Yet, sometimes, the most straightforward path forward emerges far from where one expects. A clinical field initiative unfolding in Ghana is demonstrating that with the right technology and training, frontline physicians can step into the widening gap and save lives.

AISAP, an emerging voice in AI-supported point-of-care diagnostics, announced a landmark deployment of its Food and Drug Administration-cleared cardiac diagnosis platform across Ghana. The initiative powers the country’s first nationwide program to train cardiac sonographers and is being deployed in partnership with the G-ACT Foundation. What is unfolding across this West African nation may well offer the most compelling and implementable model for tackling America’s growing cardiology deserts.

When Specialists Are Scarce, Technology Becomes the Essential Partner

Ghana’s health system faces an extraordinary shortage, with fewer than 30 cardiologists serving a population of approximately 35 million. For years, this scarcity placed extraordinary weight on general practitioners, nurses, and emergency teams who lacked the tools or training to perform early cardiac assessments. The AISAP initiative changes that.

“AISAP brings world-class AI diagnostic capability that accelerates training, safeguards quality, and ensures every scan counts,” said Alexis K. Okoh, MD, Executive Chairman of the G-ACT Foundation. “This partnership sets a new standard for accessible cardiovascular care across Ghana, empowering local clinicians to become the new frontline of heart health.”

Clinicians can now access specialist-level interpretation at the bedside. This is more than a clinical advance; it’s a rebalancing of access within care systems. When the tools of expertise reach the people closest to patients, whole nations shift from reactive care to proactive health creation.

A Proven Model for the U.S. Rural Challenge

While the headlines may focus on Ghana now, the unspoken message is aimed squarely at the United States. America’s rural hospitals increasingly rely on traveling specialists, overburdened telecardiology services, or simply do without. AISAP CEO, Adiel Am-Shalom, makes the connection:

“This project represents the heart of our mission, ensuring that access to advanced cardiac care should not depend on geographic location. We are deploying the same FDA-cleared technology trusted by major US hospitals across remote frontlines in Ghana. The model is clear – our cloud-based platform delivers specialist-grade insights to frontline physicians. This deployment is the ultimate proof of concept that AISAP can help solve the diagnostic gap for U.S. rural hospitals facing critical cardiologist shortages.”

Proof of concept is often clinical. Here, it is also a moral imperative. If a middle-income country with constrained resources can deploy expert-level diagnostic capability at scale, what excuse remains for wealthier nations struggling to bridge gaps only widened by geography and policy inertia?

Inside the Technology: When Data Becomes Diagnostic Power

The AISAP Point-of-Care Assisted Diagnosis (POCAD™) platform represents a new generation of applied AI, built not to replace clinicians, but to enable them.

Developed in collaboration with Sheba Medical Center, one of the world’s top hospitals, POCAD has been trained on more than 300,000 echocardiogram studies and 24 million video clips. The platform provides real-time, expert-grade interpretation, along with high-quality guidance for non-specialists. It also provides an Urgency Score that helps clinicians prioritize the sickest patients immediately.

The system does not require proprietary equipment. Almost any portable ultrasound device with an internet connection can transmit images to the secure, HIPAA-compliant cloud.

This accessible specialist knowledge has already made inroads in leading U.S. systems, including Mass General Brigham, Mayo Clinic, Jefferson Health, and Stanford. What makes Ghana’s deployment so compelling is the scale at which the technology is being integrated into clinical pathways, starting with training.

Building an Ecosystem of Capability: The BEAT Program

The Ghana initiative operates through the G-ACT Foundation BEAT Program (Building Echo-Capacity for Access & Triage). It is the nation’s first structured and internationally benchmarked cardiac sonographer training curriculum, developed in collaboration with Ghanaian cardiologists and global academic partners.

“The ability to deploy advanced, life-saving diagnostic capacity directly to our citizens is a monumental step forward for our healthcare system,” said Prof. Yaw A. Wiafe, Associate Professor of Clinical Ultrasound and Echocardiography at Kwame Nkrumah University of Science and Technology. “AISAP’s technology removes traditional barriers to care and offers immediate, tangible results for our population.”

Training programs tend to succeed or fail on three pillars: quality, consistency, and clinical reinforcement. By providing specialist-level diagnostic support directly to trainees, the BEAT Program bypasses traditional barriers and accelerates the development of a new cadre of cardiac professionals. It creates not only capability but confidence.

A Future Defined by Shared Solutions

Ghana’s experience is a striking reminder that innovation need not follow wealth. It follows will, collaboration, and a refusal to accept that a shortage of specialists must translate into a shortage of care.

In many ways, AISAP efforts reflect a shift taking shape across global health: solutions once designed for high-resource environments are being refined in low-resource settings and then reapplied to mature health systems that need new pathways to scale.

“The very first patient we scanned in Ghana was a 46-year-old woman, and her life was immediately changed when our platform quickly identified severe heart failure and multiple valve diseases. She was transferred for urgent care. This outcome is exactly why we built this technology,” shares Adiel Am-Shalom, AISAP co-founder and CEO of AISAP.  “We are now focused on scaling US implementations to ensure our proven, FDA-cleared technology helps even more people and provides access to critically needed care nationwide.”

For the United States, where rural communities are growing older, sicker and more medically isolated, the lesson is unmistakable. Technology that equalizes expertise is no longer optional. It is central to ensure that ZIP codes do not determine survival.

As Ghana builds its next generation of cardiac frontline clinicians, the implications stretch far beyond national borders. This initiative demonstrates what is possible when innovation and intention align, and when the goal is not just to advance diagnostics, but to advance equity.

Ghana is charting a course that others, including the U.S., can follow. AISAP deployment is not just a technology story. It serves as a reminder that health is a shared human endeavor and that the most effective ideas in medicine are those that bring care closer to those who need it most.

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Last winter, Amber Wingler started getting a series of increasingly urgent messages from the local hospital in Columbia, Missouri, letting her know her family’s health care might soon be upended.

MU Health Care, where most of her family’s doctors work, was mired in a contract dispute with Wingler’s health insurer, Anthem. The existing contract was set to expire.

Then, on March 31, Wingler received an email alerting her that the next day Anthem was dropping the hospital from its network. It left her reeling.

“I know that they go through contract negotiations all the time … but it just seemed like bureaucracy that wasn’t going to affect us. I’d never been pushed out-of-network like that before,” she said.  

The timing was awful.

The query: When a Missouri mom’s health insurance company couldn’t come to an agreement with her hospital, most of her doctors were suddenly out-of-network. She wondered how she would get her kids’ care covered or find new doctors. “For a family of five, … where do we even start?”

— Amber Wingler, 42, in Columbia, Missouri

Wingler’s 8-year-old daughter, Cora, had been having unexplained troubles with her gut. Waitlists to see various pediatric specialists to get a diagnosis, from gastroenterology to occupational therapy, were long — ranging from weeks to more than a year.

(In a statement, MU Health Care spokesperson Eric Maze said the health system works to make sure children with the most urgent needs are seen as quickly as possible.)

Suddenly, the specialist visits for Cora were out-of-network. At a few hundred bucks a piece, the out-of-pocket cost would have added up fast. The only other in-network pediatric specialists Wingler found were in St. Louis and Kansas City, both more than 120 miles away.

So Wingler delayed her daughter’s appointments for months while she tried to figure out what to do.

Nationwide, contract disputes are common, with more than 650 hospitals having public spats with an insurer since 2021. They could become even more common as hospitals brace for about $1 trillion in cuts to federal health care spending prescribed by President Donald Trump’s signature legislation signed into law in July.

Patients caught in a contract dispute have few good options. “There’s that old African proverb: that when two elephants fight, the grass gets trampled. And unfortunately, in these situations, oftentimes patients are grass,” said Caitlin Donovan, a senior director at the Patient Advocate Foundation, a nonprofit that helps people who are having trouble accessing health care.

If you’re feeling trampled by a contract dispute between a hospital and your insurer, here is what you need to know to protect yourself financially:

1. “Out-of-network” means you’ll likely pay more.

Insurance companies negotiate contracts with hospitals and other medical providers to set the rates they will pay for various services. When they reach an agreement, the hospital and most of the providers who work there become part of the insurance company’s network.

Most patients prefer to see providers who are “in-network” because their insurance picks up some, most, or even all of the bill, which could be hundreds or thousands of dollars. If you see an out-of-network provider, you could be on the hook for the whole tab.

If you decide to stick with your familiar doctors even though they’re out-of-network, consider asking about getting a cash discount and about the hospital’s financial assistance program.

2. Rifts between hospitals and insurers often get repaired.

When Brown University health policy researcher Jason Buxbaum examined 3,714 nonfederal hospitals across the U.S., he said, he found that about 18% of them had a public dispute with an insurance company sometime from June 2021 to May 2025.

About half of those hospitals ultimately dropped out of the insurance company’s network, according to Buxbaum’s preliminary data. But most of those breakups ultimately get resolved within a month or two, he added. So your doctors very well could end up back in the network, even after a split.

3. You might qualify for an exception to keep costs lower.

Certain patients with serious or complex conditions might qualify for an extension of in-network coverage, called continuity of care. You can apply for that extension by contacting your insurer, but the process may prove lengthy. Some hospitals have set up resources to help patients apply for that extension.

Wingler ran that gantlet for her daughter, spending hours on the phone, filling out forms, and sending faxes. But she said she didn’t have the time or energy to do that for everyone in her family.

“My son was going through physical therapy,” she said. “But I’m sorry, dude, like, just do your exercises that you already have. I’m not fighting to get you coverage too, when I’m already fighting for your sister.”

Also worth noting, if you’re dealing with a medical emergency: For most emergency services, hospitals can’t charge patients more than their in-network rates.

4. Switching your insurance carrier may need to wait.

You might be thinking of switching to an insurer that covers your preferred doctors. But be aware: Many people who choose their insurance plans during an annual open enrollment period are locked into their plan for a year. Insurance contracts with hospitals are not necessarily on the same timeline as your “plan year.”

Certain life events, such as getting married, having a baby, or losing a job, can qualify you to change insurance outside of your annual open enrollment period, but your doctors’ dropping out of an insurance network is not a qualifying life event.

5. Doctor-shopping can be time-consuming.

If the split between your insurance company and hospital looks permanent, you might consider finding a new slate of doctors and other providers who are in-network with your plan. Where to start? Your insurance plan likely has an online tool to search for in-network providers near you. 

But know that making a switch could mean waiting to establish yourself as a patient with a new doctor and, in some cases, traveling a fair distance.

6. It’s worth holding on to your receipts.

Even if your insurance and hospital don’t strike a deal before their contract expires, there’s a decent chance they will still make a new agreement.

Some patients decide to put off appointments while they wait. Others keep their appointments and pay out-of-pocket. Hold on to your receipts if you do. When insurers and hospitals make up, the deals often are backdated, so the appointments you paid for out-of-pocket could be covered after all.

End of an Ordeal

Three months after the contract between Wingler’s insurance company and the hospital lapsed, the sides announced they had reached a new agreement. Wingler joined the throng of patients scheduling appointments they’d delayed during the ordeal.

In a statement, Jim Turner, a spokesperson for Anthem’s parent company, Elevance Health, wrote, “We approach negotiations with a focus on fairness, transparency, and respect for everyone impacted.”

Maze from MU Health Care said: “We understand how important timely access to pediatric specialty care is for families, and we’re truly sorry for the frustration some parents have experienced scheduling appointments following the resolution of our Anthem contract negotiations.”

Wingler was happy her family could see their providers again, but her relief was tempered by a resolve not to be caught in the same position again.

“I think we will be a little more studious when open enrollment comes around,” Wingler said. “We’d never really bothered to look at our out-of-pocket coverage before because we didn’t need it.”

Author: Bram Sable-Smith: brams@kff.org, @besables

Illustrations: Oona Zenda: ozenda@kff.org

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SNAP is not an abstract line item. It is a lifeline for nearly 42 million Americans, one in eight citizens. In fiscal year 2024, the program distributed almost $100 billion in benefits, with the average recipient receiving approximately $187 per month. For families living paycheck to paycheck, this is the difference between nourishment and hunger, health and hardship.

War on Poverty

SNAP’s history reveals both bipartisan vision and enduring necessity. The program originated during the early 1960s as a pilot effort to stabilize farm prices and reduce hunger. In 1964, President Lyndon Johnson signed legislation making the Food Stamp Program permanent as part of his War on Poverty. His message to Congress was clear: a nation strong enough to feed the world must also be able to feed its own people.

Through the decades, the program evolved from paper coupons to electronic benefits, and in 2008, it was rebranded as the Supplemental Nutrition Assistance Program to emphasize nutrition and dignity rather than charity. That renaming symbolized an essential truth – food security is fundamental to health, not a handout. SNAP has survived political shifts and economic crises because it reflects a moral consensus: no one in America should go hungry.

Who Relies on SNAP

The faces behind SNAP are as diverse as the nation itself. Nearly 40 percent of participants are children, and another 20 percent are seniors. Millions of adults are living with disabilities, many of whom also qualify for Medicare regardless of age. For individuals managing chronic conditions, experiencing mobility limitations, or living on a fixed income, SNAP assistance serves as a proven vital lifeline for maintaining preventive health.

Often sympathetic to the Administration, a Fox News story shared the fear many are now experiencing. A cancer survivor who depends on disability benefits described how the possible halt in SNAP payments left her anxious and uncertain: “It’s scary. I really need the extra for food, because by the time I pay all the bills, there’s really nothing left.” Her story mirrors that of millions who balance medication co-pays against grocery costs, forced into trade-offs that jeopardize both health and dignity. Let’s not forget paying for housing and transportation.

Working families are also part of this equation. Many SNAP households have at least one employed adult. The wages are not enough to cover rent, childcare, transportation to work and medical bills, so food becomes the only variable expense they can afford to cut. SNAP ensures that food insecurity doesn’t become the hidden cost of low-wage work.

What SNAP Provides

SNAP benefits are issued through an EBT card and can be used to purchase fruits, vegetables, meats, fish, poultry, dairy products, bread, cereals, and even seeds and plants to grow food. They cannot be used for alcohol, tobacco, hot prepared meals or household items. The program supplements, rather than replaces, household food budgets, providing predictability that allows families to direct scarce income toward other essentials.

For the health system, SNAP is prevention in action. Food insecurity fuels chronic disease and poor health outcomes. According to the Centers for Disease Control and Prevention, adults experiencing food insecurity are 2 to 3 times more likely to develop diabetes and more than twice as likely to suffer from depression. Children in food-insecure households face 19% higher odds of hospitalization before age three and significantly higher risks of anemia, asthma, and behavioral problems.

A study published in JAMA Internal Medicine found that SNAP participation was associated with a 14% reduction in emergency department visits and lower overall healthcare expenditures. When families can afford healthy food, chronic illness becomes more manageable, adherence to medications improves, and children achieve better developmental outcomes. Conversely, disruptions in SNAP benefits correlate with spikes in hospitalizations for malnutrition, hypoglycemia and mental-health crises.

SNAP functions as one of this nation’s most effective public-health interventions, less visible than vaccines or prescription drugs, and essential to community well-being.

The Big Apple, Empire State and the Nation

The human impact of this shutdown can be seen most vividly on the streets of New York City, where nearly 1.73 million residents, about one in five New Yorkers, depend on SNAP to make it through the month. Grocery stores in the Bronx, Queens, and across the five boroughs see the direct connection between Federal stability and neighborhood well-being. When SNAP dollars are delayed, the effects ripple far beyond individual households: local grocers lose revenue, food pantries face longer lines, and families already budgeting every dollar must make painful trade-offs between groceries, rent and medicine. Child care for working parents is already an out-of-reach luxury.

At the state level, the scale becomes even more striking. As of January 2025, nearly three million New Yorkers –from Buffalo to Brooklyn – received a combined $655.9 million in SNAP benefits that month. These benefits circulate quickly through communities, sustaining small businesses and providing a stabilizing force in counties where economic opportunity fluctuates with the seasons. The State Comptroller’s office estimates that more than $7 billion flowed to New York households in the last fiscal year through SNAP. This Federal investment fuels local economies while preventing hunger from escalating into a public-health emergency.

Nationally, these numbers paint a powerful and painful picture of need and vulnerability. Across the United States, roughly 42 million people, one in eight Americans, rely on SNAP each month. The Federal government must provide approximately $9 billion monthly to sustain those benefits; however, contingency funds currently fall billions of dollars short of that requirement. That gap is not theoretical. Food banks and community kitchens from California to Kentucky are already bracing for the overflow, warning that their shelves and volunteers cannot absorb the loss of a Federal program that moves food on a national scale.

From a New York City food pantry to a rural supermarket in upstate counties, the story reverberates: SNAP keeps families fed, children nourished and local businesses viable. When the Federal system stumbles, the consequences cascade, turning this government shutdown into a community crisis.

A few days ago, a Federal judge ordered the government to use all available contingency funds to sustain SNAP. Still, those dollars fall short of the roughly $9 billion needed for November benefits. The result is confusion, fear and logistical strain. Governors and mayors across the country are scrambling to respond to the crisis. In New York City, Mayor Eric Adams announced $15 million in emergency funding to bolster food pantries and community kitchens. State agencies are urging residents to call 311 in the city and 211 statewide to find food resources.

Still, no local initiative can replace the Federal infrastructure that delivers food assistance on a national scale. Charity can fill temporary gaps; however, it cannot replace the efficiency, reach and consistency of a program built to prevent hunger in the first place.

Health and Economic Stakes

SNAP is among the most cost-effective anti-poverty and public-health tools the nation has ever introduced. Every dollar in benefits generates approximately $1.50 to $1.80 in economic activity, circulating through local farmers, grocers and supply chains. When benefits are delayed or reduced, families face impossible choices between food and heat, or groceries and prescriptions. Hospitals see higher emergency visits; schools see lower attendance and test scores; local economies contract.

A CNN analysis broadcast this week underscores the link between nutrition and resilience. The report notes that food insecurity not only increases health costs but also reduces life expectancy. People living in food-insecure households have a 32% higher risk of premature mortality from preventable disease. Supporting food banks helps in the short term, but it cannot replace a Federal program designed to prevent hunger on a larger scale.

Without SNAP, the nation’s social safety net frays, leaving millions exposed to physical and psychological harm and the country’s public-health foundation weakened.

The Social Impact

Food assistance is not a partisan favorite; it is a measure of a vibrant society caring for its most vulnerable. SNAP’s durability across administrations reflects a shared American understanding: no child should be hungry because adults can’t agree. The current shutdown tests the consensus and the moral fiber of the nation’s leadership.

From the individual with a disability counting on SNAP to stay fed, to the child trying to learn on an empty stomach, to the local grocer whose shelves depend on steady EBT purchases, the stakes are not political. They are human. As winter approaches, this must not become the season when America’s nutrition safety net blinks and citizens are left in the cold.

The post SNAP at Risk: What a Shutdown Means for Health and America’s Social Contract appeared first on Medika Life.

On Fridays, Stephanie Johnson has a busy schedule, driving her navy-blue Jeep from one patient’s home to the next, seeing eight in all. Pregnant with her second child, she schleps a backpack instead of a traditional black bag to carry a laptop and essential medical supplies — stethoscope, blood pressure cuff, and pulse oximeter.

This story also ran on The Washington Post.

Forget a lunch break; she often eats a sandwich or some nuts as she heads to her next patient visit.

On a gloomy Friday in January, Johnson, a nurse practitioner who treats older adults, had a hospice consult with Ellen, a patient in her 90s in declining health. To protect Ellen’s identity, KFF Health News is not using her last name.

“Hello. How are you feeling?” Johnson asked as she entered Ellen’s bedroom and inquired about her pain. The blinds were drawn. Ellen was in a wheelchair, wearing a white sweater, gray sweatpants, and fuzzy socks. A headband was tied around her white hair. As usual, the TV was playing loudly in the background.

“It’s fine, except this cough I’ve had since junior high,” Ellen said.

Ellen had been diagnosed with vascular dementia, peripheral vascular disease, and Type 2 diabetes. Last fall, doctors made the difficult decision to operate on her foot. Before the surgery, Ellen was always colorful, wearing purple, yellow, blue, pink, and chunky necklaces. She enjoyed talking with the half dozen other residents at her adult family home in Washington state. She had a hearty appetite that brought her to the breakfast table early. But lately, her enthusiasm for meals and socializing had waned.

Johnson got down to eye level with Ellen to examine her, assessing her joints and range of motion, checking her blood pressure, and listening to her heart and lungs.

Carefully, Johnson removed the bandage to examine Ellen’s toes. Her lower legs were red but cold to the touch, which indicated her condition wasn’t improving. Ellen’s two younger sisters had power of attorney for her and made it clear that, above all, they wanted her to be comfortable. Now, Johnson thought it was time to have that difficult conversation with them about Ellen’s prognosis, recommending her for hospice.

“Our patient isn’t just the older adult,” Johnson said. “It’s also often the family member or the person helping to manage them.”

Nurse practitioners are having those conversations more and more as their patient base trends older. They are increasingly filling a gap that is expected to widen as the senior population explodes and the number of geriatricians declines. The Health Resources and Services Administration projects a 50% increase in demand for geriatricians from 2018 to 2030, when the entire baby boom generation will be older than 65. By then, hundreds of geriatricians are expected to retire or leave the specialty, reducing their number to fewer than 7,600, with relatively few young doctors joining the field.

That means many older adults will be relying on other primary care physicians, who already can’t keep up with demand, and nurse practitioners, whose ranks are booming. The number of nurse practitioners specializing in geriatrics has more than tripled since 2010, increasing the availability of care to the current population of seniors, a recent study in JAMA Network Open found.

According to a 2024 survey, of the roughly 431,000 licensed nurse practitioners, 15% are, like Johnson, certified to treat older adults.

Johnson and her husband, Dustin, operate an NP-led private practice in greater Seattle, Washington, a state where she can practice independently. She and her team, which includes five additional nurse practitioners, each try to see about 10 patients a day, visiting each one every five to six weeks. Visits typically last 30 minutes to an hour, depending on the case.

“There are so many housebound older adults, and we’re barely reaching them,” Johnson said. “For those still in their private homes, there’s such a huge need.”

Laura Wagner, a professor of nursing and community health systems at the University of California-San Francisco, stressed that nurse practitioners are not trying to replace doctors; they’re trying to meet patients’ needs, wherever they may be.

“One of the things I’m most proud of is the role of nurse practitioners,” she said. “We step into places where other providers may not, and geriatrics is a prime example of that.”

Practice Limits

Nurse practitioners are registered nurses with advanced training that enables them to diagnose diseases, analyze diagnostic tests, and prescribe medicine. Their growth has bolstered primary care, and, like doctors, they can specialize in particular branches of medicine. Johnson, for example, has advanced training in gerontology.

“If we have a geriatrician shortage, then hiring more nurse practitioners trained in geriatrics is an ideal solution,” Wagner said, “but there are a lot of barriers in place.”

In 27 states and Washington, D.C., nurse practitioners can practice independently. But in the rest of the country, they need to have a collaborative agreement with or be under the supervision of another health care provider to provide care to older adults. Medicare generally reimburses for nurse practitioner services at 85% of the amount it pays physicians.

Last year, in more than 40 states, the American Medical Association and its partners lobbied against what they see as “scope creep” in the expanded roles of nurse practitioners and other health workers. The AMA points out that doctors must have more schooling and significantly more clinical experience than nurse practitioners. While the AMA says physician-led teams keep costs lower, a study published in 2020 in Health Services Research found similar patient outcomes and lower costs for nurse practitioner patients. Other studies, including one published in 2023 in the journal Medical Care Research and Review, have found health care models including nurse practitioners had better outcomes for patients with multiple chronic conditions than teams without an NP.

Five states have granted NPs full practice authority since 2021, with Utah the most recent state to remove physician supervision requirements, in 2023. In March, however, Mississippi House Bill 849, which would have increased NP independence, failed. Meanwhile, 30 Texas physicians rallied to tamp down full-scope efforts in Austin.

“I would fully disagree that we’re invading their scope of practice and shouldn’t have full scope of our own,” Johnson said.

She has worked under the supervision of physicians in Pennsylvania and Washington state but started seeing patients at her own practice in 2021. Like many nurse practitioners, she sees her patients in their homes. The first thing she does when she gets a new patient is manage their prescriptions, getting rid of unnecessary medications, especially those with harsh side effects.

She works with the patient and a family member who often has power of attorney. She keeps them informed of subtle changes, such as whether a person was verbal and eating and whether their medical conditions have changed.

While there is some overlap in expertise between geriatricians and nurse practitioners, there are areas where nurses typically excel, said Elizabeth White, an assistant professor of health services, policy, and practice at Brown University.

“We tend to be a little stronger in care coordination, family and patient education, and integrating care and social and medical needs. That’s very much in the nursing domain,” she said.

That care coordination will become even more critical as the U.S. ages. Today, about 18% of the U.S. population is 65 or over. In the next 30 years, the share of seniors is expected to reach 23%, as medical and technological advances enable people to live longer.

Patient and Family

In an office next to Ellen’s bedroom, Johnson called Ellen’s younger sister Margaret Watt to recommend that Ellen enter hospice care. Johnson told her that Ellen had developed pneumonia and her body wasn’t coping.

Watt appreciated that Johnson had kept the family apprised of Ellen’s condition for several years, saying she was a good communicator.

“She was accurate,” Watt said. “What she said would happen, happened.”

A month after the consult, Ellen died peacefully in her sleep.

“I do feel sadness,” Johnson said, “but there’s also a sense of relief that I’ve been with her through her suffering to try to alleviate it, and I’ve helped her meet her and her family’s priorities in that time.”

Jariel Arvin is a reporter with the Investigative Reporting Program at the University of California-Berkeley Graduate School of Journalism. He reported this article through a grant from The SCAN Foundation.

The post Nurse Practitioners Critical in Treating Older Adults as Ranks of Geriatricians Shrink appeared first on Medika Life.

“First 100 days,” said Means, a former consultant to Big Pharma who uses the social platform X to focus attention on chronic disease. “What should be done to reform the FDA?”

The question was more than rhetorical. Means is among a cadre of health business leaders and nonmainstream doctors who are influencing President Donald Trump’s focus on health policy.

Trump’s return to the White House has given Means and others in this space significant clout in shaping the nascent health policies of the new administration and its federal agencies. It’s also giving newfound momentum to “Make America Healthy Again,” or MAHA, a controversial movement that challenges prevailing thinking on public health and chronic disease.

Its followers couch their ideals in phrases like “health freedom” and “true health.” Their stated causes are as diverse as revamping certain agricultural subsidies, firing National Institutes of Health employees, rethinking childhood vaccination schedules, and banning marketing of ultra-processed foods to children on TV.

Public health leaders say the emerging Trump administration’s interest in elevating the sometimes unorthodox concepts could be catastrophic, eroding decades of scientific progress while spurring a rise in preventable disease. They worry the administration’s support could weaken trust in public health agencies.

Georges Benjamin, executive director of the American Public Health Association, said he welcomes broad intellectual scientific discussion but is concerned that Trump will parrot untested and unproven public health ideas he hears as if they are fact.

Experience has shown that people with unproven ideas will have his ear and his “very large bully pulpit,” he said. “Because he’s president, people will believe he won’t say things that aren’t true. This president, he will.”

But those in the MAHA camp have a very different take. They say they have been maligned as dangerous for questioning the status quo. The election has given them an enormous opportunity to shape politics and policies, and they say they won’t undermine public health. Instead, they say, they will restore trust in federal health agencies that lost public support during the pandemic.

“It may be a brilliant strategy by the right,” said Peter McCullough, a cardiologist who has come under fire for saying covid-19 vaccines are unsafe. He was describing some of the election-season messaging that mainstreamed their perspectives. “The right was saying we care about medical and environmental issues. The left was pursuing abortion rights and a negative campaign on Trump. But everyone should care about health. Health should be apolitical.”

The movement is largely anti-regulatory and anti-big government, whether concerning raw milk or drug approvals, although implementing changes would require more regulation. Many of its concepts cross over to include ideas that have also been championed by some on the far left.

Robert F. Kennedy Jr., an anti-vaccine activist Trump has nominated to run the Department of Health and Human Services, has called for firing hundreds of people at the National Institutes of Health, removing fluoride from water, boosting federal support for psychedelic therapy, and loosening restrictions on raw milk, consumption of which can expose consumers to foodborne illness. Its sale has prompted federal raids on farms for not complying with food safety regulations.

Means has called for top-down changes at the U.S. Department of Agriculture, which he says has been co-opted by the food industry.

Though he himself is not trained in science or medicine, he has said people had almost no chance of dying of covid-19 if they were “metabolically healthy,” referring to eating, sleeping, exercise, and stress management habits, and has said that about 85% of deaths and health care costs in the U.S. are tied to preventable foodborne metabolic conditions.

A co-founder of Truemed, a company that helps consumers use pretax savings and reimbursement programs on supplements, sleep aids, and exercise equipment, Means says he has had conversations behind closed doors with dozens of members of Congress. He said he also helped bring RFK Jr. and Trump together. RFK Jr. endorsed Trump in August after ending his independent presidential campaign.

“I had this vision for a year, actually. It sounds very woo-woo, but I was in a sweat tent with him in Austin at a campaign event six months before, and I just had this strong vision of him standing with Trump,” Means said recently on the Joe Rogan Experience podcast.

The former self-described never-Trumper said that, after Trump’s first assassination attempt, he felt it was a powerful moment. Means called RFK Jr. and worked with conservative political commentator Tucker Carlson to connect him to the former president. Trump and RFK Jr. then had weeks of conversations about topics such as child obesity and causes of infertility, Means said.

“I really felt, and he felt, like this could be a realignment of American politics,” Means said.

He is joined in the effort by his sister, Casey Means, a Stanford University-trained doctor and co-author with her brother of “Good Energy,” a book about improving metabolic health. The duo has blamed Big Pharma and the agriculture industry for increasing rates of obesity, depression, and chronic health conditions in the country. They have also raised questions about vaccines.

“Yeah, I bet that one vaccine probably isn’t causing autism, but what about the 20 that they are getting before 18 months,” Casey Means said in the Joe Rogan podcast episode with her brother.

The movement, which challenges what its adherents call “the cult of science,” gained significant traction during the pandemic, fueled by a backlash against vaccine and mask mandates that flourished during the Biden administration. Many of its supporters say they gained followers who believed they had been misled on the effectiveness of covid-19 vaccines.

In July 2022, Deborah Birx, covid-19 response coordinator in Trump’s first administration, said on Fox News that “we overplayed the vaccines,” although she noted that they do work.

Anthony Fauci, who advised Trump during the pandemic, in December 2020 called the vaccines a game changer that could diminish covid-19 the way the polio vaccine did for that disease.

Eventually, though, it became evident that the shots don’t necessarily prevent transmission and the effectiveness of the booster wanes with time, which some conservatives say led to disillusionment that has driven interest in the health freedom movement.

Federal health officials say the rollout of the covid vaccine was a turning point in the pandemic and that the shots lessen the severity of the disease by teaching the immune system to recognize and fight the virus that causes it.

Postelection, some Trump allies such as Elon Musk have called for Fauci to be prosecuted. Fauci declined to comment.

Joe Grogan, a former director of the White House’s Domestic Policy Council and assistant to Trump, said conservatives have been trying to articulate why government control of health care is troublesome.

“Two things have happened. The government went totally overboard and lied about many things during covid and showed no compassion about people’s needs outside of covid,” he said. “RFK Jr. came along and articulated very simply that government control of health care can’t be trusted, and we’re spending money, and it isn’t making anyone healthier. In some instances, it may be making people sicker.”

The MAHA movement capitalizes on many of the nonconventional health concepts that have been darlings of the left, such as promoting organic foods and food as medicine. But in an environment of polarized politics, the growing prominence of leaders who challenge what they call the cult of science could lead to more public confusion and division, some health analysts say.

Jeffrey Singer, a surgeon and senior fellow at the Cato Institute, a libertarian public policy research group, said in a statement that he agrees with RFK Jr.’s focus on reevaluating the public health system. But he said it comes with risks.

“I am concerned that many of RFK Jr.’s claims about vaccine safety, environmental toxins, and food additives lack evidence, have stoked public fears, and contributed to a decline in childhood vaccination rates,” he said.

Measles vaccination among kindergartners in the U.S. dropped to 92.7% in the 2023-24 school year from 95.2% in the 2019-20 school year, according to the Centers for Disease Control and Prevention. The agency said that has left about 280,000 kindergartners at risk.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

The post Make America Healthy Again: An Unconventional Movement That May Have Found Its Moment appeared first on Medika Life.

By leveraging local knowledge and fostering active community participation, these initiatives ensure that interventions are effective, culturally relevant, and sustainable. It’s about empowering the community to take control of their health destinies, making sure every step taken is a step that resonates with their unique way of life. When communities are at the helm, the improvements in health outcomes are not just significant; they are monumental, lasting, and deeply personal. This is the true power of community-driven public health: a collaborative effort that transforms lives, one initiative at a time.

Community-driven initiatives are crucial for several reasons. First, they promote higher levels of engagement and ownership among community members, leading to more sustainable health outcomes. Second, when communities are directly involved in identifying problems and implementing solutions, the interventions are more likely to be culturally relevant and accepted.

Moreover, these initiatives often leverage local knowledge and resources, making them cost-effective and adaptable to specific local contexts. Community participation also helps in building trust and accountability, which are essential for the success of any public health intervention. Finally, community-driven initiatives can bridge gaps in formal health systems by providing tailored solutions to underserved populations.

Successful community initiatives

Engaging community members in every step of the process ensures ownership and sustainability. Moreover, strong local leaders can drive change and motivate others to participate. Focusing on long-term solutions, such as sustainable agriculture or sanitation facilities, ensures lasting benefits. Collaboration with government agencies can also provide additional resources and legitimacy to the initiatives.

In India, the Swachh Bharat Abhiyan, or Clean India Mission, is a nationwide campaign launched by the government to improve sanitation and hygiene. Communities across urban and rural areas have been mobilized to build toilets, promote handwashing, and eliminate open defecation.i Similarly, the Self-Employed Women’s Association (SEWA) has also implemented various health initiatives to empower women and improve family health. Its approach integrates health education with economic empowerment.ii

The Aaraku Coffee Project in Andhra Pradesh is another unique initiative combining sustainable agriculture and health improvement. Alongside agricultural training, the project includes health education and the provision of basic healthcare services to tribal communities. The holistic approach of integrating economic development with health interventions has proven to be highly effective in enhancing the well-being of the community.iii

The Mae Fah Luang Foundation in Thailand is a prime example of how sustainable agricultural practices, such as organic farming, can drive public health improvements. Established to improve the livelihoods of hill tribe communities, the foundation has integrated health initiatives with economic development.iv By promoting sustainable agriculture, the foundation has enhanced food security and reduced malnutrition and health issues related to poverty.

Similarly, in the Philippines, community-led health and nutrition programs such as the Integrated Community Food Production initiative have empowered local communities to produce their own food through sustainable methods, thereby reducing the rates of malnutrition, especially in children.v

Another example is how Indonesia has implemented numerous community-driven projects aimed at improving water quality and sanitation, which are critical for preventing waterborne diseases. One notable initiative is the Community-Based Total Sanitation (CBTS) programme, which encourages communities to build and maintain their own sanitation facilities, thereby reducing open defecation and improving overall hygiene.vi

However, it’s important to acknowledge that these community-level initiatives often face formidable challenges such as limited resources and resistance to change. Overcoming these hurdles demands not just flexibility and persistent community engagement but also an unwavering commitment to adapt interventions based on real-time feedback.

What have we learned from these efforts? First and foremost, building trust within the community is paramount as it is the foundation upon which all successful interventions are built. Continuous education and training are equally essential, ensuring that community members are well-equipped to sustain these initiatives. Moreover, integrating economic development with health interventions has proven to be a game-changer, demonstrating that health and prosperity go hand in hand.

Community initiatives are not just a piece of the puzzle but the driving force behind sustainable public health changes. By actively engaging local populations, tapping into cultural wisdom, and emphasizing sustainable practices, these initiatives have significantly improved health outcomes across the Asia-Pacific region. These stories are powerful testaments to the potential of community-driven efforts to create lasting public health improvements. They serve as valuable blueprints for future initiatives, illustrating that we can overcome any challenge and build healthier, more resilient communities with trust, education, and economic integration.

The post Grassroots success: Community Initiatives Transforming Public Health appeared first on Medika Life.

Even a peep of news about a new flu pandemic is enough to set scientists clucking about eggs.

They worried about them in 2005, and in 2009, and they’re worrying now. That’s because millions of fertilized hen eggs are still the main ingredient in making vaccines that, hopefully, will protect people against the outbreak of a new flu strain.

“It’s almost comical to be using a 1940s technology for a 21^st-century pandemic,” said Rick Bright, who led the Health and Human Services Department’s Biomedical Advanced Research and Development Authority (BARDA) during the Trump administration.

It’s not so funny, he said, when the currently stockpiled formulation against the H5N1 bird flu virus requires two shots and a whopping 90 micrograms of antigen, yet provides just middling immunity. “For the U.S. alone, it would take hens laying 900,000 eggs every single day for nine months,” Bright said.

And that’s only if the chickens don’t get infected.

The spread of an avian flu virus has decimated flocks of birds (and killed barn cats and other mammals). Cattle in at least nine states and at least three people in the U.S. have been infected, enough to bring public health attention once again to the potential for a global pandemic.

As of May 30, the only confirmed human cases of infection were dairy workers in Texas and Michigan, who experienced eye irritation. Two quickly recovered, while the third developed respiratory symptoms and was being treated with an antiviral drug at home. The virus’s spread into multiple species over a vast geographic area, however, raises the threat that further mutations could create a virus that spreads from human to human through airborne transmission.

If they do, prevention starts with the egg.

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To make raw material for an influenza vaccine, virus is grown in millions of fertilized eggs. Sometimes it doesn’t grow well, or it mutates to a degree that the vaccine product stimulates antibodies that don’t neutralize the virus — or the wild virus mutates to an extent that the vaccine doesn’t work against it. And there’s always the frightening prospect that wild birds could carry the virus into the henhouses needed in vaccine production.

“Once those roosters and hens go down, you have no vaccine,” Bright said.

Since 2009, when an H1N1 swine flu pandemic swept around the world before vaccine production could get off the ground, researchers and governments have been looking for alternatives. Billions of dollars have been invested into vaccines produced in mammalian and insect cell lines that don’t pose the same risks as egg-based shots.

“Everyone knows the cell-based vaccines are better, more immunogenic, and offer better production,” said Amesh Adalja, an infectious disease specialist at Johns Hopkins University’s Center for Health Security. “But they are handicapped because of the clout of egg-based manufacturing.”

The companies that make the cell-based influenza vaccines, CSL Seqirus and Sanofi, also have billions invested in egg-based production lines that they aren’t eager to replace. And it’s hard to blame them, said Nicole Lurie, HHS’ assistant secretary for preparedness and response under President Barack Obama who is now an executive director of CEPI, the global epidemic-fighting nonprofit.

“Most vaccine companies that responded to an epidemic — Ebola, Zika, covid — ended up losing a lot of money on it,” Lurie said.

Exceptions were the mRNA vaccines created for covid, although even Pfizer and Moderna have had to destroy hundreds of millions of doses of unwanted vaccine as public interest waned.

Pfizer and Moderna are testing seasonal influenza vaccines made with mRNA, and the government is soliciting bids for mRNA pandemic flu vaccines, said David Boucher, director of infectious disease preparedness at HHS’ Administration for Strategic Preparedness and Response.

Bright, whose agency invested a billion dollars in a cell-based flu vaccine factory in Holly Springs, North Carolina, said there’s “no way in hell we can fight an H5N1 pandemic with an egg-based vaccine.” But for now, there’s little choice.

BARDA has stockpiled hundreds of thousands of doses of an H5N1-strain vaccine that stimulates the creation of antibodies that appear to neutralize the virus now circulating. It could produce millions more doses of the vaccine within weeks and up to 100 million doses in five months, Boucher told KFF Health News.

But the vaccines currently in the national stockpile are not a perfect match for the strain in question. Even with two shots containing six times as much vaccine substance as typical flu shots, the stockpiled vaccines were only partly effective against strains of the virus that circulated when those vaccines were made, Adalja said.

However, BARDA is currently supporting two clinical trials with a candidate vaccine virus that “is a good match for what we’ve found in cows,” Boucher said.

Flu vaccine makers are just starting to prepare this fall’s shots but, eventually, the federal government could request production be switched to a pandemic-targeted strain.

“We don’t have the capacity to do both,” Adalja said.

For now, ASPR has a stockpile of bulk pandemic vaccine and has identified manufacturing sites where 4.8 million doses could be bottled and finished without stopping production of seasonal flu vaccine, ASPR chief Dawn O’Connell said on May 22. U.S. officials began trying to diversify away from egg-based vaccines in 2005, when avian flu first gripped the world, and with added vigor after the 2009 fiasco. But “with the resources we have available, we get the best bang for our buck and best value to U.S. taxpayers when we leverage the seasonal infrastructure, and that’s still mostly egg-based,” Boucher said.

Flu vaccine companies “have a system that works well right now to accomplish their objectives in manufacturing the seasonal vaccine,” he said. And without a financial incentive, “we are going to be here with eggs for a while, I think.”

Arthur Allen: aallen@kff.org, @ArthurAllen202

The post The Chicken and Egg Problem of Fighting Another Flu Pandemic appeared first on Medika Life.

But what would I do if I could only attend one and not the other?  Sorry, you’ll have to crystal ball that answer. 

I’m dedicated to health innovation that can improve people’s health.  I recognize that the fragmented health ecosystem creates a self-inflicted system-wide chaos that diminishes the provider’s ability to help people seeking healing. It results in patients having to re-tell their medical narrative again and again to each health provider they engage.  It leads people needing preventive or follow-on care to fall through system cracks.  It means that people most at risk due to enduring and unjust health disparities are left to wither.  That injustice pains and angers me.

The Business of Industry Conferences

Who doesn’t have FOMO – the fear of missing out – as we see the explosion of selfies on LinkedIn, X, Thread and Instagram of industry friends and colleagues and realize we’re not among Nick Adkins’ #Pinksocks or Swaay Health group photo glam? It’s like being invited to a hot party, not showing up, only to hear later that it was “incredible” and how we missed out. That’s life. Even Bruce Wayne and Batman can’t be in the same place simultaneously.

Industry gatherings – conferences, summits, and meet-ups – are revenue-generating businesses, from selling lanyards to exhibit costs to sponsoring satellite sessions.  To accommodate attendees, the companies that organize these mammoth events need to drive efficiency to reach profitability.  They need to inform and entertain. Don’t begrudge them the right to make money – sustainable gatherings lead to enduring communities.  We all benefit from the consistent, collaborative exchange.

Logistics are Often Planned Years in Advance

These meetings are geo-positioned corresponding to audience size, and space is secured many years and years in advance.  HIMSS is a 36,000-person gathering.  In the United States, only three venues can likely accommodate that meeting size: Orlando, Chicago, and Las Vegas.  ViVE has almost 8,000 attendees, more location flexibility, and wisely, it is heading back to Nashville – the nation’s capital of health provider services.  As businesses, their timing depends on the competitive strategy to attract sponsors, speakers and attendees. Retaining attendees annually creates a powerful magnet to draw in others – friends of friends.

ViVE, only three years old, is a hit. The blend of major sessions held within the exhibit hall, evening social events, and size speak to people’s need to connect with thought leaders and find a place within the CHIME/ViVE community.

Competitive or Different Missions 

Our mindsets are too often structured to pit one against the other.  Don’t go there. These two health industry gatherings are very different in rationale, structure, duration of time, and desired outcome. I don’t favor one over the other and schedule for both.  Imagine if we started to choose among ATA, HIMSS, SXSW, and ViVE.  

It’s an interesting polemic – especially if you only have the budget to attend one or two of these gatherings.  If budget and time demand, I recommend picking two to three and investing your time in cementing a network of advisors, mentors, and community.  [NOTE: I tend to center my meeting schedule around CNS Summit, HIMSS, HITLAB, HLTH, and ViVE – though I attend others such as the Digital Health & AI Innovation Summit.]

Keep in mind the top speakers rotate among all these gatherings. It is their responsibility as institutional thought leaders to share their wisdom.  So, we must listen to and learn from leaders such as Rasu Shrestha, MD, Walter Greenleaf, Ph.D., or Tom Lawry, who are likely to attend or speak at many of these gatherings.  However, the attendees and the call-to-action required determine their message flow and should set your scheduling priorities.  

ViVE draws me in due to its intimacy and community.  Like CNS Summit (Collaborate for Novel Solutions), ViVe is “right-sized” to rub shoulders with key colleagues, move swiftly from session to session, and have an exhibit floor that doesn’t require cutting through the jungle.  It is a magnet for like-minded digital health grass-tops leaders who want to check in and connect about how the system can better align workflow processes.  Clear process results in better (health-system) performance.

Digital health in itself is misunderstood.  Apps and wearables are the tip of the information iceberg.  It is about digitizing the health system overall and connecting the provider system to the consumer – seamless care.  That remains an enormous undertaking for an industry sector that still clings to the old ways, like a three-year-old to a beloved teddy bear, despite being told to abandon its treasured fax machines.  Digital encompasses how we will deploy AI, ChatGPT and GenAI to improve workflow.  It demands that we position health equity as the core priority of these efforts.  It considers how we can connect consumers to their providers confidently and well within HIPAA parameters.

I like ViVE for many reasons – mainly because I can enter into conversations with people seasoned enough to influence corporate strategy or at least inspire each other and are eager to learn and hear from others who care equally about the patient experience.  I think ViVE enables attendees to revisit critical elements of the health system that determine business success. Don’t ever underestimate reflection. The CHIME/ViVE connection offers added value and brings a strong community mindset.

HIMSS is the Davos of Health Information

HIMSS is a 70-year-old society with 125,000 members worldwide.  Since 1962, it has held an annual global meeting, part of a bigger effort to serve patients by democratizing information with best-practice standards.

“HIMSS is where big ideas are discussed, innovation is created, and professionals make the connections that will change the future of healthcare. From the engineers and developers building new solutions to the technology leaders guiding health systems through major challenges like the ethical use of AI and cybersecurity, HIMSS conferences are a meeting of the minds that will create tomorrow’s health,” said Christine Buck, HIMSS chief marketing officer.

Yet, the HIMSS conference is much more than scale – 36,000 people focused on health information. It’s about where these attendees come from and their determination to shape health access and delivery standards.  They hail from 70 countries, and their titles range from Health Minister of Korea to call center manager from South Dakota.  They’re wearing US Armed Forces non-commissioned officer to bird colonel military ranks or t-shirts and jeans from the top dogs at global giants like CISCO, EPIC and Microsoft to health tech start-ups.

“My favorite part? The authentic, genuine, and casual nature of interactions with other humans in the health industry who are navigating the mutual hallways of mixed indifference and passion — the marketing formality gives way to our better nature of connection and collaboration,” says Matt Cybulsky Ph.D., host of edgy The Digital Health Roundtable.

HIMSS is a moving city, and expect to cover your step goal during its five-day 8 AM to 6 PM schedule, including hundreds of sessions curated, tracked, and peer-reviewed by HIMSS-member volunteers.  Along with a bolus of professional development, there are key NGO moments where government leaders announce new international health information management agreements. HIMSS is a society that encompasses best-practice solutions, professional development and public policy.

For example, during the meeting, Hal Wolf, president and CEO of HIMSS, and Geun Chan Lim, CEO of Korea Health Information Service, signed a Memorandum of Understanding (MOU) cementing a three-year relationship between HIMSS and the Republic of Korea for Electronic Medical Record adoption in hospitals throughout the country.  HIMSS transcends the definition of a meeting; it’s a professional society that works across industries and countries.

“HIMSS conferences and events provide our membership – and all our attendees – with unrivaled access to best-in-class thought leaders, educational programming, and groundbreaking speakers. HIMSS24 helped drive awareness of pressing health equity issues and social determinants of health while also creating a space for everyone from CIOs to nurses to build connections and collaborate,” adds Buck.

Apples or Oranges?

The idiom comparing two dissimilar objects was originally apples to oysters.  Things change over time. Originator John Ray penned his thoughts in a collection of sayings in 1670.  It wasn’t a competition between two fruits but a reminder that they’re different, so don’t compare. 

I was at ViVE.  I was at HIMSS. I value lessons learned – albeit different – from both.  Apples and oranges.  I like them both.

The post ViVE and HIMSS – Apples to Apples? Apples to Oranges? appeared first on Medika Life.

At the forefront of these preventable tragedies is pneumonia, a leading cause of death that can often be averted through inexpensive vaccines and antibiotics. Immunisation campaigns and community health programs can ensure that treatments reach those in need, transforming a potential death sentence into a manageable condition. Simple practices, such as promoting exclusive breastfeeding, can also bolster a child’s immune system against pneumonia and other diseases.

Diarrheal diseases, closely linked to poor sanitation and unsafe water, are another major threat to young lives. However, the provision of oral rehydration solutions (ORS) and zinc supplements offers a beacon of hope. These treatments, costing mere cents per dose, can swiftly restore hydration and save lives. Moreover, investing in clean water initiatives and basic hygiene education provides a sustainable path to disease prevention.

Malaria, a relentless killer in many low-income regions, particularly Sub-Saharan Africa, can be effectively combated with insecticide-treated mosquito nets and prophylactic antimalarial medications. These interventions, surprisingly affordable, can drastically reduce malaria incidence and mortality among vulnerable infant populations.

Neonatal conditions, such as complications from preterm birth, infections, and birth asphyxia, highlight the critical need for improved maternal and newborn care. Skilled birth attendance, a cost-effective strategy, can prevent many such deaths. Additionally, kangaroo mother care (skin-to-skin contact) and basic neonatal resuscitation techniques offer low-cost, high-impact solutions to neonatal mortality.

Lastly, malnutrition — a pervasive threat to child survival — can be addressed through nutrition education, support for exclusive breastfeeding, and the provision of vitamin A and micronutrient powders. These interventions prevent death and promote healthy development, all at a minimal cost.

The narrative of child mortality in low-income countries is not solely one of despair but also one of hope and opportunity. By implementing these low-cost interventions, the global community can make significant strides in saving lives and nurturing the potential of millions of children. It is a testament to the power of simple, affordable solutions facing daunting challenges, offering a brighter future for the world’s most vulnerable populations.

Low-cost interventions that save lives

Pneumonia

• Vaccination: The pneumococcal and Hib vaccines can prevent many pneumonia cases. The cost can vary, but Gavi, the Vaccine Alliance, has negotiated prices as low as USD 1.5 per dose for some vaccines in low-income countries.
• Exclusive Breastfeeding: Encouraging exclusive breastfeeding for the first six months of life can significantly improve a child’s immunity. The costs here are more about education and support systems for mothers.
• Access to Antibiotics: For cases where pneumonia develops, timely administration of antibiotics can save lives. A full course of antibiotics for pneumonia treatment can cost less than USD 0.50 per child.

Diarrheal Diseases

• Rotavirus Vaccination: Rotavirus vaccines effectively prevent the most common cause of severe diarrhoea in children, with costs in Gavi-supported countries around USD 1–3 per dose.
• Clean Water and Sanitation (WASH): Providing access to clean water and promoting handwashing can drastically reduce diarrheal diseases. The cost per child can be very low when spread across communities but varies widely depending on the specific intervention and infrastructure development.
• Oral Rehydration Salts (ORS) and Zinc Supplementation: These are highly effective treatments for diarrheal diseases, costing as little as USD 0.50 for ORS packets and zinc supplements for one treatment course.

Malaria

• Insecticide-Treated Nets (ITNs): Mosquito nets treated with insecticide are a simple, effective way to prevent malaria. The cost per net is typically around USD 2–3, and each net can protect up to two children for up to three years.
• Indoor Residual Spraying (IRS): Spraying the inside of homes with insecticides can also reduce malaria transmission. The cost varies but is generally between USD 3–7 per person per year.
• Antimalarial Drugs: Prophylactic antimalarial drugs for pregnant women and young children in high-risk areas can prevent illness. The cost per treatment is around USD 0.50 to USD 1.
• Artemisinin-based combination therapies (ACTs) are the cornerstone of malaria treatment recommended by the World Health Organization (WHO) for uncomplicated Plasmodium falciparum malaria. The cost of ACTs in low-income countries varies, influenced by factors such as local policies, subsidies, the involvement of global health initiatives, and whether the drugs are purchased in the public or private sector. A typical course is just three days of treatment, and the cost to the healthcare system is less than USD 1.
• Anti-malarial vaccines: The R21 vaccine is the second malaria vaccine recommended by WHO, following the RTS,S/AS01 vaccine, which received a WHO recommendation in 2021. Both vaccines are shown to be safe and effective in preventing malaria in children and, when implemented broadly, are expected to have a high public health impact. Three to four doses are administered at USD 2 — USD 4 per dose.

Neonatal Conditions

• Skilled Birth Attendance: Ensuring that births are attended by skilled health personnel can significantly reduce neonatal deaths. Training community health workers can be relatively low-cost, with significant returns in reduced mortality.
• Thermal Care: Simple practices like kangaroo mother care (skin-to-skin contact) can prevent hypothermia in newborns with negligible cost.
• Basic Neonatal Care: Including clean delivery practices, proper cord care, and early breastfeeding initiation. The cost here is more about training and education than direct intervention costs.

Nutritional Deficiencies

• Exclusive Breastfeeding: Promoted for the first six months to provide all necessary nutrients and improve immunity.
• Vitamin A Supplementation: This can significantly reduce child mortality from all causes, with each dose costing as little as USD 0.02 to USD 0.30.
• Micronutrient Powders: Sprinkle on foods can combat malnutrition, costing about USD 0.03 to USD 0.10 per sachet.

How many children between the ages of zero to five live in low-income countries

Unfortunately, there isn’t a single, definitive source with data on the exact number of children aged 0 to 5 living in low-income countries. This is due to a few reasons:

• Defining “low-income countries”: Different classifications are used by organisations like the World Bank. These classifications can change over time.
• Data collection challenges: Gathering accurate data in low-income countries can be difficult due to resource limitations and infrastructure issues.

However, we can look at child poverty data as a proxy. UNICEF reports that 333 million children live in extreme poverty worldwide, meaning they lack necessities like food, shelter, sanitation, healthcare, and education. This data can give us a general idea of the magnitude of the problem.

What can be done?

Governments, NGOs, and civil society play pivotal roles in mitigating child mortality in low-income countries, leveraging their unique positions to initiate, support, and scale up various interventions. Here are ways these entities can collaborate and contribute effectively:

Strengthening Healthcare Systems

• Governments can allocate increased funding to health services, ensuring that healthcare facilities are adequately staffed, equipped, and accessible to the population, including remote areas.
• NGOs often work to fill gaps in healthcare provision, providing training for healthcare workers, supplying medical equipment and medications, and setting up mobile clinics to reach underserved communities.
• Civil Society can advocate for improved healthcare policies and transparency in healthcare funding, ensuring that resources are allocated effectively and equitably.

Promoting Preventative Measures

• All three can collaborate on vaccination campaigns to protect against pneumonia and measles. Education campaigns to promote breastfeeding, proper nutrition, and hygiene practices can also substantially impact the situation.
• NGOs and civil society can support the distribution of mosquito nets and conduct awareness campaigns on their use to prevent malaria, a leading cause of child mortality.

Improving Water, Sanitation, and Hygiene (WASH)

• Governments can invest in infrastructure to provide clean water and sanitation facilities, which are crucial for preventing diarrheal diseases and improving overall health.
• NGOs frequently engage in WASH projects, constructing toilets and facilitating access to clean water through wells and filtration systems.
• Civil Society can mobilise community involvement in maintaining and protecting water and sanitation infrastructure and promote hygiene practices.

Ensuring Food Security and Nutritional Support

• Initiatives to improve access to nutritious food can significantly impact child health. Governments can implement policies and programs to support agricultural productivity, subsidise essential foods, and ensure nutritional programs reach vulnerable populations.
• NGOs may provide direct food aid, support school feeding programs, and teach sustainable farming techniques to communities.
• Civil Society can raise awareness about malnutrition, advocate for policy changes, and support community-based nutrition and gardening projects.

Education and Empowerment

• Educating girls and women has a profound impact on child health outcomes. Governments can ensure equal access to education, while NGOs can provide scholarships or support for girls’ education.
• Civil society, including local communities and parent groups, can advocate for educational reforms and support initiatives that empower women and girls.

Advocacy and Policy Influence

• Civil society organisations can lobby for policies prioritising child health, including environmental protections to reduce pollution and combat climate change, which impacts children’s health.
• They can also be crucial in holding governments and international bodies accountable for their commitments to child health and rights

Collaboration across these sectors is crucial for creating sustainable change. By pooling resources, sharing knowledge, and coordinating efforts, governments, NGOs, and civil society can significantly reduce child mortality rates and improve health outcomes for children in low-income countries. Their combined efforts can address the root causes of child mortality, ensuring that children have the chance to lead healthy, productive lives.

Concluding

The stark reality of child mortality in low-income countries, particularly among infants aged 0 to 5, represents a profound global health challenge. Yet, as outlined, the breadth of low-cost, highly effective interventions available to combat this crisis offers a beacon of hope. These interventions, ranging from vaccinations and exclusive breastfeeding to access to clean water and nutritional supplements, underscore a critical truth: the power to reduce child mortality significantly is well within our grasp.

Moreover, the detailed strategies for pneumonia, diarrheal diseases, malaria, neonatal conditions, and nutritional deficiencies illustrate a clear path forward. The low-cost solutions presented are feasible and offer a high return on investment regarding lives saved and improved health outcomes. The role of artemisinin-based combination therapies (ACTs) in treating malaria, the impact of skilled birth attendance on neonatal survival, and the potential of vitamin A supplementation to bolster child health further highlight the array of tools at our disposal.

The task ahead requires a concerted effort from governments, NGOs, and civil society. Through increased funding, the implementation of health programs, advocacy, and education, these stakeholders can change the trajectory of child health in low-income countries. The call to action is clear: by embracing these low-cost interventions and fostering collaboration across sectors, we can address the root causes of child mortality and ensure that every child has the opportunity to thrive.

This collective endeavour presents a compelling opportunity to redefine the future for millions of children in low-income countries. As we move forward, let the narrative of child mortality be one not of despair but of hope, action, and profound transformation. Together, we can turn the tide against these preventable tragedies, paving the way for a healthier, brighter future for the world’s most vulnerable populations.

The post Main Cause of Death in Infants Ages Zero to Five in Low-Income Countries; Hope for a Better Future appeared first on Medika Life.

It was a move that supercharged my mission to make a difference in the world. It sparked a passion for providing people with a better shot at prosperity by improving access to health services, often by working in some of the world’s most challenging places.

My public health journey has had a lot of high points and reached another milestone this week with the launch of the FINN Partners Global Health Impact Group dedicated to harnessing the potential for health to catalyze economic growth in emerging markets and underserved communities around the world.

Looking back, I could not have wished for a better time to shift to public health. I started my career working in the consumer goods sector in Southeast Asia when countries there were the hottest economies around. This background and my corporate experience in the U.S. prepared me to blend traditional marketing and communications practices with the real-world challenges that confronted me in DR Congo and many other African and Asian countries where I would later work.

In the years since I moved to Kinshasa, a historic shift in the balance of power has gained momentum as traditionally poor and middle-income countries – nations whose citizens make roughly between $1,100 and $13,000 per year – gain prominence on the global economic stage.

“The rise of the rest,” as author and CNN Commentator Fareed once called this phenomenon, captures the growth of the group of low- and middle-income countries that now contribute almost 34 trillion dollars to the global economy, nearly one-third of total worldwide output, according to the World Bank.  To highlight the tremendous pace that developing countries have set over the past two decades, consider:  Real Gross Domestic Product (GDP), as reported by the International Monetary Fund, increased at an average rate of 4 percent among developing economies, compared with an average just under 2 percent growth for advanced countries.

While the astounding population growth of young African consumers has not yet translated to an economic boom, as global health communication advocate Mark Chataway notes, I remain optimistic that the dynamic growth we need to drive the global economy will come from the future markets of Africa and Asia.

The emergence of lower-income consumers as a major market force in these two regions offers tremendous opportunities for companies that can re-tool their marketing mix from a model that has traditionally targeted the most affluent one billion people on the planet to one that efficiently reaches the following several billion people.

While this idea isn’t new, it warrants renewed interest and investment in a post-pandemic, highly fractured world flirting with a rejection of globalism in favor of economically ruinous national isolationism.

Here’s why U.S. companies need to deepen their engagement with emerging markets: As incomes continue to rise in more than 100 countries throughout Africa, Asia and Latin America, so too will the demand for better healthcare, convenience products, electronics, and household staples, to name a few categories. 

How can organizations most effectively and sustainably succeed in this environment? In evaluating strategies for entry and sustainable management in many emerging markets, companies should consider establishing alliances with an unlikely resource: leading Non-Governmental Organizations (NGOs) operating locally. 

Building public-private partnerships between corporate and non-profit organizations can benefit both groups working in nascent and emerging markets. NGOs can often provide sharp insight into consumer habits and preferences, access to government influencers, and opportunities to build significant goodwill, brand recognition, and loyalty among local communities through the effective sponsorship of corporate social responsibility projects.

A strategic alliance between non-profits and companies also offers a less threatening means for global firms to operate in a new country than through the development of a venture with a local company in the same industry, a potential competitor that could receive protection from a host government down the road.

International and locally based NGOs have operated in developing countries for decades and have learned through tough lessons what works and what will often lead to failure.  Working with lean budgets and staff, many of these organizations have succeeded in grassroots outreach, communications, mobilization, and behavior change within population segments, often well outside of conventional marketing channels.  Those segments define the middle and bottom-of-the-pyramid consumers now sought after by multinational firms trying to build their brands and sustain competitive advantage in emerging markets.

At the same time, many non-profit organizations now view partnerships with the private sector as essential to their long-term ability to fulfill their mission of serving local populations.  Highly effective corporate responsibility programs have become mainstream in emerging markets as companies work with NGOs to contribute goodwill to needy populations while also meeting operational interests, such as improving employee and community health or safeguarding valuable natural resources that drive local economies.

The power of partnerships can offer three areas of strategic advantage to firms entering developing markets, particularly in Africa and South Asia:

• 360^o Market Data: Rather than relying solely on outside research firms, companies can work with NGO partners to round out their understanding of the consumer landscape in a new country, mainly when vital economic and cultural elements are in play. By operating in poorer communities and managing customer research and outreach operations over several years, NGOs often have a ready-built network of communities for private companies to engage as part of their market shaping.  These communities may deliver a more representative study sample, and the methodology for any consumer research efforts will be more informed through the input that NGOs and local community representatives can offer. At the same time, NGOs need more sophisticated marketing and outreach tools, particularly in segmenting populations, to deliver more relevant messaging.  These are areas of technical expertise that private sector partners can share.

• Access to Government Decision Makers: The emergence of mainstream consumerism in developing countries alters how some governments can support private sector development and direct foreign investment. Local and international NGOs have valuable insights regarding which government contacts are most appropriate to engage and how best to work with them. Money may talk in emerging markets, but transparent relationships with key government decision-makers are paramount for long-term operational success and competitive advantage. NGOs are an integral resource for helping companies to forge these government relationships. Correspondingly, the changing world of international aid requires NGOs to develop multilateral funding streams. Public-private partnerships offer a means for NGOs to build greater credibility and differentiation by demonstrating that they have the project scope and capacity to appeal to a broad base of donors.

• Brand Equity Development: Corporate responsibility programs offer a platform for companies to create brand awareness and loyalty in new markets while building goodwill in under-resourced populations. A partnership with an NGO operating in a developing country provides the opportunity to identify projects that meet a community’s social needs and the sponsoring company’s interests. NGOs undertaking projects may also gain positive recognition through such partnerships, particularly in countries where the reputations of development organizations have suffered from aid fatigue.

The risks are significant for firms venturing into low- and middle-income markets.  Market data, local relationships, and flexible operating models are indispensable resources, as are the right alliances.  Before relying on traditional approaches for assessing new market opportunities, consider how successful engagement and communication with NGO partners may offer the insights and understanding required for companies to reach efficiently and sustainably some of the most promising but untapped segments of the world’s population.

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