserved communities in the
U.S. Partners include Providence and Swedish
Health Systems, Public Health – Seattle &
King County, the cities of Tukwila and SeaTac,
HealthPoint and WGHA. Washington State
University and Starbucks are also supporters.
For-profit partnerships connect for-profit
businesses that have expertise in product
design, manufacturing or production, with
nonprofit delivery and implementation
entities. Washington’s established industries
in biotechnology, medical devices and
health science research provide a
wealth of collaborative opportunities for
nonprofit ventures.
Depth of expertise
Because of the nature of global health,
organizations in Washington work to address
complex issues across a variety of disciplines.
The intersection of these areas of expertise
provides a distinct competitive advantage for
collaboration in Washington. Other regional
hubs like Washington DC or the Bay Area may
specialize in infectious disease or technology,
for example, but Washington is known for the
number of leading organizations from almost
every area of the global health ecosystem.
The work disciplines include the following:
• Infectious Disease. Activities and vaccines
related to the prevention and control of
communicable diseases, both emerging
and epidemic
• Technology and Devices. Includes
the development and manufacturing of
devices, diagnostics and tools, including
mobile devices and IT, used to improve
health outcomes
• Maternal, Child and Newborn
Health. Includes provision of ongoing,
comprehensive health care and nutrition
services for individuals and families
• Health Systems Strengthening.
Promotes health systems that integrate
service delivery, health workforce,
information, medical products/technologies,
financing and leadership or governance in
restoring or maintaining health
• Non-Communicable Diseases.
Activities related to the prevention and
control of diseases that continue for a
long time or constantly recur, including
cardiovascular diseases, diabetes,
hypertension, mental health and cancer
• Surgical or Clinical Interventions.
Direct treatment of individuals for specific
ailments, injuries (including traffic or
traumatic) or other conditions
• Environment. Addresses natural and
man-made environmental factors that
impact health (e.g. clean water, air quality,
sanitation) including initiatives addressing
the impact of climate change
• Agriculture. Initiatives to increase crop
yields or increase food security
• Animal Health. Detection of pathogens,
control of disease transmission and
vaccine development
All of the global health organizations that
participated in the online survey conducted
for this study responded with the disciplines
in which they work. More than 50% of these
Washington state organizations reported
work in infectious disease (and vaccine) and
technology and devices, as shown in Exhibit
3. While less than 25% of organizations
indicated current work or projects in
environment or agriculture, the growth
in funding from the Bill & Melinda Gates
Foundation suggests these two areas may be
opportunities for innovation in the near future.
Exhibit 3.
Work Disciplines among Washington’s
Global Health Organizations, 2015
Source: Washington Global Health Organizations
Survey, 2015.

Well Funded
Communicable Diseases,including HIV,
malaria, TB and enteric diseases
Ebola
Maternal and Newborn Health,
including contraceptive health
Diagnostics
Underfunded
Non-communicable Diseases,
including cancer, TB and the relationship
between those diseases
Mental Health
Tropical Diseases such as river blindness
Alzheimers and other diseases effecting
aging populations
Respondents
(n=57)
Share
5 or fewer projects 30 53%
6-10 projects 6 11%
11-20 projects 8 14%
More than 20 projects 13 23%
“Washington state
has the potential
to drive new
technologies and
new approaches
to solve massive
health problems.”
– excerpt from WGHA
leadership interview
Exhibit 4. Global Health Perceptions on Funding Availability, 2015

Source: WGHA Leadership Interviews, 2015.
Thousands of projects
in hundreds of countries
The projects designed and overseen by
global health entities in Washington state are
as diverse as the organizations themselves
and their partners. Survey participants
reported 5,100 current global health projects,
with some organizations such as Splash
and World Vision reporting hundreds of
projects underway each year.2
Most survey
respondents reported working on five or
fewer projects per year; the median number
of projects per organization was five for 2014
(Exhibit 5).
2 It is important to note that funds from the Gates
Foundation are not counted as projects. Rather,
Gates Foundation grants support organizations that
implement projects.
Exhibit 5.
Organizations by Number of Projects, 2014
Survey, 2015.
Survey participants had projects in 151
countries worldwide. Kenya was the top-
ranking country with 17 survey participants
that have active global health projects there.
Fifteen survey organizations had projects in
Uganda, 13 had projects in South Africa, and
13 had projects in India. (Exhibit 6).
the marketplace.
What drives an organization to focus on
some areas within global health and not
others is complex and can change to address
or respond to needs across the world. In
interviews with global health leaders, senior
executives highlighted the constraints of
market conditions and funding models that
impact the decision to work in different areas.
Their comments and perceptions confirm that
infectious disease projects are a strong area
of focus among Washington organizations
compared to research being done in non-
communicable diseases. Exhibit 4 presents
those areas of specialty that are well funded and
underfunded, as reported by industry leaders.

Canada
United
Kingdom
India
China
Australia
Kenya
Ethiopia
Niger
Switzerland
France
Germany
Rwanda
Nigeria
Ghana
Malawi
Mozambique
South Africa
Sudan
Nepal
Brazil
Mexico
17
Tanzania
Zambia
Zimbabwe
Peru
Uganda
Bangladesh
Pakistan
Thailand
Cambodia
Philippines
Vietnam
Guatemala
15
13
11
11
Haiti
6
Dominican
Republic5
Honduras5
Nicaragua5
5
5
5
5
5Ecuador
5
10
10
9
9
9
9
9
8
6
6
6
6
8
8
7
Malaysia
5
7
7
7
8
9
10
11
13
9-1213-17Color
Key
3-8
1-2 0
Exhibit 6. Number of Washington Global Health Organizations with Active Projects, 2014
Source: Washington Global Health Organizations Survey, 2015. Countries with fewer than 5 organizations are not labeled.

0
100
200
300
400
500
600
700
800
2010 2011 2012 2013 2014
Millions,
2013$
$704
$749 $741
$719
$790
Other
USAID
CDC
Gates
Foundation
NIH
0
100
200
300
400
500
600
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
YEAR
AWARDS
0 800400
Washington’s global health sector accounts
for a growing portion of the state’s
total economic activity. Global health
organizations in Washington state attract
external investments composed of grant
funding, product and service revenues,
private contributions and other sources. The
interdisciplinary nature of the work makes
it an important source of innovation for the
state. Expertise in designing for limited- or
low-resource settings positions the global
health community to constantly innovate in
the name of reaching customers at the bottom
of the economic pyramid. In addition, global
health organizations’ missions are a magnet
for job seekers and an educated, permanent
workforce with spending power for local goods
and services.
Funding sources and trends
Between 2010 and 2014, global health
organizations in Washington state received
more than $3.7 billion in grant funding, with
55% in funds from the National Institutes of
Health (NIH).
Awards from federal entities to global health
have steadily declined since 2011. During this
time period grants in global health and global
development to Washington global health
organizations from the Gates Foundation
have increased by almost 42%.
In 2014, Washington organizations involved in
global health received more than $790 million
from various sources, not including business
income (Exhibit 7).
Exhibit 7. Grant Funding for Global Health Activities,
Washington State, 2010-2014, Millions of 2013 Dollars
Note: Bill & Melinda Gates Foundation funding includes grants for Washington global health organizations in
both the global health and global development program areas. “Other” includes the Life Sciences Discovery
Fund, NSF and the Department of State. Source: National Institutes of Health, 2015; Centers for Disease
Control, 2015; USAID, 2015; Gates Foundation, 2015; Life Sciences Discovery Fund, 2015; Department of
State, 2015; National Science Foundation, 2015; Community Attributes Inc., 2015.
The NIH is the top funding source for
Washington’s global health organizations,
On average, between 2005 and 2014, 644
grants per year were awarded to global health
organizations in Washington state (Exhibit
8). This includes federal grants as well as
grants from the Gates Foundation. NIH
grants to Washington state organizations,
and organizations across the country, have
steadily declined since 2012.
Exhibit 8. Grant Awards for Global Health
Activities, Washington State, 2005-2014
Source: National Institutes of Health, 2015; Centers
for Disease Control, 2015; USAID, 2015; Gates
Foundation, 2015; Life Sciences Discovery Fund,
2015; Department of State, 2015; National Science
Foundation, 2015; Community Attributes Inc., 2015.
GLOBAL HEALTH CONTRIBUTES TO WASHINGTON STATE’S ECONOMY
THROUGH INVESTMENT, INNOVATION AND EMPLOYMENT
followed by the Gates Foundation, USAID and
the Centers for Disease Control. Compared
to the total funding from federal sources since
2010, grants from the Gates Foundation
are a relatively small piece of all funding for
Washington state organizations.

0
$500
$1000
$1500
$2000
$2500
$3000
$3500
2007
Millions
$1781
$2550
$1510
$975
$3270
$1724
$2487
$2853
2008 2009 2010 2011 2012 2013 2014
“Washington is the
epicenter of global
health research, but
there is a need to
recruit more people
to Seattle. It would
be ideal to attract
younger talent at the
peak of their career.”
– excerpt from WGHA
leadership interview
Year
Global Health
Employment
Global Health
Year-Over-Year
Growth
Washington State
Employment
Washington
Year-Over-Year
Growth
2009 10,630 2,836,354
2010 10,970 3.2% 2,808,445 -1.0%
2011 11,570 5.5% 2,844,391 1.3%
2012 12,060 4.2% 2,894,394 1.8%
2013 12,620 4.6% 2,960,071 2.3%
2009 - 2013 4.4% 1.1%
Bill & Melinda Gates
Foundation Grants
The Bill & Melinda Gates Foundation
granted $2.9 billion for global health and
global development projects and programs in
2014 (Exhibit 9). Global health research and
development work from 66 Gates Foundation
grants is currently underway in Washington state.
Exhibit 9. Gates Foundation Global Development and Global Health Grants Value
by Project Start Year, 2007-2014, Millions of 2014 Dollars
Source: Gates Foundation, 2015; Federal Reserve Economic Data, 2015.
Organization spending is growing
Global health spending activities involve
grant-making, payroll, and other expenses, of
which a large share accrue within Washington
state. Together these activities make up the
operating budgets of organizations involved in
global health.
Spending by global health organizations
brings money into the state and contributes to
the innovation economy. While current project
spending totaled $318 million, global health
leaders point out that this investment does not
begin to address the growing need for product
development research.
Global health benefits
Washington’s economy
Global health job impacts are counted in three
distinct categories: direct, indirect and induced.
Direct jobs (12,620 in 2013) includes the
actual jobs in global health at an organization
or business. Jobs in global health have grown
each year since 2009, from 10,630 in 2009 to
12,620 in 2013. Jobs in global health have
grown at 4.4% per year since 2009, four
times the rate of Washington state’s overall
employment (Exhibit 10).
Indirect jobs (8,200 in 2013) are created
by the business-to-business transactions
that come into existence due to the output
of workers in direct jobs. Additionally,
global health organizations in Washington
supported an estimated 12,000 jobs through
induced impacts, which are the jobs that
are supported by the spending of wages
throughout the Washington state economy
from the direct and indirectly supported jobs.
Exhibit 10. Global Health Employment and Growth Rate Compared to Washington state
Employment and Growth Rate, 2009-2013
Source: Washington State Employment Security Department, 2014; Washington Global Health Organizations
Survey, 2015.

Tax Category Direct Payments
Secondary Tax
Impacts
Total Fiscal
Impacts
B&O 1.0 15.0 15.9
Sales Tax 0.4 26.2 26.6
Other 0.0 3.3 3.4
Total 1.4 44.6 45.9
Direct Indirect Induced Total
Jobs 12,600 8,200 12,000 32,800
Labor Income 1,164.0 424.6 661.8 2,250.4
Operating Budget 5,845.8 1,317.9 2,265.4 9,429.1
State business and occupation (B&O) taxes
and sales taxes are generated, however,
from business-to-business spending from
sector activities. The sector and its indirect
and induced impacts provided $45.9 million in
state tax revenues in 2013.
Exhibit 12. Washington State Tax Revenues from
Global Health Activities in Washington, 2013, Millions of 2013 Dollars
Source: Washington State Employment Security Department, 2014; Washington State Office of Financial
Management, 2014; Washington Global Health Organizations Survey, 2015.
Economic multipliers help demonstrate
how direct output or revenues, wages
and jobs support and generate economic
impact throughout the Washington state
economy. For every million dollars in
global health output in Washington, a total
of 5.6 jobs are supported throughout the
Washington economy. For every dollar in
direct labor income an additional $0.93 is
generated throughout Washington state. As a
comparison, the apple industry in Washington
supports 3.95 jobs for every direct job and
$0.67 in labor income for every dollar of direct
labor income throughout the Washington
economy. This comparison shows how direct
job growth in global health is an excellent return
on investment, spurring both above-average
indirect and induced jobs and labor income.
Valuable fiscal impacts
Global health is important to Washington
because of the global good provided by
the sector, the jobs created locally and
the industry spending in-state. Fiscal
contributions provide another layer of
benefit, with the sector paying their share
of state provided services.
Nonprofits and philanthropies are exempt
from many taxes or do not generate taxable
income, so the direct taxes paid by the sector
are limited to primarily the for-profit entities.
Exhibit 11.
Economic Impacts of Global Health, Washington, 2013, Millions of 2013 Dollars
Source: Washington State Employment Security Department, 2014; Washington State Office of Financial
Management, 2014; Washington Global Health Organizations Survey, 2015.
Combining direct, indirect and induced
jobs, the global health sector supported an
estimated total of approximately 32,800 jobs
in 2013, including 20,200 jobs supported
by both inter-industry purchases and wage
expenditures purchases. These 32,800 jobs
produced an estimated $2.3 billion in total
labor income in 2013 (Exhibit 11).
Throughout the Washington state economy,
global health organizations directly accounted
for an estimated $5.8 billion in output in 2013.
Through the supply chain interactions and
wage spending from direct and indirectly
supported jobs, these direct impacts have
a multiplier impact of 1.6, generating an
estimated $9.4 billion throughout the
Washington economy.3
Average wages paid to
global health workers were $71,129 in 2013;
precisely 29% higher than the average wage
in Washington state for all jobs ($55,100).
While not a primary driver of Washington’s
economy, these data document global health
as an economic sector with an impact and
contribution worth recognizing and nurturing
as a part of the innovation ecosystem.
3 These numbers have been rounded. More
accurate figures are $5.85 billion in output, 1.61 as
a multiplier, and $9.42 billion in state-wide indirect
business revenues.

THIS VIBRANT SECTOR WILL CONTINUE TO GROW BY PROACTIVELY SEEKING
NEW FUNDING MODELS AND METHODS OF COLLABORATION.
Global health organizations and state
leaders in Washington have much reason for
optimism. There are opportunities to enhance
the state’s influence on the global stage,
collaborate with new and talented partners
and advance new solutions. A few challenges
are looming locally as the global health
community tackles the most complex health
challenges across the world. As global health
organizations think about their changing
strategies around staffing and the sector
competes for talent with other innovative
sectors (such as software development),
new trends will emerge. Success will be
measured by the degree to which Washington
organizations can make room for new,
more flexible funding to support continuous
innovation, manage its skilled workforce, and
add new training and education programs to
keep the talent pool competitive.
Global health growth areas
Areas of focus and need among specific
global health disciplines are difficult to predict
in the case of epidemics (the Ebola outbreak
and response, for example). Washington
organizations are uniquely tooled to address
both outbreaks and pandemics like HIV/
AIDS. In addition, the global health community
anticipates increased international focus and
spending around the United Nation’s newly-
created Sustainable Development Goals.
One measure to determine the future focus
of global health is hiring. When asked about
how the sector will grow, local HR directors
reported increased funding for projects in
several disciplines:
• Diagnostics
• Nutrition innovation (i.e. fermentation and
insects as food sources)
• Vaccine development
• Biotech
• Digital health
• Global development and agriculture research
In citing anticipated growth of these
disciplines, HR directors specifically call
out the increased need for inexpensive and
quick testing to diagnose and rapidly treat
communicable diseases. The University
of Washington and the Infectious Disease
Research Institute, among others, are working
in this space already.
Washington state’s global health community
needs to further support the emerging
research needs within agriculture and
environment. Projects in these categories
address natural and man-made environmental
factors that impact health. More and more,
organizations find health outcomes can
be improved in rural and urban areas with
breakthroughs in water, sanitation and hygiene
(WASH). Targeted investments in WASH
behavior modification and product innovation,
particularly from the Bill & Melinda Gates
Foundation, are yielding life-changing solutions
around the world.
New funding models
Important changes have occurred recently that
affect global health spending in Washington
state, including new sources of funding as
well as constraints placed on how funds are
disbursed. Current sources of funding include
government agencies, private foundations,
private coalitions and individual donors,
however, these sources are not adequate to
sustain progress in future years. In response,
many global health organizations in Washington
choose to turn to private donors who give
unrestricted gifts.
The following trends have affected funding models:
• Overall federal grant funding has slowed
• Competition for grants has increased
• Requirements for grant funding have become
more intricate
• Caps on so-called “indirect spending” limit
innovation and stifle interest in pursuing
some grants
• Grants are tied more to specific projects
versus outcomes that limit funding for new
innovations or basic science discovery
• Philanthropies defer to the Gates Foundation
to fund all global health activities
• A disconnect between funding cycles and
the time needed to implement programs
with measurable impact
• A “silo” mentality about diseases reinforced
by funding structures; organizations are not
financially incented to study how different
diseases relate to each other
• Diverse and complex granting bodies
require more specialized attention
Global health organizations were asked to
describe their biggest changes in funding.
Among them, a majority said they now solicit
funding from individuals, as well as private
foundations. This also provides increased
opportunities for individual donors to influence
programmatic focus and requires global
health organizations to mature fundraising
practices with appropriate hires.

32+68+MAre hiring now:
68%
Are not hiring
now: 32%
RESPONDENTS (n=68)
Are hiring now: 46 Are not hiring now: 22
“Global health is becoming part of Washington
state’s brand, particularly around innovation,
and WGHA is making the case to start working
together. It’s a legacy of collaboration”
– excerpt from WGHA leadership interview
Key global health challenges
Washington’s global health leaders see a
number of challenges facing global health
effectiveness. Leaders expressed urgency to
address the following barriers:
• Improving infrastructure in low- and
medium-income countries—especially
transportation, energy and communications
• Scaling and capacity building in-country
• Identification and training of
in-country partners
• Empowering women and reducing
gender inequity
The challenge most discussed among global
health leaders is matching the appropriate
levels, duration and flexibility of funding to
appropriately address complex global health
problems. Looking forward, new funding
approaches are needed to help global health
research and organizations meet the ever-
changing needs of the world’s most vulnerable
people. One recommendation from many local
organizations was to move out of a 3-5 year
project cycle to a longer-term funding model to
achieve community sustainability. In addition,
organizations are increasingly aware that
projects need to move from focusing on specific
diseases to more interdisciplinary programs with
funding-based outcomes. There is a heightened
need to generate sustainable revenue sources
for global health organizations and partner
directly with the private sector on research and
program delivery.
Government funding has declined since 2012
with no immediate indication for increases.
Global health leaders say new funding models
are essential to continue making significant
progress as seen in the last decade. The
social returns in global health make it well-
aligned with socially responsible, impact
investing, though the community has yet to
build appropriate investment vehicles.
The variety of funding has to match the
activities across the spectrum of discovery,
development and delivery. The kind of
funding available has to have flexibility and
risk tolerance to allow for innovation and the
development of new business models.
Forecasted job growth in
Washington and abroad
Washington’s global health community is
growing. Global health workers in Washington
are in high demand both within the sector and
from other industries separate from health
care. Among online survey respondents, 68%
indicated, as of 2015, they were hiring new
employees (Exhibit 13).
Exhibit 13. Washington Global Health
Organizations by Hiring Status
Survey, 2015.
Not all organizations hire global health
workers based in Washington. A recent pivot
in hiring practices has organizations exploring
and hiring in-country employees to reflect
their focus on building local capacity. With
constant emphasis on reducing administrative
overhead, employers may decide they can
reduce costs and deliver services or products
more effectively by placing workers directly
in low-resource settings or building personal
relationships with in-country partners.
How to maintain the pipeline of
global health workers
Washington state’s quality of life, coupled
with high wages and mission-driven work are
drivers for attracting a strong global health
workforce. Also important is the influx of talent
associated with the state’s universities and
colleges. Additional programs like internships
and postdoc programs further develop
existing talent. Not only do Washington’s
universities produce undergraduates and
graduates in research and technical fields,
but many schools also provide programs
in communications, public administration,
entrepreneurship and finance, which
provide education for global-health-related
occupations. Washington State University has
just created a position titled Senior Director
of Global Health to centralize its many global
health activities. The influence of large
employers such as the Gates Foundation
and Fred Hutchinson Cancer Research
Center are undeniable.

Management
Software and Web Development
Research and Technical Assistants
Professors and Faculty
Scientists
Finance and Grant Managers
Manufacturing
Business Development
Evaluation and Metrics
Sales
Even so, recruiting challenges persist.
Washington state may not be top of mind
among graduate students and schools on
the East Coast, thereby limiting the pool
of applicants. Most global health positions
require a high and/or specialized level of
education and training, which means there
are fewer candidates who meet the minimum
qualifications. There is an outsized demand
for global health programs that the state’s
universities are not currently set up to meet
due to state funding constraints. For example,
the University of Washington’s School of
Nursing is exploring creating global health
emphases due to a demand from students.
Finally, the cost of living in the Seattle area
can be a negative factor among candidates
coming from less expensive geographies.
Even when a candidate wants to work in
global health in Washington state, his or her
skills or salary expectations might not be
appropriate for the jobs that exist; alas some
occupations in global health remain more
difficult to fill than others (Exhibit 14).
What makes a global health job difficult to fill?
• Increasing specialty roles such as program
managers and engineers
• Increasing demand for workers with upper-
level management experience
• Increasing competition from local software
development companies
• Wage gaps between nonprofits and the
private sector
• Increasing need for candidates to live or
work abroad
Exhibit 14. Most Difficult-to-Fill Positions,
as Indicated by Survey Participants
Survey, 2015.
Growing the talent pool of qualified candidates
will increase Washington’s impact in solving
global challenges like HIV/AIDS, tuberculosis
and malaria. Many organizations have a role
to play—universities, nonprofits, the private
sector, and convening groups like WGHA.
5. Create new business models through
new partnerships with aligned corporate
and government entities to develop new
revenue-generating opportunities in the
development and delivery of global
health solutions.
Conclusion
Washington state has the talent, innovative
spirit and unique concentration of
organizations to lead the world in global
health discovery, development and delivery.
To realize the potential of this sector, strategic
investments and new partners are needed.
Through organizations dedicated to improving
and saving lives around the world, the global
health community drives awareness of
Washington state as an economy focused on
improving lives at home and abroad.

Responding Organizations
Funding
Research
Product
Development
Delivery&
Distribution
U.S.or
International
Policy&
Advocacy
Education,
Outreachand
Training
Metrics,
Evaluation
Other
Non-
Communicable
Diseases
Infectious
Diseases
Technologies
andDevices
Surgical
orClinical
Interventions
Maternal,Child
andNewborn
Health
Agriculture
AnimalHealth
Environment
HealthSystems
Strengthening
Other
Agros International X X X X
Aseptico X X
AttoDX X X X
Battelle X X X X X X X X X X X X X X X
Benaroya Research Institute
at Virginia Mason
X X X
Bethany Community Church X X
Big Water Consulting X X
Bill & Melinda Gates Foundation X X X X X X X X X
Burn Manufacturing X X X X
Camber Collective X X X X X X
Center for Infectious
Disease Research
X X X X X X X
Centurion Medical Products X X X
CRISTA/World Concern X X X X X
Critical Practices LLC X X X X
Day for Girls International X X X X X X X
EG Walker Associates X X
First Presbyterian Church
of Spokane
X X X X X
Fred Hutchinson
Cancer Research Center
X X X
Gambia Health Education
Liaison Project
X X X X X X X
Geneva Foundation X X X X X X X X X
Global Health Activities Global Health Focus Areas
WGHA ONLINE SURVEY RESULTS
WGHA Member

Funding
Research
Product
Development
Delivery&
Distribution
U.S.or
International
Policy&
Advocacy
Education,
Outreachand
Training
Metrics,
Evaluation
Other
Non-
Communicable
Diseases
Infectious
Diseases
Technologies
andDevices
Surgical
orClinical
Interventions
Maternal,Child
andNewborn
Health
Agriculture
AnimalHealth
Environment
HealthSystems
Strengthening
Other
Global Alliance to Prevent
Prematurity and Stillbirth – an
initiative of Seattle Children’s
X X X X
Intellectual Ventures
(Global Good)
X X X X X X X X X X X X X
global HELP X X X X
Greater Spokane Incorporated X X X X X X X X X
HDR X X X X X X X X X X X
Health Alliance International X X X X X X X X
Infectious Disease Research Institute X X X X X X
Institute for Health Metrics
and Evaluation
X X X X X X X X X
International Training and Education
Center for Health
X X X X X X X X X X
JBLM 84th Civil Affairs Battalion X X X X X
Just. X X X X X X
Kineta X X X X X
Life Sciences Discovery Fund X X X
Limbs For U X X
MalarVx, Inc. X X
Max Foundation X X X X X X
MED25 International X X X X X X
Medical Teams International X X X X X X X X
Micronics X X X
Microsoft X X X X X X
Mobility Outreach International X X X X X X X X X X
Mobisante X X
WGHA Member

Funding
Research
Product
Development
Delivery&
Distribution
U.S.or
International
Policy&
Advocacy
Education,
Outreachand
Training
Metrics,
Evaluation
Other
Non-
Communicable
Diseases
Infectious
Diseases
Technologies
andDevices
Surgical
orClinical
Interventions
Maternal,Child
andNewborn
Health
Agriculture
AnimalHealth
Environment
HealthSystems
Strengthening
Other
Mountain Safety Research
(MSR Global Health)
X X X X X X X
Northeastern University X X X X X X X X X
Oasis Diagnostics X X X X X X X
One by One X X X X X X X X
PATH X X X X X X X X X X X X
Philips Healthcare X X X X X X X
Pilgrim Africa X X X X X
Planned Parenthood of the
Great Northwest
X X X X
Sherris Consutling X X X X X X X X X
SightLife X X X X X X X X X
SIGN Fracture Care International X X X X
Splash X X X X
SpringStar Inc. X X X X
Stratos Product Development X X X X X
Strengthening Care Opportunities
through Partnership in Ethiopia
X X X X X X
University of Washington X X X X X X
University of Washington
Department of Global Health
X X X X X X X X X X X X X X X
UW Bioengineering Lab
(Paul Yager)
X X
Village Reach X X X X X X X X X
Washington Research Foundation/
WRF Capital
X X X X X X
Washington State University X X X X X X X X X X X X X X X
WGHA Member

Funding
Research
Product
Development
Delivery&
Distribution
U.S.or
International
Policy&
Advocacy
Education,
Outreachand
Training
Metrics,
Evaluation
Other
Non-
Communicable
Diseases
Infectious
Diseases
Technologies
andDevices
Surgical
orClinical
Interventions
Maternal,Child
andNewborn
Health
Agriculture
AnimalHealth
Environment
HealthSystems
Strengthening
Other
Washington State University –
Spokane campus
X X X X X X X X
Water for Humans X X X X X X
Weber Shandwick X X X X X X X X X X X X X X
World Concern X X X X X X
World Vision X X X X X X X X X X X X X X
WGHA Member

Washington Global Health Landscape Study 2015 Final Report

Washington Global Health Landscape Study 2015 Final Report

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