Health workers in the Mississippi Delta are taking inspiration from an unexpected source in their bid to improve the health of the region’s disadvantaged population. Nellie Bristol reports.

Health advocates for the poverty-stricken Mississippi Delta in southern USA have spent millions of dollars over the years attempting to address seemingly intractable health issues disproportionately affecting the region’s African-American population. Now a group is turning to an unlikely source for a model of primary care provision: the health house programme of rural Iran.

Established in the early 1980s, the model uses community health workers to track villagers’ health, and provide basic care and health education. Trusted workers chosen from the community help patients connect with appropriate high-level services when needed. The programme has bolstered the health status of Iran’s rural population and garnered high praise internationally.

Continuous monitoring and support, and a community-based link to the fragmented US health-care system is just what the Delta needs as well, say health house advocates. The present system has failed the rural region for decades. Saddled with a long history of discrimination and unemployment, more than 20% of the population is uninsured, and rates of diabetes, hypertension, obesity, and infant mortality are among the highest in the country. Many residents have no access to regular care and turn to the hospital emergency room when they need attention.

Aaron Shirley is a long-time champion of health care for the Delta and chair of the Jackson Medical Mall Foundation, supporting a facility that attends to Mississippi’s underserved population. He is leader of the health houses initiative. Critical to its success, he said, is community involvement in both designing the programme and implementing it. “You’ve got to know the Mississippi Delta. There’s a distrust factor. But this [programme] is from the ground up”, says Shirley. “You’d be surprised at the response that we’re getting starting with the people and saying ‘here’s an idea, what do you think about it’ rather than going in and saying ‘here’s what we’re going to do’”, he added. “They’ve had a lot of that.”

Delta health houses, like those in Iran, will employ members of the community to serve as health workers. They will bridge the divide between public health and clinical medicine, tracking individual household’s health status and serving as advocates to improve living conditions including water quality and access to healthy food. They will help patients to negotiate the complex medical system, and follow physician instructions. The group initially will train workers with at least a high school education using the equivalent of nursing assistant certification, but hopes to develop an expanded curriculum with increased focus on community issues and even disaster preparedness.

Shirley and others are seeking US$30 million to begin supporting up to 15 health houses in the Delta region. With tight budgets in Washington, and reticence to adopt a model from a country in extreme disfavour in the USA, funding is an uphill battle. But the group is moving ahead with a pilot project in a donated building in Greenwood, MS. In addition to serving as a headquarters for the health workers, James Miller, another advocate for the project and managing director of Oxford International Development Group in Oxford, MS, says the building will be a meeting place for healthy activities, and will house exercise equipment and blood pressure monitors.

With health reform faltering in Congress, provision of community-based primary care for underserved populations will be paramount in the USA, both to improve access and cut costs. The use of community health workers like those in the Delta project, long a staple in global health programmes, is becoming more widely recognised and supported in the USA. According to Carl Rush, a community health expert based in San Antonio, TX, more states, insurers, hospitals, and the federal government are realising the value of the workers. They enhance disease prevention, ensure adequate prenatal care to prevent low birthweights, and encourage patient follow-up to reduce hospital readmissions.

Advocates hope turning to Iran as an unlikely ally in the promotion of rural primary health will finally start to meet the needs of the Delta population. “This is a human disaster that’s been hitting here for decades”, says Miller.

Nellie Bristol

Volume 1, Number 2 of International Health, a journal of the Royal Society of Tropical Medicine and Hygiene.

The following will appear in the February 20 issue of The Lancet:

Radiation protection The US Food and Drug Administration has an­nounced an initiative to reduce high radiation exposure from CT, nuclear medicine studies, and fluoroscopy. It will hold a meeting next month to solicit input about the requirements for manufacturers to incorporate safeguards in the development of technologies and provision of appropriate training for practitioners.

Dubious drugs A third of anti­malarial drugs available in three African nations are substandard, according to the USAID-funded Promoting Quality of Medicines pro­­gramme. Researchers sampled 491 antimalarials (artemisinin-based com­bination therapy and sulfadoxine-pyrimethamine) in Madagascar, Sene­gal, and Uganda. The results are part of a larger ten-country project.

Technology for health Pharmaceutical companies are turning to non-traditional partners, such as telecoms and information technology, to meet the needs of their customers. Ernst & Young’s report—Progressions, Pharma 3.0—discusses the need for innovative approaches, such as iPhone applications for glucose monitoring, to improve clinical outcomes.

Yemen law Yemen could introduce a complete ban on female genital muti­lation within 4 years if new evidence shows that the practice is continuing unabated 9 years after a ban on health workers doing the practice came into force. Women’s rights groups say that although the practice may have stopped in hospitals, it is now done at home where the tools are less clean.

Stem cells for stroke? The first clinical trial of stem cell therapy for strokes has been granted approval. If successful, the 2-year trial of 12 patients with ischaemic stroke could provide a promising treatment option for stroke survivors, with the potential to provide some recovery of function to people left disabled. Extensive animal tests lend support to the use of neural stem cells for brain tissue repair.

Haiti aid Only 6% of post-earthquake assistance funds have been allocated to nutritional aid for women and children in Haiti. UNICEF has warned that high levels of acute malnutrition will result if insufficient provision for these vul­nerable groups continues. The target beneficiaries are 2·4 million women of childbearing age, 240 000 pregnant women, and 600 000 children younger than 5 years.

Pharmacovigilance Experts gathered in Brussels, Belgium, late last month to discuss the European Commission’s proposals for strengthening pharma­covigilance in the European Union. Delegates welcomed direct reporting of adverse drug reactions by patients to health authorities, but were wary of a shift in responsibilities to the pharmaceutical industry. The draft legislation will be voted on in the European Parliament later this year.

Cholera outbreak Papua New Guinea is struggling to contain its cholera outbreak, which has spread to 2000 people. The waterborne disease has killed at least 40 people since July, 2009, and is spreading to new areas, owing to poor sanitation in the country. WHO officials have urged the government to ensure people’s access to clean water.

Don’t forget Pakistan The UN has urged donors not to neglect Pakistan as Haiti’s plight dominates headlines. The organisation has appealed for US$538 million to assist the estimated 1 million Pakistani nationals who remain displaced by fighting between the army and the Taliban. Many are living with host families, but tens of thousands are in camps where food is desperately needed.

Cigarette tax hike A report by the US Campaign for Tobacco-Free Kids, the American Heart Association, and others projects that adding a tax of US$1 per pack to cigarettes in the USA would raise more than $9 billion in new revenue per year, and save $52·8 bil­lion in immediate and long-term health-care costs; it also would prompt 1·2 million adult smokers to quit.

Deadly heatwave An unprecedented heatwave that began last month is continuing to cause deaths in Latin America. Those affected are mostly older people and those with existing medical disorders. With temperatures as high as 40°C in Paraguay and 43·9°C in Brazil, medical staff have launched campaigns to inform people of the dangers of dehydration, and the need to drink regularly.

Lost in space Global positioning systems (GPS), used in emergency services and disaster relief, might soon have their usual accuracy of 3 m decreased to 10 m as the sun wakes up from low activity. The speed of GPS signals entering the ionosphere is affected by the sun’s radiation. The Newton-Raphson equation for position might well need another dimension.