Building a Consortium for Wellness: The Transformation Federation

Energizing a Movement to Transform Wellness and Nutrient Security

David Aylward, July 9, 2012

Precis: Evidence is critical to sectoral transformation and to rapid learning networks.  We propose a path for developing new common measurements of wellness, and using a large, shared, and growing evidence base from many independent social entrepreneurs, NGOs, and others of the benefits and costs of transformed methods of improving health, wellness, and nutrition.  

Billions of people around the world lack access to basic primary health care, and knowledge of how to be healthy.  Millions die every year as a result.  There is abundant evidence that the food supply in poor and wealthy communities alike does not meet people’s nutritional needs, especially in supplying the micronutrients and other elements that are essential to nutrient sufficiency.  At least two billion people suffer from the hidden hunger of malnutrition.  This unmet need—for sufficient micronutrient density in diet (or effective bio-available supplements to achieve nutrient sufficiency)—undermines wellness and creates or exacerbates a wide range of health concerns.[1]  At the same time, the information revolution has created the possibility of transforming healthcare to a distributed system of personalized wellness, where acute care is the last stop, and only for those who need it, not the first.  Instead of only talking about saving lives, we lift our goals and seek to enable people with the physical and mental capacity to live meaningful lives.

On a parallel track, innovators are attacking each step of the broken food chain, seeking to re-introduce nutrients as the guiding principle at each step.  A particularly important area is soil regeneration so food grown in it receives the proper nutrients.  Various promising techniques have been advanced for this.

To cause these transformations, particularly for those at the base of the economic pyramid, we need to create awareness of solutions and empower people of all incomes to demand a new level of wellness for themselves, their children, and their communities.  To be successful, this movement must provide compelling new evidence that can motivate change throughout countries, and must also stimulate market forces, by appealing to the self-interest of companies, for their employees and for the creation of new, positive markets.

Many Ashoka Fellows and others are working on aspects of this problem, but they lack compelling evidence of how nutrient sufficiency and distributed health/wellness in specific populations and contexts can transform lives–evidence that will allow them and others to perfect and scale solutions. We need evidence that will create public demand.  And social entrepreneurs tend to work in isolation, so their work is not integrated with their colleagues in the same communities (but in different silos: health, wellness, nutrition, agriculture, education, development), and not aggregated with that of colleagues around the world.  Individual social entrepreneurs are often stymied.  They lack the rapid learning networks of “big data” that will produce this evidence in the first place, and then keep improving solutions over time using the modern techniques of multi-variate analysis, as conditions change.  The same is true for soil regeneration.

How can we build rapid learning networks: growing aggregations of data, systems to create knowledge from them, and efficient distribution of that knowledge?  And how can we ensure that virtuous cycle keeps rolling forward?  We believe this can be done if our Fellows and other interested stakeholders who are delivering services at the base of the pyramid adopt some common practices in the IT systems they use (while pursuing different operational aspects of these problems).  As byproducts of service delivery, these large data bases can be produced if a wide range of parties used common measurements, common templates, standardized data sets, and affordable information tools as they gather the required evidence of how hidden hunger and micronutrient poverty can be detected and alleviated, how distributed health and wellness can be effectively delivered, and the connections between nutrient repleteness, wellness, and disease prevention.[2]  This would allow common pooling of data, the application of sophisticated analysis, and the creation of economic value (a wide array of parties would be interested in paying for appropriately anonymized versions of this data) that would both advance the mission and help fund the underlying services.  This compelling evidence would also energize global thought leadership that can bring these concepts to broader awareness, marshaling support for change to persuade key public and private decision makers to fully embrace these integrated, new approaches.

More specifically, we seek partners and supporters for each of the actions described in more detail below.  We believe there are a wide variety of profitable business opportunities in this new eco-system.

1.     Information Systems and End State

• Move from inputs to measuring nutrient sufficient outcomes:
  • Create an agreed set of initial metrics for nutrient sufficiency of a human being which can be implemented in low resource settings; these may vary for pregnant mothers, babies, two year olds, teenagers, and workers.  These need to be holistic, not measuring a single variable (e.g. iron).  Initially, these will need to be a handful of proxy markers for measuring nutrient status (see short test for nutrient sufficiency), while science develops more unified solution(s)
  • Similarly, create an agreed set of initial metrics for nutrient sufficiency of soil, and for food in markets.
  • Agree on a standardized taxonomy and message structure for data reporting, ideally using international standards
  • Agree on an approach to evaluation and research up front, creating guidelines for participants to follow
  • Create a common optional use mHealth software application for administering programs, tracking nutrition and health actions, and recording health and wellness outcomes.[3]

2.     Products

• Standardize effective, low cost, self-help aggressive programs designed to achieve nutrient sufficiency like homestead food production, including indigenous food source recipes

• Agree on an initial technical and operating definition of high quality, low cost, full range nutrient supplements in bio-available, home fortification forms that could be included in indigenous food source recipes.  Find 3-5 products that meet the definition and work out agreements to use them.
• Standardize effective, low cost, programs designed to achieve nutrient sufficiency in soil regeneration.

3.     Develop a Common Integrated Approach

 Create a set of operational guidelines for federation participants to follow, although they may focus on any population they wish (mothers and babies, employees, students, rural villages, adolescents, seniors, sick people), use any operational focus they wish (chronic illness, behavioral health, industrial productivity), and use any business model they wish (charity, for pay, government, etc.).  These guidelines will include the following:

• Provision of the nutrition self-help program and/or nutritional supplement in a measurable, accountable way for at least 6 months and preferably a year
• Provision of best practice educational materials on the value of nutrient sufficiency, including how to improve local diets
• Combine nutrition with one or both of the following
  • Clean water
  • Scheduled vaccinations (may be provided by government)
• Provide regular health checkups (once a quarter) and basic diagnostics; referrals to existing medical organizations for acute care as needed
• Provide a monthly visit to home, work site, or school by a wellness worker armed with modern mobile ICT for supporting this activity
• Use of an individual personal electronic wellness record for recording these nutrition and health vitals, interventions and the outcomes
• Reporting of data from the electronic record using common taxonomy and message structure
• Use of one of the members of the federation’s Research Consortium (alone or in conjunction with local partners) to conduct independent research, and/or validate the data
• Sharing of successes and failures with other members of the federation.

The last three bullets apply to soil regeneration rapid learning networks.  The equivalent of the earlier bullets must be developed for them.

4.     Field trials

 We plan to develop templates for trials in each of the following areas, and to encourage partners to use them.  Each template will measure outcomes of critical importance to that area (e.g. productivity, days missed, accidents in businesses), as well as the standard health and nutrient sufficiency variables.  We need funding for at least 2 significant trials in each area, while supporting IT systems for many others.

Wellness trials:

• Mothers and Babies: participate in versions of the 1000 Days Initiative
• Small contained communities, e.g. rural villages; focus on homestead production
• Schools

1. Elementary and secondary schools, rural areas and urban
2. Separate different classrooms, control which children receive supplements.
3. Rural and urban areas
4. TB
5. HIV/AIDS
6. Malaria
7. Diabetes
8. Mental illness

• Sports teams/leagues
• Employees of specific businesses
• Seriously ill patients

We will start with a few key countries where we make this happen: Bangladesh (co-sponsor with Helen Keller International, Grameen, BRAC), India, South Africa, with others to come. Once the program is established, we will look for Ashoka Fellows and others in developed countries to participate – with focuses on those living in poverty, aged and the obese.

Nutrient dense soil regeneration trials:

There are a handful of different methods for regenerating the productive value of land and soils.  We want a common reporting mechanism for those.

5.      Research and Evaluation

We will establish one or more research consortia of international organizations and leading academic institutions.   They will manage and use the growing mass of data we create, conducting multi-variant analyses and randomized control tests.  The data base we create will have great value to many public and private parties.  We will explore business models to ethically use that value to sustain the activities of the Federation and the field work of its members.

6.      Short Tests

We need to motivate or cause the creation of four short tests.  We will begin this by developing consensus functional specifications, and then launching international global contests.  Ashoka’s ChangeMakers platform is excellent for this.

• Personal nutrient sufficiency: replace calorie counting, and “what went in” with a simple way(s) to measure what got absorbed, ideally an inexpensive device.  As noted above, initially these will need to be a handful of proxy markers for measuring nutrient status while science develops more unified solution(s)
• Nutritional content of food: ideally an inexpensive device

• Shopping list and “menu analysis”: smart phone based applications that use information from packaging and fresh food, menus, and decision support from research to advise on the creation and purchasing of nutrient sufficient menus – and making them culturally and locally specific.
• Nutrient value of soil.