2009 was one for the health care record books–and from the looks of things 2010 promises to be just as dramatic.  And Disruptive Women will be right there in the middle–framing, commenting, and providing insights and perspectives to some of the most pressing health care challenges.

We are planning several more e-books, in person briefings and conferences and have added a number of esteemed new bloggers to our Disruptive Women roster–stay tuned for an upcoming post introducing our newest colleagues.

Some of the topics we plan to focus on in-depth include:

• Mental Health
• Informatics–EHRs, PHRs, Meaningful Use
• Caregiving/Workfore
• Women’s Health (and a conference)
• Telehealth/Remote Monitoring/Mobile Health
• End of  Life
• Alternative/Integrative Medicine
• Public Health
• Genomics/Genetics/Personalized Medicine
• And oh yes, Health Reform

I am very interested in your feedback:  which topics, either listed here or not, would you like us to address in the coming year?

On behalf of all the Disruptive Women, best wishes for a year of good health, much happiness, and peace.

Think you have maternity coverage? Think again.

Welcome to the first entry of the book I’ll be publishing in 2010 entitled: You gotta laugh: Life in the trenches of the health insurance business. Because I think Disruptive Women readers will find it useful, each month I’ll post an example of a health insurance problem that is so maddening and frustrating that we just gotta laugh at its absurdity.

My goal, however, is to find a way to improve health insurance for beneficiaries and I have some suggestions at the end of this post.

This month’s question: What do you do when you have it in writing from your insurance company that you have maternity coverage — but when you go to use the benefit, the customer service department tells you otherwise?

The situation: When our client, Ms. R, found out a few years ago that she was having a baby she was thrilled. Immediately, she called the insurance company to confirm her pregnancy benefits. Making the call was merely a formality. When she originally purchased the policy, she was single and didn’t opt for the maternity rider. After she got married, she added maternity coverage because she wanted a family.

Indeed, when she called the insurance company, they confirmed she had the insurance she needed. However, after her first OB check-up she received a letter saying she was, in fact, not covered.

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On December 2nd, 2009 Disruptive Women in Health Care launched our new series on The Value of Health: Creating Economic Security in the Developing World at the Women in the Arts Museum in Washington DC. I had the privilege of speaking at the launch program along with World Bank economist Dr. Maureen Lewis and Creative Women founder Ellen Dorsch, both of whom contributed to the series.

I would like to call attention to and thank our generous sponsors:

• Strategic Health Policy International
• Medco
• Global Health Strategies
• Amplify Public Affairs
• VirtuArte
• CreativeWomen
• Multilateral Consulting

Their support contributed to the success of both the program and the e-book. And a huge shout-out to Disruptive Women Dr. Glenna Crooks and Debbie Myers for their assistance, wisdom and vision in framing both the event and the series.

As is our custom, we have compiled this incredible series of posts into a free e-book for you to read and share. In addition to our own pool of experts, Disruptive Women invited a number of guests to post on this critically important topic.

Please feel free to share, cross post and distribute with others who would find this of interest.
As always, we welcome your feedback and comments. All the posts remain on the blog and it’s not too late to comment on specific posts.

Download a free copy of the “Value of Health: Creating Economic Security in the Developing World” e-book.

The following guest post by Malvise A. Scott, Senior Vice President, Partnership and Resource Development at National Association of Community Health Centers (and Former Community Health Center CEO), is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

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Health is an important part of economic security – not only in the developing world, but in the US. No one knows that better than those who, for over 40 years, have worked within Community Health Centers (CHCs) providing primary and preventive care to the medically underserved.

These private, not-for-profit corporations are so keenly aware because:

• Boards of Directors are made up of at least 51% patients,
• They are located in medically underserved neighborhoods,
• Their hours of operation reflect patient needs/preferences,
• Their sliding-fee scales accommodate the patient’s ability to pay and
• They provide “enabling services” such as transportation, translation, outreach and health education designed to meet the needs of their patients.

Are CHCs needed in the US? Yes, and by many people. During 2008, CHCs operating over 7,500 sites, provided care for over 20 million patients, of whom:

• 38.3% were uninsured
• 70% were below poverty, and
• 59% were women and among women, 40% were in the traditional working-year ages of 20-64.

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The following post by Liz Scherer, Principal of Digital Copy, LLC, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

Liz Scherer is a digital copywriter, health reporter, medical writer, marketing and social media consultant, blogger and women’s health advocate. With over 25 years experience in the healthcare arena, Liz has worked in the private and public sectors on behalf of web-based and traditional science publishers, public relations and advertising agencies and non-profits.

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There’s an elephant in the room: band-aids.

Poverty and its relationship to the provision of and access to healthcare is a global problem. This month, esteemed Disruptive Women in Healthcare bloggers and guest posters are writing on this critical issue with a unique look at the problems abroad. Yet, this has prompted me to look within, for if we can’t address our own problems, how can we possibly be successful at addressing problems outside our immediate borders?

It’s no secret that the divide in the U.S. comes down to socioeconomic status. And while our representatives in Washington continue to battle it out to devise a healthcare reform bill that, for all intents and purposes, may ultimately serve the power lobbies more than the public, a significant proportion of our population is being pummeled into submission with powerful drugs.

According to an article in the New York Times, children from poor families receive antipsychotic medications four times as often as those from wealthier families. What’s more, it appears that these children are likely to receive a prescription for less serious conditions than would commonly prompt a prescription for a wealthier child. The divide: Medicaid versus private insurance.
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The following guest post by Rachel Hampton, Research Associate at the Global Health Council, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

Rachel’s areas of focus include maternal, newborn and child health and reproductive health. She has authored research briefs on private sector involvement in health systems, commercial sexual exploitation, the integration of maternal, newborn and child health and family planning, in addition to a variety of other publications from the GHC.

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Women’s economic autonomy and employment opportunities are crucial to their health, particularly their reproductive health. Each year, 536,000 women die, nearly 10 million are disabled, and 250 million years of reproductive life are lost because of poor reproductive health. Enabling women’s economic sovereignty has the potential to allow women to take control of their fertility – they would have the resources to access family planning services, effectively space wanted pregnancies and limit unsafe abortions – all of which are leading factors to poor maternal health.

Limited economic security, limited access to education and poor employment opportunities contribute to lack of access to health services, education and employment, and lead to high fertility rates and increased maternal mortality and morbidity. In many countries, women are not allowed to own property and are limited in their economic opportunities, restricting their economic security and limiting access to reproductive health services. Lack of finances is particularly problematic for women who are heads of households or married women who have little say in family finances.

Limited financial autonomy for women also has a profound impact on their children, resulting in generations of young people who have limited opportunities for education and employment. Young girls are particularly vulnerable, as they often miss out on educational or employment opportunities because they have to provide care for sick relatives or have children at a young age. Economic empowerment could break this circle of poverty and ensure economic security and improved health for generations to come.
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The following guest post by Dr. Gunther L. Faber, CEO of The HealthStore Foundation^®, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

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Context: Lack of Access to Quality Basic Healthcare:  The market for drugs and basic healthcare in sub-Saharan Africa is large and fragmented, with millions lacking adequate access to basic healthcare and low quality standards prevailing in many existing private and public facilities.  This leads to unacceptable statistics, including 2007 under-5 mortality rates of 12.1% in Kenya^[1] and of 18.1% in Rwanda.^[2] Furthermore, throughout the world 10 million children die each year, almost two out of three from a short list of easily preventable or treatable diseases and illnesses.^[3]

Approach:  Business Format Franchising: From SUBWAY, to ExxonMobil, to Marriott Hotels, the franchise business model has proven to be the most effective way to mass distribute goods and services where standards matter most.  The HealthStore Foundation^®–founded by an American entrepreneur and a Tanzanian pharmaceutical microbiologist—applies lessons learned from the franchise industry to increase access to high-quality essential drugs and basic healthcare through its Child and Family Wellness (“CFW”) franchise network.

CFW Franchisee Mrs. Credence Maina serving a Patient

A typical setting of a CFWclinic in rural Kenya

Empowering Female Nurses in Africa to Own Their Own Clinics: Since opening its first outlets in 2000, The HealthStore Foundation^® has developed a network of franchised medical clinics and drug shops now totaling 85 locations serving approximately 45,000 patients and customers per month in Kenya and Rwanda.  CFW franchisees are in business for themselves.  They create wealth for themselves and their families, and they create other jobs as well, such as by hiring local women to clean their clinics.  As the CFW network grows, hundreds more nurses will own their own clinics, building wealth for themselves and jobs in their communities, all the while improving conditions for economic development by reducing illness and death.

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The following guest post by Susan Crowley, President of Multilateral Consulting, LLC, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

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By any measure, giving programs directed at developing countries by research-based pharmaceutical companies are the most generous of any industry. The Geneva-based International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), whose methodology and data presented in its most recent “Partnerships Report” were validated by the London School of Economics, reported $6.7 billion in giving.

The 2009 “Index on Global Philanthropy,” published by the Hudson Institute, provides a measure of global private giving and, once again, demonstrates that private flows continue to make up a larger percentage of resource flows to the developing world than official development assistance (ODA, i.e., government). Hudson reports that total corporate contributions to overseas programs amount to $6.8 billion. Of this amount, Partnership for Quality Medicine Donations, whose source is pharmaceutical firms, accounts for $6.1 billion, or 90% of total corporate contributions from all sectors to developing countries. Moreover, the $6.8 billion reported by Hudson is greater than the combined annual health budgets of USAID, WHO, the World Bank, and the Gates Foundation.

The geographical scope and therapeutic breadth of these contributions, and the programs they support, are evident immediately via the Global Health Progress searchable database. What is less obvious, but also important, is that these companies have amassed considerable experience in designing and implementing health initiatives across the developing world, and can offer invaluable insight to partnering organizations.

Although the industry’s, and individual companies’, commitments to improving health in developing countries are documented on a scale unmatched elsewhere in the private sector and – in fact—one which exceeds the magnitude of overseas giving programs of several OECD-member nations, staff at the UN institutions, including WHO, remain, on balance, unaware or unimpressed.

The breathtaking generosity of the pharmaceutical industry does little to alter deeply-entrenched views throughout UN organizations and among UN leaders that health and profits are incompatible. Yet, these programs give innovative medicines companies an entry ticket to UN discussions, and the opportunity to engage and make their case. Let’s hope they can succeed.

The following post by Lois Privor-Dumm, IMBA, Director of Alliances and Information for the PneumoADIP at Johns Hopkins Bloomberg School of Public Health, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

Lois heads up several vaccine projects related to advocacy and communications as well as access and implementation. She is currently working as Director, Large Country Introduction for the Accelerated Vaccine Introduction Technical Assistance Consortium (AVI TAC), a GAVI-funded project with an aim to accelerate introduction of pneumococcal and rotavirus vaccines in low-income countries. Lois has been at Johns Hopkins since 2005 helping guide strategies and accelerated uptake on both the Hib Initiative and PneumoADIP and has been leading projects in developing and donor countries to support strengthening of policies and awareness for childhood pneumonia as part of a global World Pneumonia Day Coalition effort.

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Hib, pneumococcal and rotavirus vaccines that have long been available in the US, offer significant promise to the children in developing countries. Not only could these vaccines, save millions of lives over the course of the next couple of decades, but they also have the potential to add to the wealth of nations. Yet, despite enormous promise, there are still delays 1-2 decades before children in developing countries have access.

Vaccines have long been considered one of the most affordable and cost-effective public health interventions available today. Historically, they have been pennies per dose. According to the World Bank’s Disease Control Priorities Report, at $7 per DALY averted in Sub-Saharan Africa for the Expanded Program on Immunization (EPI), a package of six WHO recommended vaccines including diphtheria, tetanus, pertussis, polio, measles and represents excellent value for money. By comparison, statin with aspirin, beta blocker and ACE inhibitors for ischemic heart disease costs $2,028/DALY averted.

However, with newer vaccines costing not pennies, but dollars per dose, do we need to reestablish our paradigm for affordability?

A recent review of the economic case for expanding vaccination coverage of children done by researchers at Harvard and Johns Hopkins suggests that new vaccines are a good investment. Cost-benefit analyses of Hib vaccination, for example, indicate that the cost of vaccination is less than the savings accrued by preventing mortality, lowering future health care costs, and reducing productivity losses among parents (who no longer have to stay home with a sick child). However, even these analyses may underestimate the true economic benefits of childhood vaccination.
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The following guest post by Ellen Dorsch, Founder of Creative Women, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

Building on her commitment to women’s well being, her love of travel, her desire to experience the challenges of the private sector, and her love of hand-made products, Ellen Dorsch decided to leave the non-profit sector and start Creative Women. Today, Creative Women imports elegant hand-woven products from women-owned businesses in Ethiopia, Afghanistan, Swaziland, and Mali. Each product Creative Women sells, allows the company’s colleagues to hire more workers and to pay them decent wages and benefits helping them, and their families, to live a healthier lifestyle, and to receive health care when needed.

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When I left my consulting business about seven years ago, friends and colleagues asked me if I thought I would miss working in Public Health. I had been working, for over 30 years, in Vermont (my home), nationally, and in East Africa, Central American, and Russia … in program development, evaluation, and administration. I had decided that I no longer enjoyed writing grants or looking for new contracts, and I very much wanted to experience working in the private sector.

I left and started Creative Women, an importer of elegant textiles from Ethiopia and a business with a social mission … to create jobs. I soon realized that I didn’t leave public health, but rather was impacting on women’s lives from another perspective. I saw that with some independent money, women would have more options about their lives, including (hopefully) the ability to leave a relationship where they or their children are not safe.

After 7 years working with women-owned businesses in Ethiopia, Swaziland, Afghanistan, and now Mali, I’ve expanded my definition of Public Health and believe that employment is as necessary for good health as vaccines and clean water. Initially, I argued that financial independence, or at least some earning power, meant a woman could say no to an abusive partner, or could pay school fees for her daughter(s). This became more real to me as I heard stories from some of the sewers and cleaners who worked at Menby’s Design, the first business I worked with in Ethiopia. A woman whose husband beat her up because she objected to him having a “second wife” was able to take her children and leave her unsafe home. And because she had some income, she could return to her parent’s home and not be a financial burden to them. This income meant the difference between safety and abuse to her and her children.
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The following post by Dr. Agnes Binagwaho, Permanent Secretary of the Ministry of Health of Rwanda, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

Dr. Binagwaho is a pediatrician specializing in emergency pediatrics, neonatology, and the treatment of HIV/AIDS in children and adults. She has served 4 years as Chair of the Rwandan Steering Committee for the United States President’s Emergency Plan for AIDS Relief (PEPFAR), and was responsible for the management of the World Bank MAP Project in Rwanda, while also serving on the country’s High Commission on Aid Policy.

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A few days ago the world celebrated Mental Health Day, and more recently it was the Human Rights Day, as such I have decided to post a reflection on the rights of all people to access mental health care as a part of the access to health care as a basic Human Right. I especially dedicate this reflection to the issues surrounding access to quality mental health care services for women.

Unfortunately, in the majority of the developing world, mental health is not an issue that is given adequate attention. However, if we take the definition of WHO, mental health plays as important part in overall health as the physical aspects do. To improve mental health, governments have to create a well-trained and well-equipped workforce to care for mental health and ensure that the funding and human and physical infrastructures are available. This will help to increase access to mental health care, but should be completed by making drugs available, like psychotropic drugs. Many of these medications are not so expensive and can be part of public essential drugs available at public health facilities. It is a matter of paying attention to the problem.

Also, the general population should be educated via mass media campaigns so that they will have less fear and a better understanding of mental health diseases and those who suffer from them, causing mental health patients to suffer from less isolation, stigma and discrimination. This can be done by partnering the government with civil society organizations to improve the public education on this issue through TV, radio, speeches, billboards and community events.

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The World Health Report 2008, from WHO, entitled “Primary Health Care Now More Than Ever” acknowledges the need to improve health systems for all through a Primary Health Care (PHC) reform. The report cites Brazil among other countries as good example of successful implementation of PHC policies and emphasizes the role of integrated health information systems as instrumental to achieving this reform.

It is impossible to deliver high quality health services to hundreds of thousands or millions of people without robust processes. That doesn’t mean taking away the human nature of health care. It means that it is possible to put methods in place that can, with the strong support of technology, organize health care delivery, support promotion and prevention, improve services quality and extend its reach. That IS eHealth.

In general, eHealth only makes sense if it supports a Health System. An example I’ve been closely involved with is SIGA SAUDE system in Sao Paulo city. SIGA SAUDE is São Paulo city’s integrated health information system. It is in operation since 2003, and today is present in all 700 health care facilities, with 14 million people in its database, processing 45 thousand scheduling requests a day. SIGA SAUDE implements all the business rules of the Brazilian National Health System, from family and community care, to surveillance and patient flow management.  The system reflects our country’s experience of using a national health system heavily focused on PHC and its long tradition of developing health information systems, now in the move to an integrated architecture.  Thirty years ago, we started developing several health information systems to deal with specific health issues, leading to 200 different systems that did not talk to each other. From 1999 on, we made the decision to move to an integrated health system to support the nation health system comprehensively. The basic premise is that information should be collected only once at the point whre it is generated and from that shared in the network.

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The following guest post by Miriam Temin, Health & Social Policy Professional and Co-Author, Start With a Girl: A New Agenda for Global Health, with contributions by Sandy Stonesifer, Program Coordinator at the Center for Global Development, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

Miriam Temin has 12 years of experience in Africa, the United States, and Europe working on HIV/AIDS, sexual and reproductive health, and social protection with donors, UN agencies, and non-profit organizations. Previously, Temin was a senior AIDS policy advisor at UNICEF headquarters, where she brought greater attention to children affected by HIV/AIDS through research, advocacy, and technical assistance.

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The recent attention given to women’s role in development is great. Even better, it happens to coincide with an increasing focus on health system strengthening. And in the case of the Obama administration’s Global Health Initiative, these two are coming together to promote women-centered health care.

We’re thrilled. But we also need to remember that healthy, empowered women don’t just spring out of the ground ready to contribute to their nation’s development. Adolescent girls are the foundation for progress on a slew of major global health goals—including maternal mortality, HIV, and infant mortality reduction—not to mention accelerated social and economic development. Yet there are around 600 million adolescent girls whose rights aren’t assured. So what can we do to make sure that girls pass through the critical juncture of adolescence with their rights to health, education, and safety intact?

Most girls enter adolescence healthy. It’s what happens to them in the eight or nine years following puberty that shapes their future. Unacceptably, it is factors largely beyond their control—both social and biological—that put them at risk.

Girls’ health status during adolescence has lifelong consequences for them, as well as for the next generation. Unhealthy mothers pass on poor health status to their babies. This relationship spans multiple generations; research in several countries shows that grandmothers’ height is significantly associated with their grandchildren’s birthweight. The inter-generational transfer of ill health is amplified when mothers are young, since babies of young mothers are less healthy than babies born to older women.

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The following post by Debbie Myers, Founder of Virtuarte, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

Deborah E. Myers has more than 25 years of experience in international economic development, including advocacy, public policy and developing strategic partnerships. She has worked with major corporations, governments, non-government organizations, and international organizations to find solutions to problems facing the people and governments in the developing world.

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Events in Life often force you to step back and review where you are. In 2007 this is exactly what happened to me. I had spent the last 15 years working for three different multinational corporations, the last one for six years. As is often the case in the corporate world, in early 2007 my job suddenly changed. So I took the opportunity to evaluate where I was in my career and to think about what I really wanted to do next.

In the early years of my career I worked at the Inter-American Development Bank, an institution that focuses on economic development in Latin America. This was my first “international” experience, where I got my passion for developing country issues and found that I love to travel. I left the Bank after 10 years and began the next phase of my career working for multinational corporations. Each position I held over these 15 years allowed me to continue to work internationally on developing world issues and travel extensively. On these travels I always took the opportunity to look for artwork and crafts that were unique to bring home either for my own enjoyment or to give as presents.

In the developing world people have always produced crafts. Over the years the skills of these individuals have developed and many have now become true artists/artisans. However, many of the creators of these beautiful products — artwork, jewelry, weavings, and textiles – are located in countries and often in remote areas where their works are seen only by locals, expats or a few tourists who venture to these regions. Many of these items are being made by women who live in rural areas that are trying to earn an income to support their families. Their products are often expressions of traditions and customs that are slowing dying out because there is insufficient incentive — economical or cultural — to pass on these traditions/customs on to the next generation. These products are not only interesting from an anthropological perspective, they are works of art that will stand the test of time and are worthy of a place in the marketplace of beautiful objects.

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The following guest post by Peg Willingham, Senior Director for External Affairs for Aeras Global TB Vaccine Foundation, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

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Shortly, I will be heading to Cancun, Mexico, for the 40^th Union World Conference on Tuberculosis and Lung Health.  The meeting will bring together hundreds of dedicated researchers, project implementers, World Health Organization officials and advocates who have committed themselves to stopping tuberculosis, which is second only to HIV/AIDS as the most infectious disease killer globally.  Yet decades after the first meeting of this august body, we are still using the same outdated, inefficient and marginally effective tools to fight TB.  Meanwhile, the wily tuberculosis bacterium – which has been killing people for tends of thousands of years – continues to get ahead of us with its growing resistance to available treatment.  Vaccines remain the most medically efficient and cost-effective ways to prevent and eliminate disease.   To stop TB, we must do all we can to mobilize the scientists, researchers, public health decision-makers and funders to make new TB vaccines a reality.

The development of new TB vaccines is a vast and expensive undertaking requiring an all-hands-on-deck approach.  Private foundations and a select group of European governments are supporting this work, but the US government lags woefully behind.  The US established itself as a world leader in HIV/AIDS through President’s Emergency Plan for AIDS Relief (PEPFAR) and contributions to the Global Fund to Fight AIDS, TB and Malaria.  The U.S. also is a dominant force behind ramped up HIV and malaria vaccine research.  Yet, the US has failed to take up TB vaccine research as a priority funding area.  Because of PEPFAR, many are now living full lives with HIV, only to be struck down by TB.   Why this lack of action on TB?

The pandemic is ever-more dangerous as it evolves globally and thousands of Americans become ill with TB each year.  TB is a disease of poverty and it kills nearly as many women as all causes of maternal mortality.  Active TB disease hampers a mother’s ability to care for her family and robs many children of their mothers.  Children, especially those living in the crowded conditions of poverty, are also at greater risk of becoming infected with TB when a parent or family member has TB.

The good news is that there is tremendous momentum in TB vaccine research, with seven TB vaccine candidates currently undergoing clinical testing.  My organization, Aeras Global TB Vaccine Foundation, and a handful of others are doing all we can with available resources to accelerate the process to get new, safe and effective vaccines to those who need them so urgently.  Although Aeras is a non-profit research organization, developing new vaccines is still a complex and expensive undertaking.  One large-scale clinical trial designed for potential licensure of a vaccine will cost approximately $160 million.  Yet this represents a smart investment, because a TB vaccine would be save millions of dollars – and lives.  As the Obama administration and Congress outlines their foreign assistance agendas, TB vaccine research should be prioritized. Investment in preventing TB today will translate into fewer resources in treatment and lost productivity – and lives – in the future.