Date: October 7th, 2014
Recently I attended a meeting of a few Baltimore City health professionals to talk about ways to enhance the youth-friendliness of Baltimore City clinics that provide sexual and reproductive health services to adolescents and young adults. During the course of our brainstorming session, we came up with a number of innovative strategies and approaches, many of which we knew to have been successfully implemented in developing countries, in low-resource settings, with positive outcomes. The realization that Baltimore as a city—and the United States as nation—are lagging behind many countries with weaker health infrastructure and poorer economic support, in terms of finding and implementing innovative, sensible, and cost-effective solutions for a vast number of public health challenges was paramount on my mind as I made my way back home from the meeting. I began to think, “What are some lessons that the United States can learn from global public health?”
Having worked as a physician, researcher, and public health practitioner in both international and domestic low resource settings for many years, I have always viewed health as a basic human right that every man, woman, and child is entitled to—regardless of who they are, where they come from, or where they are headed—and not as a privilege. In my opinion, the politicized nature of health in the United States is the single most important factor that has prevented us from adopting more real-life, innovative, and sensible solutions that can reduce the burden of health disparities on the American population. If health could only be viewed as what it truly is, without all the baggage of politics, policies, religion, privilege, money, etc., I imagine there would not be so many obstacles in achieving it. I think other countries do a much better job of viewing health through a more objective lens, providing an excellent lesson for us to learn. I know this might sound like a simplistic approach, but sometimes the most groundbreaking solutions are the most simple.
“Reverse Innovation” is a term used to describe innovation that begins as a practical solution to meet the needs of populations in developing countries, and then “trickles up” to developed countries where the same practical solution which was born out of necessity and constraints is essentially repackaged as an innovative, low-cost solution for the populations of developed countries. There are many such reverse innovation solutions in the field of health that the United States might be able to adopt to solve contemporary health system challenges particularly those in the field of adolescent sexual and reproductive health. Here are just three examples:
- Modified Service Delivery Models: To combat the chronic shortage of skilled health care workers, developing countries are promoting novel approaches and introducing specialized worker education and training. Many developing countries are training mid-level workers to perform emergency procedures. This approach has improved health access through task-shifting. Such workforce substitution has most recently been implemented with great success by the Contraceptive CHOICE research project where non-clinical, lay, frontline staff were trained to provide contraceptive counseling to overcome the barrier of clinicians not having enough time to provide full contraceptive options counseling to patients. Similarly, community health workers (CHWs) and peer health workers can be mobilized following the example of countries such as India and Pakistan to increase positive health outcomes in communities across the United States.
- mHealth and Telehealth: Despite the widespread availability of mobile health (or mHealth) and telehealth technology, the United States seems to be hesitant about fully embracing and taking advantage of such innovation that has the potential to drastically decrease existing health disparities in the country. Countries such as Kenya, Uganda, South Africa, Rwanda, and India have jumped to the forefront of mHealth innovation using new technology to transform healthcare through improved data collection, disease surveillance, post-discharge surveillance, health promotion, diagnostic support, disaster response, and remote patient monitoring. Both mHealth and telehealth can be used in the field of adolescent sexual and reproductive health (ASRH) to deliver health education to disadvantaged communities and to increase access to sexual health services for adolescents and young adults.
- Leadership and Governance: Visionary leadership is required to successfully implement and sustain public health initiatives. Such leadership can kindle community optimism which is important for community support of any initiative. Despite leadership development being a top priority for health leaders, underdeveloped leadership and management skills coupled with a high rate of turnover in key positions plague most health systems in the United States. The State of Ceará, in Brazil, mandates that public servants receive leadership training to apply for management positions. By doing so, the state has been able to strengthen leadership and management of public sector employees. Over time, this has contributed to improved health system performances. Between 2000 and 2004, 25 (out of 37) municipalities in Ceará reduced infant mortality–some by as much as 50%. The United States can certainly learn from the success story of Ceará.
We need to be more creative in our approach to public health in the United States and embrace innovation and change with open arms. Although traditional approaches may be tried and tested, the reality is that these tried and tested approaches have not been able to eradicate the vast disparities that exist in health indices in the United States among different groups of people, particularly in the field of ASRH. Perhaps for some, a sense of urgency has still not arisen. Maybe that is why they are still content with the status quo. I, on the other hand, am not satisfied with how things are and shall continue to advocate for more integration of successful lessons from global public health.
What are some other lessons the United States can learn from global public health? What hurdles have you faced when attempting to introduce new and innovative strategies in your own work?
Additional reference: http://www.globalizationandhealth.com/content/8/1/17#B48