Digital Health Action Alliance: Public-private collaboration to bring health within reach 

The Digital Health Action Alliance (DHAA) is a collaboration between Mercer and the World Economic Forum (WEF), the international organisation for public-private cooperation.

The goal of the DHAA is to research how new digital health technology, coupled with proven treatments and trusted sources of care, can help reduce premature deaths due to non-communicable diseases (NCDs), particularly cardiovascular disease. The alliance currently comprises 54 organisations, advocates, and entrepreneurs who are collaborating to meet this challenge.

On January 18, 2023, the DHAA addressed the WEF’s Annual Meeting in Davos, Switzerland. This presented a unique opportunity for alliance members to share their agenda and findings with governments, businesses, and influential non-governmental organisations from across the globe.

The session was led by Dr. Lorna Friedman, Senior Partner for Health, Transformation and Sustainability at Mercer. Here she explains the importance of the DHAA’s agenda and the work it has achieved so far.

Cardiovascular disease is the world’s number one killer. It’s the cause of around 18 million deaths each year — that’s almost a third of all deaths worldwide. And about 6.5 million of these are considered premature deaths — that is, people dying before the age of 70¹.

Addressing this issue is recognised as a major sustainability goal by the member states of the United Nations, which set a goal of reducing premature deaths from NCDs by one-third by 2030².

Most of these deaths are in low- and middle-income countries and represent a significant and costly metric of global health inequity. However, premature deaths also occur in affluent nations, where there is the production of and access to the most advanced technologies and effective medications. In the UK and the US, for example, there are significant health disparities and considerable differences in life expectancy across regions — and even between different cities. A lot of that comes down to varying rates of cardiovascular disease³.  So the gains we have made in clinical science and health management are not being distributed equally.

Premature death robs families, communities, and societies of individuals who are often in their prime years of economic and social contributions. So this is an issue that affects everyone. And from an employer perspective, reducing ill health, premature impairment, and even death from NCDs has a significant economic benefit — again, because the people affected are often in the prime of their working lives.

We’re in the midst of a digital transformation in healthcare. So, we asked ourselves, is there an opportunity to apply digital technology as a catalyst to help reduce NCD deaths and close the health gap? To help answer this question, we first sought to understand how healthcare is being accessed currently and how technology is being used in a diverse set of specific communities.

In communities where extensive health resources are unavailable or aren’t receiving adequate investment, you find that health promotion and services are facilitated by or delivered through community health workers. They are pivotal actors supported by government policies and federal health systems in countries like India, Brazil, and Kenya^4,5,6. But again, we’re not just talking about low- and middle-income countries. In the US, many rural communities and Federally Qualified Health Centres operate health clinics staffed with qualified community health workers. These health workers integrate into health teams that often include pharmacists, nurses, midwives, and others⁷.

And the trend is growing.

Why? Because there is literature to suggest that these workers are able to forge a high degree of trust. Community health workers often come from the communities they serve. They have generated social capital, relationships and interpersonal connectivity, which translates into trust^8,9. And when you’re talking about chronic conditions like cardiovascular disease, that’s very important — people have to feel comfortable talking about their health problems and the challenges of managing a lifelong condition.

Our research at the DHAA looks at health across four different areas: prevention, diagnosis, treatment, and community healthcare. We found that community health workers are a thread through all of those elements.

That was when we became really interested in how technology could be applied. If we could put the right digital health tools in the hands of these community health workers — the people on the front lines interacting with families and often delivering health services to people in these communities — that could be almost the perfect marriage. A trusted advocate is now enabled to be more effective and efficient.

The main benefits are increased and quicker access to information and targeted activity based on need. In diagnosis, for example, one thing that is really exciting at the moment is what we call “point of care” diagnosis — that is, the idea that you can find out what is wrong with you without leaving the house.

Since COVID-19, we’re all now pretty comfortable with the idea of self-swabbing. And that’s huge. You don’t have to take a day off work. You don’t have to walk to a nearby town. You don’t have to find somebody to take care of your children. So there’s a huge economic value in just changing the site of care.

With COVID-19 tests, you get your test results immediately, and those results also inform your behaviour. But other diagnostics may require someone to interpret the test and suggest further action. And that’s where the community health worker comes in. If we get them the right digital technology, including artificial intelligence (AI), we can make their job much easier. They can get a diagnosis right there and then, and communicate with a team to understand what options to offer the patient.

Of course, we cannot just assume that community health workers will want this new technology or responsibility. We need to understand their experience, aspirations and obstacles as well. So, we have also developed a survey in 11 languages — and we are working with an extraordinary group of on-the-ground educators and service providers to better understand the view of the community health worker. We want to understand what digital tools they’re already using and how they feel about them. We then combine these surveys with interviews, so we have a good mix of quantitative data and qualitative input to help us understand what’s really happening out in the field as well as the variables in diverse settings.

The World Health Organisation (WHO) predicts we may have a global shortfall of 18 million health workers needed to achieve universal health coverage by 2030¹⁰ — so we desperately need to address this issue. Community health workers may offer one solution, and technology may help to increase their impact.

Like any workforce, though, we need to address existing challenges and answer key questions, such as: How can we recruit and retain community health workers? How can we craft the role to be engaging and meaningful? Compensation? Training? How do we upskill and create career paths?

We’re hopeful that introducing new digital health technology will help in many of these areas. The early results of the survey are already showing us that existing workers in the field want more technology. They have an appetite for it, and they can see the possibilities. They can see the value of making notes and recording data on a tablet rather than having to write everything down on paper, and of being able to communicate in real time rather than having to wait. It shortens their work, reduces errors, and results in better care.

Employers have a huge role to play. Number one, they contribute to health insurance, which some employers are increasingly looking to expand for their entire workforce. HR managers and risk managers may want to ask themselves: Are our benefits fit for purpose? Are our insurance policies fit for purpose? Are our policies contributing to health being delivered equitably, effectively, and efficiently?

Increasingly, this means looking at what is available and needed at a local level. Most international organisations set their policies at a regional or global level, and many strive to deliver globally consistent benefits. However, “consistent” does not mean equitable. Different parts of the world have very different requirements when it comes to healthcare, and employers benefit from understanding local strengths and challenges.

We are starting to look at metrics like community vulnerability and community resilience indices — these are data points that risk managers work with. But increasingly, they are also concepts that business operation leaders and benefits managers are becoming familiar with. Employers benefit from understanding what the potential health risks and social supports are in the different places where their employees work and, in particular, how these systems respond in times of crisis. If a key site or supply chain is affected by a major flood, for example, how will they ensure staff can access the medicines they need? What is the resilience of the local health centre, and how does that impact business resilience?

Employers have often worked collaboratively to ensure services are available within their local communities, and they are often seen as leaders and certainly as influencers. To be impactful, we must understand the existing assets or gaps in community health and social support structures. When we work together to strengthen health systems, we improve health outcomes for everyone and, in doing so, contribute to healthier societies for all.

Collaboration is vital in ensuring that health capital will be distributed more fairly in the community. And whether we call it a public-private partnership, sponsorship, or advocacy, at the end of the day, people need healthcare. Employers have a current and historic role, as well as a vested interest, in promoting and contributing to healthcare where their employees, customers, and supply chains operate.

People are still at the heart of care. Business leaders can be important advocates for health transformation, including supporting community health workers in getting access to the tools they need.

As employers, we need to recognise this new reality and can no longer distance ourselves from employees’ health. We can no longer question the need to invest in our employees’ wellbeing. We have the chance to make a difference, to show employees and their families that we understand their concerns and to provide them with the help and support needed to get through challenging times.

¹  _{World Health Organisation. “Cardiovascular Diseases (CVDs)” Fact Sheet, June 11, 2021, available at https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).}

² _{World Health Organisation. “SDG Target 3.4 — Noncommunicable Diseases and Mental Health,” available at https://www.who.int/data/gho/data/themes/topics/indicator-groups/indicator-group-details/GHO/sdg-target-3.4-noncommunicable-diseases-and-mental-health.}

³ _{Song S, Ma G, Trisolini M, aet al. “Evaluation of Between-Country Disparities in Premature Mortality Due to Stroke in the US, JAMA Network Open, May 12, 2021, available at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2779781.}

⁴ _{Wadge H, Bhatti Y, Carter A, aet al. “Brazil’s Family Health Strategy: Using Community Health Care Workers to Provide Primary Care,” Commonwealth Fund Case Study, December 13, 2016, available at https://www.commonwealthfund.org/publications/case-study/2016/dec/brazils-family-health-strategy-using-community-health-care-workers.}

⁵ _{Shanthosh J, Durbach A, and Joshi R. “Charting the Rights of Community Health Workers in India: The Next Frontier of Universal Health Coverage,” Health and Human Rights Journal, Volume 23 Issue 2 (2021): 225–238. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8694295/.}

⁶ _{Gitau A. “Kenya Launches New Community Health Strategy,” Johnson & Johnson Centre for Health Worker Innovation, March 23, 2021, available at https://chwi.jnj.com/news-insights/kenya-launches-new-community-health-strategy.}

⁷ _{Sabo S, Allen C, Sutkowi K, aet al. “Community Health Workers in the United States: Challenges in Identifying, Surveying, and Supporting the Workforce.” American Journal of Public Health, Volume 107 Issue 12 (2017): 1964–1969. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678391/.}

⁸ _{Saint Onge JM, Brooks JV. “The Exchange and Use of Cultural and Social Capital Among Community Health Workers in the United States,” Sociology of Health & Illness, Volume 43 Issue 2 (2021): 299–315. Available at https://pubmed.ncbi.nlm.nih.gov/33211336/.}

⁹ _{Berner M aet al. The Value of Relationships: Improving Human Services Participant Outcomes Through Social Capital. US Department of Health and Human Services, 2020. Available at https://ncimpact.sog.unc.edu/wp-content/uploads/sites/1111/2020/10/The-Value-of-Relationships-Improving-Human-Services-Participant-Outcomes-Through-Social-Capital.pdf.}

¹⁰ _{World Health Organisation. “Addressing the 18 Million Health Worker Shortfall — 35 Concrete Actions and Six Key Messages,” May 28, 2019, available at https://www.who.int/news/item/28-05-2019-addressing-the-18-million-health-worker-shortfall-35-concrete-actions-and-6-key-messages.}