Probably a good point to add my stats about LBW
I did not have time to find the global calculations but note the cost of LBW in the USA was calculated in 2007 that the societal economic burden associated with prematurity in the US was at least $26.2 billion annually, being $5.8 billion only for hospital costs after birth.
More info: https://pediatrics.aappublications.org/content/120/1/e1
For this Business Fights Poverty Challenge we are particularly interested in how self-care can reach vulnerable populations and help achieve equality of access. There certainly seems to be some great examples of action in this regard - from self testing HIV kits in Kenya reaching the LGBQTI community, to food fortification improving the life chances of mothers and children globally including through social protection programmes in Brazil and Mexico. Walmart is also exploring retail healthcare to provide more affordable options in the USA. Does anyone have examples of where national governments have really got behind this agenda - e.g. The Australian government’s My Health Record lets citizens access their health data at any time, while incorporating data from apps and wearables that allow individuals to track fitness goals and heart rate. Are people aware of other similar nation-wide efforts?
When people self-care, they are not helping to help themselves, but also society and health systems at large by freeing up precious resources that can be used to support patients with more serious conditions.
For a long time, governments and policy makers have been looking out for “best buy” interventions for self-care. Excellent examples to tackle non-communicable diseases such as type 2 diabetes, lung disease, heart disease & some types of cancers include the framework convention for tobacco control (getting people to stop smoking), active travel schemes (cycling to work for example) and healthier eating initiatives…
Self-care also enables people to be more productive members of society. The Center for Workforce Health and Performance in the U.S. estimates that chronic conditions, such as allergies, heartburn and headaches—all of which can be easily treated at home, for most people—account for $165 billion in lost productivity costs.
Overall, it is estimated that 15% to 20% of all births worldwide are LBW, representing more than 20 million births a year. In low-income countries, 25% of low birth weight (LBW) was attributable to maternal anaemia during pregnancy
(Iron and Folic Acid) IFA supplementation has demonstrated a great impact on the perinatal outcomes.
MMS are also proving in recent studies their potential to reduce 12-13% Low birth Weight and estimated to also reduce Small for Gestational Age (SGA) by 9%, if they were implemented at the current level of coverage IFA worldwide.
https://www.who.int/nutrition/topics/globaltargets_lowbirthweight_policybrief.pdf
Check this video conference of WHO and UNICEF on the new recommendations for supplementation during pregnancy for more information:
Business benefits come in different form for different audiences. Manufacturers are going to be a lot more focused on an ROI – with still a focus on how their engagement could increase and improve community relations. For example, we’ve gone through external parties for Benefit to Cost analysis. In one of these studies, Catalyst Management Systems (CMS) showcased a 2.77 benefit to cost ratio.
Business associations will have a stronger focus on enabling their members meet compliance to attract international buyers. Brands would rather consider how a workplace program will increase the resilience of their supply chain and help them invest in the relationship they hold with their suppliers or producers.
With the advent of COVID, we now have a very good example of how self-care can limit the spread og he virus (for example by exercising social distancing, regular handwashing and goo hygiene practices).
The use of online symptom checkers offers another excellent example of a technology that is democratising self-care. People can choose to check their symptoms using an online tool that could give them appropriate triage recommendations, and when to see a doctor, and can really help in improve the health literacy of individuals as regards common and everyday conditions.
Some countries can afford bleeding healthcare funds to treat medical complications that could be reduced by an effective primary health care and self-care system, but for most LMIC this is simply not possible. The annual national budget for the Republic of Niger was roughly $3.7 billion in 2019, of which 10.6% was dedicated to Health expenditure nationwide. The health system is barely equipped to deal with regular births and basic health problems, hence the result of lack of efficient ways to tackle and reduce LBW results in a high related mortality.
Prior to the Coronavirus outbreak, there were 18 million GP appointments and 3.7 million visits to A&E in the UK every year for self-treatable conditions.
During the first peak of the pandemic, people were advised against visiting GP practices and other care services, and as a result, people practised self care – both for mild coronavirus symptoms and other minor ailments.
PAGB carried out a survey in June which found that the lockdown has prompted positive behaviour change:
Not only is self care most appropriate for these people, but it is better for the NHS. We have calculated that £780 million of resource could be released if all of the people who told us they are now more likely to self care, actually do change their behaviour.
Given the above, it is easy to imagine that a substantial reduction on the pressure on the health system on the treatment of complications related to pregnancy/perinatal problems, LBW and SGA would signify huge savings that can be invested again on further self-care interventions and a stronger primary health care system.
This will contribute, along with other multisectoral initiatives like the ones shared today by my fellow panellists, to strengthen health systems with updated knowledge, stronger implementation based and workforce with an efficient allocation of resources, to the measure that they can provide high quality reliable care at all levels of the system, from primary to Intensive care and Surgery, and be the foundation for Universal health Coverage by putting the resources where they are needed.
https://www.who.int/reproductivehealth/self-care-interventions/financing-economic-considerations/en/
UHC: https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
Ther are many like iniatives in the UK currenlty. The MyCareMyWay intiaitive in North West London helps people access their ‘electornic halth rrcord’, promotes integration of data, symptom tracking and personalised care budgets.
As we think about life post-COVID-19, accessibility to self-care for underserved communities needs to take center stage. We need to start working on ways to create and adapt health literacy programs so they fit within existing community norms. We also need to ensure the same science and rigor goes into creating preventative measures as other elements of healthcare. Once access is achieved, the solutions need to work to keep people healthier and leveraging health services differently.
I think this is a great point. Can we learn from other sectors (or movements) that have taken the approach to measure ROI vs cost-benefit or cost savings? What might that look like in practice?
Here I got some examples of Nutrition related self-care interventions:
Home based treatment of Acute Malnutrition . With the introduction of RUTF in the 90’s, the treatment of SAM changed from Hospital based only, to treat 90% of cases at home with a ready to use paste that doesn’t need preparation and is taken straight out of the sachet. Mortality rates where close to 50% but this new approach is now keeping under 10%.
By just allowing parents and families to treat the children at their, avoiding the costs of lengthy absences at hospital, leaving other children behind, etc, which was one of the main reasons for defaulting the programme, it was possible to change the face of the treatment of acute malnutrition and gave an opportunity to survive and thrive to millions of children.
Home fortification programmes . Based on Multiple Micronutrient Supplements (MMS). More info: https://www.who.int/elena/titles/micronutrientpowder_infants/en/
The 2012 Copenhagen Consensus panel of experts ranked providing micronutrients to preschoolers as the single smartest way to allocate global aid dollars, with every $1 spent generating $30 in social benefits. Those benefits have a large span as they are on better health, better brain development, better experience at school, better work prospects and higher capability to undertake higher studies, better income for the household and the breaking of the vicious cycle of deprivation and poverty.
A country will certainly also benefit as their population grows healthier and stronger, less funds are spent on childhood illnesses and as the generations grow there are more youth capable of becoming nurses, engineers, teachers, go to university… a long list of benefits that concur, eventually, to increase the wellbeing of all the population, reduction of inequalities and higher GDP. Simple, right?
Social Protection Networks
From Unicef report SOCW 2019. https://www.unicef.org/media/63016/file/SOWC-2019.pdf
Social protection programmes are a powerful instrument to not only lift families and children out of poverty, but also to promote maternal and child nutrition. However, a recent ILO reports shows that only 35% of children worldwide enjoy effective access to social protection. Almost two thirds of children globally – 1.3 billion children – are not covered, most of them living in Africa and Asia. https://www.ilo.org/global/about-the-ilo/newsroom/news/WCMS_601903/lang--en/index.htm
A range of interventions, such as conditional and unconditional cash transfers, food rations and school feeding, can all help limit the long-term effects of deprivation and provide communities with the means to access and
afford nutritious food. Cash-transfer programmes have proven benefits for the nutritional status and health outcomes of children.
In 2003, Brazil started a programmed called “Borsa familia” that reached 13 million families and changed the nutrition profile of the country’s most disadvantaged children, including a dramatic reduction of child mortality. Similarly, Mexico’s conditional cash-transfer programme, Prospera, has benefited around 7 million families. As studies have shown, the programme has helped to promote nutrition and optimum growth, and has also enhanced dietary diversity among families and children.
All case study references can be found in SOWC report 2019. Link for a study on Brazil’s ground-breaking experience:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60715-1/fulltext
Many thanks Katie. Hi everyone, I’m Judy Stenmark, CEO from Global Self-Care Federation. It’s a pleasure to be part of this panel.
Absolutely! Great data! COVID-19 has led to behaviour change and it’s an opportunity to greater promote self-care.
You make an interesting point Daniella that self care is broad - this is an opportunity (it is a wider landscape on which good can be done!). This breadth also highlights that in some areas of this spectrum, we want to dig a little deeper to realise the benefits in a coordination fashion. It’s an interesting dance we’re all having to do, between the broad approach to self care and then self care when we are working on or talking about one specific intervention, be that hypertension management, HIV self testing or emergency contraceptive pill use.
We think there is a unique opportunity now to put policies in place to ‘lock in’ and further promote this positive self care behaviour. We published a policy paper The future of the NHS: self care during and beyond the COVID-19 pandemic which sets out where we feel action should be taken.
Our second question today:
Q2.
How do we negotiate the barriers to self-care (including access, affordability and regulation)?
The solutions are not always sexy or quick. Policy plays a critical role in drivers such as behavior change, investments in needed infrastructure and the wrap up around services or programs needed to tackle long-term change. Policymakers need to act as an enabler to create practical policies that enable access.