Confronting global crises: Oliver Sabot on health, climate change, and education

“One thing that motivates me the most in life is that whatever the problem—whether it’s economic, environmental, health, social—it’s always the lower-income people who get screwed,” Oliver Sabot told me in a video interview in spring 2024. He’s right, of course: poverty is associated with shorter life expectancy, higher mortality, and numerous health inequities. Children who grow up in poor families are four times more likely to be in poor or fair health compared with children in higher-income families.

Oliver’s perspective comes firsthand, two decades into his career on the front lines of three of humanity’s most important fights: health, education, and climate. After formative early experiences in Africa and at the Clinton Health Access Initiative, where he focused on large-scale programs to reduce child mortality and transform health systems, Oliver has founded three companies (so far). Today, when he’s not signing into Zoom to chat with LEFF, he’s an active entrepreneur, investor, and board member based in San Francisco.

The transcript has been edited for length and clarity.

LSG: The world has a huge set of problems, and you seem game to take on several of them. Where did you start, and how’s it going?

Oliver Sabot: I arrived as a teacher in southern Africa just after the turn of the millennium during the peak of the HIV epidemic before antiretroviral treatments had arrived. The town I lived in had two modern buildings: a bar and a funeral parlor. Even in a sparsely populated area, so many people were dying of HIV at that stage. It was devastating communities, and I emerged from that deeply galvanized to play whatever small part I could in helping turn the tide.

All these big priorities—global health, education, climate change—require massive movements to solve. They require a village. So I’m always clear that my part in this is adding one small thread to the broader tapestry. It took a massive mobilization across many, many organizations, but today, more than 90 percent of people with HIV in Africa are receiving life-extending therapy. It is one of the greatest transformations in the history of humanity.

Change often comes when we collectively—humans and communities—start to see hard realities clearly and stop trying to avoid them or deflect in some way. We’ve seen that in global health, and we’re seeing that with global warming. We’re all now living with heat waves and storms and wildfires. And this is just the very beginning of this.

LSG: What’s the explicit connection between climate change and health?

Oliver: There are many. Infectious diseases thrive on chaos. Extreme heat is very bad for health. But if climate change didn’t exist, low-income countries would still face challenges in managing basic healthcare. Too many children die from pneumonia and basic infections before the age of five. Too many women die in childbirth from a lack of good maternal facilities. In many areas of rural Africa, basic clinics aren’t always stocked with drugs and a skilled healthcare provider. Part of the challenge is that even if climate change didn’t exist, low-income countries will still face many challenges in managing basic healthcare.

So we’re already dealing with a fragile, limited system. And on top of that, you’re going to add all this extreme climate stress. In parts of sub-Saharan Africa, for example, there are going to be more places that are effectively unlivable. They’re already tough places to make a sustainable living—grow crops, keep livestock, etc. With greater droughts and extreme heat, people simply won’t be able to stay there to feed their families.

And so there’s going to be mass migration to cities and to other areas of countries—and that migration will have a huge impact on health as well. If there’s a major storm that wipes out homes and people need to move, or if extreme heat causes disruption, all these public health measures and all the things that are protecting against infectious disease are now broken or disrupted. Migration also has an impact on nutrition, on infectious diseases, on the general health of children. And now all those communities and those people are much more vulnerable.

What we need to do is invest in the root healthcare infrastructure and the basic clinics, especially ones that are more adaptable. A big focus in a lot of Africa is on community healthcare workers, who are not trained doctors but who can provide a lot of essential, basic services, such as malaria drugs or pneumonia drugs. They can also quickly adapt if a whole community has to migrate because of climate stress.

The question we should be most focused on globally is: What are we doing to help mitigate the impact of tens of millions of people who are going to be particularly hit hard and displaced by the worst outcomes of climate change? What do we do about it?

“The question we should be most focused on globally is: What are we doing to help mitigate the impact of tens of millions of people who are going to be particularly hit hard and displaced by the worst outcomes of climate change? What do we do about it?”

Oliver Sabot is a social impact entrepreneur, executive coach, and investor focused on developing and scaling new approaches to transforming climate, health, and education outcomes, particularly in emerging markets. He currently leads climate-related initiatives and investments for several philanthropies and is an executive coach for a range of rapidly growing climate-tech companies.

Oliver spent more than a decade in leadership in global health and development, serving for most of that time as the executive vice president for global programs at the Clinton Health Access Initiative (CHAI). At CHAI, he led the design and execution of large-scale programs to reduce child mortality and transform health systems in more than 20 countries and managed the organization’s relationships with major global institutions. Oliver also served as the chair of the Market Dynamics Committee for the Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria, guiding the development of improved strategies to better leverage the institution’s $22 billion in investments to shape health product markets.

LSG: What lessons did you learn in the fight against HIV, and how are you applying them to other challenges?

Oliver: Often, there’s a sense that something like global health needs nonprofit energy, but I learned early on that global health challenges—such as HIV or malaria or vaccines—should be approached with the same urgency, the same rigor, the same creativity that you would see in the most driven private company, like Goldman Sachs or McKinsey. We are going to work with the same intensity and the same problem-solving drive, except the clients here are not the shareholders of a Fortune 500 company. The clients are the poorest people in Rwanda or Zambia, or wherever it may be. Just as if you work at one of those big firms, you need to put in the extra hours—and it’s not profit on the line, it’s lives.

“Global health challenges need to be approached with they need the same urgency, rigor, and creativity you would see in the most driven private company, like Goldman Sachs or McKinsey. Except the clients here are not the shareholders of a Fortune 500 company—they’re the poorest people in Rwanda or Zambia.”

Money is precious, and it’s always going to be extremely limited when we’re talking about working on these problems. Every dollar we spend on diabetes or dialysis is a dollar we can’t spend on malaria or community health workers. There are huge complexities and real trade-offs. And everyone has different perspectives. So how any given community, institution, or country figures that out is going to vary.

One of the worst things we can do is invest money that we think is going to help based on our prediction of the future, only for the future to end up not playing out that way. Unfortunately, I hear about important projects that organizations put a lot of money into, such as building a new pipeline to bring water into a community: You spend years and many millions of dollars to build it, and then it turns out that because of climate change, the source of that water has now dried up, so the project has achieved nothing.

We at LEFF are, at heart, storytellers. We are dedicated to amplifying voices and causes from all over the world, regardless of gender orientation, race, or economic background. And the stories we tell as part of the Into the Weeds interview series are particularly important to us. We will be interviewing inspiring individuals whose work contributes to the achievement of the SDGs at every level; we’ll bring you insights from the leaders of global organizations, renowned experts and academics, and innovative local businesses.

Our goal for this series is the same one that underpins all of LEFF Sustainability Group’s client work: to use our storytelling skills to build awareness of the issues that threaten our planet and to draw attention to all the people, initiatives, and innovations that are fighting back.

LSG: Given the fight for dollars, how do you “get the economics right” for tackling climate challenges?

Oliver: Climate change is a whole-economy problem and requires a whole-economy set of solutions. We basically need to transform the way the entire world manages every aspect of life—what we eat, how we move ourselves around, where we live, our clothes, and the things we buy. That’s beyond a moonshot; it is a huge, extremely complex mobilization of the world, requiring a lot of different efforts across a lot of different sectors. It’s going to take time, and it’s going to be messy. You don’t transform the way eight billion people do everything in their lives in a few years.

We have a lot of tools. We have clean technologies and lifesaving devices, but they’re not always getting into all the hands that need them. A lot of all this comes down to execution, execution, execution—and that’s where talent plays a critical role. To my point earlier about managing big global challenges like a private company, we need the mobilization of incredibly dedicated, smart, and thoughtful people who are willing to devote themselves and bring a diversity of toolkits to it. What we want to do is make the right solutions inevitable by making them much better, cheaper, and easier than the alternative.

We will get to that moment when everyone stops driving gas cars, not because they think it’s the right thing for the planet but because it’s cheaper. Same with malaria drugs: We have to get to the point where it’s cheaper, easier, and better to do it. It’s market shaping, and it takes a long time.

LSG: It’s 2024. Looking forward, what are the most important gaps yet to fill in education?

Oliver: In lower-income countries, for a long time, the education focus was access. There were too many kids, specifically girls, not in school. We’ve gotten more children into schools, and now the primary challenge around the world is quality. It is heartbreaking to see very-low-income families who are just getting by and who make huge sacrifices to get their child into a school—and the child learns next to nothing. The data on the number of fourth graders in many low-income countries who still can’t read is horrifying, and it is very hard to change. But we’ve got to solve it because it is a deep betrayal of children and families when we don’t.

And of course, the impact of COVID-19 on education has been horrific. In Uganda, a country I know well, children were out of school for two years perpetually, and many of those children will never go back to school. These were kids who were already at the margin, and now it makes more sense for the families to keep them working in the fields or to marry them off.

If I could wave a wand and somehow change this world in one way, it would be to take politics out of education, because so often, these things get caught up in a lot of noise and a lot of power dynamics among groups of adults. It’s the kids who suffer.

“If I could wave a wand and somehow change this world in one way, it would be to take politics out of education, because so often, these things get caught up in a lot of noise and a lot of power dynamics among groups of adults. It’s the kids who suffer.”


Behind the scenes

This interview is part of LEFF’s Into the Weeds interview series—a series that amplifies individuals whose work contributes to the achievement of the SDGs at every level. We’ll be bringing you insights from renowned experts and the leaders of global organizations and innovative local businesses. Clair Myatt (she/her) is the manager of LEFF Sustainability Group, for which Katie Parry (she/her) is the director.

Comments and opinions expressed by interviewees are their own and do not represent or reflect the opinions, policies, or positions of LEFF or have its endorsement.

LEFF Sustainability Group would like to thank Brittany Williams for her contribution in writing this interview, one of many that you can read about here.