how glasses can change china and the...

JAMEs CHEN

How GlAssEs CAN CHANGE CHINA ANd THE woRld

the China report: FoCus on rural China

“This opens our eyes to how a 700 year old invention can change the lives of so many people.”

baroness ariane de rothsChild

Poor vision is the largest unaddressed disability in the world today. An estimated 2.5 billion people, 720 million in China, the majority in rural areas, struggle with poor vision because they don’t have access to a simple pair of glasses – a solution that has been around for centuries. It is an issue the world has ignored, even though tackling it would transform countless lives – helping children to learn, improving gender equality, increasing productivity, and ultimately reducing poverty.

The world is on the cusp of a new technological revolution but those without good sight cannot participate in this progress and will fall further behind. Insufficient funds are available to tackle the issue, yet helping the whole world see would save trillions of dollars in health costs and lost productivity. In this extraordinary report, businessman and philanthropist James Chen asks why this should be, and describes his quest to answer that question.

Here Chen identifies the barriers to universal access to vision correction and how they particularly affect rural China. He reveals the personal stories of some of those affected and delivers a passionate call to governments and international institutions to collaborate.

JAMEs CHEN

How GlAssEs CAN CHANGE CHINA ANd THE woRld

THE CHINA REPORT: FOCUS ON RURAL CHINA

“The best ideas are the simplest. James Chen’s engaging report opens our eyes to how a 700 year old invention can change the lives of so many people, equipping them with the ability to reach their full potential. The solution is on the end of our noses – if only we could see it.”B A R O N E S S A R I A N E D E R O T H S C H I L D , CO-FOUNDER, THE EDMOND DE ROTHSCHILD FOUNDATIONS

“There are 2.5 billion people in the world, 720 million in China, being left behind due to lack of access to vision care, 90 per cent of whom could be helped with a simple pair of glasses.”RONNIE CHAN GBM, CHAIRMAN OF HANG LUNG GROUP AND HANG LUNG PROPERTIES

“James Chen is a modern-day philanthropist from whom we can all learn. He has highlighted a problem and shown us how to solve it. He is someone with a bold vision who has the resources, the determination, and the inspiration to make it happen.”PROFESSOR WANG ZHENYAO, DEAN OF CHINA GLOBAL PHILANTHROPY INSTITUTE, DEAN OF CHINA PHILANTHROPY RESEARCH INSTITUTE, BEIJING NORMAL UNIVERSITY

“This report articulates a heartfelt yet practical way to address a major, often overlooked barrier to opportunity and growth. The subject here is poor vision and James Chen’s focus is China, but his approach could well be a shining case study for solving many poverty related challenges in the world today.”VICTOR FUNG GBM GBS CBE, GROUP CHAIRMAN OF LI & FUNG GROUP

“James Chen’s mission is a game changer for delivering the Sustainable Development Goals. In reading this insightful report, it becomes profoundly clear that helping the whole world see will enhance educational opportunities, life chances and prosperity for literally billions of people. Our focus is on investments for the long term. James Chen sets out a compelling case for new action in this neglected area of health care.”STEPHEN HEINTZ, PRESIDENT, ROCKEFELLER BROTHERS FUND

HOW GLASSES CAN CHANGECHINA AND THE WORLD

THE CHINA REPORT: FOCUS ON RURAL CHINA

JAMES CHEN

A world where everyone has access to a pair of glasses would be fairer and more prosperous for all of us.

1

FOREWORD

I failed an eye test when I was just 15 years old after applying for a driving permit.

I was living with my family in America at the time. It was a blow to my self-esteem, but not a lasting one. I got my first pair of glasses and, wow, the world I had lived in for 15 years suddenly became clearer. I’m short-sighted (or near-sighted, as some countries describe it).

I did not know that I had poor sight. I had got along OK. I saw what my eyes showed me. I had nothing to compare it with. Now I knew what I had been missing. There would never, ever, be any chance of going back to a world without glasses. Life was better and I was more assured of the world around me. I can never know how being unable to see perfectly affected my self-confidence as a child. But it must have had an impact.

Looking back, that incident has fuelled my passion to do something about the international problem of poor vision.

My fate then is shared in different degrees now by at least 2.5 billion of our fellow human beings who do not have access to vision correction. And many of them, some 720 million, live in China, the majority in rural areas. That’s about half the population. My mission is to try to make life better for them and in doing so, boost the world economy.

And my eternal good fortune is that fate has smiled on me and made it possible for me to try to do so. That is what the Clearly campaign to help the whole world see is all about. I

2

launched it with a simple thought in mind: if the American space programme is planning to put someone on Mars by the 2030s, or even earlier, we must ensure that everyone on Earth has the chance to clearly see the pictures of this happening.

Quite simply in the world of today, everyone, and I mean everyone, should have a right to see. And sadly far too many do not.

To prove to myself and others that this was a problem that could be tackled, I set up a charity, Vision for a Nation (VFAN), in Rwanda in 2011. It has made great strides as I explain in the chapters ahead.

Then in 2016 I founded Clearly, a global campaign to bring clear vision as quickly as possible to the 2.5 billion people worldwide denied it. We began by organising an innovation prize, the Clearly Vision Prize, for entrepreneurs and innovators to stimulate solutions, and the Clearly Labs, a programme of brainstorming events in nine cities across four continents charged with coming up with even more radical and futuristic ideas. The campaigning arm is now flexing its muscles with a concerted effort to raise ‘vision for everyone’ up the international agenda, starting with the Commonwealth Summit in London. Through the campaign and my book Clearly: How a 700 Year Old Invention Can Change the World Forever, I am trying to persuade world authorities that this is an issue they must urgently address.

I’ve told you why. Now, let me tell you how I am in this position.

I was born in Hong Kong on 19 July 1961. My father and his father were born in mainland China. Grandpa ZaoMing had a humble upbringing but became a highly successful businessman, launching an enamelware business

3

in Shanghai. In 1947 he moved the family and business to Hong Kong, at the time under British rule. He then set up a business in Indonesia and from there moved to Africa, eventually consolidating the business in Nigeria, setting up another enamelware factory and several other manufacturing businesses. I spent much of my early life in that country. I now remember how few Africans were wearing glasses, whereas many expatriates from richer countries were. That memory has regularly come back to me since we launched Clearly.

My late father, Robert, continued to build up the business and his success enabled him to become a philanthropist who contributed not just money but so much of his time and other resources to improve the conditions of our family’s hometown. Since his death, I have carried that work forward and fate has guided me on an amazing journey to find an international answer to the problem that suddenly dogged me when I applied for that driving test.

Much of my father’s philanthropic work was in our ancestral hometown, Qidong, in Jiangsu province across the Yangtze River from Shanghai. I found his work over 15 years inspiring.

I convinced him to set up a family foundation so that we could contribute in a more structured way. The Chen Yet-Sen Family Foundation’s articles of association were the final documents my dad signed before he died. The work our philanthropic arm has done in the past fourteen years is very much inspired by his example of not just donating money, but understanding the real needs of the community we are

4

trying to serve and spending time and effort to meet that need. I also serve as the non-executive chairman of Wahum Group Holdings, the holding company of our Nigeria-based business.

In this latest phase of our work at the family foundation, we have devoted our time and effort to enhancing early childhood literacy in China and developing the reading culture in the communities we serve.

My entry into the field of eye care was inspired by innovation. I had a chance encounter with Professor Josh Silver, the man who first saw the full potential of the modern fluid-filled adjustable lens, which allows the user to adjust their glasses to see clearly at any distance. I immediately grasped the potential of these lenses in the developing world, where distribution and logistics are fragile and expensive.

I had already begun to wonder whether my family’s philanthropic foundation could do more to make an international impact, going beyond what was until then more geographically focused work in Asia. Because of my encounter with Josh, my eyewear company Adlens was founded. Then came VFAN and Clearly.

What follows in this supplement is a summary of my book Clearly, which was published in October 2017, and an account of how China is affected by a vision crisis, along with recommendations on how it might be addressed.

Seven hundred years after the invention of the first spectacles it is extraordinary and wrong that so many hundreds of millions have no access to vision correction. I am desperate to contribute what I can to putting that right.

Chapter 1

Time To Wake Up

7

T i m e T o Wa k e U p

More than 700 years ago, spectacles were invented. One of the greatest innovations in our history had arrived.

In those early years, perhaps only aristocrats and the clergy used glasses. But the invention of the Gutenberg press in around 1440 meant that very quickly there was a mass audience wanting to read, and requiring glasses if they could not see properly. Over the centuries, as aesthetics improved and our understanding of the eye advanced, we have become so comfortable wearing glasses that we now buy them in all sorts of shapes and sizes. Would Steve Jobs or Bill Gates have been able to code without their glasses? How would Elton John have learned the piano? Would the magical world of Harry Potter ever have been created if J.K. Rowling didn’t have a pair of specs?

The Clearly campaign is about the unfulfilled potential of getting this centuries-old innovation on the noses of all the people who need it. A staggering 2.5 billion people who need a pair of glasses don’t have them.1 In many instances, they simply cannot get hold of a pair because local markets for affordable glasses do not exist. Or, sadly, they do not understand the simple and proven benefits of spectacles. And 720 million of these people live in China,2 the country with the largest number struggling with the impact of poor vision. It also happens to be the country where most of the world’s spectacles are made.

In a world of huge opportunities for those who can see clearly, we have a third of the world’s population – and nearly a half of China’s – who are being held back and unable to reach their full potential. This could turn out to be one of the biggest oversights in history.

8

C h a p t e r 1

Poor vision is the largest unaddressed disability in the world today, but for decades it has not received the level of attention it should. Governments, the United Nations, the World Health Organization (WHO) – none have done enough to acknowledge this problem and act on it.

Helping the world to see is about so much more than health. It’s about the future of our children, because a child who cannot see a blackboard cannot get a decent education; it’s about gender equality, because far more women suffer than men; and it’s about productivity, because if you cannot see clearly, it’s difficult or impossible to work. Not least, it is about the mental health and dignity of the individual to feel stimulated, productive and self-sufficient.

The time for action is now, because the phenomenal technological change taking place in the world looks set to leave behind anyone who cannot participate in progress. By 2020, most people in the world will have access to a smartphone. In the next five years, another 3 billion consumers will come online. 3D printers will transform production costs. More and more people will spend their working lives at computers. We must ensure that no one is left behind because they cannot see clearly. Imagine the huge benefits if all those people without proper sight could use computers, read books or carry out mechanical tasks that poor vision prevents them from doing today to their full potential.

And we are hardly touching this problem. As Jordan Kassalow, founder of VisionSpring, a social enterprise that is one of the leaders in this field, tells us, his organisation has distributed over 4 million pairs of glasses over the past fifteen

9


years in some developing countries. ‘But as we did, it has become more and more apparent that if that figure was 10 million or 100 million we would still only be making a dent in this worldwide problem.’

Entrepreneurs are doing their bit to bring down the cost. But we also need governments to step up. We must convince world governments that universal eye care is ultimately self-financing. If governments are looking for results, the answer is in eye care.

Sight is the golden thread of human development. We have a proven, tested, legal and highly desirable product that can change billions of lives in an instant.

We have a chance now to correct this. It is critical that governments, global authorities, non-governmental organisations (NGOs), businesses, and the public at large understand the scale of this problem and work together to solve it.

It will cost money, but the investment will be repaid so many times over that I believe the economists and finance ministries will not struggle with the ‘business case’.

But there are four big barriers to achieving this – what I call the four Ds: diagnosis, distribution, dollars and demand.

First, there are simply not enough people carrying out the relatively simple task of diagnosing someone’s eyesight.

Second, we must distribute glasses to those who need them. If we can get a bottle of cola to villages across the world, surely we can deliver a pair of glasses?

Third, we must cut the cost of glasses by ensuring they can retail at dollars rather than tens of dollars. And fourth, the stigma over wearing glasses persists in the developing world, meaning that there is insufficient demand. I will look at the 4Ds in detail, and how they affect China, in Chapters 3 to 6.

10

C h a p t e r 1

If humans are to be on Mars by the 2030s, or even earlier, as many predict, it will be to the world’s shame if everyone cannot see it happen. That’s my dream, my aim. Let’s get the world to see before we get to Mars.

If you are reading this, there’s a one in two chance that you’re doing so with a pair of glasses or contact lenses. Just imagine what your life would be like without them.

We cannot escape the fact that 700 years after glasses were invented the world has been prepared to tolerate a situation where billions of people still cannot see clearly.

Despite the lack of focus from some international organisations, progress is being made in some of the most unlikely parts of the world. New inventions mean that vision screenings and glasses have never been more affordable. But the pace of technological change means that if we don’t act quickly we will condemn a third of the world’s population to miss out on this progress.

On the flip side, if we get this right – ensuring that state and markets work together so that everyone has access to a sight test and an affordable pair of glasses – we will achieve a radical leap in productivity, prosperity and opportunity. This will be of benefit, yes, to those 2.5 billion people – including those 720 million in China – and the many more yet to be born who have poor vision. But it will also be to the good of everyone who can already see clearly by creating more human ingenuity, more human creativity and more human happiness.

No longer can we let down the forgotten billions. It’s time to wake up and help the whole world see clearly.

11


References1. We use this figure throughout to describe the number of

people worldwide who are affected by poor vision and need a pair of glasses but cannot get access to any. The figure derives from a methodology developed by the Boston Consulting Group for Essilor and widely cited, including by the World Economic Forum: Smith, E., Chen, W., Congdon, N., Frick, K., Kassalow, J., Naidoo, K., Sloan, J. A. (2016). ‘Eyeglasses for Global Development: Bridging the Visual Divide’.

2. MacKenzie, G.E. (2017). ‘Clearly: The Global Need for Eyeglasses’. https://clearly.world/wp-content/uploads/2017/10/The-Global-Need-for-Eyeglasses.pdf

Chapter 2

China’s Vision Crisis

15

C h i na’ s V i s i o n C r i s i s

China has a vision crisis. It is the world’s most populous nation with nearly 1.4 billion inhabitants. At least half of them cannot see properly through lack of access to eye examinations and therefore glasses, according to Clearly’s country-by-country breakdown published in late 2017.1 And this is the country where most of the world’s spectacles are made.

It is a crisis that, if left unchecked, has the potential to reach epidemic proportions. It is not just me, the Clearly campaign or the charities and social enterprises operating in this great country who are saying that. The Government itself acknowledges it, something that gives me guarded cause for optimism.

This is what the National Health and Family Planning Commission’s 5-Year Eye Health Plan says: ‘China still has the largest number of people with visual impairment and blindness in the world. The prevalence of age-related eye diseases is increasing. Uncorrected refractive error among young people has become a prominent issue. Cataract blindness among rural poor people remains an unsolved problem. There is an inadequacy of quality and properly distributed eye-care resources. Primary eye care needs to be strengthened and public awareness of eye health and vision protection needs to be promoted.’

It then, and I am delighted by this, commits to providing ‘universal eye medical care for everyone and the gradual elimination of avoidable blindness and visual impairment.’ This is impressive because it shows that the Government of China recognises the problem.

16

C h a p t e r 2

No one is pretending this will be anything other than a monumental task. It may be impossible. But the first step towards tackling a crisis is recognising that there is one.

So, as Clearly’s research has shown, 720 million people in China, tens of millions of them children in rural areas, struggle with poor vision. Since economic liberalisation in the 1970s, China has grown fast and its economy is now second only to that of the United States (and, indeed, first using purchasing power parities). But while poverty has been reduced and prosperity increased, there is still a big gap in wealth and services between urban and rural China. When it comes to eye care and the services available to deal with it, China is faced with a dichotomy within its population: urban vs. rural. Both parts are struggling with the vision crisis but while the urban population has the services and medical staff to tackle it, the rural part, which makes up 43 per cent of the population, does not.

In the public mind everywhere, the words ‘poor sight’ instantly conjure images of conditions that require complicated medical interventions. These conditions, which affect 165 million people worldwide – things like cataracts, glaucoma, macular degeneration and others – automatically make vision a problem that should be left to the ‘experts’.2 It is little wonder then that almost all efforts have been directed towards these issues, while almost no attention has been paid to the 2.5 billion who cannot see properly for want of a pair of glasses.

The cost of this issue is considerable: poor vision costs the global economy some $3 trillion a year in direct costs, productivity losses, tax and welfare spending, and informal care costs.3 This is nearly half of what we spend on healthcare globally4 and the figure is projected to increase by approximately 20 per cent by 2020.

17


The World Health Organization has estimated it could cost $28 billion over five years to tackle the sorts of poor vision that can be corrected with glasses.5 Over ten years, the additional investment required to eliminate poor vision caused by preventable eye conditions that lead to blindness in the developing world is estimated to be $128.2 billion.6

Regrettably, only $850 million is spent by the top ten eye-care NGOs each year7-15 – primarily on tackling the eye conditions that affect the 165 million people with eye conditions that can’t be corrected with glasses. This is the scale of the challenge facing governing authorities and donors.

People with poor vision can be divided into roughly two groups: the 10 per cent who need surgery and special medication to deal with diseases like glaucoma and cataracts and the 90 per cent who need little more than a pair of glasses to see well enough to go about their daily lives independently and productively.

The sorts of eye conditions that can be corrected with glasses are called refractive errors. Refractive errors come because the shape of the eye results in light being focused inaccurately on to the retina, resulting in a blurred image.

The main types of refractive errors are myopia (short-sightedness or near-sightedness), hyperopia (long-sightedness or far-sightedness), presbyopia (loss of near vision with age), and astigmatism.

Refractive error varies markedly from one part of the world to another. More than half of all Chinese are short-sighted, compared to less than 10 per cent of people in Nigeria. Europe and the United States lie somewhere between these extremes, with about a quarter of the population suffering from short-sightedness.1

18

C h a p t e r 2

Short-sightedness has reached severe proportions in China, and it is still on the rise. Research shows that short-sightedness in China increases dramatically with age, affecting 5 per cent of 6 year-olds, 52 per cent of 10 year-olds, 60 per cent of 12-year olds, 80 per cent of 16 year-olds and even surpassing 90 per cent in university students. In fact, using current projections roughly half the world’s population will be short-sighted by 2050. It goes without saying that China will bear the greatest burden of this epidemic.16-19

A factor that complicates things further in China is the ancient system of hukou for household registration. Hukou was a system designed to ensure that the rural population stayed in the countryside and provided the food and resources that the urban population needed. However, as China’s economic boom gathered pace, the towns and cities needed labour from the countryside and a massive migration took place.

These challenges apply not just to the labour markets, but to education too. It is surprising that in a country that has placed so much emphasis on education as it has risen to be one of the world’s great powers, so many youngsters who need glasses are without them. Only one out of every seven children in rural China who needs glasses to enhance their ability to learn actually has them. That is a sobering statistic.20

19


The 5-Year Eye Health Plan:21

• Integrate eye disease prevention and treatment into the healthcare system

• Government should maintain a leadership role, cooperating with ‘multiple sectors’ and engaging Chinese society

• By 2020 build a cross-country network of eye disease and prevention centres

• County hospitals should provide eye-care services as a matter of course

• Increased focus on the treatment and correction of uncorrected refractive errors (URE), also known as short- and long-sightedness, in children

• Visual impairment caused by URE must be tackled and every county in China should have people qualified to provide optical services

The need to provide glasses to those who need them in China is obvious, or so you would have thought. One of the problems encountered by China’s national and local government leaders, and wonderful NGOs and social responsibility organisations like the Esquel-Y.L. Yang Education Foundation, the Fred Hollows Foundation, the Brien Holden Vision Institute, and Smart Focus, when they have set about bringing help to the rural developing communities, is a deep suspicion of glasses that has been handed down from generation to generation.22 While there are other big obstacles such as cost and a lack of trained personnel to carry out sight tests and put pupils on the road to better vision, there exists a misconception that spectacles can harm eyesight.

20

C h a p t e r 2

We need to look deeper at why there is such a large-scale problem in China and much of the rest of Asia. New research shows that short-sightedness is the cause of 90 per cent of all poor vision among Chinese children.23 Nearly one-third of the world’s myopic children live in China,1 and about half of the children with the most severe forms of short-sightedness can be found in China too.24 As we saw in the previous chapter, these figures are set to rise rapidly over the coming decades. The rate of increase of short-sightedness in Asian children is faster than anywhere else in the world,25 and much of the reason appears to be social. A 2012 study26 of 15,000 children in the Beijing area found that poor sight was significantly associated with more time spent studying, reading or using electronic devices, along with much less time spent outdoors. New research is showing that this last factor – time spent outdoors – is particularly important when it comes to the development of short-sightedness. Once they start school, Chinese children spend about an hour a day outside, whereas their Australian counterparts have up to four hours away from their computers.27

One of the most significant findings in this area comes from a study28 led by Professor Mingguang He of Sun Yat-sen University in Guangzhou. Professor He’s study, which involved 2,000 children from 12 primary schools in Guangzhou, found that increasing the amount of time children spent outdoors by as little as 40 minutes a day produced a 23 per cent reduction in the rate at which short-sightedness developed.

Professor He recommends that schools and parents should encourage students to spend more time outdoors so long as the proper sun protection measures were undertaken.

21


‘Schools, if they can’t add more outdoor classes in the curriculum, should at least bring the students outside during school recess. Parents should encourage or bring their children outside on the weekends, in particular children at high risk of developing short-sightedness, for example, those who have parents who are both short-sighted.’

The legendary Kovin Naidoo, chief executive of the Brien Holden Vision Institute, has echoed Professor He’s words. Speaking to the Clearly team, he warned of a public health crisis for developed and developing worlds unless action was taken soon to persuade people, particularly children, to spend more time outdoors.

He referred to another major study, this one from 2016,29 suggesting that half the world’s population will be myopic or short-sighted by the year 2050, with up to a fifth of them at a significantly increased risk of blindness. This study also attributed the rapid increase in the prevalence of short-sightedness to ‘environmental factors, principally lifestyle changes, resulting from a combination of decreased time outdoors and increased near work activities.’ This included time spent at a computer screen. Unless checked, China’s economy will bear the brunt of this rise in short-sightedness.

It’s not just time spent outdoors that slows the march of short-sightedness. A study by the Rural Education Action Program (REAP – developed in China by America’s Stanford University)20, which involved 20,000 children at 250 schools in China, found that the short-sightedness of those who had been given glasses at the beginning of the year progressed slower than that of those who did not receive glasses.

So the message must be: wearing glasses and spending more time outdoors is good for your health and good for your eyes.

22

C h a p t e r 2

China: The Numbers

There is a real irony in the fact that China is the country in the world worst affected – in numbers – by poor vision. It is one of the few countries that not only meet, but exceed the World Health Organization’s target for numbers of eye surgeons per head of the population.

With more than 28,000 ophthalmologists it has one for every 48,600 of the population, five times better than the WHO guideline which is one for every 250,000 people.30 Strictly speaking China only ‘needs’ 5,500 ophthalmologists.

And in China, the ophthalmologist’s role also tends to cover that of the optometrist – eye testing, and prescribing and dispensing glasses – in other parts of the world. In China, optometry is considered a sub-specialism of ophthalmology. In many ways, these figures represent a good news story. In numbers alone China has an ample supply of eye specialists.

But, as we have seen already, there is a serious problem. The overwhelming majority of the specialists are in the towns and cities, and rural China, nearly half of the overall population, is under-served.

A new cadre of ‘refractionists’ is being trained to do some of the jobs that optometrists would do in other countries. These roles would include vision screening and the provision of glasses and perhaps the detection of eye infections and some cataracts.

But the truth is there are not enough specialists to go around to meet the need for refractive services in areas that are hundreds of miles from the nearest urban centre.

Which is why I will argue that for this world-wide problem to be met we have to go for task-shifting on a grand scale.

23


It has worked in Rwanda – where after a three-day training programme, nurses have been allowed to carry out eye examinations and hand over glasses to the people who need them. It could work in China, too. In rural schools, teachers are already doing a fantastic job, according to social enterprise organisations already working in China. They have a captive audience. They are in the best position of all to see whether a student needs an eye test and glasses. And they are in the best position to make sure that they wear them. By the time they get to high school, a big majority of Chinese pupils will need glasses.

So if the teachers can do it, let’s get that training to the nurses and community health workers. With today’s modern methods of diagnosis, including smartphone-enabled apps from innovative companies like Peek Vision and Vula Mobile, judgments on eye conditions can be made by experts thousands of miles away.

Nathan Congdon, one of the few foreign eye surgeons to practise and live in China, insists that the quality of training should be improved.

However, we should not pretend that conducting eye tests and giving glasses to the people who clearly need them is rocket science.

This sentiment is important, because we should keep in mind the scale of the problem ahead of us. Of the 720 million Chinese people who need glasses, 482 million need distance glasses and don’t have them; 121 million need reading glasses and don’t have them; and 117 million need both distance and reading glasses and do not possess them. The overall number affected includes people who need a simple pair of reading glasses all the way to people who are avoidably blind and need cataract or other medical treatment.

24

C h a p t e r 2

We need radical thinking and brave action to address this problem.

The need for action to help people in rural China was underlined by a study of refractive error among schoolchildren in Yangxi County. It had started with the premise that myopia would be less of a problem than in metropolitan areas, in line with a tendency for less academically rigorous classes and lower education pressures in rural than urban environments.

The findings bore that out when comparing the prevalence rate with that in a semi-rural and urban area, but prevalence of myopia was still staggeringly high:31 37 per cent for 13-year-olds and 54 per cent for 15-year-olds, quite serious enough given the lack of services available in rural areas.

The study’s conclusion was that reduced vision because of uncorrected myopia was a public health problem in rural China. More than half those who could achieve normal vision with refractive correction were without the glasses they needed. It found that barriers to the use of corrective spectacles included parental awareness, cost, and concerns that glasses might make poor vision worse. It concluded there was a need for vision screening in schools, accompanied by parental education, followed up by quality optometric services and access to affordable glasses. I would not argue with any of that.

25


References1. MacKenzie, G.E. (2017). ‘Clearly: The Global Need

for Eyeglasses’. https://clearly.world/wp-content/uploads/2017/10/The-Global-Need-for-Eyeglasses.pdf

2. Pascolini, D., Mariotti, S.P. (2012) Global estimates of visual impairment: 2010. British Journal of Ophthalmology 96:614-618.

3. Gordois, A., Cutler, H., Pezzullo, L., Gordon, K., Cruess, A., Winyard, S., Hamilton, W., Chua, K. (2012). ‘An estimation of the worldwide economic and health burden of visual impairment’. Global Public Health, 7 (5), 465-481.

4. World Health Organization: ‘Spending on Health: A Global Overview’. http://www.who.int/mediacentre/factsheets/fs319/en/

5. Fricke, T.R., Holden, B.A., Wilson, D.A., Schlenther, G., Naidoo, K.S., Resnikoff, S., Frick, K.D. (2012). ‘Global cost of correcting vision impairment from uncorrected refractive error’. Bulletin of the World Health Organization, 90 (10), 728-38.

6. Fred Hollows Foundation (2013). ‘Investing in Vision: The costs and benefits of ending avoidable blindness’. Pricewaterhouse Coopers, Australia.

7. Fred Hollows Foundation. http://www.hollows.org/getattachment/au/Annual-Report-2015/2015-FHF-Group-Financial-Statements-v20160330-FINAL-Signed.pdf.aspx

8. SightSavers International. http://www.sightsavers.org/wp-content/uploads/2016/09/2015_AnnualReport_Accessible_WEB.pdf

9. Orbis International. http://gbr.orbis.org/page/-/Orbis%20final%202015%20Audit%2012-31-15.pdf

26

C h a p t e r 2

10. CBM. http://www.cbmuk.org.uk/wp - content/uploads/2016/04/MU21187- CBM-Annual-Report-accessible.pdf

11. Brien Holden Vision Institute. http://develop.brienholdenvision.org/bhvi_2015/images/pdfs/resources/annual_reviews/foundation/11-12_bhvi_report.pdf

12. Lions International. https://www.lionsclubs.org/resources/all/pdfs/lcif/lcif30_14-15.pdf

13. Light for the World. https://www.light-for-the-world.org/sites/lfdw_org/files/download_files/lftw_ar_2014_15_screen_0.pdf

14. Optometry Giving Sight. http://www.givingsight.org/images/media_centre/AnnualReport_2015_V9_acr.pdf

15. Helen Keller International. http://www.hki.org/sites/default/files/attach/2016/07/HKI_Annual_Report_2015_Finalweb.pdf

16. Ma, Y., Qu, X., Zhu, X., Xu, X., Zhu, J., Sankaridurg, P., Lin, S., Lu, L., Zhao, R., Wang, L., Shi, H., Tan, H., You, X., Yuan, H., Sun, S., Wang, M., He, X., Zou, H., Congdon, N. (2016). ‘Age-Specific Prevalence of Visual Impairment and Refractive Error in Children Aged 3-10 Years in Shanghai, China’. Investigative Ophthalmology and Vision Science, 57(14) 6188-6196.

17. Li, S.M., Liu, L.R., Li, S.Y., Ji, Y.Z., Fu, J., Wang, Y., Li, H., Zhu, B.D., Yang, Z., Li, L., Chen, W., Kang, M.T., Zhang, F.J., Zhan, S.Y., Wang, N.L., Mitchell, P.; Anyang Childhood Eye Study Group.(2013). ‘Design methodology and baseline data of a school-based cohort study in Central China: the Anyang Childhood Eye Study’. Ophthalmic Epidemiology; 20: 348-359.

27


18. Wu, J.F., Bi, H.S., Wang, S.M., Hu, Y.Y., Wu, H., Sun, W., Lu, T.L., Wang, X.R., Jonas, J.B. (2013). ‘Refractive error, visual acuity and causes of vision loss in children in Shandong, China. The Shandong Children Eye Study’. PLOS One 8: e82763.

19. Sun, J., Zhou, J., Zhao, P., Lian, J., Zhu, H., Zhou, Y., Sun, Y., Wang, Y., Zhao, L., Wei, Y., Wang, L., Cun, B., Ge, S., Fan, X. (2012). ‘High prevalence of myopia and high myopia in 5060 Chinese university students in Shanghai’. Investigative Ophthalmology and Vision Science; 53: 7504-7509.

20. Ma, X., Zhou, Z., Yi, H., Pang, X., Shi, Y., Chen, Q., Meltzer, M.E., le Cessie, C., He, M., Rozelle, S., Yizhi, L., Congdon, N. (2014). ‘Effect of providing free glasses on children’s educational outcomes in China: cluster randomized controlled trial’. BMJ 349:g5740

21. National Health and Family Planning Commission (2016): The 13th 5-Year National Eye Health Plan (2016-2020)

22. Li, L., Lam, J., Lu, Y., Ye, Y., Lam, D.S.C., Gao, Y., Sharma, A., Zhang, M., Griffiths, S., Congdon, N. (2010). ‘Attitudes of Students, Parents, and Teachers Toward Glasses Use in Rural China’. Arch Ophthalmology. 128(6) 759-765.

23. Morgan, I.G., Ohno-Matsui, K., Saw, S.-M. (2012). ‘Myopia’. The Lancet 379(9827) 1739 – 1748.

24. Resnikoff, S., Pascolini, D., Mariotti, S.P., Pokharel, G.P. (2008). ‘Global magnitude of visual impairment caused by uncorrected refractive errors in 2004’. Bull World Health Organ 2008; 86: 63-70

28

C h a p t e r 2

25. Donovan, L., Sankaridurg, P., Ho, A., Naduvilath, T., Smith, E.L., Holden, B.A. (2012). ‘Myopia progression rates in urban children wearing single-vision spectacles’. Optometry and Vision Science 89(1) 27-32.

26. You, Q.S., Wu, L.J., Duan, J.L., Luo, Y.X., Liu, L.J., Li, X., Gao, Q., Wang, W., Xu, L., Jonas, J.B., Guo, X.H. (2012). ‘Factors Associated with Myopia in School Children in China: The Beijing Childhood Eye Study’. PLOS ONE, 7(12), e52668.

27. The Economist. ‘Why so many Chinese children wear glasses’. http://uk.businessinsider.com/why-so-many-chinese-children-wear-glasses-2014-11?r=US&IR=T

28. He, M., Xiang, F., Zeng, Y., Mai, J., Chen, Q., Zhang, J., Smith, W., Rose, K., Morgan, I.G. (2015). ‘Effect of Time Spent Outdoors at School on the Development of Myopia Among Children in China: A Randomized Clinical Trial’. JAMA 314(11):1142-1148.

29. Holden, B.A., Fricke, T.R., Wilson, D.A., Jong, M., Naidoo, K.S., Sankaridurg, P., Wong, T.Y., Naduvilath, T.J., Resnikoff, S. (2016). ‘Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050’. Ophthalmology 123(5), 1036-1042.

30. Vision 2020: The Right To Sight. (2007). Global Initiative for the Elimination of Avoidable Blindness: action plan 2006-2011. World Health Organization, Geneva.

31. He, M., Huang, W., Zheng, Y., Huang, L., Ellwein, L.B. (2007). ‘Refractive Error and Visual Impairment in School Children in Rural Southern China’. Ophthalmology 114(2) 374 – 382.

Chapter 3

The four Ds : Diagnosis

31

T h e f o u r D s : Di ag n o s i s

As the Clearly campaign has progressed, we have identified four big barriers blocking our goal of bringing relief to the 2.5 billion. We call them the four Ds: diagnosis, distribution, dollars, by which we mean cost, and demand. We have looked at each of these in turn and suggested potential ways through. The four Ds apply in China just as they do in the rest of the world. In the next four chapters we examine them.

Diagnosis: The Problem

There are simply not enough people in the world carrying out the relatively simple task of diagnosing someone’s eyesight. State regulations mean that in many countries screening people to see whether they are short- or long-sighted can only be done by eye doctors with years of training. But only a tiny proportion of these experts live in the developing world, and where they are in developing countries or some middle-income countries like China, they tend to live in the big cities, leaving rural areas largely without cover. The eye profession itself is nervous about others, say nurses and community workers, doing their jobs. They maintain that allowing people to buy their glasses from someone other than an eye specialist will put people at risk because it might ‘distract the public from regular eye examinations’.

At first glance, this argument seems reasonable, but when you scratch the surface it becomes clear that this is a coercive tactic that does not help the public image of the eye-care profession: conflating ‘the need for glasses’ with ‘eye health’ undermines the professionalism of the people working in eye care and it causes massive inflation of prices for eyewear.

32

C h a p t e r 3

First, let’s address the issue of eye health examinations. Regular examinations of eye health (i.e. when an eye specialist looks at and inside your eyes to assess your health) are vital not only to look for conditions that may lead to blindness but also because the eye is a subtle barometer of general health, and is quickly affected by systemic diseases. A professional can pick up all manner of serious health issues including diabetes, hypertension, tumours, infections etc. There is no question that regular examinations of eye health are important. The question is whether restricting the sale of glasses is an effective way of ensuring that people get regular eye examinations.

Put simply, the people who argue against moving the prescription and sale of glasses on this basis (known as task-shifting) subscribe to the belief that restricting access to glasses is the best means of forcing the public to have their eyes examined more frequently. This is a coercive approach – and one that has failed in almost every public health initiative in which it has been applied, whether for the management of hypertension, obesity, diabetes or alcohol abuse. Indeed, when it comes to matters of public health and the means by which large-scale behaviour change is enacted, it is generally recognised that coercive approaches are ineffective.

Rather, there is growing consensus that eye examination frequency is increased by efforts to educate people about the health benefits of obtaining comprehensive eye examinations at regular intervals.

Responsibility for educating the general public about the health benefits of regular eye examinations rests with the profession itself. If it has been unable to do so until now, then it is a failure of the profession that must be addressed. Regrettably, this noble task is understandably hampered by

33


the dual role that optometry plays in our society. On the one hand, the eye-care professionals are learned people tasked with testing our eyesight and, on the other hand, they rely for their income almost exclusively on the commercial activity of selling the eyeglasses they prescribe. Almost all their revenue comes from the sale of glasses, and very little of their income comes from examining the health of the eye.

That this dual role exists is not a bad thing in and of itself. Indeed, there are many sound practical reasons to house both roles under one roof – not the least of which is sheer convenience for the consumer. Nevertheless, the difficulty comes because this dual role is protected by trade regulations. Protection of this sort means that the sale of corrective eyewear need not be subject to free market pressures... and that means that prices will be inflated. What I would argue for in my ideal world is the deregulation of the trade of measuring the power of the eye and selling the glasses to correct it. Furthermore, I would argue for even stronger regulation of the professional act of examining the health of the eye, and call on regulators, trade bodies and the health sector to improve public education of the benefits of regular examinations of eye health.

Case Study: Happiness Was Glasses for Chung

Let me introduce you to Chung, who is 13 and recently received an eye test through a screening programme conducted by the Brien Holden Vision Institute (BHVI), funded by Standard Chartered Bank’s Seeing is Believing Project. The Clearly campaign is following in the footsteps of giants.

34

C h a p t e r 3

One such giant was Brien Holden who founded the NGO – now run by Kovin Naidoo – which brings vision help to many parts of the developing world, including China.

Chung’s case is a classic example of how the diagnosis problem can be approached.

He told us: ‘I was really young when I started having trouble seeing clearly. I remember the time when I started middle school in grade 4. The first day the teacher wrote all our names on the school board and we had to walk over and point to our name. I was really struggling to see anything at all on the school board. I felt so stupid as I couldn’t do what all the other children did so easily. I remember crying and feeling like everyone was staring at me.’

‘I didn’t know then that this experience was just the beginning of my trouble at school. Often I felt a lot of stress about school and learning, and I never wanted to go. Even though this made much trouble with my parents and grandparents.’

Luckily, Chung had his eyes screened through the school eye health programme and he was referred to the local hospital for a full eye examination. The optometrist at the hospital explained to Chung and his parents that with correctly prescribed and fitted spectacles Chung would be able to lead a normal life and study well like the other children of his age.

‘Once I could wear my new spectacles my whole life changed. Soon I felt comfortable wearing my glasses all the time, even playing sport, which I love. I don’t get dizzy or confused anymore. I feel so much happier,’ he said.

Chung explained that he has been telling everyone he knows about getting their eyes checked at the eye clinic. ‘Sometimes we might not know when we have a problem

35


with our eyes. We think we are just stupid or lazy and it means we will not do well at school. But once the right eye doctors help you, everything becomes a miracle and your life just becomes the dream you wanted it to be.’ One happy young man.

Diagnosis: The Answer

So Chung has shown us. In China as elsewhere we must train tens of thousands more people – from community nurses to teachers to entrepreneurs – to carry out basic sight tests. This would also free up the eye professionals to focus on more serious eye diseases which only they are qualified to address.

The ‘eye establishment’ must drop its objections to such task-shifting. The use of smartphones to screen vision and detect refractive error must spread across developing and middle-income countries and not be confined to certain age groups. Companies developing apps like Vula Mobile, winner of the Clearly Vision Prize, which connects health workers who have tested sight with experts in the cities and elsewhere, should be encouraged.

Non-specialists should be allowed to prescribe as well as dispense glasses. People should be able to measure their own visual acuity using apps. Entrepreneurs should be able to sell reading glasses. Looking further ahead artificial intelligence should be used to detect eye problems.

As I mentioned earlier, in my ideal world, those to whom these tasks are shifted would be able to prescribe as well as examine. It should be noted that a child self-refraction study in China in 2011 showed that there was no statistically

36

C h a p t e r 3

significant difference in the accuracy of refraction between school kids correcting their own vision with adjustable glasses, and an ophthalmologist correcting their vision with top-range equipment.1,2 And this would be a bonus for eye doctors. The more people screened, the more people with serious eye problems would be referred to them.

Michael Young, chief executive of Smart Focus, a social enterprise organisation spun off from the Rural Education Action Program (REAP), says the key to success is to work in partnership with local governments to raise awareness of the problem. ‘We are now being encouraged to enter schools by the government. We have provided vision screening for over 250,000 students and we have already set up a network of 10 vision centres across those regions.’

‘Some 30 to 50 per cent of children screened get referred to the centres. It is a beginning. China has a massive problem of poor vision to tackle but the eventual aim is to upscale our model across the country. There are still many remote rural areas that are not covered at all.’

Once the vision centres are up and running, they provide glasses to most rural youngsters for free while at the same time charging the equivalent of a few dollars for examining and providing glasses to adults and better-off urban students. The vision centres will then repay the initial investment after recouping their start-up costs.

I believe this is an exciting adoption of the market approach and it should become self-sustaining.

This programme has provided access to vision screening for 3 million people, and within a few years that figure will go up to 10 million. Given the scale of the problem, this is only a start.

37


References1. He, M., Congdon, N., MacKenzie, G., Zeng, Y., Silver,

J.D., Ellwein, L. (2011). ‘The child self-refraction study results from urban Chinese children in Guangzhou’. Ophthalmology. 118(6):1162-1169.

2. Zhang, M., Zhang, R., He, M., Liang, W., Li, X., She, L., Yang, Y., MacKenzie, G.E., Silver, J.D., Ellwein, L., Moore, B., Congdon, N. (2011). ‘Self correction of refractive error among young people in rural China: results of cross sectional investigation’. BMJ. 343:d4767.

Chapter 4

The four Ds : DisTribuTion

41

T h e f o u r D s : Di s T r i bu T i o n

Distribution: The Problem

We must distribute glasses to those who need them. If we can get a bottle of cola to villages across the world, surely we can deliver a pair of glasses? Yet rules and regulations in many countries stop local shops or kiosks from selling reading glasses, and only a handful of countries have been brave enough to take on the eye health industry and allow prescription glasses to be sold over the counter. As a result, millions of people – including children at the start of their lives – are denied a simple solution to their vision problem. If they live 50 or 60 miles from the nearest town, they have little chance of getting help.

And herein lies that irony. China is the world’s leading manufacturer of glasses. It is also the largest potential consumer of those products. According to Euromonitor estimates, retail sales of glasses in China rose by 6 per cent to about RMB70 billion ($10 billion) in 2016.1 Consumer spending on contact lenses has been rising at an annual rate of 10 per cent with imports, yes imports, soaring to $215 million in 2016.

Go to a big city or town and the opportunities to buy glasses are endless. In a modest street in Beijing lies a four-storey building dubbed Glasses City. There are ten or so spectacle shops containing everything you need to make a pair of eyeglasses. You can get your eyes tested and the prescription filled next door. Some of the sales teams speak English but if you get your frames in a shop with non-English staff you can buy the frames and let another shop with English speakers take care of the lenses.

The manufacturing industry has developed into four main clusters in Guangdong, Fujian, Zhejiang and Jiangsu.

42

C h a p t e r 4

To give some idea of the scale of this, Danyang in Jiangsu, considered to be the main production base of spectacles in China, has around 2,000 manufacturing enterprises with a combined workforce of about 60,000 people. The industry grossed RMB13 billion ($2 billion) in sales in 2015. These are staggering figures.

Whatever the other hurdles in the way of getting vision care to the 720 million who need it, distribution should not be one of them. As Nathan Congdon says: ‘China has glasses all over the place. The solution is literally there under our noses.’

Case Study: Nurjiang

Nurjiang is 10. His vision was so bad that he could not see the blackboard at primary school, read books, or even play table tennis. Now he wants to become an astronaut. I have mentioned that I want to help tackle the world’s vision problem so that everyone can see the first human mission to Mars. Perhaps Nurjiang will be on board.

Nurjiang was one of the thousands helped by the Esquel–Y.L. Yang Education Foundation – part of the Hong Kong-based textiles company – whose goal has been to bring eye-care to China’s most remote areas. The Esquel Foundation’s original mission was education but it moved into vision when it ascertained that poor vision stood in the way of better education results.

Excitingly, it has just launched the new China Rural Eye Care Fund (CREF) to bring together the right partners, expertise and resources to build a vision care model which is very much in need in rural China – a model that connects

43


children to early screening, early prescription of eye glasses, and early treatment or surgery. It believes that the model must be sustainable and comprehensive. This is a model that will help distribution at scale.

It will also aim to expand eye health education to make children aware of hygiene and the risk of eye infection.

Agnes Cheng, head of strategy and development at the foundation, says parents need to be made aware of both the need to seek medical help and of affordable and accessible eye-care services. Teachers should be trained so that they can identify students with vision problems and recommend them for screening.

Education, education, education. That has been the priority of the foundation since it first organised its vision care programme in rural Xinjiang in 2012. It started by sponsoring a learning trip for five optometry students, but it has developed fast and to date has screened 6,000 children, provided thousands of pairs of eye glasses, and sponsored over 100 surgeries. This is marvellous news and helps us tackle another of the Ds.

The foundation has found that the challenges faced in rural Xinjiang are similar to those we have found on our travels around developing countries – the lack of basic eye-care facilities, services, and trained eye-care professionals.

As the Esquel programme has grown, it has appreciated the sheer magnitude of need in rural China and has supported the development of one-stop vision care services on a grand scale, says Agnes.

The CREF is supported by partners including the Fred Hollows Foundation, Smart Focus, and the Hong Kong Polytechnic University School of Optometry.

44

C h a p t e r 4

So back to our would-be space-man. Nurjiang’s teacher had noticed his deteriorating academic performance. During class, he would have to squint or rub his eyes, hoping to read more clearly, or he would lose his concentration altogether when he could not.

In 2015, he was invited to attend the foundation’s screening and was diagnosed with serious myopia. After receiving free prescription glasses, his teacher noticed almost immediate improvement in his studies. But more importantly, he was able to enjoy games and a social life with his friends. Two years later, he returned to the foundation’s screening to thank the team and to get another screening. That was when they learnt of his flying ambitions.

I say good luck to Nurjiang. And I say all power to the foundation and its new fund. It so deserves to succeed.

Distribution: The Answer

Restrictions on the sale of glasses on the open market should eventually be eliminated. As will be shown later, this would drastically reduce the price of glasses. We should markedly streamline the supply chain by giving local entrepreneurs the ability to screen patients, assess vision, and sell reading glasses. They should ‘piggyback’ on organisations that already have networks of people selling health products, helping innovative companies come to the fore. In future, distributors could partner with the fast-moving consumer goods companies to get glasses into the regular supply chains across the developing world.

45


We should be trying to revolutionise the delivery chain by taking advantage of the drone ports that are springing up everywhere. Rwanda is already out there using drones to deliver emergency medical supplies. Why not glasses? And we should use clever companies like what3words – which has broken the world up into 3-metre squares, each with an address, to make sure they to get to the right people.

46

C h a p t e r 4

References1. Euromonitor International. (2017). Eyewear in China.

Retrieved from Euromonitor Passport database.

Chung had his eyes screened through the Brien Holden Vision Institute’s school eye health programme. ‘Once I could wear my new spectacles my whole life changed. Soon

I felt comfortable wearing my glasses all the time, even playing sport which I love. I don’t get dizzy or confused anymore. I feel so much happier,’ said Chung.

Case study and photos courtesy of the Brien Holden Vision Institute

Nurjiang, in rural Xinjiang, could not see the blackboard at primary school, read books, or even play table tennis. On screening by the Esquel-Y.L. Yang Education Foundation

programme, he was found to have serious myopia. After receiving a prescription for free glasses, his teacher saw an almost immediate improvement in his studies. Now

Nurjiang wants to be an astronaut.Case study and photos courtesy of the Esquel-Y.L. Yang Education Foundation

Ling Ling in rural Shaanxi had failing grades and therefore expected to drop out of school and get a job to help support her family. Nurses from a Smart Focus vision

centre went to her school and screened all the pupils. The screening confirmed Ling Ling was struggling with poor vision and she was offered a free pair of prescription

eyeglasses. Now instead of dreading school, she likes it, and she ranks in the top 5 per cent in her class. What’s more, she’s now a confident and cheerful young girl!

Case study and photos courtesy of Smart Focus

Xiao Zhuang in rural Shaanxi brought a letter home from school requesting his parents’ permission to have his eyes examined, his mother didn’t initially agree. ‘I didn’t think my son had a vision problem. He clearly didn’t have any problem watching TV all the time,’ she said. After a visit to the Smart Focus vision centre, she was impressed. But

she was afraid that wearing glasses would hurt her son’s vision even more. Her anxiety and misconception turned to enlightenment when the doctor explained that eyeglasses

would prevent her son’s myopia from getting worse. Case study and photos courtesy of Smart Focus

Chapter 5

The four Ds : Dollars

49

T h e f o u r D s : D o l l a r s

Dollars: The Problem

Glasses cost too much, especially prescription glasses which have custom-made lenses. There is no true free market in glasses anywhere in the world. In most parts of the world, the price of glasses is highly inflated as a consequence of who may – and who may not – sell glasses.

Let me explain. There are two main categories of spectacles: prescription glasses, which contain lenses customised to the needs of the individual, and reading glasses, which are not made for any particular person. Prescription glasses, which are usually only sold by eye specialists, can be made for between $5 and $30.1-3 These same glasses will retail for anything between $50 to $500.4 Reading glasses, which can typically be sold by anyone, including non-specialists, will typically retail for between $1 and $5.

While there are differences in how these products are manufactured, the difference in mark-ups is primarily a consequence of the fact that the sale of prescription glasses is protected. Removing protections for the sale of prescription glasses – thereby enabling further task-shifting of the sort I have been discussing – could change this and bring the cost of prescription glasses more in line with the cost of reading glasses.

Many governments exacerbate the problem of cost by imposing heavy import duties and taxes on glasses, which render them unaffordable for most consumers in the developing world. We found in Uganda, for example, that the starting price for simple corrective lenses with a cheap frame was around $41 and could go up to $55.

50

C h a p t e r 5

Case Study: Free Glasses Changed Ling Ling’s Life

All over developing and middle-income countries, the educational development of children is being held back by poor vision. If they can’t see clearly what’s up on the blackboard, they are in trouble. This is so true in China, particularly its rural areas. What follows is a heart-warming story, and I am grateful to Smart Focus for providing me with it, of how that trend can be bucked.

Ling Ling, a fifth-year student in Binxian County, appeared to be on the same road as her sister and millions of other poor rural kids. Like them she expected to drop out of school and get a job to help support her family. Her grades at school were falling. She had been able to keep up by listening closely to her teacher, but as more schoolwork was presented on the blackboard, she fell behind. She couldn’t see clearly.

Help was at hand. In Rwanda, after I established Vision for a Nation, nurses were able to conduct eye screenings after just three days of training. Lives were changed when they held clinics at work-places and villages, and gave people the chance to have their eyes tested for the first time.

Something similar was to happen for Ling Ling and millions of others because of a new eye-care initiative in rural areas. Nurses from a Smart Focus vision centre went to her school and screened all the pupils. The screening confirmed Ling Ling was struggling with poor vision. She was told free care and glasses were available at the vision centre several hours away.

As she walked the long road home, Ling Ling was both excited and conflicted. She liked school and wanted to do well. And she knew from classmates that eyeglasses cost hundreds of yuan, so a free pair was a valuable opportunity.

51


Luckily a nurse called her mother to follow up. The nurse explained that Ling Ling might need a pair of eyeglasses and that care would be free. The family decided: Ling Ling would go with her grandfather into town to get a comprehensive eye test. The five-hour round-trip ride on a public minibus down the winding road from the footsteps of the Loess Plateau to the county town was worth it.

The Smart Focus clinic was bright and clean. All the testing equipment was new. The clinicians were kind and patient, and gave her grandfather some water while he waited. The examination found Ling Ling was myopic or short-sighted – able to see things close up but not far away. She picked a pair of eyeglass frames with pink and white flecks. The moment she put them on, her face lit up. She told her grandfather she’d never seen things so clearly.

After a month with eyeglasses, things began to change for Ling Ling. Instead of dreading school, she really liked it. She was eager to do her homework. Instead of thinking about dropping out, she was excited to go as far as she could with her schooling. In fact, she now ranks in the top 5 per cent of her class. What’s more, her confidence and cheerfulness has increased. This is marvellous news for Ling Ling and let us hope for millions of others. She has shown us again what we know: glasses change lives. And she has shown why making glasses free for children is so important.

52

C h a p t e r 5

Dollars: The Answer

In China cost is something that we must take account of as well. I believe that just as the process of screening should be deregulated, so should the prescription and sale of glasses. The scale of this is so great that we must banish all the hurdles that inflate the cost of providing sight tests and quality eyewear.

We should embrace the service delivery models of the likes of Smart Focus and the Esquel-Y.L. Yang Education Foundation. The key is sustainability, a belief that eventually for the system to work it must pay for itself. Generous donations from companies like UBS, via its Optimus Foundation have been integral to getting these ventures off the ground, but in the end, running costs must be met if they are to carry on. And remember for the Chinese in rural areas, vision correction is not covered by health insurance.

In most places, the sale of prescription glasses is protected, meaning that they can only be prescribed by a professional. My contention is that there is little difference between prescription and reading glasses, and it is time to start treating the sale of both of them as over the counter items. Then watch the prices come down.

We recommend that in most countries, taxes and import duties on all forms of non-branded glasses should be removed, a move that would drastically reduce prices. In some countries, import duties are as high as 90 per cent. We appreciate the situation is different in countries like China where glasses are made. So scrapping duties here may not be the answer. We believe local manufacture is vital to cutting

53


costs.There are a number of companies like Contour in China

which have invested in methods of lens manufacture that ensure prescription glasses are ready for use straightaway, without the need for additional steps. That would cut costs in a big way.

And we should grasp all the technological advances that present themselves. 3D printing of glasses frames is already under way but we came across a company in Belgium, Luxexcel, which has developed the technology to print lenses as well. This could eventually be transformative in bringing down costs and helping local production.

Nathan Congdon is quite clear about costs. He believes it is in central and local governments’ interest to get free glasses to all children. Purchased in bulk, a good pair of glasses can cost a little over a dollar. It is a good educational and economic investment.

54

C h a p t e r 5

References1. ‘International Optical Trade Analysis: Frames June 2016’.

The Vision Council, Virginia.2. ‘International Optical Trade Analysis: Lenses June 2016’.

The Vision Council, Virginia.3. ‘Vision Care Market Quarterly Overview: December

2016’. The Vision Council, Virginia.4. Coppola, E. (2012). ‘The Eyewear Market: Luxottica’s

Leadership, Strategy and Acquisitions’. Libera Università Internazionale degli Studi Sociali Guido Carli, Rome.

Chapter 6

The four Ds : DemanD

57

T h e f o u r D s : De m a n D

Demand: The Problem

Around the world the stigma over wearing glasses persists. Glasses are still not seen as a necessity; indeed, to some they imply a sense of weakness. Cultural barriers in some countries such as India mean that women in particular are deterred from wearing them.

This is as true in China as elsewhere – among the adult and child population. Pupils, it appears, have inherited their doubts from parents, teachers, and administrators.

Unhappily, in many places, even in developed countries, glasses are seen as uncool and people do not appreciate the value of glasses to changing their lives and prospects.

In China, families for generations have relied on the practice of rubbing exercises around the eyes to eliminate muscle tension and prevent the occurrence of myopia. There is no evidence that the rubbing exercises have staved off myopia.1

Michael Young said: ‘It is a challenge to convince people that glasses are good for them. People fear that if they wear glasses it will make their short-sightedness worse.’

While the impact of glasses on academic performance is fairly well understood by all, research shows that many teachers in China feel that correcting early or mild cases of short-sightedness is not important.2

More recent studies show that this belief is both mistaken and harmful, and that correcting even mild amounts of short-sightedness can have an important impact on a child’s ability to function.3-5

It is for this reason that we need to find ways to persuade the leaders, teachers and families of China that glasses are good for them, and to help those that need glasses acquire them.

58

C h a p t e r 6

Case Study: A Mother’s Doubts Are Dispelled

Here is a story that shows how prejudice against glasses in China can run deep, but thankfully can be overcome.

When Xiao Zhuang, a fifth-grade student in Xianyang, Shaanxi province, brought home a letter from school requesting his parents’ permission to have his eyes examined, his mother didn’t initially agree.

‘I didn’t think my son had a vision problem. He clearly didn’t have any problem watching TV all the time,’ she recalls. She also was sceptical about the offer to give her son free eyeglasses if he needed them. ‘There is no such thing as a free lunch,’ says his mother, who farms a small plot of corn and walnut trees with her husband.

But his mother had a change of heart when she received a phone call from the eye doctor at the Smart Focus clinic inside the county hospital explaining that a vision screening at school indicated Zhuang might have a vision problem, but more tests were needed to know for sure if he needed eyeglasses. His school performance and future depend on good vision, the doctor told her.

Not wanting to harm her son’s future, she took him to the clinic in early 2017. She was immediately impressed. ‘The clinic was clean and bright. There were lots of children there. Everything was well organised. The doctor asked lots of questions, including my son’s personal habits and the number of family members wearing eyeglasses,’ she says. In the examination room, his mother was even more impressed. ‘I never knew getting a simple pair of eyeglasses required so many careful inspections with so many different instruments.’

59


His mother was thankful the doctor considered her son’s vision so important. And she also was grateful when Zhuang received a free pair of eyeglasses to correct his myopia. ‘The free eyeglasses reduced the financial burden on our family,’ she says. His mother was also grateful for advice on good habits to practice at home, such as making sure Zhuang had good lighting and a proper table and chair height when doing his homework, plus the right TV viewing distance.

B u t s h e d i d n’ t a g r e e w i t h a l l t h e d o c t o r ’s recommendations. ‘The doctor advised Zhuang to wear his glasses all of the time. I didn’t think so. I insisted that he should not wear them except in school to see the blackboard clearly. I was afraid that he would always want to wear glasses and that would hurt his vision.’

Her anxiety and misconception turned to enlightenment when the doctor explained that eyeglasses would prevent her son’s myopia from getting worse. They were important for convenience, comfort and safety, he said. Children who wore eyeglasses advanced more than a grade year in learning compared to short-sighted students who did not wear glasses. Children’s confidence grew with glasses and their future job prospects improved. The doctor even explained that kids who see clearly also tend to listen more carefully, the mother said. Well that’s a new one to us at Clearly! But what a rewarding story.

60

C h a p t e r 6

Demand: The Answer

We must break down the taboos about wearing glasses. In the United Kingdom, J.K. Rowling’s Harry Potter has changed young people’s attitudes towards wearing glasses and reading. They are now seen as cool.

Similarly we should look to Pixar, Disney, and Bollywood role models to help spread the word. We learnt when researching the book that Tinie Tempah, an English rapper and songwriter, wears specs but does not need them. He wears them for effect.

And we must also show people, particularly the young, how wearing glasses can positively benefit their lives and careers. We spoke to the head of marketing at Waitrose, the UK-based supermarket chain, who suggested the creation of a demand movement, sending a simple robust unit to remote parts to give people the experience for the first time of being able to see properly, showing them the value of glasses to their lives.

In writing this book I have found so many people whose lives have been changed by glasses. We must get their stories out there for all to see.

In China, the Rural Education Action Program (REAP) team have set about breaking down those inhibitions. I have mentioned how their research has shown that glasses can slow the rate of progression of short-sightedness. Their work is also changing the view of glasses as a ‘medical device’ to a tool that enables academic achievement. Along with Chinese universities, it measured the academic performance of pupils after they had been given glasses. The initial test scores for short-sighted students was around 68 per cent. After receiving glasses those scores soared to 86 per cent in just six months.6

61


It is for this reason that the activities of organisations like Smart Focus – a finalist in the Clearly Vision Prize of 2016 – are vital if we are to persuade the teachers and families of China that glasses are good for them, and to help those who need glasses acquire them.

But if the message comes from the very top – and I mean central and local government – that glasses mean better lives, greater productivity and better education outcomes, we will really start breaking down this barrier.

Conclusion

Those are the four Ds and how they apply to China.Can this problem be cracked?Michael Young, CEO of Smart Focus, is optimistic:

‘Yes, absolutely,’ he said. ‘We are showing that this social enterprise model works. We are generating revenue to cover costs. We have already provided sustainable eye-care access for 3 million people; by the year 2020 it will be up to 10 million.’

‘We are doing it one patient at a time, one pair of glasses at a time, one school at a time, one county at a time, one province at a time. But we believe this is a model that can scale.’

It has to work. China depends upon it. REAP showed us that eyeglasses not only improve the welfare of children, but also lead to extraordinary gains in school performance. As education is increasingly critical to succeed in Chinese society, correcting short-sightedness plays a key role in extending opportunity to China’s rural youth, a vast and struggling segment of China’s population.

62

C h a p t e r 6

As Scott Rozelle, Stanford senior fellow, said: ‘Based on my 25 years of research experience, correcting vision with glasses is the single most effective health intervention when it comes to improving academic performance.’

Like nearly all rural children in China, short-sighted youngsters lag more than one whole year behind in academic achievement compared to their urban peers. This persistent achievement gap has implications for China’s continued economic growth, as vast numbers of rural youth grow up unprepared to compete in the labour market of an increasingly modern economy.

Glasses were discovered towards the end of the 13th century. Today, in 21st century China, we must get glasses to the people who need them – and persuade them to wear their glasses.

63


References1. Wei, M.L., Liu, J.P., Li, N., Liu, M. (2011). ‘Acupuncture

for slowing the progression of myopia in children and adolescents’. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD007842. DOI: 10.1002/14651858.CD007842.pub2.

2. Li, L., Lam, J., Lu, Y., Ye, Y., Lam, D.S.C., Gao, Y., Sharma, A., Zhang, M., Griffiths, S., Congdon, N. (2010). ‘Attitudes of Students, Parents, and Teachers Toward Glasses Use in Rural China’. Arch Ophthalmology. 128(6) 759-765.

3. Zhou, Z., Congdon, N.G., Zhang, M., Chen, L., Zhen, Z., Lin, X., He, l., Choi, K., Lam, D.S. (2007). ‘Distribution and visual impact of postoperative refractive error after cataract surgery in rural China: study of cataract outcomes and uptake of services report 4’. Journal of Cataract and Refractive Surgery 33 (12) 2083- 2090.

4. Esteso, P., Castanon, A., Toledo, S., Rito, M.A., Ervin, A., Wojciechowski, R., Congdon, N.G. (2007). ‘Correction of moderate myopia is associated with improvement in self-reported visual functioning among Mexican school-aged children’. Investigative Ophthalmology and Vision Science 48 (11) 4949- 4954

5. Lamoureux, E.L., Saw, S.M., Thumboo, J., Wee, H.L., Aung, T., Mitchell, P., Wong, T.Y. (2009). ‘The impact of corrected and uncorrected refractive error on visual functioning: the Singapore Malay Eye Study’. Investigative Ophthalmology and Vision Science 50 (6) 2614- 2620.

6. Ma, X., Zhou, Z., Yi, H., Pang, X., Shi, Y., Chen, Q., Meltzer, M.E., le Cessie, C., He, M., Rozelle, S., Yizhi, L., Congdon, N. (2014). ‘Effect of providing free glasses on children’s educational outcomes in China: cluster randomized controlled trial’. BMJ 349:g5740

Professor Nathan Congdon examining a patient. His work is focused on improving the quality of eye care in areas of limited resources, especially in rural Asia. Dr. Congdon is the Ulverscroft Chair of Global Eye Health at Queen’s University Belfast, where he directs the Translational Research for Equitable Eye Care Centre. He is the Director of Research for ORBIS International in Asia, helping to design and evaluate ORBIS’

projects in China and Mongolia. Prof. Congdon also maintains a position as Professor of Preventive Ophthalmology at Zhongshan Ophthalmic Center (ZOC) in China.

Photo courtesy of Nathan Congdon

A Smart Focus vision centre in Shaanxi province.Photo courtesy of Smart Focus

In-school vision screening in Shaanxi province.Photo courtesy of Smart Focus

Children being screened in rural Xinjiang through the work of the Esquel-Y.L. Yang Education Foundation.

Photos courtesy of the Esquel-Y.L. Yang Education Foundation

Monks in Tibet having their vision tested.Photo courtesy of the China Research Exploration Society

Prototype of adjustable focus glasses. Photo courtesy of the China Research Exploration Society

Chapter 7

A Blueprint

67

A Blu e p r i n t

There are reasonable grounds for hope that answers to China’s vision crisis can be found. As the 5-Year Plan shows, the Government is very much on this case. The experts we have consulted in compiling this report see a way through. And it is upon them, experts in their own field, that I rely in making the following suggestions. Many of the recommendations Clearly has made for developing countries are equally applicable to the economic powerhouse that is China. These are the moves that we believe are necessary:

Diagnosis:

1) Empowering practitioners: Restrictions preventing health workers, nurses, teachers or entrepreneurs from carrying out straightforward tasks like vision screening should be swept away. Research shows that teachers can facilitate both sight testing and refraction when handed the right tools.

2) Simpler diagnosis: The use of smartphones to screen vision must spread across the developing world rather than being confined to certain countries and age groups. According to a report in 2015,1 China had over 950 million smartphone users, more than the United States, Brazil and Indonesia combined.

68

C h a p t e r 7

Distribution:

1) Use the fact that China is the biggest manufacturer of glasses in the world to its advantage. Develop programmes to buy glasses in bulk so that the average cost of a basic pair of glasses – minus the frills that some will want – is little more than $1.50.

2) Market creation: Governments must subsidise the provision of glasses to the poorest people to help the eventual development of an open market. Global authorities like the United Nations must wake up to this problem and recognise explicitly that global prosperity cannot be achieved without clear vision for all.

3) Removing inappropriate regulations: Restrictions on selling glasses over the counter should be removed so that shops around the world can stock glasses alongside other items such as biscuits and soft drinks.

The Clearly campaign believes that if some – or all – of these measures were adopted the world could start to get to grips with a problem that should have been addressed a long time ago. Let’s bang the drum for better vision. Let’s help the whole world see clearly.

69

A Blu e p r i n t

Dollars:

1) Subsidise through central and local governments the cost of glasses so that all children can get their first pair free and allow county hospitals and social responsibility bodies to build sustainable models. For example, charging better-off people for glasses, that will enable the underprivileged to get the glasses they need. The increased productivity will more than pay for itself over time.

2) Businesses should also think about providing free or subsidised glasses for their workforce. We know that clear vision helps improve productivity so it will pay for itself as well as increasing loyalty to the firm.

Given the volume of glasses produced in China it may be better to keep taxes and duties on all imported spectacles. I realise this is different from my proposals for other parts of the world. But this would help the local industry and prevent the creation of a black market in non-branded fashion spectacles.3) Unlocking technology: All exciting technological

developments – for example the 3D printing of glasses, the use of drones for delivery, and artificial intelligence to detect eye disease – must be studied to see how they can help crash the cost of getting glasses to people.

70

C h a p t e r 7

Demand:

1) Elimination of cultural barriers: A public education programme led by central and local governments, assisted by the NGOs operating in China, to kill the myths that glasses can worsen eyesight and that rubbing eyes can somehow stave off myopia. One in six children who need glasses don’t wear them. This is a crying shame and we must address it.

2) A similar public education programme to warn rural and urban Chinese that spending too much time cut off from the daylight is a cause of vision problems. A couple of extra hours a day outside could have a massive effect in reducing the threat of myopia.

3) Sensitive use of role models and cultural figures to break down taboos over wearing glasses.

71

A Blu e p r i n t

References1) http://www.businessinsider.com/china-has-more-

smartphone-users-than-us-brazil-and-indonesia-combined-2015-7?IR=T

Chapter 8

Where We go from here

75

W h e r e W e g o f r o m h e r e

Rwanda showed us that change is possible. But I believe that only by relentless pressure on international organisations can we get change of the scale we need.

There can be no let-up if we are to ensure this issue is not forgotten or ignored.

Our first target is the international organisations. We need the world’s leaders to embrace this issue and consider its impact. Many of them wear glasses. I hope they will listen. We organised an event at the United Nations general assembly in September 2017, to call for vision for everyone.

Now we want a discussion and new commitment at the Commonwealth Summit in London in April 2018, which can be used as a springboard for further progress in other institutions. Some 900 million of the 2.5 billion people lacking good vision are in the Commonwealth.

At Clearly, we are working with a group of like-minded organisations including Sightsavers, the Fred Hollows Foundation, the Queen Elizabeth Diamond Jubilee Trust, the International Coalition for Trachoma Control, and Peek Vision to put together a ‘common platform’ on the issue of poor vision. We have written to the foreign ministers, finance ministers and health ministers of every Commonwealth country to press our case.

A group of celebrities including Elton John, James Corden and Annie Lennox have joined our cause – recording a short film showing them wearing their glasses. Everywhere I go and talk about this issue, people are stunned to hear about the scale of the issue and how simple it is to solve. But there is serious work to do.

In 1999, the World Health Organization agreed an ambitious goal of eliminating avoidable blindness by 2020.

76

C h a p t e r 8

But in truth, relatively little progress has been made in achieving this and poor vision barely gets a look-in. Indeed, the WHO does not even keep proper records on the number of people who need a pair of glasses. The opportunity is there for the WHO to widen its ambition, put the resources in place, and measure their progress.

My blueprint sets out the problem of import duties and taxes, and that of regulations which artificially add to the cost of getting a pair of glasses to someone who needs them. So in keeping with their mandates, the World Trade Organization and World Bank have the chance to take a lead on this issue. In the past, these organisations faced criticism for calling for the removal of regulations or taxes which protected consumers or workers. But in the case of branded and prescription eyewear, these rules are ripe for removal as they only protect a vested interest.

Clear vision is the golden thread that runs through many development objectives, helping to achieve the United Nations’ Sustainable Development Goals (SDGs) on good health, quality education, decent work, gender equality and poverty elimination. Yet there is not one mention of eye health among the 169 targets and 241 indicators that underpin the 17 goals adopted in 2015.

I would call that blurred vision on the part of world leaders. This issue is too urgent to wait for the next batch of development goals, whenever they may be.

It is a huge pity, but it reflects the reality that eye problems are further down the ladder in the priorities of governments and aid donors than the killer diseases. Despite the massive number of people affected and the huge cost to the economy, poor vision is considered non-urgent and tends to drop off the

77

W h e r e W e g o f r o m h e r e

scale when measured against life-threatening communicable epidemics such as HIV, Ebola and malaria, all of which are directly referenced in the SDGs. We at Clearly think it is time for this to change.

So we need the big multilateral donors – like the World Bank, the European Union and regional banks such as the African Development Bank and Asian Development Bank – to begin prioritising this issue. By providing upfront resources – for training and infrastructure – it is possible to subsidise a domestic market for glasses, as Rwanda has shown. Innovative financing models – like payment-by-results – are another way of incentivising innovation and encouraging collaborative thinking from practitioners on the ground.

Bilateral donors can also build on the work they’ve already done. The Department for International Development in the UK has been a generous donor to Sightsavers and the Queen Elizabeth Diamond Jubilee Trust for their work on preventable blindness. Both they and the United States Agency for International Development gave funding for Vision for a Nation. The Australian Agency for International Development has funded the Fred Hollows Foundation. But these donors could help mobilise resources within developing countries to put in place primary eye-care systems that are available to all – as has taken place in Rwanda.

But global and developed world action on its own is not enough. Developing countries themselves need to understand and embrace this issue.

Universal healthcare is a major component of countries’ delivery of the Sustainable Development Goals, but we need them to be explicit about including primary eye care. Only clear demand from developing countries will unlock real funding.

78

C h a p t e r 8

And what about you? I hope after reading this you feel as energised as I do and as motivated to do something about it. So let me suggest two courses of action.

First, if you wear contact lenses or glasses, try going a day – or even an hour – without wearing them. Obviously avoid operating any machinery or driving, but see how difficult it is to get up in the morning, to find your way to work or college, to take part in the normal course of your day, to come home in the evening and read your kids a bedtime story or make dinner or watch the evening news. If you don’t need glasses, talk to your partner, a parent or a colleague who does and get them to describe it. Remember, that’s how a third of the world and half the population of China lives, all day, every day.

Second, get involved in the Clearly campaign. Like any organisation trying to change the world, we are only as powerful as the size of our support. You can make a difference. We have launched a petition calling on world leaders to wake up to the issue of poor vision. Add your name at www.clearly.world/action and send a message to let them know that now is the time to act.

The race to Mars is on. When a human finally lands on the red planet, everyone must be able to see it. There should be no excuses.

The battle has been joined. We know the answers are there. We just need the will to do it. So I say to politicians and global authorities – show us and the billions lacking access to clear vision that you understand this problem and will help all of us to do something about it.

For those of you who wear glasses, the answer is on the end of your nose.

Also by James Chen

hoW A 700 YeAr oLD INVeNTIoN CAN ChANge The WorLD foreVer

#1 Best Seller in Kindle ‘Non-Profit Organisations & Charities’

Praise for the book

“If we fail to act, those left behind will never catch up.”GORDON BROWN, FORMER UK PRIME MINISTER

“A bold vision.”PROFESSOR AGNES BINAGWAHO, FORMER MINISTER OF HEALTH, RWANDA

“The time for the whole world to see has come.”HELLE THORNING-SCHMIDT, CEO, SAVE THE CHILDREN INTERNATIONAL

Available on AMAZON

Born in Hong Kong, James Chen is the third generation in a family of successful businessmen and entrepreneurs, having learnt his trade at the feet of his father and grandfather.

In 2011, he set up the charity Vision for a Nation in Rwanda with the aim of providing nationwide access to eye care and affordable glasses to a country of 12 million people. A stunning success, eye-care services are now available to all and more than 2 million people have received vision screenings.

In 2016, he launched Clearly, a global campaign to enable access to glasses for everyone in the world. His ambition is that if a human is to set foot on Mars in the years ahead, everyone should be able to see it.

James Chen, Founder oF Clearly

www.clearly.world Jameschen.vision

What is the most negleCted disability in the World?

PooR VIsIoN.

hoW many people are being leFt behind? 2.5 BIllIoN.

hoW many oF these are in China? 720 MIllIoN, THE MAJoRITY IN RURAl AREAs.

hoW Can We Fix this? GlAssEs.

hoW Would We beneFit? IMPRoVEd EdUCATIoN, BETTER

oPPoRTUNITIEs To woRK, ANd A MoRE EqUAl ANd PRosPERoUs woRld.

the global issue oF poor Vision must be resolVed – noW.

“90 per cent of those left behind could be helped with a simple pair of glasses.”

ronnie Chan gbm, Chairman oF hang lung group and hang lung properties

“James Chen is someone with a bold vision who has the resources, the determination,

and the inspiration to make it happen.” proFessor Wang Zhenyao, dean oF

China global philanthropy institute

“A shining case study for solving many poverty related challenges in the world today.”

ViCtor Fung gbm gbs Cbe, group Chairman oF li & Fung group

“James Chen’s mission is a game changer for delivering the sustainable development Goals.”

stephen heintZ , president, roCKeFeller brothers Fund

how glasses can change china and the...

Documents