Public Health Progress, In a Perilous Time

Travel to India, Bangladesh, Ethiopia, and Nigeria highlights the challenges — and great promise — of community-led public health

Visiting a Health and Wellness Centre in Varnasi, Uttar Pradesh.

The power of community

I first traveled to India to work on tuberculosis control in 1995, and I had the honor and pleasure of living and working in India, on secondment from the U.S. CDC to the World Health Organization, from 1996–2002. I’ve traveled back for work just about every year — until the pandemic — so it was great to be back.

“She’s better than the doctors in town! Because of her, we’re able to get the medicine we need!” one patient told me, his eyes beaming with pride.

Perhaps the most promising health development in my 27 years working with colleagues and communities in India is the country’s expansion of Health and Wellness Centres. These community-based health facilities, staffed by nurses and other health professionals with advanced training, are able to care for the most common needs of patients.

Meeting dedicated health workers and their patients was a highlight of my visit to India.

A little can go a long way, but more support is needed

In Bangladesh, Ethiopia, and Nigeria, far too little funding and attention goes toward saving lives from heart disease and stroke. Unfortunately, these and many other countries don’t have the budget to pay for even basic medications. Medicines to treat hypertension need not cost more than $5–10 per patient per year, and yet this is more than many country health budgets can cover.

Imagine how many more lives could be saved if countries were able to fully fund their efforts to prevent heart disease and invest in public health systems.

With terrific support from our local partner, the National Heart Foundation (NHF) of Bangladesh, Bangladesh was able to start their 100,000th patient on hypertension treatment. By coincidence, this happened while I was in the country — something it was possible to know because they have adopted the Simple app, which Resolve to Save Lives created, so they have accurate, real-time information on treatment. I was honored and delighted to meet the NHF’s 93-year-old visionary founder, Professor Abdul Malik. Dr. Malik spoke at a conference on heart disease and addressed the problem that some efforts focus on education without providing life-saving treatment. He commented, “Dead people don’t listen”! Clear thinking: Education is important, but doesn’t replace treatment.

Left: Entrance to Entoto Fana Health Center in Addis Ababa, Ethiopia. Right: Reviewing the center’s hypertension treatment program.

Preparedness is key

It costs far less — in dollars and lives — to rapidly detect and effectively stop a disease threat BEFORE it spreads widely than to respond after it becomes an epidemic. The Covid pandemic, which has cost the world millions of lives and trillions of dollars, is a searing example.

Primary care is where it’s at

Details matter. Policies may make headlines, but small, focused investments can make a huge difference. One example is accurate blood pressure monitors. Mercury-based monitors work well for skilled health care workers in quiet offices with plenty of time. But we’re phasing out mercury — for good reason. Digital monitors are the way to go — as this 1-minute video we produced shows. But even the best monitor won’t be accurate unless it’s used correctly. Daniel Burka, our Director of Design and driving force behind the Simple app, made this clear poster with a checklist to measure BP correctly. That poster is now in use in tens of thousands of health facilities in countries all over the world.

A patient gets her blood pressure checked at Baushi Community Clinic in Golapganj, Bangladesh.

The stronger our primary health care systems are, the more people will be treated effectively for high blood pressure.

Not all digital monitors work well. Some are not validated, some are made for home use rather than the more frequent use in health care facilities, and some break often. This is an area Resolve to Save Lives has worked on for years, and we’ve learned a few lessons. For the busiest health facilities, an “arm-in” monitor, widely used in Thailand and elsewhere, can be a good choice. For rural health posts without regular electrical supply, a semi-automated monitor, which requires the health care worker to pump the bulb to inflate the cuff so that the rechargeable battery can last at least a few days between charges, is most practical.

Left: Showcasing a digital app to improve hypertension control. Center: Discussing challenges in Thane, Maharashtra. Right: Visiting a primary health center in NTR District, Andhra Pradesh

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President and CEO, Resolve to Save Lives | Former CDC Director and NYC Health Commissioner | Focused on saving lives. twitter.com/drtomfrieden

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Dr. Tom Frieden

President and CEO, Resolve to Save Lives | Former CDC Director and NYC Health Commissioner | Focused on saving lives. twitter.com/drtomfrieden