Three Things the United States Can Learn About Public Health From Around the World

Jul 23, 2015, 10:45 AM, Posted by Najaf Ahmad

When it comes to bridging health and health care delivery, the U.S. has an opportunity to learn from global innovations that link the public health, social services, and health care systems.

A boy with a soccer ball in front of a mural of a globe. Image via Joseph Li

It started with three hundred Boy Scouts from across Uganda being trained as “social monitors”. They were tasked with reporting the conditions of their communities to Uganda’s Ministry of Health through their mobile phones. In less than a year, these “U-reporters” grew to over 89,000. The U-report itself is a free SMS-based system that allows young Ugandans to share what’s happening in their communities and work with community leaders and government to affect positive change. The information gathered is disseminated through radio, TV, websites, youth events, community dialogue and other ways.

This system of real time surveillance is a vital new development for the world’s fifth-fastest growing country. Reliable health information in Uganda can mean the difference between life and death. As has been seen recently, epidemics like Ebola or West Nile thrive on information delays. Furthermore, U-reports are empowering Ugandans to share responsibility for creating healthier conditions within their communities.

The U-report is just one of the many exciting global innovations highlighted in a report by the Robert Wood Johnson Foundation (RWJF) and AcademyHealth. Written by Margo Edmunds and Ellen Albritton at AcademyHealth, the report showcases innovations that link public health, social services, and health care systems. These initiatives serve as examples of bridging otherwise disparate elements of health and health care delivery. The authors deliberately selected racially, ethnically and economically diverse regions around the world to ensure that their innovations were applicable to and reflected the diversity of the United States. A Google Hangout also convened several experts to discuss the report’s findings.  

I sat down with the RWJF's own Katie Wehr and Paul Kuehnert to gather their insights on the report. They stressed how important it is for existing and emerging health professionals to expand their perspectives by delving into the report’s examples and considering how much the United States can learn from them. RWJF is already looking at promising models and approaches from around the globe that can be adapted to our work to build a Culture of Health domestically. Our conversations brought to light three reasons why the United States must pay close attention to how our foreign counterparts are creatively addressing public health challenges in their own communities.

Although the United States spends the most on health care, our outcomes are much worse than other nations.

In 2013, the United States spent a whopping $2.9 trillion a year on health care. That’s almost $10,000 per person and more than any other nation spends. Despite a recent slowdown on health care spending due to the Affordable Care Act, the United States still outspends other countries whose citizens live longer, healthier lives than we do. We also rank behind most countries on several measures of health outcomes, quality and efficiency. A variety of  sources have supported this troubling finding. In 2013, the IOM released a report—Shorter Lives, Poorer Health—highlighting the United States’ status as one of the wealthiest but least healthy countries in the world. Compared to other peer countries, Americans die younger and suffer from more chronic illnesses, including obesity and diabetes, heart disease, lung disease and HIV/AIDS.

It takes more than health care to make a country healthy.

Elizabeth H. Bradley, director of Yale University’s Global Health Leadership Institute, and Lauren A. Taylor offered an explanation for this phenomenon in their book The American Healthcare Paradox. They note that while the United States spends a significantly higher percentage on health care services, we spend much less on education, disability and sickness benefits, family support and employment programs, unemployment benefits, and housing. In sum, it takes so much more than health care to make a country healthy.

At RWJF, Paul Kuehnert is leading efforts to address this very problem by building strong connections between health care, public health and social services—all of which have traditionally operated in siloes. Breaking down these siloes by “bridging” health with health care will help people get the services they need, when they need them. This “bridging” will also better ensure that resources are placed in systems that are not traditionally thought of as health-related but have a significant impact on health: education, housing, and transportation are some examples. Paul notes that acknowledging and addressing the array of needs people have will help them live longer, healthier lives.

To illustrate this, he recounted his career as a public health nurse in the early days of the AIDS epidemic. The stigma that HIV patients faced led many to be fired from their jobs, abandoned by their families, and ultimately homeless on the streets. Food, shelter, and safety were priorities for many before they could focus on getting medical care. Had health care and other sectors been coordinated, many may have faced better outcomes. In addition to addressing disease, Paul notes that bridging sectors helps promote health.  

To strengthen the integration of health services and systems, use the right building blocks.

No innovation or intervention is perfect. And Katie points out that the public health and health care challenges that America faces are too big for one organization to take on alone. But the examples featured in the report help encourage fresh new thinking on how to use public health innovations to tackle health challenges within communities in the United States.

Katie shared a great analogy for how to think about these issues. “When you build a house, you don’t start by putting the walls up. You start by ensuring you have a sturdy foundation in place”, she notes. “This analogy can be applied when thinking about building a strong foundation that integrates health services and systems. The foundation’s building blocks will look different depending on the needs, assets and histories within a given community. The report helps us consider how using the correct building blocks can help communities respond to emergencies, assure access to quality of care, and provide support to ensure that the healthy choice is the easy choice”.