GHIC 2020: Global Health & Innovation Conference
April 4-5, 2020 at Yale University and the Historic Shubert Theater
New Haven, Connecticut

Unite For Sight's 2011 Global Health & Innovation Conference

Blog Report by Daniel Ting, Global Health Leadership Intern Alumnus

"Innovation Dissemination and Take Up: What Works?"Elizabeth Bradley, PhD, Professor of Public Health, Division of Health Policy & Administration; Director, Global Health Initiative, Yale University, and Leslie Curry, PhD, Research Scientist, Division of Health Policy & Administration, Yale School of Public Health

The gap between knowledge and impact in policy is a frustrating one. Effective, cheap, pragmatic ideas abound in public health, ideas that would save countless lives but prove refractory to widespread implementation. Acclaimed surgeon-writer Atul Gawande writes in The Checklist Manifesto about the drastic improvements in surgical outcomes when surgical teams routinely ask themselves basic questions before starting surgery—such as what allergies the patient has, or how much blood loss is expected. The concept is simple, but getting surgical teams to adopt the policy is difficult, be it because of misconceptions, skepticism or downright hubris. 

Uptake of novel public health measures resembles a sigmoidal S-curve (FIG. 1). The initial uptake of the new idea (depicted by the black line) is slow, but after reaching a critical point where the intervention is widely accepted, it quickly spreads until tapering off as the most stubborn conservatives finally give in.  But what if we could speed this process up? The red line depicts an enviable target for all policymakers—expediting the whole process to minimize cost and maximize benefit.

FIG. 1. Graphical representation of public health uptake over time

Betsy Bradley and Leslie Curry, both of Yale University, believe that this optimization can be achieved with a new paradigm of how public health messages are disseminated, and they turn to an unlikely model: a retrovirus, of which the most famous example is HIV. The process resembles the following:

We broke into smaller groups to discuss how such models could be applied to different scenarios. I sat down with Lawnray, a recent Yale University graduate to discuss the introduction of cell phones in Ethiopia(1) over the past two decades, using the viral life cycle model to retrospectively evaluate the strategy. We were both surprised by how well our example of cell phones in Ethiopia was able to fit into the viral life cycle model. We also concluded that a primary strength of the model was that it made us consider the needs of the target population. Clearly, the ability by cell phone manufacturers to adapt cell phones to the Ethiopian market was critical for the success of the product introduction. 

Take-Home Messages

(1) Although cell phones are not necessarily instruments of healthcare, they are tools of communication and thus of public health.