Rethinking Global Public Health

Click here to read an original op-ed from the TED speaker who inspired this post and watch the TEDTalk below.

In 2007, Nicholas Christakis and James Fowler concluded in the pages of the New England Journal of Medicine that obesity appears to spread through physical social networks. This was an important scientific observation because it opened up a debate about the role of social interactions in shaping public health behaviors. Yet in many ways, their findings were not new; ancient thinkers have long recognized both the existence and importance of "stone age" social networks in shaping individual behaviors. One only has to recall the proverbial wisdom, "bad company corrupts good manners."

Over the next few decades, the global economy will lose trillions of dollars to diseases that are largely preventable and manageable through simple behavior modifications like eating healthier meals and exercising more. Yet we cannot expect individuals to change their behaviors in a vacuum. Families and friends make healthy or unhealthy choices based on social and cultural pressures, especially when it comes to profoundly social activities like exercise and eating. If we are ever going to solve this trillion-dollar problem, we have to think outside the box, outside the clinics, and outside the hospitals. We have to think about how people behave in their neighborhoods, homes, and places of business.

In short, we need to rethink global public health. We need to rethink some basic categories of analysis. For example, a disease may be biologically infectious (e.g. HIV/AIDS) or non-infectious (e.g. diabetes), but the behaviors driving major chronic disease epidemics like diabetes are in a very real way socially "infectious." What would happen if public health systems around the world thought about diabetes as a socially "infectious" disease? What would they do to contain its spread?

When illness is prevented, employers have more productive work forces, governments save more taxpayer dollars, and insurance companies pay fewer claims. This really is one of those rare "win-win-wins." -- Daniel Zoughbie

Public health systems must respond to a changing global epidemiological landscape by addressing the sociological aspects of disease prevention and management, and not simply the important biological or technological aspects -- which Nathan Myhrvold explores in his TEDTalk. But this work cannot be coordinated by governments alone. The private sector, academic researchers, non-profit institutions, and other stakeholders need to work hand-in-hand with public health departments and ministries of health towards the common goal of prevention. When illness is prevented, employers have more productive work forces, governments save more taxpayer dollars, and insurance companies pay fewer claims. This really is one of those rare "win-win-wins."

At Microclinic International, the organization I founded and lead, our staff and global partners have been putting these ideas into practice. We call this sociological approach "contagious health." For example, in Appalachia Kentucky, we are partnering with departments of public health to implement our microclinic social network model for the prevention and management of obesity, diabetes, and cardiovascular disease. Using rigorous scientific methods, we have demonstrated in a pilot program called Team Up 4 Health that physical social networks can be harnessed to reduce body mass index and blood pressure by significant amounts. Participants simply join our program as groups of friends and family, learn some basic information, and apply what they have learned in their homes, neighborhoods, and social circles.

Leigh Ann Baker, who leads Team Up 4 Health at the Bell County Health Department, has first-hand evidence of the program's success in her home: "My own family has benefited. My mom participated in phase one of the program and she has made small steps that are lowering her weight, blood pressure, and blood sugar, a key marker for diabetes risk. She's now more active, walking more with her new Team Up 4 Health friends, my Dad and our neighbor. I'm very pleased with the changes in my mom's life and with the way the microclinic concept has come to life for my mom and her social and family circles."

Humana, Inc., Team Up 4 Health's sponsor, is also taking notice of the power of social networks to change behaviors. "The project we're sponsoring in Kentucky has had fantastic success," said Humana's Alan Player, a Communications Consultant and the Humana team lead for Team Up 4 Health. "We've seen exciting improvements in clinical outcomes and a shift in the community at large toward healthier living. We're proud to be part of an initiative that is saving lives by pioneering an innovative approach to managing our nation's most urgent health needs."

The concept of contagious health is not only applicable in U.S. communities like those we work with in rural Kentucky. For example, in the Middle East, which is currently experiencing great political and social upheaval, the unchecked diabetes epidemic could burden already destabilized economies with billions of dollars in losses. Since 2005, Microclinic International has been working on a solution for this problem. With the World Diabetes Foundation, the International Diabetes Federation, the Blum Center for Developing Economies at UC Berkeley, Queen Rania's Royal Health Awareness Society, and the Jordanian Ministry of Health, we have demonstrated how social networks can be leveraged to reduce weight and blood sugar levels.

Because the principle of contagious health is rooted in a fundamental truth about humanity -- that we exist in social communities - the microclinic social network model is also gaining traction in completely different cultural contexts. It not only works in rural Appalachia for obesity, or in Jordan for diabetes, it also works on a remote island in rural Kenya for HIV/AIDS. In partnership with UCSF researchers, the Organic Health Response, Google, Rise Up Foundation, and others, we are showing that the microclinic social network model can be used to change unhealthy behaviors that lead to death and disability in communities struggling with HIV/AIDS. As Chas Salmen, the program's director put it, "by focusing on HIV affected social networks, as opposed to infected individuals, we seek to redefine the unit of intervention in sub-Saharan Africa."

At Microclinic International, we believe that public health is not simply about building the best "bricks and mortar" infrastructure of clinics and hospitals. It is also about activating a robust social infrastructure comprised of family and friends who can make good health contagious, in every community, culture, and nation.

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