Needed: Boring Health Care Solutions: Does global health have an unhealthy fixation on innovation? (Bi-Weekly Checkup, 8/3/13)
I have a confession to make: I recently developed an innovation addiction.
It started harmlessly, with a post I wrote back in June on the potential of 3D printing in health care. To my surprise and delight, the post blew up on Twitter, and while the reTweets didn’t reach Bieber levels, they were pretty impressive for the BoP health niche. The post’s traffic was orders of magnitude greater than most of our content.
So I wrote another post on innovations in sight and sound – and what do you know, it got another big reaction. To date, the posts stand as the second and third highest traffic blogs we’ve ever run on NextBillion Health Care – with #1 being another recent post on an mHealth innovation.
All of this may sound trivial, but in the life of a blog editor, traffic is king. So I soon found myself fixated on health innovation, constantly seeking out new inventions and exciting technologies to feature on the blog, hoping for another big hit.
Then I read this recent New Yorker article by Atul Gawande (a definite must-read, if you haven’t already seen it). In it, Gawande argues that there’s too much attention paid to flashy technological solutions to persistent health problems, and not enough to the slow, “boring” approaches that often bring more lasting results:
“We’re infatuated with the prospect of technological solutions to [health] problems—baby warmers, say. You can still find high-tech incubators in rural hospitals that sit mothballed because a replacement part wasn’t available, or because there was no electricity for them. … [But] with most difficulties in global health care, lack of adequate technology is not the biggest problem. We already have a great warming technology: a mother’s skin. But even in high-income countries we do not consistently use it. In the United States, according to Ringer, more than half of newborns needing intensive care arrive hypothermic. … Getting hospitals and birth attendants to carry out even a few of the tasks required for safer childbirth would save hundreds of thousands of lives. But how do we do that?”
The rest of the article attempts to answer that question, describing how difficult it is to instill health-promoting behaviors among both patients and their medical providers, and how big an impact these behaviors could make.
For instance, Gawande argues, if hospitals and birth attendants changed their approach to handling newborns, countless babies could be spared the harmful, even fatal effects of hypothermia. And if more parents gave their kids an affordable, easily produced oral rehydration solution (ORS) when they got diarrheal disease, millions of lives could potentially be saved.
Yet even when public health advocates recognize the potential of behavior change interventions, he says, they tend to turn to technology for a quick fix.
“In the era of the iPhone, Facebook, and Twitter, we’ve become enamored of ideas that spread as effortlessly as ether. We want frictionless, “turnkey” solutions to the major difficulties of the world—hunger, disease, poverty. We prefer instructional videos to teachers, drones to troops, incentives to institutions. … But technology and incentive programs are not enough. … People talking to people is still how the world’s standards change.”
He backs up his point by referencing the stunning success of BRAC’s outreach campaign in Bangladesh, which, starting in 1980, sent teams door-to-door in over 75,000 villages to teach parents to mix and administer ORS at home. The campaign led to a more than 80 percent drop in diarrhea deaths among children. Three decades later, almost 90 percent of children are still given the solution when they fall ill – while in other countries and contexts, countless innovative products and eye-catching mass media campaigns have come and gone, without making much of an impact.
After reading the article, I started to question my own approach to health issues, and by extension, what seems to be the dominant tendency of many in global health, social enterprise – or just about any other field these days. We’re all fascinated by the latest breakthroughs, the coolest technologies and the solutions that fall farthest “outside the box.” But simple things like breastfeeding babies and hand washing could prevent millions of deaths and provide a lifetime of health benefits. And if Gawande is right, the best way to promote these practices may be through old-fashioned, face-to-face outreach.
Too expensive? Too slow? Just too dull? Maybe. But the money is out there, and there are models to follow. So next time you hear about millions being invested in a mind-blowing new technology, think what might be achievable if that money were spent on solutions that aren’t so sexy – but that might have far greater impacts.
(And don’t worry, NextBillion Health Care will still find time to cover the cool innovations – hey, we’re only human.)