Forbes | December 5, 2014

By Bill Frist, MD and Jenny Eaton Dyer, PhD

As governments, organizations, and private individuals commit large contributions to fight Ebola in western Africa, we are reminded of the need to invest in building health care systems in developing nations that are designed to handle public health crises, and provide basic primary health services for the people they serve. The World Bank estimates that the world will spend $32.6 billion by the end of 2015 to combat the spread of Ebola.

The human and economic return on that investment is yet to be determined. But for many global health issues, we know every dollar we invest today will allow us to reap a strong return on investment. For instance, every dollar invested in clean water initiatives now will return at least $4 in economic productivity and decreased health care costs.

Similarly, global investments that provide women and girls with the information and tools they need to time and space their pregnancies are driving progress across the health and development spectrums. This November, a report by the global initiative FP2020 showcased the impressive progress in 2013 to expand access to contraceptives across 69 of the world’s poorest countries:

  • More than 8.4 million additional women and girls, compared to the prior year, gained access to contraceptives
  • More than 77 million unintended pregnancies were averted
  • More than 125,000 women and girls’ lives were saved from complications due to unintended pregnancies
  • More than 24 million abortions were averted

Let’s understand the realities behind these numbers. First and foremost, healthy timing and spacing of pregnancies saves lives. We know that if young women in developing countries delay their first pregnancy until they are 20-24 years old, they are 10-14 times more likely to survive than those who have babies when they are younger.

And if women in these countries are able to space their children every three years, their newborns are twice as likely to survive their first year. Access to family planning reduces maternal and infant mortality worldwide. This is why our organization, Hope Through Healing Hands, is leading an awareness and advocacy initiative to promote education and action for maternal and child health, with a special emphasis on healthy timing and spacing of pregnancies.

Ethiopian First Lady Mrs. Roman Tesfaye recently told the Center for Strategic and International Studies, “To be engaged in the economic sphere, to create income, to contribute to family health and well-being and to the country’s development, we must have family planning services.”

Ethiopia has become a standard-bearer for increases in healthy timing and spacing of pregnancies. Between 2005 and 2011, the country increased women’s access to education and contraceptives for family planning, leading its contraceptive prevalence rate to increase by 51%, from 14.7% to 28.6%.

At the same time, the country’s GDP per capita also increased from $236 in 2007 to $453 in 2012, a 47% increase per capita. While there are clearly many factors in such a change at the national level, access to family planning is one of them. Access can allow mothers to work for income, providing stronger financial support for their families. This is a critical component of lifting families, communities, and nations out of poverty. For every dollar invested to support women in healthy timing and spacing of pregnancies, countries save at least $6 in health, education, water, housing, and other public services.

There is another dimension to the economic impact of healthy timing and spacing of pregnancies. When infant and child mortality rates decline, population growth rates decline as well. This makes sense—when women are educated, have the information and tools they need to plan their families, and are confident their children will survive childhood, many naturally choose to have smaller families.

The aggregate effect of these individual decisions is that there are relatively fewer dependents that rely on government services, and the working-age—and therefore economically productive—population goes up in relative terms, setting the stage for rapid economic growth. Examples of the effects of this shift, known as the ‘demographic dividend,’ can be seen in the economies of Thailand, Bangladesh, South Korea, and Brazil.

Investing in global health issues, like healthy timing and spacing of pregnancies, yields impressive returns in terms of saving lives and promoting economic growth in developing nations. Yet family planning often goes overlooked on the crowded landscape of urgent global health issues. Let’s reconsider its role, and how the U.S. budget might better invest in programs that save the lives of women and children while also helping to break the cycle of poverty and create sustainable futures for some of the world’s most vulnerable populations.

Roll Call | December 4, 2014 

By Bruce Wilkinson

Pandemics as rapid and devastating as the current Ebola outbreak, although rare, serve as an important reminder of the critical security and humanitarian work the U.S. does around the world and here at home — not with drones and air bases, but with medical tents and syringes.

It is my hope at times such as these that, despite fear-inducing headlines and finger-pointing politics, U.S. foreign aid will find a moment of rare appreciation, and support. U.S. foreign assistance provides indispensable global leadership concerning both emergency and on-going global health needs. This work is instrumental in saving millions of lives around the world and protecting ourselves here at home.

At just one fifth of 1 percent of the entire federal budget, U.S. global health funding is a tiny portion of government spending, but the American government nevertheless remains the world’s single largest development donor.

Read more at Roll Call

How time flies, it is hard to believe my days in Munsieville will come to an end soon. We come and help building the new home every weekend (everyone was volunteering, so progress is slow, but tent and food are provided, so the family who lost their home is fine), today, the house is finally done, and I feel so happy and think it is a privilege to help people who live in shack. It is amazing that, with such limited resource, we build a high quality house in the shack with passion and faith.
There was an exciting activity going on throughout the whole week! It is called Munzy Kids Holiday Club. This five-day long event gathered nearly 200 children from kids in the community, most of them are from shack area like Mshenguville and Mayibuye. Without education background of leadership, our Thoughtful Path director Betty, a local woman, is naturally an excellent leader.
I was warmly welcomed by Mr. Paul Brooks, the executive director of Project HOPE UK and Ms. Betty Nkoana, the director of Thoughtful Path, Munsieville when I arrived in Johannesburg, South Africa. Before I came to South Africa, I learn from newspaper and other media source that although South Africa has the best economics condition in Africa continent, it has one of the highest HIV/AIDS prevalence as well as many other infectious diseases.

The Tennessean | November 24, 2014

By Bill Frist

In traveling the country I love to brag on Nashville as the "Silicon Valley" of health services. And that's not an affectionate epithet — it's true.

The Nashville health-care industry contributes $30 billion locally and $70 billion globally. With this amount of health-care dollars in Nashville, and with Nashville as a rising "it" city, one would expect to see a reflection in the health of Nashville. But this is simply not the case.

Currently, Tennessee holds the ignoble distinction of being one of the unhealthiest states in the union: 42nd out of 50. And Nashville/Davidson County specifically ranks 13th out of Tennessee's 95 counties, according to the Robert Wood Johnson Foundation Healthy County Rankings.

Davidson County is also not competing with our peer cities. Compared with Austin, Texas; Charlotte, North Carolina; Cincinnati, Ohio; and Raleigh-Durham, North Carolina, Nashville ranks fourth among the five, according to researchers at the University of Wisconsin. Specifically, Nashville has the worst rates of obesity, children living in poverty, children living in single-parent homes, premature death, injury deaths and violent crime of all five cities.

Poor health carries a cost, and the price of inaction over the next decade will cost us at least $10 billion.

We absolutely have to do something about this.

In taking a closer look at the $70 billion in health-care dollars coming out of Nashville, we see that it comes from the work product of more than 250 health-care companies operating in Nashville and working on a multistate, national and international basis. Nashville is also home to more than 300 additional professional service firms (e.g. accounting, architecture, finance, legal) working in the "peri health care" space. Of these corporations, more than 260 of them are members of the Nashville Health Care Council, which is also something unique. This nonprofit organization holds together a coalition of the most powerful names in health care.

We are sitting on a powerhouse of health-care resources and dollars. So how did this happen to us?

We know that health care does not equal health, and 80 percent of how healthy we are depends on social determinants like local environment, education, diet and culture. For example, 72 percent of Davidson County Metro public schoolchildren suffer from economic disadvantages. We may be succeeding in these large business arenas, but the well-being of our population is not following.

If we consider actual health-care dollars spent on avoidable illness and loss of productivity of our workforce — either because they are sick or are caring for an ill loved one — the price of an unhealthy community over the next decade will cost us at least $10 billion, and maybe as much as $20 billion. It will be more expensive to live and raise families here, and more expensive for employers to build here or even continue to stay here. Inaction will result in lost jobs over time, a stagnation of our economic market, rising unemployment and a rising cost of health care for our population.

If we want to build a thriving and successful city and state, this has to change, because the health of our workforce and citizenry are paramount to the success of the region.

The good news is there is something we can do.

Already in Nashville there are public health champions doing incredible work every day. But our city is large and our problems complicated. No one organization working alone or even with a few others is capable of the scale of change we need to reset the trajectory of our city. But together we can do this work. We must organize as a citywide collaborative, leveraging the relationships we already have and the dollars we know are here. This way we can attack the problems from multiple angles, focus resources on the neediest areas and, in making these changes, save the city millions of dollars over the next decade.

In my opinion, this is the most important thing we can do for our city and our state right now and for the next 10 years. If we truly want to ensure Nashville stays an "it" city for years to come, and more importantly remains the place we all love and want to raise our families, we have no choice.

William H. Frist, M.D is a nationally acclaimed heart and lung transplant surgeon, former U.S. Senate majority leader, and chairman of the executive board of the health service private equity firm Cressey & Company.

Last month I sat on a panel hosted by the Center for Strategic and International Studies (CSIS), the Vanderbilt Institute for Global Health, and Hope Through Healing Hands. I want to share some notes from the discussion.
In my third week at Karapitiya Hospital I was introduced to Dr. Kumara, senior lecturer in Surgery. Participating in various surgical cases was what I was most looking forward to on my rotation in Sri Lanka. Walking into the OT I noticed it was quite a different set up from the operating rooms back in the states. Patients were lined up on a bench right outside of the open theater doors with their medical chart in hand.
After a long journey to the other side of the globe, I was finally in Sri Lanka. It was 1:00 am when I landed then I arrived at my lodging at 4:00am. I had 4 hours to sleep and be ready to work! When I woke up to monkeys howling and playing in the trees 20 feet away, I knew I would like this place.
I had plenty of time to contemplate all that I had seen during 12 hours of travel back home from a medical mission trip to Georgetown, Guyana. I had just spent three weeks working in the Accident & Emergency (A&E) department at Georgetown Public Hospital and using my training as an Emergency Medicine resident in the United States to help teach new ER doctors core material such as EKG reading, airway management, and the approach to shortness of breath and chest pain. I had not realized when I arrived how much of my time would be dedicated to sitting in the metaphorical trenches and caring directly for patients coming to the A&E. I was prepared for a foreign experience in a distant land, but instead I found myself right in my element.

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