In our wonderfully convenient century, so many services are readily available without the long wait times or long trips of decades before. It's hard to believe now, but in the recent past we could only make bank deposits and withdrawals in an actual bank, and only on weekdays between 9 a.m. and 3 p.m.!
Yet in this age of advancement, our most important service -- health service -- has remained stubbornly resistant to change.
As we discovered with banking, you don't need to visit a polished, ivory-columned institution with hushed formality and maddeningly rigid hours to access your money. We have cash machines on nearly every street corner for that now.
Yet we still generally schlepp to a hospital or other formal health care facility for every manner of health service. Sure, you need a hospital and specialist physicians in an emergency, or for critical care, just as you'd visit a banker in a suit and a leather chair to close on a mortgage.
But for many everyday preventive and chronic care and health management needs, there's no equivalent to the ATM where many of us do our day-to-day or on-the-fly transactions. The health service industry is woefully out of date. It's not meeting us where we are, and delivering the level of service that we need when we need it.
Dr. Allen Hammond, health innovator and author of The Next 4 Billion: Market Size and Business Strategy for the Base of the Pyramid, says you don't always need a doctor and a clinical setting. In fact, most of the time, you don't.
"It's quite widely accepted in public health systems that 80 to 90 percent of primary care could actually be performed by a nurse, perhaps assisted by a clinical decision support tool," Hammond said.
Such non-traditional points of service are beginning to pop up all over the globe. In many instances, the driving force is access. Due to poverty or remoteness of location, or both, old notions of health service delivery are being bulldozed and something less expensive, more efficient and more effective is emerging.
For those in poor, rural communities in India, a long trip to a city medical center is prohibitively inconvenient and expensive. So E Health Point stepped in to build small village clinics set up with a water filtration system and a pharmacy. While picking up their daily water supply, people can be connected to doctors via videoconferencing and have their prescriptions filled on the spot.
In communities like these, a modification of traditional health care delivery models was absolutely necessary, but is also proving to be more effective than the old way of doing things. That doesn't surprise Hammond, who serves as chair of E Health Point.
"The data shows that if you have point-of-care diagnostics and a remote doctor doing evidence-based medicine, the result is actually likely to be better than if you walked in and saw a doctor in-person," he said.
Similarly, in Mexico, where diabetes is on the rise, there's a new, low-cost, accessible chain of diabetes clinics that is cutting patient costs by 60 percent and reducing their chances of developing serious complications from the disease by an estimated 50 percent. How? By meeting patients where they are: in their communities, at a cost they can afford, with minimal travel and wait times, and focusing specifically on the care diabetics need.
"Every year more than 70,000 people were dying in Mexico from the lack of sustainable health delivery mechanisms for poor people," said the founder of the Clinicas del Azucar, Javier Lozano, an MIT business school graduate. "I was also motivated because my mom has diabetes and I saw how difficult it is for her to get and affordable and convenient care."
Clinicas del Azucar offer unlimited access to the clinics' screening equipment, diagnostics, lab work, and consultations for a fixed annual fee. The very low equipment and personnel requirements means the yearly cost to patients is down from $700 to less than $250. This model of better, cheaper care is one that can be replicated in our own diabetes-addled United States and around the world, where the disease is almost uniformly on the rise.
Men's Sheds of Ireland is taking the idea of "meeting people where they are" to another level. Not only do they provide a physically-accessible space, designed to improve community health and well-being, they meet the target audience where its members are socially and psychologically.
"I had been working in community development for a long time, and was conscious that while it was easy to engage women in local health and wellbeing initiatives, the men were missing!" said John Evoy, founder and CEO of the Irish Men's Sheds Association. "The more I looked into this, the more apparent it became that this was not just a local or national issue, but one that affected men worldwide."
Noting that there are few comfortable, welcoming spaces for men to commune and decompress from the stress in their lives (which is often at the root of illness), Evoy lamented that the common gathering place is arguably one of the least healthy: a local pub. He understood the connections between the alarming rates of stress, depression and suicide rates among men and a culturally reinforced reluctance to talk about emotions and ask for help. He had been inspired by community gathering places he visited in Australia that were modeled on a backyard shed for puttering and fixing things.
"It didn't matter if it was a shed that cost thousands to build, or one that was just a few pieces of timber thrown together," he says. "I thought to myself, this has to happen everywhere!" So back home in Ireland, he began helping communities build sheds set up with comfy sofas, tables, woodworking equipment, toolboxes, and the like, where men could work on projects and talk safely about what is going on in their lives. The Irish Men's Sheds Association now counts over 65 sheds with more than 700 members.
"Men's Sheds can change the world," Evoy said. "The concept is simple and effective."Simple and effective world-changing solutions. They can be found all around the globe, and 15 of them, including these three, surfaced as finalists in a global competition organized by Ashoka Changemakers in partnership with the Robert Wood Johnson Foundation's Pioneer Portfolio, Innovations for Health: Solutions that Cross Borders. The exciting thing about all these initiatives is that they have the potential to be as effective around the world as they are proving to be in their founding countries. Rural health service, diabetes, and stress-related illness among men are equally critical around the world, including in the United States.
These models are addressing the very real fact that our health delivery system has a lot of catching up to do to live up to the promise of the 21st century. It's stuck way back in the Middle Ages, if you ask Al Hammond:
"Incremental change is not going to solve our problem. We have to get out of the medieval guild model of health care and into an industrial age model of health care, because otherwise we simply can't afford it."