“For those people who are in a health desert, their first line and last line of care is self-care.” - Daniella Foster, Bayer.
In too much of the world—from desert villages in the Sahel to isolated jungle enclaves in the Amazon to impoverished villages, neighborhoods, and cities everywhere—modern healthcare isn’t there, or it’s very difficult to access and use. This situation is particularly acute for women, whose healthcare and needs have too often been sidelined or ignored, and for diverse populations who have traditionally lacked access to physicians, treatments, education, attention, and basic care.
So, what’s to be done when global resources, inadequate policies, neglect, and discrimination continue to leave billions of people behind?
During the United Nations General Assembly Science Summit in September, Cure and Bayer hosted a roundtable to address the burgeoning world movement of self-care to empower these billions—to help them help themselves stay healthy and to make preventive care a reality.
“What I am obsessed with is how do we enable access to self-care,” said Daniella Foster, Senior Vice President and Global Head of Public Affairs for Bayer’s Consumer Health Division—and the co-convenor of the roundtable, “which is health education, products, and more access to community health care workers. It's also technology, including digital technologies, that tackle challenges like last-mile delivery.”
Convening at Cure’s healthcare innovation campus in New York City academics, diplomats, nonprofit leaders, entrepreneurs, investors, physicians, patients, and activists from around the world shared on-the-ground stories about the urgent need for self-care initiatives and what the activities of their organizations.
The impetus for the gathering was the World Health Organization’s program on Self-Care, which the WHO defines as “…the ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health worker.”
Roundtable participants emphasized high- and low-tech solutions, plus a need to listen to people’s needs while also developing a potent investment case for self-care. They spoke to the collecting and sharing of data on the impact of self-care interventions and what works—and what doesn’t. They also stressed the impact of climate change on vulnerable populations, particularly on health equity and poverty.
The conversation kicked off when Cure CEO Seema Kumar talked about the critical need to show the world not only the challenges of making self-care a reality, but also to highlight examples of where communities, companies, and organizations are acting to make a real difference in people’s lives.
“The dynamic intersection of technology, human ingenuity, education, and a respect for all people around the fundamental human right to healthcare is fueling a revolution in self-care, one that Cure proudly supports.” - Seema Kumar, Cure CEO.
Foster then cited a recent Gates Foundation Goalkeepers Report that noted after 20 years of steady gains in combating the lack of healthcare access for half the world’s population, progress stagnated, particularly in promoting practical preventative care.
“We can feel it,” said Foster when describing this lack of improvement. “We can see it, and we especially see it when it comes to health. We see it in all other areas, too—poverty, gender equality, and a number of others, but specifically in health it is quite staggering.”
Despite this stagnation, attendees highlighted where progress is being made and recommendations for further initiatives and actions. For instance, Behavioral scientist Jylana Sheats, PhD, MPH, Associate Professor at Tulane University’s School of Public Health, then dove deep into a specific example of her work using digital tech to help people with ambulatory challenges.
She introduced the attendees to Carmen, a virtual health advisor who has proved as effective as human health advisors in improving walking behavior among the elderly with a bonus on offering social interactions, too. “We found that beyond the 12 months of the study, people still came to the center to talk to Carmen,” noted Sheats.
Priyanka Jain, Founder and CEO of Evvy, a vaginal microbiome testing company, described how women around the world have often been left out. “We aren't getting the education we need from the education system as it relates to our bodies,” she said.
Vaginal discomfort is the leading reason that women in the US seek healthcare advice. “But when women go to the doctor, they are more likely to be misdiagnosed and not get better rather than receive a correct diagnosed and get better,” Jain noted. “Because the healthcare system isn’t serving them, women turn to the internet, each other, and self-care products and platforms. This is why Evvy focuses on an app to reach and inform their customers to organize their testing. We have 300,000 followers on social media.”
Digital pioneer Esther Dyson next highlighted her 10-year Wellville project, which aimed to foster community-based self-care and reduce reliance on traditional healthcare systems. Her experiences in working in five small, underserved communities in the U.S. illustrated the importance of community collaboration, the need for long-term solutions rather than short-term interventions, and the value of community resilience and self-care.
April Smith-Hirak, PhD, a Regional Health Administrator at the US Department of Health and Human Services, emphasized the importance of community resilience and singled out the rising epidemic of loneliness and social media addiction on health.
“We’re working really hard to connect basic science with practitioners in the clinic and in the field,” she said. “For example, how do you get the molecular biologist to talk to the psychologist who's studying the effects of loneliness? Because we have so much potential for interconnection, and this plays into how we improve self-care.”
Ambassador Malik Abid, Secretary General of the International Human Rights Commission at the United Nations, talked about “the fundamental human right to self-care” and the challenges in current healthcare systems, stressing the need for legislative changes at national and international levels to promote self-care. He specifically highlighted the importance of cultural tailoring in designing solutions for self-care and health equity.
David Ripin, PhD, Chief Science Officer and Executive Vice President, Infectious Diseases at Clinton Health Access Initiative, gave two examples in which community-based care saved lives. In Rwanda, community health workers helped eliminate hepatitis B and C. In Nigeria, they helped spearhead an effort to reduce maternal and infant mortality rates by pushing behavioral change in the community and making sure pregnant women saw healthcare professionals more frequently.
“In some remote and underserved areas of Nigeria this led to a 37 percent reduction in maternal deaths in 12 months, and a 43 percent reduction in newborn deaths,” said Ripin.
Lauren Ruotolo, an author and rare disease and disability advocate, provided a patient’s perspective. She pointed out that all the technology in the world won’t be as effective as it should be without a fundamental respect for patients—and programs to help educate patients living with a disability to help themselves.
Other participants included Glennis Mehra, PhD, Director of BioLabs @NYULangone; Andrea Feigl, MD, PhD, Founder & CEO, Health Finance Institute; Alison Sullivan, MPH, Health Security Leader at Innovative Program Design, Deloitte; Brian Li Han Wong, MBA, Global Public Health Lead and Global Health Advisor, WHO; John Harlow, MBA, CCO, Melinta Therapeutics; Edward Booty, CEO of Reach52; and medical student Kiburan Demissi, UN Youth Representative for Ethiopia.
The meeting ended with calls to action that include support for the United for Self-Care Coalition's efforts to create a WHO resolution on self-care, which could significantly impact global health systems. Also, participants pledged to help support and investigate innovative financing models to support preventative care and self-care initiatives.
“We need to look hard at the key systems and behavior that drive the lack of access and equity in healthcare,” concluded Kumar, “because it's not enough to go with just education, or to make a lot of promises. There is also the issue of trust, which is so critical. We also need to acknowledge that there are no silver bullets, while at the same time convening conversations like this, of movers and shakers who are devoted to moving the dial—and doing much more to create impactful solutions.”