Imports like aspirin (Germany) and the heart transplant (South Africa) have become almost as American as apple pie. But in preventive health — keeping people from getting sick, or helping them manage the conditions they do have — we adapt too few of the best foreign innovations and models that have proven to be effective and sustainable at scale.

The U.S. spends far more per capita on healthcare than any other nation. Clearly we need to adopt cost-effective prevention efforts where we can. And we have to do so in a way that fits our health care infrastructure, including reliance on the private sector — a mix of for-profit and non-profit payers and providers — as the bedrock of our system. Two tactics that do fit, and can both lower costs and improve patient care, include more expansive use of mobile technology and of lay health workers. Both can be supported by non-profit intermediaries. Scalable models for these interventions are in use and successful in emerging economies, and are particularly germane where it comes to preventing illness and disease in low-income or geographically or linguistically hard-to-reach patient populations.

India’s Telemedicine

Take telemedicine for example, an approach to getting information to remote populations at a fraction of the cost of circuit-riding physicians. In India, 70% of the population lives in rural areas, but only 3% of the country’s specialist physicians practice in those areas. A nonprofit called World Health Partners (WHP) is working to bridge the gap by identifying informal health providers at the village level and using live streaming over the internet to connect them to highly qualified specialists far away. These lay workers, compensated through consultation fees and a reasonable mark up on drugs sold, measure blood pressure, temperature, heart rate, respiratory rate, and can assess EKGs and transmit the results directly to the specialist physicians.

The University of California at Berkeley has studied the program and reported a dramatic increase in access to reproductive health services among six million villagers at a cost of $5.84 per adult for a couple of years protection from pregnancy. Perhaps the most important lesson for the U.S. in WHP’s telemedicine initiatives in India is its approach to scale. Rather than implementing a program and figuring out later how it might be brought to very large numbers of people, WHP is building scalability into the design through low-cost approaches, and a reliance on for-profit rural practitioners — effectively working with the private sector to build a new market for preventative health.

INSIGHT CENTER

Brazil’s Integration of Lay Health Workers

More deeply integrating lay workers into our health system offers another path to lowering costs and broadening the reach of preventative health care. Most nations, including the U.S., make some use of lay or community health workers, but Brazil is notable for the scale at which it does this, and its success in integrating such workers into its larger healthcare system. A recent Johns Hopkins study notes that Brazil now deploys over 220,000 Community Health Agents (CHAs) to reach more than half of its 200 million residents. They work as members of health teams, including at least one doctor, one nurse, an assistant nurse and six CHAs to serve approximately 1,000 families. All the team members are salaried, full-time employees, and the CHAs must live in the communities they serve, promoting and delivering preventative health practices such as breastfeeding, prenatal care, immunizations, and screening for diseases including HIV and tuberculosis. In tandem with this approach, Brazil now has one of the most rapidly declining childhood mortality rates in the world, and has made striking gains in immunization coverage and other measures of preventive health addressed by the CHAs.

While the U.S., too, has some promising community health worker models, such as “health coaches” at AtlantiCare in Atlantic City, N.J., and “ promotoras” at Latino Health Access in Santa Ana, CA, Brazil’s experience offers us a path to scale, one that no longer views community health workers as “non-traditional,” but integrates them into the healthcare system, and, ultimately, pays for them in the same way that care in clinical settings is remunerated.

Mindset Before Model

 The “market” for preventive services is almost nothing like the market for automobiles; we can’t rely on market forces alone to increase the flow of global preventive health innovations into the U.S. But we should recall that Japanese automakers had been innovating for a long time before American automakers got serious about exploring and adapting these innovations. The first change may need to be mindset: expanding our view of where we might find powerful models for improving preventive health in the U.S., expanding our idea of who should be involved in identifying, prototyping, and scaling these models, and thinking big — designing for scale — from the outset.