Tuesday, January 14, 2014

Door Step Vitality: the Antidote to the Failings of Sick Care

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.

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