Arnhold Institute for Global Health

Research and Development

Health care is in a period of deep transformation. Global and domestic macroeconomic pressures are driving focus away from fee-for-service medicine toward high-quality care that is cost-efficient, also known as value-based care. This paradigm shift results in a move away from managing disease to managing the overall health of populations, setting the course for the Arnhold Institute’s Research and Development (R&D) agenda. R&D at the Arnhold Institute is rooted in data science.

The call for healthcare transformation coincides with unprecedented availability of data from electronic health records, genomics, insurance databases, clinical trials, and other sources. That data science team aims to leverage that data for knowledge discovery by applying recent advances in computer science and econometrics in novel  ways. The data science team is an interdisciplinary group of computer scientists, economists, software developers, and clinician researchers.

The Arnhold Institute is investing in new academic capabilities and business partnerships to advance the fields of health system design and global health, leveraging the resources of the largest health system in New York.

The following projects are examples of partnerships that are advancing the Arnhold Institute’s mission of creating lasting global health impact at scale for the poor.

The Moment

As the United States enters a new era of foreign policy, there has never been a more urgent moment to reaffirm the link between global engagement and a more competitive nation. Within the last decade, local and global health agendas have converged on the overarching goal of building public health and healthcare systems that result in healthier lives for all people. Moving toward this vision requires achieving breakthroughs in lowering healthcare costs, health system designs that are responsive to populations, innovative uses of information and communication technologies, and a new generation of leadership for better health. Americans must embrace the advantage of thinking globally or fall further behind global peers in health outcomes, health equity, innovation and costs of care.

The Work

The Arnhold Institute is convening and hosting a special Task Force on Global Advantage, supported by the Robert Wood Johnson Foundation, that will bring together global and domestic experts to identify areas of work in healthcare and public health where global solutions can be utilized to achieve breakthroughs in domestic health.

Areas of Global Advantage

Areas of global advantage are bounded by three defining characteristics: (1) currently low-performing in the United States, (2) currently under-defined in the United States, and (3) addressed by a broad diversity of global innovations. Bounded by these three principles, the Global Advantage team has identified four core areas of global advantage:

  • Health System Design
  • Chronic Disease Action
  • Information and Communications Technologies for Population Health
  • Workforce and Training

The Impact

The Global Advantage Task Force will provide United States health system and public health leaders with a new arsenal of tools to create transformative change in their communities. Drawn from global health innovations, these tools must be calibrated to work in the economic, social, and political context of the United States. By disseminating these tools across national networks, the Task Force will catalyze local benefit from global experience.

Two-thirds of child deaths could be prevented by expanding access to existing health interventions. However, delivering health products and services to rural populations in low-income countries remains a practical challenge.

Microfinance institutions, which provide small loans to 200 million rural poor households globally, constitute a promising platform to deliver health products in low-income countries at scale. Researchers at the Arnhold Institute for Global Health led the first randomized controlled trial (RTC) showing that microfinance institutions can effectively deliver health products.

With support from United States Agency for International Development (USAID), Fonkoze, the largest microfinance institution in Haiti, is scaling up an innovative community health entrepreneur (CHE) initiative across rural Haiti. Through the initiative, 1,800 CHEs will be trained, deployed, and supervised by nurses. They will learn how to sell subsidized health products and provide free basic health services, such as malnutrition screenings, referral, and follow-up. Each CHE will use a tablet with a custom-built malnutrition monitoring and information system to record activities and track child and maternal malnutrition cases and risk.

The Arnhold Institute for Global Health is leading a prospective, controlled evaluation of the initiative in partnership with Fonkoze. To estimate the health and financial impacts of the model, the evaluation will use data from three large field surveys, malnutrition monitoring and information system data, and administrative financial data from the bank.

The Problem

Heart diseases like hypertension are now the leading cause of death and disability worldwide. In low- and middle-income countries like Ghana, hypertension is often more common than in the United States—and causes death and disability at younger ages. Community health workers (CHWs) in Ghana travel door-to-door to provide essential medical care such as child immunizations and prenatal evaluations, through the Community-Based Health Planning and Services (CHPS) program. However, CHWs do not yet provide care for hypertension or heart diseases, or counseling on how to prevent them through diet, exercise, and other healthy habits.

Our Approach

With grant support from the NIH Fogarty International Center, and in collaboration with Columbia University, the Arnhold Institute is designing a program to train CHWs to fight heart disease using the World Health Organization’s HEARTS protocol. The protocol uses simple measures like blood pressure, weight, age, and smoking status to identify and treat high-risk persons to prevent heart attacks and strokes. Through interviews and focus groups engaging CHWs, their supervisors, and the community members they serve, we are identifying the barriers to implementing this program - such as medications and training courses - in order to implement an integrated heart disease initiative adapted to local needs. Following pilot implementation in the Upper East Region of Ghana, this program can be scaled up to other regions of the country through the nationwide reach of CHPS.