This simple pivot unlocked progress for billions with poor vision
16 February 2022
- James Chen, a philanthropist, founded the international campaign Clearly to bridge affordable vision care gaps.
- Reframing affordable eyecare as an economic challenge, not a health challenge helped garner the much-needed political buy-in to ensure affordable eyecare made global agendas.
Eyeglasses were invented hundreds of years ago – but still 2.2 billion people suffer from poor vision.
James Chen, a philanthropist, has spent nearly 2 decades working on this deceptively simple problem: how to bridge vision care gaps and make eyecare affordable.
In his pursuit, he founded the Vision for a Nation Foundation (helping health ministries provide local eyecare services), and Adlens (a business pioneering the development of adjustable lens glasses).
He didn’t see real progress, however, until he reframed affordable eyecare as an economic challenge, not a health challenge. This pivot helped leaders understand how eyecare was essential to tackling a range of other goals, from GDP to job growth. His educational initiative Clearly helped make possible the first-ever UN resolution on vision last July, getting eye care on global agendas.
Change, says Chen, requires more than just new tools. He learned firsthand the need for political buy-in and organization to ensure that solutions can be delivered effectively.
“Probably the biggest contribution of the Clearly campaign was to really reframe the issue for the global community for policy makers and government leaders,” said Chen.
Chen talked to Meet the Leader about how coming from a long-line of entrepreneurs helped him stay resilient. That background shaped his perspective on social action and a concept he calls ‘moonshot philanthropy’. According to Chen, there’s a unique magic that comes when philanthropists gain domain expertise, take an active role in solving social problems and take on risk.
“Throughout this journey,” he said, “my guiding principle has been to deliberately deploy my limited capital to risky, out-of-the-box ideas that I felt had asymmetric impact outcomes.”
Meet The Leader/Linda Lacina: Tell us about the discovery that helped change your life – when you realized you had a vision problem.
James Chen: I’m a third generation member of a family business. And my family built a business, a manufacturing business, which at varying points in our history had operations in Shanghai, Hong Kong, Indonesia, Sudan, Ghana, Ivory Coast and, today, still in Nigeria. I think of myself as a first-generation global nomad, so to speak.
I was born in Hong Kong, left for Nigeria at the age of three, where I attended primary school then left for English boarding school at age 10, high school and university in the US, early working life also in the US, and then back to Asia, where I worked in many parts of developing Asia.
I was in upstate New York in high school. And I wanted to get my driving licence. I went to fill in the form and then the first thing they have you do is take the eye test.
And I failed that eye test. That’s when I realized that I had an eye problem, a vision problem. And so that was something very impactful that if I had not had my vision corrected, I realized that it would have a big impact on my life. As it probably did in my younger days and I didn’t realize I had an eye problem.
Even in the developed world, kids slip through the cracks. For example, in the US around 25% of kids who need glasses, either don’t have glasses or have the wrong prescription.
I also spent time growing up in Africa and then working, in my early career, in developing parts of Asia and noticed that very few people in the developing world actually wear glasses and it always kind of stuck in my head.
I wore glasses, do they not need glasses? Or perhaps they don’t have access to glasses. Of course. Now I know that it is the latter, right? They don’t have access. And despite all the setbacks that I’ve encountered, what has kept me going in this industry journey, on trying to understand the issues behind the access for vision correction is really my own need for glasses and how this has changed my life’s trajectory.
Understanding the affordable eyecare challenge
Meet The Leader/Linda Lacina: And part of the reason why you didn’t know you had a vision problem is because you’ve lived abroad in many of these developing areas. Is that part of that?
James Chen: Yes, that’s right. I think in those days, whether it’s living in developing world countries or moving around somehow, I guess I slipped through the cracks. Even today, it’s interesting that even in the developed world, many other many kids slipped through the cracks in terms of getting their eyes tested and getting the correction that they need. For example, in the US the best figures are that something like 25% of kids who need glasses, either don’t have glasses or have the wrong prescription.
Meet The Leader/Linda Lacina: What are these barriers to people getting the eyecare they need either in the developed or developing world?
James Chen: Well, as part of my journey, I actually wrote a book [Clearly: How a 700-year-old Invention Can Change the World Forever] about the vision issues and the challenges, particularly in the developing world. And we put into something called the four Ds, that all the challenges essentially fall into.
Issues with a diagnosis, which is having someone who could give you a vision screening. That’s number one – to figure out whether you do need a vision correction or glasses.
Number two is a distribution; often the challenge is very much around getting the right pair of glasses, with the right lens power to the person in the developing world. That is a very expensive proposition, if it’s even possible to do.
Third is dollars, by which you mean there’s a cost involved – both to set up a system, but also for individuals as to whether they have the income to be able to afford glasses.
And then fourthly is about demand, which is this issue that I had as a child – you don’t know what you don’t know. And you don’t really understand what’s a different dream. You know, you think the world is the way it is. The blurry vision is normal, so to speak, until you get glasses and say, ‘Wow, okay.’
So it’s really being able to get a pair of glasses on someone’s face to help them to see better before they can recognize what really is normal. So that’s the Four Ds.
Seeking traction on affordable eyecare
Meet The Leader/Linda Lacina: Tell us about some of the early initiatives that didn’t get the traction you’d hoped.
James Chen: The campaign, as I mentioned, the Clearly campaign was only in the last five years or so. Before that, I spent over a decade… myself, when I started, aside from the fact that I need glasses, I knew nothing about the problem – what was out there, it seemed to be such a frictionless thing for those of us in the developed world to go to a shopping mall or a high street retailer and there are optical shops.
You go in, get a test and pick out your glasses and that’s it. So it’s very low friction, but that model doesn’t work in the developing world.
And so the early part of my journey, it was really a very steep learning curve to understand the issues and the barriers. And certainly for the first few years, the more I dug into it, the more problems there were. It wasn’t like I was finding solutions – I was really uncovering more and more problems.
As I mentioned, I started with this company that made adjustable powered lens glasses, which was intuitive to me, particularly having grown up in Africa, that this could really simplify the cost of distribution and get the glasses with the right power to the people who need it.
So I was very excited by that. We went to the World Bank and really spent a lot of effort educating them and trying to understand what their view was. To cut a long story short – after two years of effort, we failed.
And so very much, it is this journey. Number one it’s about learning about the issues and then the challenge of facing setbacks and failures. It’s very tempting to want to stop and say, ‘You know, this is too complicated. This is too much brain damage.’
And, anyway, the professionals are telling you it can’t be done. But perhaps in your – in my – naivete, it’s like, ‘wait a minute. No, I think it can be done.’ So sometimes, not being an expert probably helps, just pig-headed perseverance. There’s something to be said for that, I guess.
Meet The Leader/Linda Lacina: With those adjustable lens glasses, made that fall apart and what did you learn from that effort?
James Chen: Sometimes you tie your shoelaces and you end up with lots of these knots. And then you just have to slowly kind of unpick those knots to untie your shoelaces.
What I realized the more I dug into it, there were these knots. And those four Ds – we had to go through all of them, painfully one at a time, to understand what the challenges were behind all of those and how do you untie those knots?
I think very early on, it was the sense of ‘I’m someone who’s new, a novice here’, and the extras are telling you it can’t be done. The self-doubt around ‘can this be done?’.
But luckily I had a very good group of advisors who said to me, ‘We think that people like the World Bank are wrong, the optical professionals are wrong.’ I don’t know why I thought they were right. But again, I go back to this point, that having the need for glasses myself – every morning, putting them on – that’s really the anchor of allowing me to continue on that journey, despite all the pushback and the setbacks we were having.
The pivot that made the difference
Meet The Leader/Linda Lacina: You started to get traction with these issues, when you started to frame vision as a sustainable development issue. For those who are listening, the SDGs are the United Nations sustainable development goals. That’s a set of 17 interlinked goals that tackle things like poverty or education with certain aims by 2030. And so you shifted from just a healthcare thing to saying to people ‘hey, if you want to transform your country, people need to see.’ So, I think it’s really interesting that people didn’t priortize it when it was just health and wellbeing but when it came to the fact that,‘Hey, this is a key to growth and economics’ then people started to pay attention. Can you talk a little bit about that?
James Chen: I think you hit the nail on the head. Probably the biggest contribution of the Clearly campaign was to really reframe the issue for the global community; for policy makers and government leaders.
Prior to the campaign, poor vision was put into the health silo. And within the health silo, as the ministry of health, you’ve got so many priorities, and so many others that seem much higher priority than someone with poor vision – not someone who’s blind, someone who just has fuzzy vision, it intuitively seems like this is a low priority issue.
You’ve got Aids, malaria, child malnutrition, so many things that seem to be much more important. Or, if you’re in education, as you say, there’s learning, productivity… so many other issues that seem to be higher priority than someone with blurry vision.
But with the campaign, our success has been to reframe that. I guess, in a way, we’re lucky that the SDGs – the Sustainable Development Goals – came around when they did. They allowed us to show that correcting poor vision was the golden thread to achieving some of these SDGs.
And I think that is what has resonated in the global community to realize that, ‘Wow, you’re right.’ If there are 2.2 billion people in the world who have poor vision, if their vision is not corrected, they can then intuitively see that that’s going to have a carry-on effect on productivity, education, outcome, gender equality – so many of the things that the world community has pledged to help fix.
Meet The Leader/Linda Lacina: You also have helped to drive research to show that connection between vision and productivity. Can you talk a little bit about the PROSPER [PROductivity Study of Presbyopia Elimination in Ruraldwellers] study, what it is, and also what surprised you about it?
James Chen: So the PROSPER study was a randomized controlled trial which was done in Assam, India, with tea pickers, which were mostly older women. And what we were able to do is to take a sample and half the people did not get their vision corrected and half of them did get their vision corrected.
The result was that those who had the vision corrected, their productivity improved by an average of almost 22%. And for those over the age of 45, it actually went up over 32%. If you can think about that, that is equivalent to one extra day of productivity a week. So that’s a huge impact.
In fact, from what we know, that is probably the biggest impact from any health intervention that has been studied. And so, having that study published by The Lancet Global Health, which is a peer review journal, that really helped to start to show the evidence behind the link of poor vision and, in this case, agricultural productivity.
Meet The Leader/Linda Lacina: There’s also this research being done with the Wellcome Trust. Can you talk a little bit about some of those findings and what’s really standing out?
James Chen: Yes. Well, the Wellcome Trust collaboration on research is actually a very new. This just happened and was approved by the Wellcome Trust late last year.
So we’re just about to start these four research trials, but it’s essentially in the same track of trying to show that link – whether it is to education outcomes or the link to services to the elderly. And there’s one that will happen in Vietnam, which is not an SDG, but which is a very interesting link between poor vision and accidents or road traffic safety.
Today in Africa, road traffic accidents are the largest killer of people under 30. Again, we intuitively understand that the link between poor vision and the potential for traffic accidents. But there’s never been a study done to actually show how to quantify that link. So that’s what we’re trying to attempt to do in our study in Vietnam.
Meet The Leader/Linda Lacina: Let’s talk about what happened in July. Last summer, the UN adopted its first resolution on vision, and this was an effort that you had campaigned on for many years. Can you talk about this resolution and why it was important?
James Chen: It’s really the kind of dream outcome, I would say, of the Clearly campaign. We launched just around the time when the SDGs were adopted in 2015. Right. And, of course, the pitch has been, ‘Hey, you know, this is the issue that the world forgot.’
So to have the UN unanimously pass a resolution in this past year, in 2021, to acknowledge that vision correction is an important issue that needs to be addressed by the world community and actually sets a target of 2030, where countries should strive towards delivering access to vision correction to all its citizens. And so, very much with a timeframe, with the commitment of all, all the countries in the world, it’s now for the eye community to rally together, to figure out how to help governments to deliver on this pledge.
Meet The Leader/Linda Lacina: It’s such an achievement to become part of the agenda. But it’s also amazing to me how much work it took just to get there.
James Chen: Exactly. I tell my colleagues, ‘You know, while we’re celebrating it all, all that means is that we now can really begin our journey to correct the problem.’ Up until now, my 18 years, was to try and convince people that there is a problem. Now, we have to figure out how to fix it, which is not an easy challenge, shall we say?
But because glasses, as I mentioned, have been around for 700 years, and that is the core of the solution to the vast majority of the 2.2 billion people who have need for vision correction, we have the solution. It’s not like a vaccine that needs to be invented, the solution exists.
It’s just now the political will and to be organized well, to be able to deliver that access. And, of course, there is a small matter of the funding issue, which we’re also trying to work on. The not so small matter, particularly in the pandemic era. As you can imagine, the competition for scarce resources we can see is a big challenge.
Meet The Leader/Linda Lacina: The day that they made the resolution public, what was that like for you? What were you thinking?
James Chen: It almost felt surreal. That was kind of a dream kind of outcome for the campaign and to have it actually occur… You set really high goals and of course you strive to achieve them, but it’s not often that you actually get the big prize. And so it’s really, really gratifying and I have to say that it really was due to the efforts of so many people involved to be able to achieve that. But there were some real champions and heroes along the way that allowed this to happen.
Meet The Leader/Linda Lacina: Should everything go right and countries tackle vision issues in their countries, what does the world look like? What’s our before and after?
James Chen: I think what the world community cares about – is that, ‘Wow, what’s the impact on GDP, so to speak, on productivity, which leads to income.’ The research that we’re doing, establishing those links, gives these governments a confidence to kind of raise the priority of this issue.
Because they can see, if you think about it from a return on investment point of view, that this is going to deliver a very high return on investment, which means for the people that they have a better income standard, higher income.
But there’s also this quality of life issue, which is qualitative and so not as easy to measure. But very much, we believe, it helps families and individuals within families to lead a better life or to achieve higher potential.
Some kind of anecdotal evidence would be a typical family in Africa, for example. The women – the mother and daughters – are the backbone of the family and the mother of the family, typically it’s her role is to cook for the family. But once she lose not to lose her vision she starts to be less useful for the family in, for example, in cooking, chopping and all this. That then falls to the, to the daughter to do, which perhaps means that younger person either doesn’t get to go to school or doesn’t get to go out and earn an income for the family.
So there’s lots of these effects, not least of which is that quality of life dramatically improves for someone who has better vision or clear vision.
Funding – and finding – solutions that work
Meet The Leader/Linda Lacina: Tell us about what’s needed to fund this. Can you put this into context for us?
James Chen: Well, again, it’s all very relative. You know what I read about the Sustainable Development Goals. I think it’s a figure of $5 trillion to achieve the SDGs. Within that context, I think, the vision piece would be quite small.
The best estimate that I’ve seen is that if we can spend $14 billion a year over the next 10-year period, that would be the quantum of funding that’s needed to be able to tackle this issue. Because my experience is that throwing money at a problem doesn’t solve the issue.
You actually actually have to figure out how to do it. And so there are some question marks around that. But again, nothing that I think is unsolvable because the key tool that’s needed exists and then it’s just more about organizational issues and political will to achieve this.
But in terms of the funding issue, I think the quantum we’re talking about is $140 billion or so, over a 10-year period – which against the backdrop of the entire need just for the SDGs, forget about climate change and many other issues.
I think that’s perhaps something that will also resonate with governments because at each government level, that figure breaks down to a perhaps more manageable number.
I did want to bring up, if I may, another corollary point. Even with the funding, this ideal, whatever that number is, I think the challenge – and this is an observation about philanthropy – is that lots of money is spent to tackle social issues. But then we find we’re often frustrated why the money seems to be not having any impact, or lots of examples of fraud and waste.
But if I look at my journey, where the approach that I took – which is this high risk, funding, these risky ideas – this is the part which I see as missing in the world today that is desperately needed. The risk capital to help uncover and to test new ideas and new approaches, and then to scale up the things that work. The term I put together is that what we’re trying to do is to privatize failure and to then socialize the successes.
So where there are failures we, as the philanthropists absorb that, and where there are successes, we share with the world. And so that’s kind of the core of what I would call the ‘moonshot philanthropy’ approach to tackling the world’s problems.
“What we’re trying to do is to privatise failure and to then socialize the successes.”
—James Chen, Philanthropist and Clearly Founder
Meet The Leader/Linda Lacina: I think that’s a really important point because you believe very strongly that philanthropists need to take on risk. Why has that sort of not been the case so far?
James Chen: Well, I think, number one, it’s really hard to do. It’s taken me 18, 19 years to get to this point. And along the way, when you take risks, there are going to be setbacks and failures, and that is a huge kind of emotional challenge.
Particularly in the early years, I know so little and, and yet all the professionals are saying, ‘no, no, it can’t be done’. So there’s that element of self-doubt and kind of the fear of ridicule – like that people think of you having more money than brains.
“There are going to be setbacks and failures, and that is a huge kind of emotional challenge.”
—James Chen, Philanthropist and Clearly Founder
Of course, also there’s this emotion that I think is very difficult to process, which is, I’m doing this thing with overwhelming odds and the thought is, am I squandering the family capital that was so hard for my, you know, early generations to accumulate?
That I’m kind of throwing it down to a bottomless pit, with a dubious sense of what the outcomes would be. So these are very kind of tangible challenges. I think what I see in what most donors do today is what I would call a charity or patronage – which is very much a kind of reactive rather than a proactive approach, you know? It’s risk averse rather than risk taking.
But what’s important is that in the world today, there are not groups or actors who can take the risks. If you think about institutions like governments, or even corporates, they are actually agents of the owners of the capital – i.e. either taxpayers or shareholders. It’s very hard for them to explain setbacks and failures. Whereas for us, the private philanthropic community, we’re able to because it’s our money. As I mentioned, if it fails, it’s our money; if it succeeds it’s for the greater good.
Meet The Leader/Linda Lacina: With the proactive approach, people would then be more invested in where that money goes and you’d have more passion plays in the space?
James Chen: I think in most things in life, the more effort you put in, the more gratifying the outcome. And that’s what we strive to do, to keep moving the ball forward, to get away from the status quo, to really try and think and improve outcomes.
Meet The Leader/Linda Lacina: So, in contrast to reactive philanthropy, you can take a holistic picture of things and be like, ‘Okay, this is what I can see is going to be the need and here’s maybe a way that we can navigate to tackle it.’
James Chen: I also want to say that I don’t want to cast aspersions on reactive philanthropy. Certainly, whether it’s charity or patronage, that’s number one, that’s better than not giving.
I think everyone, particularly the wealthy parts of society, have an obligation to give and give generously. MacKenzie Scott has been in the news and what she’s doing is amazing in many ways. It’s quite smart. She’s taken on a group called a Bridgespan to help her distribute her fortune in a smart way.
A big rock can create waves. But it can’t create the tsunami of change that is needed.
But, when I look at that, I still can’t get past this idea that with all the problems and issues out there, it’s like an ocean. And that even with as big a rock as she has, when you drop it into the ocean, it creates some waves. But, ultimately, it doesn’t create the tsunami of change that’s needed. You don’t kind of change the status quo, so to speak.
So that’s where I think the proactive moonshot philanthropy steps in. And not for everyone, but certainly I think there are people who have, if they have the passion and a willing to persevere, I think they could make some huge strides in helping to solve some of the most intractable problems in the world.
Meet The Leader/Linda Lacina: And when it comes to taking on risk, what is the biggest risk that you’ve taken?
James Chen: Well, as I think I shared earlier, that the biggest risk was to go on this journey and to persevere in this journey. It does have a personal, emotional toll. That’s probably the toughest part of the journey that I went through personally.
I would share a story that before we started the Clearly campaign, after the success of Vision for a Nation where we showed that there is a model that works to correct vision, even for the poorest members of society. When we stepped back and thought about that, we thought how can we scale that up? If we did it one country at a time, it would take a thousand years. And then the out-of-box thinking is, ‘Hey, let’s do the Clearly campaign.’
But when I went to discuss this with my mother and my wife — my original commitment that I said to them was it was going to be $5 million. And they said, ‘So, if we take that $5 million, how many people, based on our experience in Rwanda, how many people could you correct a vision for?’ I said, ‘Well, a million perhaps,’ and they said, ‘Yeah, well, isn’t that enough?’ And I said, ‘Well, yeah, it helps that one million, but what about the other 2 billion, 199 million people.’
And so spending the $5 million – do you spend it on the one million or just spend it to try – Very low chance, but if we are successful then that will help all the 2.2 billion. And so I think this journey for the philanthropist is very much around saying that we have very limited capital; we can’t solve it with our own money. But what we can do is to identify the game changers. Risky, but if you give it a shot and it works, it’s game-changing.
Philanthropists have limited capital. They can’t solve big problems with money alone. But they can identify the game changers.
An entrepreneurial spirit in social action
Meet The Leader/Linda Lacina: You had said that there was a sort of an emotional toll. Can you describe a little bit what that feels like?
James Chen: You kinda step back and say, ‘Why am I doing this, this pain? Nobody likes failure, rejection, suffering. Perhaps having gone to a Jesuit boarding school in England helped to develop a fortification, to persevere despite the suffering.
That is something that I think that philanthropists who go on this moonshot journey really need to realize that it is not an easy journey. It is a journey, but it is a tough journey. If problems were easy to solve, they would have been done already. But they are solvable, with different players playing their part.
And that’s another big point about my journey is it wasn’t me. I provided funding, but more importantly, my improving domain expertise, I think helped me to understand better what the right things are to bet on.
But collaboration is such an important part, whether it was the health minister in Rwanda, whether it was Ambassador Webson at the UN, who is legally blind and championed our cause and took and helped to take the resolution to its successful conclusion. There are many collaborators along the way and talented people who have very much contributed to the success of my journey.
“I provided funding, but more importantly, my improving domain expertise I think helped me to understand better what the right things are to bet on.”
—James Chen, Philanthropist and Clearly Founder
Meet The Leader/Linda Lacina: Was there a moment when you did sort of hit a wall? Where you thought, ‘Maybe I’ve taken this as far as I can’?
James Chen: Yeah, many times in every phase of my journey, that thought came through. That rejection from the World Bank, that would have been the first time I encountered that.
But, I think that perhaps again – coming from an entrepreneurial business family – I think the mark of entrepreneurs is to take a rejection of failure and then figure out something better – what’s a different way or better way to do this. What did we learn from that setback and how do we retool the model and then try it again. Perhaps that’s another good reason why wealthy families, that have this entrepreneurial business experience, would have the right mindsets to be able to go on these philanthropic moonshot journeys.
“In the social sector, risk capital is desperately in need and being able to deliver that risk capital, with some expertise behind it, will really help to deliver huge change.”
—James Chen, Philanthropist and Clearly Founder
Meet The Leader/Linda Lacina: Would you say that your habit you can’t work without – thinking about problem solving not like a philanthropist but as an entrepreneur?
James Chen: What I’ve done, in the finance world, would be really the seed or the venture funding. A component where it’s very high risk and the chance of failure is 99%. But that 1% success has exponential impact. It helps to overcome the failures.
That’s why I’m so keen to push this message of the fact that the risk capital is needed in the social sector, not just in the for-profit sector where it’s been shown that it’s made a huge difference. As we see in the world today, all of these new technologies that are being nurtured and grown, that model works.
And my observation is that in the social sector, risk capital is desperately in need and being able to deliver that risk capital, with some expertise behind it, will really help to deliver huge change in the social sector.
A book recommendation
Meet The Leader/Linda Lacina: Is there a book that you recommend?
James Chen: Well, in fact, it’s a very timely question because there’s a book that was just released; it’s called In Defence of Philanthropy by Professor Beth Breeze. It is a book where she characterizes the modern critiques of philanthropy. There’s been several quite influential books written in the last few years critiquing philanthropy and in this book she really tries to address these misunderstandings of how philanthropy actually works, as well as what it has achieved.
One of the big points is very much that the critique is that ‘oh, donors do this to gain more power’. And while that may be the case, what matters is what is that power used for? Is it used for the greater good or is it used for self-aggrandizement? And it could be one of the other, but I think that for most people, if they’re serious about doing philanthropy and particularly if we’re going to put in all that effort, there are easier ways to do that.
Meet The Leader/Linda Lacina: And if someone was reading that book, what would they take from it?
James Chen: I think in that book that what comes through is this idea that passion matters as much as strategy. That it’s very much not just about writing cheques. It’s about being, you’re utilizing your own skills and this risk-taking mindset. But also, if there’s no passion there, you won’t be able to stay the course.