Emory University

Destination Zero: Ending Death and Suffering from Diabetes and Hypertension Highly Ranked

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Project Summary

Diabetes and hypertension are among this century’s foremost threats to health and development. They are top contributors to premature death and disability in even the least developed countries (1). India, with 275 million people affected, is a critical battleground to reverse the global rise and devastation from these conditions. Socio-economically deprived populations are particularly vulnerable to fatal and debilitating health complications from diabetes and hypertension because effective prevention and treatment strategies fail to reach them. We propose Destination Zero, our proven package of digital technology tools and healthcare worker training programs designed to strengthen community outreach and patient engagement initiatives, developed over a decade of field testing across India. Destination Zero will reach over 100 districts covering over 200 million Indians to enhance the ability of health systems, healthcare workers, patients, and communities to affordably and equitably prevent and manage these silent killers and disablers to improve health and wellbeing.

Problem Statement

Diabetes and hypertension are among this century’s biggest threats to health and development. These silent and stealth conditions cause more premature deaths than HIV, malaria, and tuberculosis combined. Diabetes and hypertension receive only a minuscule fraction of global disease funding. India, a country of 1.3 billion people with rapidly changing socio-demographics and economics, is at the epicenter of global diabetes and hypertension pandemics. These diseases together affect over 275 million Indians and their families, striking substantial numbers of young people, with disproportionately worse outcomes—such as higher rates of death, blindness, kidney failure, heart attacks, and stroke—seen amongst the poor and underserved. Families often are forced to spend large proportions of their income and liquidate assets to finance care, leading to catastrophic health expenditures and decreased investments in education and household wellbeing. This creates a vicious cycle which perpetuates poverty and undermines development. Strong evidence exists for [1] specific behavioral changes to prevent individuals from developing diabetes and hypertension (2) and [2] high-quality, individualized treatment algorithms to prevent disabling and costly health complications once diabetes and hypertension have developed (3). These knowledge-based strategies for diabetes and hypertension prevention and management often fail to reach rural and poor populations who experience intersecting disadvantages of low access to affordable, quality healthcare infrastructure and limited health awareness and literacy. Multi-media, digital technologies tailored to user needs can be used to efficiently and rapidly expand the dissemination of these knowledge-based strategies to rural and poor communities to avert loss of life, health, and income.

Solution Overview

Destination Zero is an integrated community outreach and patient engagement and clinical care program to transform the prevention and management of diabetes and hypertension at scale. It is built on a package of our freely-accessible digital tools and educational modules that strengthen existing public primary care infrastructure to efficiently and equitably address these deadly conditions in alignment with national health policy. Community outreach is driven by existing community health workers equipped with smartphones containing multi-media digital tools for prevention education and door-to-door screening and clinic referral to connect the community with high-quality clinical care, affordable diagnostics, and medications. A social media campaign with celebrity champions will reinforce salient motivational health messages, and all evidence-based resources will be publicly available for download. Once patients are connected with clinic services through community outreach, the patient engagement and clinical care program is driven by non-physician clinic staff trained as patient advocates. Patient advocates will use tablets containing an application to track clinical outcomes, customize treatment strategies, and refer and follow-up with patients to optimize disease management. Patients may download a separate application on their smartphones to remotely receive personalized health recommendations, access their electronic health record, and communicate with their clinic-based advocate.Data from both applications will be filtered to a data hub for health systems administrators to track population health and health system performance, identify gaps, and dynamically improve remedies. These tools will be deployed in Tripura, Odisha, Gujarat, Karnataka, and Andhra Pradesh, socioeconomically and linguistically diverse states.

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Project Funders

  • U.S. National Institutes of Health
  • United Health Group/Ovations
  • Emory University - Ongoing

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