Changing the Course of Chronic Disease,                                                                           One Comm...
Non-Communicable Diseases (NCDs):       An Urgent Issue            UN High Level Meeting on NCDs* Sep 19/20 2011         ...
Prevention: The Holy Grail for Tackling NCDs   WHO: a healthy diet, exercise and avoiding tobacco can prevent    •   80% ...
The Arogya World Approach to the NCD Crisis                               Two-fold mission Galvanize global action to addr...
mHealth (Nokia Life):Scalable Development Platform                                            Encourage Micro             ...
The Case for mDiabetes in India        Prevention             Arogya World         Program                 mDiabetes      ...
Nokia Life: Livelihood & Life Improvement Services High appeal and daily relevance in the lives of the Next Billion usersK...
Nokia Life, Arogya World mDiabetes Offering   Main Menu                     Health Topics Menu               Healthcare Menu
Arogya World mDiabetes Program At A Glance   ProgramDevelopment                           MessageRefinement         Effect...
mDiabetesInitial Consumer Insights
mDiabetes – Adaptation of Content   Pretesting       Nov/Dec 2011. Consumers. Simulated situations.       Part I N= 44,...
mDiabetesFirst Real World Consumer Insights
Message Recall                                         Message Usefulness100                                              ...
Critical Success Factors   Compelling messages: science + behavior change   Consumer-testing and local adaptation   Beh...
Back-Up
Arogya World Network of InfluencersBoard*    Dr. Nalini Saligram – Arogya World; Dr. Pamela Yih, Treasurer – Pamela Y-F Yi...
Our Track Record  • Feb 2009 – Workshop with 66 stakeholders in Delhi to gather input on priorities.  • World Diabetes Day...
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mDiabetes: Leveraging Mobile Technology for Diabetes Prevention in India

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Presentation given by Arogya World CEO, Nalini Saligram, PhD, at the Geneva Health Forum PL03 Innovation & Inclusion:
Opportunities & Challenges for Chronic Diseases

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  • Awareness on simple practices around hygiene, sanitation, tobacco control and fitness leads to significant improvement in living standards for self, family and community as well as prolonging the onset of non-communicable chronic diseasesMDG 5: IMPROVE MATERNAL HEALTH, Equipping expectant mothers with timely, personalized information around nutrition, safety and milestones relevant to different stages of pregnancy and child growth lead to better maternal and child health Messages around practices and healthy habits that could prolong the onset of non-communicable diseases like diabetes and heart diseases that threaten to cause damages in the Billions to emerging economies Equipping youth and young adults with information on healthy living, nutrition and prevention of commonly occurring ailments in the region (malaria, pneumonia, tuberculosis and other neglected infectious diseases) ensures that they are continuously productive. Preventive messages and compliance reminders for HIV and STDs lead to decrease in the burden of HIV/AIDS and deaths in young populations Timely reminders on vaccination schedule for children will lead to increased adherence and possible reductions to infant and child mortality rates. Information on locally available food resources and the importance of healthy eating address mal nourishment concrens in the emerging economies. Information on milestone related development and the need for monitoring MDG 8: Develop a Global Partnership for Development and leverage the rich ecosystem that Nokia Life has developed over timeMDG 3: GENDER EQUALITY and WOMEN EMPOWERMENT through women specific education and health services and focused Life Skills information to women MDG 2: Universal Primary EducationEmpowering millions in the emerging economies aspiring to become job ready and employable with FUNCTIONAL ENGLISH SKILLS (through their own language) will greatly increase their chances at getting jobs and doing better, leading to financial sustenance for self, family and societiesEquipping the millions in emerging markets living under $2 a day with foundational LIFE SKILLS (Personal Competencies, Social & Interpersonal Skills, Job & Small Business Skills) and FINANCIAL LITERACY (Personal Home, Small Business Finance) will significantly empower them in increasing their chances at financial sustenance for self, family and societies
  • mDiabetes: Leveraging Mobile Technology for Diabetes Prevention in India

    1. 1. Changing the Course of Chronic Disease, One Community at a TimemDiabetes: Leveraging Mobile Technologyfor Diabetes Prevention in India Nalini Saligram, Ph.D. 19 April 2012 Geneva Health Forum PL03 Innovation & Inclusion: Opportunities & Challenges for Chronic Diseases Arogya World is a U.S. based non-profit 501 © 3 organization. The name of the organization is simply an articulation of our mission: Arogya in Sanskrit means good health. More literally it means to live a life without disease.
    2. 2. Non-Communicable Diseases (NCDs): An Urgent Issue  UN High Level Meeting on NCDs* Sep 19/20 2011 • NCDs: one of the leading health and development challenges of the century • Political Declaration: “whole of government” and “whole of society” approach  Nearly 2 out of every 3 deaths in the world due to NCDs • 80% of NCD deaths occur in low- and middle-income countries • But, only 3% of overall global development assistance for NCDs.  Cost of inaction > cost of action • Economic Burden of NCDs: World Economic Forum/ Harvard** : NCDs (+ mental health) have cumulative loss of economic output = $ 47 trillion. • Action: WHO Best Buys*** cost $11 billion per year in LMICs , roughly 1$ per person per year  Prevalence of NCDs alarmingly high • >20% of population in India**** has at least one chronic disease; >10% more than one* NCDs = Cardiovascular diseases, diabetes, cancers + chronic respiratory disease**WEF/Harvard Global Economic Burden of NCDs Sep 2011; ***WEF / WHO Report – From Burden to Best Buys 2011****The Lancet series January 12, 2011 © 2010 Arogya World. All Rights Reserved. 2
    3. 3. Prevention: The Holy Grail for Tackling NCDs WHO: a healthy diet, exercise and avoiding tobacco can prevent • 80% of premature heart disease • 80% type II diabetes • 40% of cancersCompelling Clinical Proof Exists that Diabetes Can Be Prevented Landmark Trial - Diabetes Prevention Program (DPP) • 3234 high-risk adults in the US. 30 min physical activity/ day + low-fat diet reduced chance of getting diabetes by 58%, ( metformin: 31%) NEJM Feb 7, 2002. • The Lancet (2009) …diabetes prevention through lifestyle changes sustained 10 years. Finnish Diabetes Prevention Study  NEJM May 3, 2001. Indian Diabetes Prevention Programme  Diabetologia. 2006 Feb;49(2):289-97. © 2010 Arogya World. All Rights Reserved. 3
    4. 4. The Arogya World Approach to the NCD Crisis Two-fold mission Galvanize global action to address Implement Diabetes Preventionnon-communicable diseases (NCDs) through Lifestyle Changes in India ► Leverage UN NCD Summit Sep 2011 ► Op-ed, blog and social media campaign ► Multipronged Approach in ► Case studies schools, workplaces and the community ► Women and NCDs ► mDiabetes: leverage mhealth and ► Women for a Healthy Future Petition partnerships. Culturally relevant. ► 10,000 Women “Perspectives on NCDs” ► Science based work Global Survey ► Measure effectiveness and impact © 2010 Arogya World. All Rights Reserved. 4
    5. 5. mHealth (Nokia Life):Scalable Development Platform Encourage Micro Entrepreneurship MDG 8: Global Partnership for Life Skills and Development Financial Literacy Hygiene, sanitation, Functional tobacco control and English Skills fitness MDG 2: Universal Prevent Non- Primary Education Communicable Diseases MDG 3: Gender MDG 6: Combat Equality and Women’s HIV, Malaria and Empowerment other diseases MDG 4: Reduce MDG 5: Improve Child Mortality Maternal Health The Promise of mHealth: Increasing Access to Healthcare. 5.9 billion people (87% global population) have access to mobile phones.
    6. 6. The Case for mDiabetes in India Prevention Arogya World Program mDiabetes Nokia Life broad reach in rural, Accessible urban India 53% population have mobile phones Scalable (2011 Census) mHealth success in maternal health + HIV. Arogya applying to diabetes Persuasive prevention. Expert + consumer insights. 12 languages. Cultural relevance. Adaptable Content, frequency adaptable from research + tech advances Future: integrate with workplace + Integrated rural health worker programs
    7. 7. Nokia Life: Livelihood & Life Improvement Services High appeal and daily relevance in the lives of the Next Billion usersKnow more, Live more. Built for Emerging Markets High appeal and daily relevance in the lives of the Next Billion users
    8. 8. Nokia Life, Arogya World mDiabetes Offering Main Menu Health Topics Menu Healthcare Menu
    9. 9. Arogya World mDiabetes Program At A Glance ProgramDevelopment MessageRefinement EffectivenessTesting Evaluation and Expansion (2nd Half-2011) (2011 - 1stHalf-2012) (2012-2013)  2011 Clinton Global  56 Messages -  Full Roll-Out 1  Comprehensive Initiative Emory million evaluation of Commitment  Pre-Tested with  Multiphased outcomes  Nokia Life Platform consumers evaluation  Extending free  9 Jan 2012 roll-out content to 1 year  1,000,000 Consumers  30,000 recipients Mar  Effectiveness Eval insights from 1,000  Content, Sequencing  Free for 6 months  mDiabetes name Improvement consumers, phone  25 messages x 30  2x/wk; 12 languages  Interactive consumers = 750  Village Testing: face-  Accuracy, Cultural to-face in-depth Technology consumer insights. Relevance - Behavior feedback Incorporation  Telephone feedback Change Task Force  Data analysis and  Sustainability and  Real-world Scalability Current Partners Publication consumer insights to  Nokia, Emory, Ipsos refine messages  Aetna, J&J, Biocon© PharmARC Analytic Solutions Pvt. Ltd., 2009 Slide 9
    10. 10. mDiabetesInitial Consumer Insights
    11. 11. mDiabetes – Adaptation of Content Pretesting  Nov/Dec 2011. Consumers. Simulated situations.  Part I N= 44, N + S India (Hindi + Kannada); Telephone interviews  Part II – N=8 Semi-Urban Tamil Nadu; face to face interviewsKEY TAKEAWAYS Overall messages liked and found to be useful Simple short sentence with one concept will improve ease of reading Direct call to action is desirable compared to indirect persuasive messages Messages with no specific action scored low on likability and usefulness Link messages to diabetes Message should communicate whether it is primarily for control or prevention of diabetes Message frequency could be increased in the beginningACTION TAKEN Messages were modified per consumer feedback obtained Frequency of messages was increased to 6 messages for the 1st week and then 2 messages per week
    12. 12. mDiabetesFirst Real World Consumer Insights
    13. 13. Message Recall Message Usefulness100 100 80 80 60 60 90 86 88 81 40 80 40 80 67 70 70 70 20 20 0 0 1 2 3 4 5 1 2 3 4 5 Recalled receiving and reading the message Perceived message to be useful or very useful Ease of Understanding Willing to share100 100 80 80 60 60 92 95 96 100 40 87 85 88 40 88 88 85 20 20 0 0 1 2 3 4 5 1 2 3 4 5 Perceived message to be easy or very easy to understand Yes, willing to share Y axis = % consumers. X axis represents messages.
    14. 14. Critical Success Factors Compelling messages: science + behavior change Consumer-testing and local adaptation Behavior Change Task Force: Medical & non-medical experts = technical accuracy + cultural relevancy Comprehensive measurement and evaluation In-house expertise + external evaluation partner Multisector partnership: Industry (mobile phone, pharma, health insurance), academia, civil society Unifying purpose: Make meaningful public health impact, improve outcomes Scalability, sustainability Innovation; leverage technology advances
    15. 15. Back-Up
    16. 16. Arogya World Network of InfluencersBoard* Dr. Nalini Saligram – Arogya World; Dr. Pamela Yih, Treasurer – Pamela Y-F Yih Inc.; Kathryn Graves – Emory Univ Rollins School of Public Health; Dr. MeryleMelnicoff– formerly at WISTAR InstituteIndo-US Scientific Steering Committee* Based in India - Dr K. Srinath Reddy – President, Public Health Foundation of India, Dr V. Mohan – Madras Diabetes Research Foundation, Dr Ashok K. Das – Additional Director General Health Services, Dr Prabhakaran – Centre for Chronic Disease Control, and PHFI, Dr Nikhil Tandon – All India Institute of Medical Sciences, Dr. Prasanna Kumar – Bangalore Diabetes Hospital Based in the US - Dr K.M. VenkatNarayan – Emory University, Dr Sreekumar Nair – Mayo Clinic, Dr Francine Kaufman – Medtronic, Dr KarmeenKulkarni – Abbott Diabetes Care, Dr Sethu Reddy – Merck, Dr. Om Ganda -JoslinAdvisors*Dr A Ramachandran - India Diabetes Research Foundation, Chennai; Dr SubhankarChowdhury-IPGME&R and SSKM Hospital, Kolkata; Monika AroraHriday-Shan; C.V. MadhukarPRS Legislative Research; Deanna M. HoelscherMichael and Susan Dell Center for Advancement of Healthy Living; Dr Sudeep Singh Gadok, International Health and Development Expert; Raj Dave ARE Consulting, Dr. ArunChockalingamWorld Hypertension League, Dr. David C U’PrichardDruid ConsultingBehavior Change Task Force* Based in the US - Dr. Fran Kaufman, Medtronic, Dr. LinelleBlais, Emory University, Andrea Falls, Edelman Based in the UK – Zoe Hellman, Weight Watchers Based in India – Dr. Ranjani Harish, Dr. Mohan’s Diabetes Specialities Centre, Dr. Monika Arora, Hriday-Shan, SukantiGhosh, APCO Worldwide, Dr. KanavKahol– PHFI*all working pro-bono+ConsultantsTheaJoselow (Washington DC – digital media expert), Dr. S Kumar (Bangalore - senior consultant India), Dr. SandhyaRamalingam (Bangalore – market research expert), Beau Young (Philadelphia- accountant)
    17. 17. Our Track Record • Feb 2009 – Workshop with 66 stakeholders in Delhi to gather input on priorities. • World Diabetes Day 2009; 40 community walks in Delhi; 6,000 children asked MrsGursharanKaur, wife of Prime Minister of India, for help in making policy changes •Formalized as US-based non-profit organization March 2010. •New Diabetes Friendly Recipe Created for Arogya World by celebrated Manhattan chef from Devi Nov 2010 •Initiated Schools diabetes education program in India 2011; completed year 1 program, encouraging results •Clinton Global Initiative Commitment 2011 – 1 million consumers diabetes mHealth campaign in India; 30,000 consumers received messages through March 2012. • Healthy Workplace Stakeholder Input Session in India Bangalore, Feb 24, 2012 •Women for a Healthy Future – 2011 petition;

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