Taking advantage of the
information revolution to deliver evidence-based integrated vitality programs
The
primary mission of healthcare for disadvantaged populations to date has been to
treat disease and reduce death. The primary mission of feeding programs has
been to fill bellies. These are worthy, but limited, goals. Merely keeping a
malnourished mother and her stunted infant alive consigns the baby to a life of
hardship and failure. Instead, our objective should be vitality: the capacity
to achieve the full human possibilities, the capacity to be a success as a
changemaker.
Vitality is physical strength and mental vigor. Vitality requires
physical and mental health;
sanitation and full nourishment; personal
empowerment/education and care from
skilled professionals; and nourishment of humans and communities and their
environment.
Achieving
vitality requires new leaders with radically different goals, approaches and systems.
These must be explicitly designed to transform from sick care to vitality, from
expert-centered to person-centered, from siloed services to holistic, and from
facilities-based medicine to “door step health.” What are the “holistic person
solutions” to deliver vitality? The essential elements include full
nourishment, primary healthcare, behavioral healthcare, safe drinking water and
sanitation, and detailed outcomes measurement using modern technology from the
global information revolution.
Give people knowledge and control by personal
education/empowerment about these elements, with information in their hands. Build
a community that nourishes around them. Lift them up before they get sick; you
get less sickness, and you can manage chronic illness better.
“Door
step health” means using mobile ICT and diagnostics to enable services in
people’s homes, where they work, and at local wellness centers, while
connecting them to typical medical care when needed. Experience with this model
indicates that it broadens access to care; it creates better compliance and
behavior-change; it addresses the shortage of doctors and nurses by empowering
lay health workers with IT-based protocols, mobile diagnostics, and interactive
patient education tools; we believe it will achieve better outcomes at far
lower cost than Western-style, facilities-based care; and it captures more
comprehensive information (enabling far richer and faster research, including
big data analysis).
This
model also addresses the growing global malnutrition crisis, visible in both
the hundreds of millions of stunted children and the worldwide obesity epidemic
among adults. In addition, new scientific evidence shows that a seriously
malnourished mother will give birth to a child with an altered profile of
activated genes and far higher numbers of fat cells—and a lifelong propensity
toward obesity, diabetes, and heart disease. Still other evidence shows the key
role that insufficient or inappropriate nutrition plays in triggering the onset
of chronic illnesses like diabetes, heart disease, and depression. At the same
time, evidence is mounting that combining medical treatment of even severe
diseases such as TB and HIV/AIDS with full nutrition can markedly enhance
recovery.
So how
do we enable and empower people to demand these changes? The most powerful
creators of demand for vitality (and thus key target populations) appear to be
(1) infants and children (1000 days of pregnancy and infancy, and
schoolchildren) and (2) working adults. If they achieve vitality, we believe
there will be large, measurable outcome changes: babies will develop far
better, schoolchildren will learn more, and workers will be more productive and
less apt to get sick – whether they own a small business, or work on a farm or
construction site, or in a mine or factory.
The
combination for disadvantaged populations of vitality programs and modern ICT
systems holds the promise of effective and highly disruptive innovation
solutions, and exciting new business, humanitarian, and ongoing rapid
learning/research opportunities. Entrepreneurs have demonstrated successful
innovations for each of the components of integrated vitality solutions
described above. What is needed now is to combine the best into integrated
packages that can be locally contextualized and trialed, producing the critical
evidence to both improve the approaches and fuel growing demand.
Once
tipped towards vitality, this new ecosystem should unleash waves of innovation and
investment at which we can only guess. Vitality and nutrient measurement and accounting
for consumers and businesses will be provided by new devices and systems. We
will see new generations of apps, tools and instruments, and new places where
services are dispensed. Successful companies will lead the charge so they have
the most vital staff. All the while, new information capture, analysis and
distribution systems will generate a spiral of rapid, evidence-based
improvement in each of these. New capabilities, professions and business will
emerge. People will be empowered to consume wellness/health services
effectively. Collections of entrepreneurs will build communities that nourish,
including shifting agriculture companies and farming communities toward nutrient
generative farming and land management practices.
That
is down the road. So what are the challenges today? We need to show what is
possible both in outcomes and cost from basic vitality programs. What are the
content, business models, and partnering approaches – encompassing but not
limited to earlier discovery and treatment of disease – that can achieve
widespread vitality, and do so far more efficiently than traditional Western
approaches? How is behavioral health done where almost nothing exists? What are
the relationships between social entrepreneurs, the citizen and private sectors,
and government that can transform the delivery of health to pursue this higher
goal? How and where can we catalyze the launch of the multi-partner systemic
trials needed to produce the compelling data which will drive change?
We
have work to do – together.