
How McKinsey infiltrated the world of global public health - stopads
https://www.vox.com/science-and-health/2019/12/13/21004456/bill-gates-mckinsey-global-public-health-bcg
======
sailfast
The title of this article is "How McKinsey infiltrated the world of Global
Public Health" and the straight answer is: "The WHO hired them, and sometimes
the Gates foundation prefers their money is used to hire consultancies"
Because management consultancy = conspiracy is the new fad I guess? Hell, they
even mention Accenture as one of these "secretive" orgs. Clearly they don't
understand the business.

The article continues to talk about how WHO hires consultants to do jobs that
consultants are typically hired to do, and then states "how these secretive
businesses, which mostly profit from serving corporate interests, are shaping
global public health is an open question — and one that’s hard to answer."

Next breaking story on Vox: "How are these shadowy, secretive [insert private
held company in any industry] typically profiting from corporations impacting
[other big thing they also do work in]." Hard pass.

EDIT: None of the above is saying that consultancies are the best use of this
money to achieve impact, of course, or that this model yields out-sized
results, or an endorsement. It's on the person that hires them as to what they
do with the advice and let them do within your org. My comments are rather an
indictment of the tone of the argument for click bait and distraction from the
main issues that are really important, like how to effectively eradicate
disease with a pile of money.

~~~
o09rdk
So, I shared some of your impressions, but also some of what Vox is conveying.

Speaking from personal experience, the problem with large public institutions
(maybe any institution?) hiring these consultancies is that there's _enormous_
intrinsic pressure to accept their recommendations.

Say, public institution X spends exorbitant fees on consultancy Y. Now they're
going to choose to ignore the recommendations?

If the recommendations are bogus, there will be hellfire about why the public
institution is transferring huge quantities of funds to a private organization
that is incompetent or sketchy. If the recommendations are not, then there
will be hellfire about why the public institution is ignoring the
recommendations.

As a result, a lot of times there's suspicion that these consultancies are
just cover for administration or management making decisions that would be
unpopular, controversial, or self-serving. At least in my experience, they're
seen as a power grab for those already in positions of power. That is, the
consultancy comes in, asks management/admin what they would like to see, and
then they put it in the recommendations. Then admin can say "look, we didn't
tell ourselves to [do incredibly controversial thing Z, like cut basic staff
and give administration big raises], this fully independent third party said
to do this."

As a result, I think hard questions about what you're getting from
consultancies are actually apropos of the Vox article, and relevant to the
perception that shady constituencies are somehow hijacking public services for
their own benefit. When you pay large sums of money to a consultancy, whose
methods are unclear, and have unclear scientific support, and assumes that,
e.g., management of publicly traded for-profit companies and management of
non-profit government organizations can be treated similarly, it leads to
legitimate questions about whose motives are being served.

The WHO would have been better off imho convening a special strategy or reform
committee made of inside and outside members than something like McKinsey.

~~~
darawk
I think a more fair characterization of that process might be: Controversial
decisions require extra convincing to get done. If you know your organization
is bloated and you need to downsize by 20%, you could just do it yourself, but
then you run the risk of your organization revolting against you for it. If,
on the other hand, you hire a consultancy, and they come to the same
conclusion, that represents corroborative evidence for your view.

That is to say, another way of looking at this is that tough decisions require
extraordinary evidence. If a neutral third party comes to the same conclusion,
a cynical way to characterize that is it gives you "cover" to do what you
wanted to do anyway. But an equally true way to characterize it is that if you
weren't sure before, it allows you to be more confident that that was really
the right decision.

If I were going to say, fire 20% of my staff, i'd want a neutral third party
to come in and evaluate that decision before I just went off and did it too.

~~~
jaclaz
>If I were going to say, fire 20% of my staff, i'd want a neutral third party
to come in and evaluate that decision before I just went off and did it too.

I think you have a queer idea of "neutral".

Do you call the consultancy firm telling them:

1) I don't know what to do, please tell me what I should do?

2) I know that I have 20% people that I should lay off, what do you think of
this?

3) My personnel costs are too high, how can I solve this issue?

Expect as a result:

1) Some bogus advice about marketing and growth AND some apparently good,
reasonable, data and very good looking graphics leading to a suggestion to
reduce personnel by 10-30%.

2) Some apparently good, reasonable, data and very good looking graphics
justifying a reduction of personnel by 20%.

3) Some apparently good, reasonable data and very good loking graphics
suggesting to cut personnel by 30%.

~~~
darawk
You call them and ask them to consult with you about how to make your business
or organization more efficient. If their recommendations concur with your
already-held beliefs, you implement them. If they disagree with you, maybe you
reconsider. That's what I would do, and it's what I assume these people are,
for the most part, doing.

~~~
jaclaz
>You call them and ask them to consult with you about how to make your
business or organization more efficient. If their recommendations concur with
your already-held beliefs, you implement them. If they disagree with you,
maybe you reconsider. That's what I would do, and it's what I assume these
people are, for the most part, doing.

Sure, but the point is that you call them becase you believe you have not
enough profits (or are losing money).

Now, there are generically speaking three ways to fix that issue:

1) increase the efficiency of the organization ( _really_ increasing it) which
is something that sometimes is possible, sometimes isn't and anyway needs time
and dedication by really expert people and produces - maybe - results in
two/three years time or more, and often comes at an additional initial cost
(investment in new technologies, machinery, etc.).

2) increase the income (i.e. produce and sell more) which again it is
something that sometimes is possible, sometimes isn't and anyway needs time
and dedication by really expert people and produces - maybe - results in
two/three years time or more, and often comes at an additional initial cost
(investment in new technologies, machinery, etc.).

3) a mild reorganization of the current processes AND reducing workforce by
20-30%, which takes little time and produces results immediately or almost
immediately.

What they advice is usually #3, mainly because it is "easy" and "fast, and by
the time you can see the possible overall long period adverse effects of the
"cure" they have been already paid and are happily consulting some other firm.

Mind you it is not that many organization are perfectly efficient and actually
very often workforce is larger than really needed, and as well a "spending
review" can often solve part of the issue, so - when they propose the 20-30%
cut on workforce, and remove each and every possible "fringe benefit", etc.
they are not doing anything particularly "wrong", still they will be paid an
(usually very high) amount of consulting fees to provide what amounts to some
"obvious" measures and confirmation of your intuition/gut feelings.

I.e. all in all very often they are "an excuse" (the consulting firm has
determined that ...) for whatever unpleasant you will be doing to your
personnel.

~~~
darawk
You can call it an 'excuse', but you can also call it a corroborating opinion,
like I said. If you're going to do something unpleasant, it can be good to get
an outside opinion, so you don't do it if it's not actually necessary.
Characterizing it as just an "excuse" or "cover" to do what you wanted to is
unnecessarily cynical and reductionist. And even if it were true, so what?

~~~
jaclaz
You can of course classify or characterize it as you wish and like, still you
will have spent an (usually awful) amount of money in consulting fees (from a
company that isn't going too well) for a "corroborating opinion".

Your company, your money, your freedom to spend it as you prefer.

------
thinkingkong
Genuine question. I get the world is turning against management consulting but
what is up with all these mckinsey articles? Knowing how PR works Im having a
tough time believing about a dozen outlets all decided to write and release
investigative articles within the same month.

~~~
danso
The first major investigation into McKinsey ran a year ago. Here's the NYT's
explainer about it:

[https://www.nytimes.com/2019/02/19/reader-center/mckinsey-
he...](https://www.nytimes.com/2019/02/19/reader-center/mckinsey-hedge-fund-
reporting-investigation.html)

> *The most basic question we set out to answer was this: Did McKinsey’s
> pristine reputation as the foremost purveyor of “best practices” match its
> record? After nearly a year of reporting, we found that the answer was often
> no.

Every recent ICE investigation is related to an ongoing major story:

\- Chinese global economic policy:
[https://www.nytimes.com/2018/12/15/world/asia/mckinsey-
china...](https://www.nytimes.com/2018/12/15/world/asia/mckinsey-china-
russia.html)

\- The opioid crisis: [https://www.nytimes.com/2019/02/01/business/purdue-
pharma-mc...](https://www.nytimes.com/2019/02/01/business/purdue-pharma-
mckinsey-oxycontin-opiods.html)

\- ICE: [https://www.nytimes.com/2019/12/03/us/mckinsey-ICE-
immigrati...](https://www.nytimes.com/2019/12/03/us/mckinsey-ICE-
immigration.html)

\- Rikers Island prison:
[https://twitter.com/i_m_m/status/1204793794975141890](https://twitter.com/i_m_m/status/1204793794975141890)

The more recent spate of McKinsey articles are related to the fact that Pete
Buttigieg has entered the top tier of presidential candidates, and McKinsey is
his third other job on the resume.

It's not tough to believe if the investigative hypothesis is correct: that
McKinsey is the goto consulting firm trusted by the world's most powerful
governments and companies when it comes to decisionmaking.

~~~
droopyEyelids
And even in the specific random example of Buttigieg:

He was at McKinsey working for Loblaws (canadian grocery store) on pricing
strategies, and afterwards Loblaws was convicted of price fixing.

Of course Mayor Pete wasn't responsible, but it's still not a good look for
McKinsey.

~~~
claudeganon
Since whatever his actual work was is still covered by NDAs, we can’t actually
say whether or not he had any involvement with price fixing. I don’t really
think we should take him (or any other politician) at their word on this kind
of stuff.

------
creddit
I can’t believe this article was written and now published in a relatively
well known publication. It basically starts with the premise that consultants
are evil and then writes as though they are doing terrible, nefarious things
by existing in a particular industry without ever really spelling out any
nefarious doings in that industry. What a rag.

~~~
corporate_shi11
I can believe it. Most "journalism" today is glorified blogging, the venting
of emotion laden opinion, griping, etc. And all the "mainstream" pseudo-
journalists seem to be of one mind.

------
sct202
I don't know if I've been desensitized to large numbers but a large
organization like the WHO spending a few million dollars per year on
consulting services seems pretty minor.

------
rayiner
Always interesting to see Gell-Mann at work. My knowledge of public health is
indirect, but my dad spent his entire career in that sector. The article's
portrayal of the public sector versus the private sector is slanted.

Here is a fact that many people don't want to admit but is widely acknowledged
within the public health sector: UN organizations like the WHO are
indispensable, but also among the most bureaucratic, ineffective, and
inefficient entities on the planet. There is a reason that the impetus for
hiring McKinsey came from inside the WHO itself. Private-sector organizations
like Gates Foundation have been welcomed into the field not only because of
their resources, but because of their effectiveness and organizational
capabilities.

The second point is that governments in developing countries are corrupt and
direct aid money is quickly siphoned off and dissipated.

The third point, following from the first two, is that the United States'
foreign aid efforts have always relied heavily on consultants and public-
private partnerships, and have been extremely effective. Say, for example,
USAID wants to address infant mortality in Bangladesh. It doesn't give money
directly to Bangladesh. It gives money to a consulting firm, which hires
"boots on the ground" (doctors, etc.) and secures supplies. USAID and the
consulting firm then work closely with the health ministry in Bangladesh to
execute the vaccine program. This structure works quite well: in Bangladesh,
for example, it has been instrumental in reducing infant mortality and
improving family planning.

The issue with McKinsey, etc., is not that they're "secretive" or "for-profit
entities." It's that they have little experience in the sector compared to
specialized consulting companies who have been doing that sort of work for
decades.

------
crazygringo
The word "infiltrated" in the headline is inflammatory clickbait.

It's just a company going after a market, same as their competitors are. You
might as well say "Apple infiltrated the world of cell phones" or "Warren
infiltrated the presidential race".

Totally irresponsible. Shame on Vox.

------
jshaqaw
The surge of negative articles about McKinsey lately seems to suspiciously
benefit a certain Democrat running for President at the expense of another.
Call me suspicious but this all seems like a politically coordinated hit job.

~~~
jshaqaw
I expected the downvotes. I am no McKinsey apologist. I worked there for a
short time. I didn't like it and left. I have no illusions about the place.
But if you don't know what it looks like when a political campaign generates
astroturf coverage of an issue in the press then you are naive.

