Baroness Dambisa Moyo: Health and economic growth – a vital connection

Matthew

Hello and welcome to the latest edition of Health on the Line. Our figures are rising nicely, so thank you for listening. And if you have time to subscribe or put a review on your podcast platform, that would be great. Things are busy at the NHS Confed as always. Recently we welcomed the team from Understanding Patient Data who’ve joined us from the Wellcome Trust.

Last week we held a successful conference of our mental health network. We've been meeting with our ICS Network to explore next steps on the Hewitt review. And of course, there's the work of NHS Employers, a part of Confed, on the ongoing industrial dispute. Speaking to and visiting leaders, I know the impact that industrial action has had and how desperate our members are to avoid further action.

On a positive note, it was good to see a successful resolution for Agenda for Change of staff in Wales. This week we'll find out more about trade union ballots and plans. And we will continue to do everything we can to encourage both sides to find a path to positive resolution. But Health on the Line also offers an opportunity to stand back a little from the day to day and hear different perspectives on the challenges we face.

So please sit back, or whatever it is you do while you're listening, and enjoy my conversation with Baroness Dambisa Moyo.

Matthew

So, I'm delighted to welcome to our Health on the Line Baroness Dr Dambisa Moyo.

Dr Moyo is a preeminent thinker who influences key decision-makers in strategic investment and public policy. She's respected for her unique perspectives, her balance of measured judgment, but occasionally contrarian thinking as well. Her ability to turn economic insights into accessible and exciting ideas, Dr Moyo is a co-principal of Persica Investments, a family office focused on growth investing globally.

She serves on a number of global corporate boards, including 3M corporations, Chevron, Condé Nast, as well as the Oxford University Endowment Investment Committee. So, Dambisa thank you for joining us.

Dambisa

Thank you. Delighted to be here.

Matthew

So, we're speaking nearly three years to the day since the UK went into lockdown. And I want to explore issues about the relationship between health and the economy with you. But let's start with covid. What do you think has been the kind of lasting effect of covid on the global economy?

Dambisa

Well, I think, to be quite candid, it's still too early to know. You know, there are many second order effects that are still being calibrated. At a very high level the World Bank has estimated that there are about 200 million people globally that have slipped back into poverty, abject poverty, because of the pandemic and lockdowns associated with that.

But there's so many additional consequences that we're still feeling, the sort of reverberations from that experience. Growth remains weak around the world. We are dealing with inflation, partly, of course, because of the war in Ukraine. But beyond that, supply constraints that have emerged because of the pandemic. China only has just come back online in the last sort of six weeks to two months.

Issues around education remain question marks around that. What the knock-on effects are of young people who are not able to attend school. And then of course the healthcare effects. And we continue to look at long-term consequences and possible long-term effects of the disease itself, but also mental illness stemming from the pandemic. So, I think it would be far too shortsighted to say that we have all those answers. And it's certainly an ongoing area of inquiry.

Matthew

No, I'm sure that's right. I'm sure historians will still be arguing about the impact of covid on the economy in 50 years’ time, but you highlighted the health impacts and of course, one of the things which seems to have impacted the UK more profoundly has been the effect on labour force participation.

And this hasn't really occurred in anything like the same way in other countries, a bit in the States as well. And of course, that's causing economic problems because when labour markets are tight and inflation is high, you want more people to be working. We've got this very high number, 2 million people who are not working, who say that health is the major reason why they're not working.

Do you have a view of why it is that this seems to have been particularly a phenomenon in the UK?

Dambisa

I don't, but I will say the following though, I think the questions around labour participation are not a UK-specific problem and indeed are not a problem that are only associated with the pandemic. Long before the pandemic, I myself had written about some of the concerns associated with both the quality and the quantity of the workforce.

For decades now, there's been a lot of studies from the OECD PISA surveys looking at a deterioration in skills in the workforce. So, you know, I imagine that we'll get more clarity as to issues like, you know, maybe UK specific, but I think it would be, again, wrong to just say that this is a UK problem. There's a lot of evidence, even before the pandemic hit in earnest, that suggests that both the quality of the workforce and the quantity of the workforce, particularly in developed markets where there's immigration, has been quite paltry and we've had an ageing population.

The issue of the labour force has been top of mind for public policy as well as for business. So, I think those are some of the areas that I'd be thinking about.

Matthew

But this issue of labour force participation and health, it does seem to me to open up this question of the relationship between the economy and health. And I think we because we have an overwhelmingly publicly-funded system in the in the UK, we tend to have this kind of model, which is that we have a productive economy which generates wealth, and then the state takes a portion of that wealth and pours it into health and care.

And indeed, there's a growing proportion of it into health and care. What often gets missed out in that account is the fact that actually investing in health and care can have benign externalities for the economy, or conversely, that not investing in health and care can have malign externalities in terms of the economy. Do you think that, this seems to me, in the last recent while, to be more conversation about that relationship between, as it were, health and wealth?  Do you think it's good that we're starting to focus on that a bit more?

Dambisa

Yeah, I do think we ought to think about this. I think that again, like most complex issues, there are a number of factors and variables that impact that sort of a question. So, for example, if you think about the workforce, an unhealthy workforce, and whether that's from obesity or from other ageing-related diseases or mental illness, that reduces productivity.

So, on the one hand you have the sort of asset or the contribution coming from a productive workforce going down. And then on the other hand, which is also an impact on the economy, any costs associated with, again, sort of diabetes, type 2 diabetes or any ailments that have to be paid for, not just in a public system, but any form of a system.

Healthcare costs increasing affects the sort of bottom line of the economy in GDP. And so, I think those are just very superficially two levers. Not only have you got a reduction in the asset, but you have an increase in the liability, if I can use the balance sheet parlance. And I think that very often in these sorts of conversations, people tend to focus on one thing and not the other.

And I think if you start to look at not just the immediate costs, but again, the second order effects, you know, families that may have unproductive parents might lead to worse outcomes in terms of food, in terms of access to healthcare because of a lower quality of incomes, all those knock-on effects, I think, are hitting the economy in a very real way.

And, you know, obviously the questions around mental health are something that's quite relatively new. Also, lots of studies in The Lancet and other multinational organisations that are now looking at this is a new cost which has material effect, both, again, in terms of the ability for a workforce to be productive, but again, in terms of costs that perhaps in the past we had to really calibrate for.

Matthew

That's fascinating. And I read a report just the other day that looked at some of those second or even third order effects. So, you know, there is conversation now and government is developing policy in relation to people who are not able to work because of health conditions. But also, as you say, a lot of people provide care which enables other people to work. And if they're ill, they can't provide that care. So, these multiplier effects are complex and we published work last year looking at the kind of multiplier effect of health investment in relation to the labour force. There's quite a lot of this kind of work around. I'm kind of interested. Why do you think economists still find it so difficult to be able to have a more holistic account of the way in which investment in services, like health, has these kind of economic effects?

Dambisa

Well, I think there are a number of reasons. One is that in some environments, the state views healthcare as a public good, the UK obviously would be an example of that. In other locations, it's still very much in the private markets. So, the United States would be a sort of contrasting example of that. But even if you take the case of the United States being able to calibrate, the costs associated with health are very complicated because there's so many vested interests.

There's the patient, there’s the medical doctor, there's the insurance companies, there's the pharmaceutical companies. And so calibrating and calculating each of those different points becomes incredibly challenging. So, I don't think having sort of one model of healthcare system actually works. And this is one of the reasons it's been quite challenging to think about these productive effects in terms of lost productivity from healthcare loss, but also what some of the costs that we talked about already, trying to figure out what the costs of missed work, the costs of second order, participation from family support, etc., and social care.

All of these are elements that tend to be more or less important depending on what environment of jurisdiction you're talking about. So that's part of the reason I think it's quite complicated.

Matthew

Part of the reason I wanted to explore this with you, is that you are a strong advocate of the vital importance of economic growth. There are various criticisms of a focus on growth in terms of sustainability or the relevance of GDP to understanding real progress and people's wellbeing.

But I think you want to say, look, without economic growth, it's very hard to solve any kind of problem. And so, we do have to focus on having a root to growth. Is that a fair characterisation of your view?

Dambisa

Yeah, I'd say it'd be impossible to address it. And you only have to visit the emerging markets to get a better handle of what I'm talking about.

Just to be clear, I'm not saying the pursuit of growth at all expense. I'm not saying at all that that's the right approach. I mean, there are clearly considerations that we need to think about, sustainability aspects, as you touched on, thinking about cronyism within capitalist systems, inequality. I mean, these are all costs to a model that just pursues growth at any or all costs.

So, I think that would be a naive and I think most commentators now understand that it's not when we say pursuit of growth, we're not saying just gangbusters without those considerations. But on the other hand, as you just intimated, if you cannot increase the pie and we cannot actually grow these economies, we're not going to be able to provide the taxes and the tax base for public goods to be provided.

We're not going to be able to fund innovation that can cure cancer but fund better access for people to get healthcare. So, it really is essential that we do have growth. And I think that it's been a lost opportunity. Certainly, I would say in the last decade and a half since this sort of anti-growth mantra gained some importance.

But I, and hopefully others, can be voices for resetting, recalibrating the conversation, because it's not just about health, it's about the environment. It's about many other aspects of public goods, infrastructure, education that we need to be able to fund for over 8 billion people around the world in a sustainable, cost-effective and affordable way. And so, we shouldn't be losing sight of that and I think that's what's really important.

Matthew

Yes. And I think if you look at the international evidence suggests that you need to tick both boxes, you need to tick the growth box, because without growth, it's hard, as you say, to fund innovation, new services, meet needs. But you also need to be able to tick the equity box to some extent because obviously if we compare United States of America with Scandinavia, we can see that the former may be richer in terms of GDP per head, but it's certainly not better in terms of health outcomes.

So, we need a model. What we're interested in here is a form of growth which is good for health. Yes, we need growth if we're going to fund the health service and other services, but we also need growth which is reasonably inclusive and fair, because if we have high, very high levels of inequality, for example, and poverty, we're going to have to spend even more on health.

Dambisa

Yeah, I think that, and I say this in a way to insult, but I think that should be motherhood and apple pie. I think that - I've never come across people who are pursuing growth at the expense of others in public policy or in business - I think that there's a sense that there is a shared responsibility and communal sort of importance for society to move forward and for human progress that we do address these issues in more stakeholder and community-based way.

Matthew

Just interrupt for a second. It's really interesting that you say that it's obvious, but yet, if you look at the discourse in this country over the last year, you look at the kind of the Liz Truss interlude, it wasn't just that Liz Truss was saying, you know, it's growth at all costs. She also seemed to be saying, and growth at all costs means you probably care a little bit less about equality or social justice.

So that that kind of rather crude polarisation between growth and fairness is still part of the debate, I think.

Dambisa

Yeah, I mean, frankly I wouldn't have characterised Prime Minister Truss intervention in that way. But, you know, that's up for debate, I suppose. But I guess what I'm trying to get at is that despite hundreds of years of economics and public policy, there are still fundamental questions around the tension that you describe, not just within developed economies like the United Kingdom or the United States, but also between countries, the United States and China, two economies that are number one and number two largest in terms of GDP have completely different political systems.

One is democratic, one is deprioritised democracy, completely different economic systems, one market capitalist, one state capitalism. And yet they have roughly the same Gini ecoefficiency in measures of inequality. So, I suppose what I would love to underscore here is that very often these debates, especially among politicians, are sort of packaged as fait accompli. So, we know, no, we don't.

And in fact, there are enormous questions and multitude of questions that remain open, as I said, not just between extremes like the US and UK and China, but also within developed economies. And I think we have to have much more humility about how we address these questions and understand that very often there are calibrations and there are second order effects that are hard to quantify in the near term but have serious long-term consequences in the longer term.

So that's all I'm saying. I am saying that I think ultimately most public policymakers are in it for economic success, but also recognise that even in a deprioritised or non-democratic state are looking for populist support. And to achieve that, you do need to understand that there has to be fairness and has to be forms of equality and progress for all. So that was really the point I was making.

Matthew

Yeah, absolutely. And there's one issue I think which draws all the threads of the conversation we've had so far together, and that is population ageing. So, some people would argue dispassionately I think, because it's it feels like a kind of harsh thing to say, but that demography is fate and that it is extremely difficult for societies to escape sluggish growth if they’re ageing, if they have a higher dependency ratio.

That's obviously part of the story of Japan. I think I read a statistic that said if you took population ageing out of the equation, Japan would have had very good growth rates for the last 20 years. But the problem is those very of growth rates have been hidden by the effect of ageing. And then if you take it to the kind of health policy scale, we argue at the Confed for more funding for health, and part of the reason we argue for that is that the final year of life is the year we consume most health resources, and in a decade’s time will be about 20 per cent more people entering the final year of life.

So, one of the really big challenges here is, is how do you avoid this kind of sense that an ageing population does lead to lower economic growth and higher costs for health and care in particular? You don't strike me as a pessimist. How do you think we do can break out of that?

Dambisa

Well, let me give you, without delving into countries’ unique circumstances, I think there are sort of two touchpoints that a lot of economists think about.

And certainly health economists spend a lot more time in this area. One is in extending work life. I lived in Paris many years ago when the retirement age was 50 years old. If you think about life expectancy being in the mid to late seventies in many developed economies, you can see how there's a very good and strong, compelling argument that there's a lot of productive work, if I can value it like that, that could be missing by people retiring or leaving the workforce at 50.

And so, I think extending the work life not just for GDP consequences, but really for quality-of-life arguments, I think is one area that this trade-off that you're referring to, it becomes possible. The other areas, immigration that I'm talking about, orderly migration here, I think that economies such as the United States to some extent, but really places like Australia and Canada have shown that actually investment in immigration, and you picked on Japan in contrast, a place like Japan, immigration does play an important role in enhancing the longer-term growth argument, but also it does help to drive some of these questions around the trade-off between health and GDP.

So those are two areas that I would think about. They're not specifically areas of my expertise, but certainly the areas in the literature that people do look at as a way of addressing the tension you're talking about.

Matthew

Yeah, absolutely. And I think the point is, one can't underestimate that challenge. And raising labour force participation amongst older people has to be key to that.

And just at the moment, we're kind of going in the wrong direction here in the UK. So, we have to think really, it seems to me one thinks about an election next year that actually parties having coherent, credible policies for how it is that they enable people to be healthier longer and enable people to work for longer. Creating a kind of virtuous cycle is really important and actually, again, against pessimism.

I remember I worked for the Labour government in the late nineties and into the noughties, and there was a lot of pessimism then about older workers because we saw the shake out, particularly of older working-class men with the kind of decline of manufacturing in the early eighties and the participation rate fell, the number of people on various forms of disability benefit rose.

But then that was turned round. Those participation rates did start to rise. Unfortunately, covid seems to push us off in other direction, but we've done it once and I guess we've got to try and do it again.

Dambisa

Yeah, and I mean, I think I'm more optimistic. I think that maybe it's because I'm a woman of a certain age, but I think that it does show a lack of imagination that we put people over a certain age onto the trash heap of life, so to speak, and say, well, they're not productive citizens.

Or they can't be productive. I think there's enormous talent, expertise, knowledge that we're missing out, that society is missing out on by that, in that approach and attitude. And so hopefully we're at the beginning of seeing another turn around to that and being enormously helpful. And I know and certainly in the healthcare space and policymakers have been talking about trying to encourage retired doctors and nurses to come back into the NHS.

And I think that that's all a win individually for people who want to be able to be productive and contribute, but also a win for society that clearly we need that talent.

Matthew

Now. It's really interesting. And you know, as someone who's 62, I completely endorse the idea that we underestimate the offer that older people can make and in fact, I was talking to someone the other day who worked with a lot of companies around innovation.

And she said that for a while there was a kind of view that innovation was all about kind of chaotic creativity. It was all about young people, it was all about informality. And actually she'd noticed in the companies, organisations, there’d been a shift, first of all, to a kind of view that actually innovation comes out of structure, it comes out of well-run organisations, and also it often comes from older people who have a greater capacity to understand an issue in the round, to understand why change is difficult; it’s all very well thinking of a technological solution but if that solution doesn't work with how the policy works, how people work, how culture works, often doesn't achieve what it wants to achieve. So, look, you know, you and I, we should form a movement around you're much younger than me, but around innovation and older people challenging that prejudice.

Dambisa

No, absolutely. And look, I don't want to sound rah rah rah America, but you know the United States, there's so many people, certainly in the boardrooms in which I serve, but also, you know, look at Warren Buffet's boardroom. I think the average age is close to 85. But, you know, in places like Africa where I was born and raised, this reverence for the elderly, the wisdom that comes from that, the ability to look and see pattern recognition.

They've seen pandemics, they’ve seen wars. They know how economies navigate those challenges. And so, it's an oddity to me, this notion that somehow you get to a certain point of age and therefore it's not productive. And I think it's an untapped reservoir of amazing contribution and productivity for society.

 Matthew

Well, you segway beautifully into conversation about boards, and I am going to come to that in a second. But just before we do that, just speaking to you as an economist and as a sort of business guru, of course, the one other aspect to this kind of conversation about health and wealth we should just touch on is that health is one of the fastest growing global marketplaces. You know, we do some work at the Confed with hospitals that are interested in the potential to bring in external income, not just from kind of treating some patients through their private wings or whatever, but actually in terms of selling products, selling insights, selling services.

There's a lot of scope, isn't there, there? And even though the NHS is having a hard time, it's still a strong brand. Do you think that we are putting enough emphasis on the scope for us to be a player in that health marketplace?

Dambisa

Well, I hope so. One of the arguments that I've made in terms of sort of telegraphing where investment is going, investment in the future, you know, I talk a lot about technology, and not technology in the sense of consumerism or networks, and that's kind of been done, we know about about that, but really about technology going hand-in-hand with the healthcare service to really innovate and really reduce costs and sort of improve outcomes. And I think state-led programmes such as the NHS actually should be leaders in that in that they're able to provide sort of ground zero in figuring out how best to scale and to drive those types of outcomes, both in terms of delivery of new innovations but also cutting costs.  And so, I think that the NHS and others should be at the vanguard of that of those changes.

Matthew

So, let's turn to boards. You know, you've recently written a book about how boards can work better in this kind of challenging world in which we live. I have a wonderful board at the Confed, I'm not just saying that because it might be listening, but I do.

But I've had some pretty grisly board experiences, some of the most miserable experiences in my life have been dealing with problematic boards and difficult chairs. What insights can you offer? Because governance is terribly important in the NHS. Trusts have got boards and our integrated care systems have got boards, and non-executives are very important figures actually in the health service.

So, what are the insights you have to offer about what makes for an effective board and a board that can work effectively given the kind of world we now live in?

Dambisa

Yes. So, the book I wrote, I think some mistakenly assume it was really just for large global complex corporations when actually I think that there hopefully were lots of learnings also for school governors and trustees and museums, as well as healthcare systems.

And so, you know, maybe just to use the framing that I used in the book, to my mind, this sort of three key aspects of the board mandate, in no particular order. One is about strategies of thinking about these institutions, not just in the here and now, but thinking about them in the long term. How should they evolve?

And this is really picking up on some of the things you've talked about already in terms of innovation, in terms of reducing costs, in terms of sort of thinking about what the challenges and issues of the of the future might look like. So that's a very key area. What geographies do you want to be in that that sort of thing?

The second area is around succession, succession not just of the CEO or the chief executive at the helm, but also to the board itself. And also other areas or other people in senior leadership roles. You know, I can imagine in the context of the healthcare system, it's not just thinking about the public policy aspect and the administrators.

It's also thinking about, you know, the people who manage the system on a day-to-day basis, the doctors, the nurses, the other aspects of care. So, thinking about succession is absolutely critical. Some would actually argue that that might be the only job that the board really has any real clout on. And then the third aspect is, is really going back to the area you were probing about earlier.

This is the questions around equity and fairness. And I think that it's clear that certainly in the business space in 2019, we had the Business Roundtable that really reasserted the questions around broader stakeholders and not just thinking about shareholders, financial shareholders, the in the corporate sense. But I think as we think about the healthcare systems and think about what the role of the board is there, there are clearly areas that need to be thought about thinking about the different levels of inputs, the vested interest.

Some of the things I touched on earlier, how do you trade off pharmaceuticals versus the medical staff versus the patient versus insurance versus the state? All of those things need to be navigated, especially when resources are constrained, as we've seen recently in places like the UK. So those were really the three areas. And dare I say it, I mean, ethics is another area that certainly in the private sector has become a much more important area.

And as we look to the future and think about AI and telecommunications and bio science, I think that areas of ethics will also be a big area in the science space. So those are the three areas that I focused on.

Matthew

Yeah, really interesting, and we haven’t got much time, but I'll just put two or three things that are sparked by what you said.

I mean, the first is how far do you think we are along the journey of boards realising that some of the issues at that kind of cultural frontier around kind of diversity and inclusion are not kind of add ons, but they are integral to being a dynamic and effective organisation. And that equally ethical concerns, again, are not things to be thought of as a sort of kind of regulatory issues, but are intrinsic to your business model, to your model of wealth creation.

In your experience, are boards thinking in those terms, or is there still a kind of sense of, well, look, the business is fundamentally about the bottom line, making as much money, and we have to kind of tick a few boxes as well.

Dambisa

You know, that's not my sense at all, dare I say it, maybe this comes across a little bit too crudely in a podcast where I'm not able to really highlight the nuance here.

But for these institutions, ultimately success is critical. And I often hear from different groups, not just business people but other organisations. People say, well, we should be thinking about these organisations as almost like a football team, you know, sports team, where really you want the best people in the best seats and it doesn't matter, ultimately, what their background is.

It really ought not to matter. And it's really just to answer your question directly, these institutions need to perform. We need to think about mortality in the healthcare space, delivering quality healthcare to a broad array of people. And in order to do that, we need the best people in the best seats and it really doesn't matter where they come from and what we want to do, and what I think a lot of institutions have done, in response to the emphasis on issues of diversity and equity and ethics is to make it much more transparent that things like what we in business would call KPI.

So key performance indicators, things like compensation, things like hiring promotion become much more transparent because there is no doubt about it that there has been unfairness in the system. But I think now it's not about hiring or promoting people just because they happened to look in my case like they're a black woman, but you're hiring them for talent.

And the more transparency we can have around hiring and compensation and promotion, the better the system is, because ultimately, we want to have the best people in the best seats. And so, I think this is all great and I think it's already being embedded into the system, it's forever ongoing because, you know, we don't have equity everywhere, but I'm much more optimistic than perhaps is sometimes telegraphed in sort of common press or in discussions.

Matthew

Final question, and I'm taking a risk here because you're not afraid to speak plainly if you think something is a stupid idea. But I just wanted to share with you that I did a lot of work in the organisation I ran before Confed about change and why change is difficult. And to cut a long story short, the view we came to about the kind of mindset you needed to be as effective as possible in thinking about change, particularly complex change, is that it involves two very different kinds of skillsets.

So, we talked about thinking like a system and acting like an entrepreneur, by which we meant you need a wide lens in terms of understanding phenomena and thinking about what has to change. If you want things to change, it's never about just one pulling one lever, changing one thing. It's about being able to reimagine a different way of working a different system.

But on the other hand, alongside that kind of capacity to have a wide lens and to see a system of the complexity of a system, you need agility because the world is incredibly unpredictable and therefore, if you lay down plans for years ahead, which are inflexible, well you’re almost certainly going to land flat on your face because you won't have predicted, well, covid or the Ukraine war or inflation or whatever it is that we now have experience which nobody thought was going to happen five years ago.

Does that kind of view, that thinking broadly but acting in an agile way, is that the secret of effective change? And if it is, how do boards do that? How do boards have that wide lens, but also to permit that agility?

Dambisa

Well, Matthew, you're going to have to invite me back because you've just opened a massive can of worms. You’re talking about systems and entropy; you're talking about process versus outcomes. Different jurisdictions have different approaches. You know, the Europeans tend to be much more rules based.

Americans tend to be much more principles based in addressing same types of problems. There's a lot to do with how do you think about the short term versus the long term. We think about incentives. We think about compensation as an incentive promotion. How do we think about compensating people in one year, should we be extending pay, there are so many aspects to what you address.

But, you know, fundamentally I am much more driven now by something that a very dear friend of mine, someone I served on a board with who's in his eighties now, is about 87 years old. And he said, I just want you to know one thing. You're always going to be surprised. Always. It might be a pandemic, it might be a financial crisis, it might be a war, maybe economic decline or an upsurge in the economy. But you're always going to be surprised.

And I think that that is a very good compass for me, certainly, but hopefully for others in thinking about how we manage and oversee these organisations. They are complex organisations and they're things that, you know, six months from now you and I can touch base and I'm sure we'll be surprised by something else that has happened.

And so, the key is making sure that you have institutions that can weather those challenges. And, you know, very often processes can be incredibly helpful in that regard. But at the same time, you do want that flexibility, you want that ability to innovate so that you can take advantage and move quickly in circumstances when they do emerge. So absolutely, it sounds very simple, but certainly from the board perspective, we tried to embed a lot of that complexity which emerges in this debate into what sort of day-to-day management of how we think about hiring, promoting, compensating and really providing guardrails for the company.

Matthew

Well, yes, if only we had more time to delve more deeply. But for those people interested in reading a few more of your ideas your recent book is called How Boards Work.

Baroness Dambisa Moyo, thank you so much for joining us.

Dambisa

Thank you very much.