Author Archives: Deborah Bae

Positioned for Transformation: Expanding the Scope of Health Care

May 18, 2012, 10:58 AM, Posted by Deborah Bae, Jane Isaacs Lowe

In the Stanford Social Innovation Review’s “Realigning Health with Care,” authors Rebecca Onie, Paul Farmer and Heidi Behforouz express their collective belief that—in the United States—we need to expand our understanding of the scope of health care, where it’s delivered and who delivers it. They also make it clear that the time to do so is now if we are going to confront our country’s rising health care costs, primary care physician shortage and expansion of the ranks of those living in poverty or hovering just above it. 

Onie, Farmer and Behforouz also propose that we need to look beyond our shores and borders for models for how to do so, pointing out that “in the developing world, there is no choice but to design health care systems that account for limited financial resources, scarce health care professionals and significant poverty.” 

We couldn’t agree more.

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Introducing Innovations for Health: Solutions that Cross Borders

Nov 14, 2011, 8:28 AM, Posted by Deborah Bae

At RWJF, we’re focused on solving the most intractable health and health care challenges in the United States, but we recognize that innovations come from all over the world and that many effective health solutions are emerging with the potential for immediate adaptation, replication and impact. That’s largely because, despite their differences, many countries throughout the world face a surprisingly similar set of health care challenges.

In today’s interconnected world, we have an important opportunity to learn from each other – especially when a new idea has the potential to make a difference in a big way. For example, the New York Times recently released a special section, “Small Fixes,” which focused on low-cost health care innovations to improve global health. The small fixes ranged from simple, self-adjusting eyeglasses for those who don’t have access to optometrists to the sophisticated, Gates-funded “postage stamp” paper to detect liver disease nearly instantaneously—the samples don’t have to be sent to a laboratory to be processed.

The innovation that most caught my interest in this article was one in Mozambique that organized patient groups to take turns picking up their medications, thereby forming strong social bonds, reducing stigma and increasing adherence to antiretroviral drugs. The organized patient groups also reduced the burden on health care workers while increasing patient engagement and self-management of care. Some consider this “small fix” a potential game changer for HIV care.

What’s striking about many of these solutions is that they highlight the universality of health problems faced throughout the world, such as lack of preventive care, provider shortages and rising health care costs. And, while most of the solutions are geared towards solving health problems outside of the United States, with some imagination, I believe many of these fixes could easily improve people’s lives in our country.

It’s this desire to accelerate change by tapping into unconventional thinking around the globe that led the Pioneer team to partner to launch the Innovations for Health: Solutions that Cross Borders competition with Ashoka Changemakers. We’re looking to find solutions to these universal health care issues, and are most interested in those that have potential to:

  • Increase capacity and training for health care workers and providers;
  • Scale low-cost interventions to increase access to medical, preventive, or dental care;
  • Reduce barriers to health information and services;
  • Provide high-quality care in non-traditional settings; and
  • Engage patients directly in their care, particularly those managing chronic illnesses.

We’re thrilled to seek these global health care solutions and hope you’ll check out the competition, learn more about the three $10,000 prizes, and share the link with your network of pioneering thinkers. And why not submit an entry yourself, nominate an organization to compete, or comment on the submissions? We can’t wait to see what ideas you might have.

Three things I Know to be True (TED edition)

Mar 9, 2011, 11:12 AM, Posted by Deborah Bae

TED presentor Sarah Kay, an amazing 22 year old spoken word poet (check out her TED talk when it gets posted), asks her students to list what they believe to be true to help them tell their stories.  It’s great advice.  I was stuck all week trying to figure out what to write about, but it was fairly easy to come up with just three things I think are true about TED. 

1)      TED can be very intimidating.  Attendees include world renowned scientists and researchers, successful entrepreneurs and venture capitalists, celebrated designers and artists, and famous actors and actresses.  And, it seemed like they all knew each other really well. It was easy to feel small, unaccomplished and left out.  But over the course of the week, you meet lots of people and realize that there are many attendees who have similar feelings and that most people don’t know each other.

2)      Meaningful conversations do happen at TED.  Once you get over the intimidation factor and can strike up a meaningful conversation, you find out about some great projects.  I talked to an acclaimed industrial designer, Yves Behar, who designed the Jawbone headset and the $100 laptops for One Laptop per Child.  He’s also designed high-quality, free or low-cost, fun eye glasses for kids in Mexico with hopes to bring these glasses to students in the US. 

3)      Optimism pervades TED.  A major theme at TED is the use of cutting edge technology and its role in solving big problems.  For example, Dr. Anthony Antala gave a presentation on “printing” organs to solve the organ donation shortage.  But there were other speakers and attendees who spoke less about how they’re using technology, and more about their desire to make the world a better place.  I met Shantanu Sinha, who gave up his prestigious consulting job to join his best friend, Salman Khan, on a non-profit venture called Khan Academy.  Khan Academy is attempting to fix our broken education system by “providing a world-class education to anyone anywhere."  They’ve posted thousands of videos on math and science, and they’re just beginning to branch into other subjects.  These free videos are intended to help students learn at their own pace at home- they can watch the videos over and over again until they understand the concepts while getting more targeted interventions at school.  After Sal Khan gave his talk, there was a collective sense of optimism that prevailed for the rest of the conference. This optimism has re-inspired me to think positively, differently and creatively to solve some of our most challenging and pressing issues in health and health care.

The Need for More Randomized Controlled Trials in U.S. Social Policy Interventions?

Feb 17, 2010, 3:45 AM, Posted by Deborah Bae

Esther Duflo, a development economist at MIT, gave a thought-provoking talk at TED on using randomized controlled trials to study the impact of anti-poverty interventions in developing countries. Instead of trying to answer the big, controversial question, “Does (international monetary) aid work?” Duflo tries to answer smaller, local questions that provide insight to the big question.  For example, mosquito nets are highly cost-effective for preventing malaria, but they’re not being used widely.  Duflo wanted to know why and whether cost had something to do with it.  Are poor villagers more likely to use mosquito nets if they have to buy them (at a low, subsidized price) versus getting them for free?  Her research showed it’s more effective to give the nets away for free. 

What’s most appealing about Duflo’s research is that she’s able to show what works (or doesn’t) and she can back it up with data.  Randomized controlled trials are the gold standard- for example, the 1971 Rand Health Insurance Experiment is still cited today, yet, they’re not extensively conducted on U.S. social policy interventions (with the exception of education) primarily due to cost, ethical issues, and complexity of the research design.  Knowing what works would ensure that scarce funds are directed towards those policies that have meaningful, lasting impact to improve the lives of millions of people.

Duflo’s talk raises some important questions: When is appropriate to conduct randomized controlled trials in U.S. social policy?  Should we conduct more randomized controlled trials in health and health care to understand which interventions work and to invest in? Or are randomized controlled trials too controlled, localized, unrealistic and infeasible?

Super-empowered, Hopeful Individual.

Feb 17, 2010, 12:50 AM, Posted by Deborah Bae

This is a phrase  Jane McGonigal, game designer, used to describe the type of individual she believes gaming can produce. But the term is also fitting for what I feel right now after attending TED2010. I listened to some of the most intelligent, passionate speakers on a broad range of issues — from zapping mosquitoes (Nathan Myhrvold) to suspended animation (Mark Roth). I feel super excited, energized and optimistic, but I’m left with the question, “now, what?”  Of course, I’ll talk about TED with friends and colleagues in the coming days and I might use for computational type searches, or download Andrew Bird’s album — but is that it?

One talk that feels “actionable” is Esther Duflo’s presentation on using randomized trials to study the impact of anti-poverty interventions in Africa.  Instead of trying to answer the big, controversial question, “Does (monetary) aid work?,” Duflo tries to answer smaller, local questions that provide insight to the big question. For example, mosquito nets are highly effective for preventing malaria, but they’re not being used widely. Duflo wanted to know why and whether cost had something to do with it.  Are poor villagers were more likely to use mosquito nets if they have to pay for them (at a low, subsidized price) versus getting them for free?  Her research showed it’s more effective to give them away for free.

While Duflo talked about global health and poverty alleviation, the concepts she talked about can be applied to the U.S. health and health care system. Instead of asking big questions like “Does prevention work?” or “Do we need universal coverage?” perhaps we can ask a series of smaller, answerable questions. 

What are some of these smaller questions that can provide insight into the bigger health and health care questions?