Gregg Masters 00:10
This is PopHealth Week on HealthcareNow Radio. I’m Gregg Masters Managing Director of Health Innovation Media and the producer co-host of the show. Joining me in the virtual studio is partner co founder and principal co host Fred Goldstein, president of Accountable Health, LLC. PopHealth Week engages industry leadership and stakeholder voices spanning payer, provider, patient, vendor and regulatory communities in population health best practices and strategy. To create private label thought leadership content connect with us via www.popupstudio.productions or following direct message me on Twitter @GreggMastersmph and that’s Gregg with two G’s. On today’s episode, our guest is heart centered and mission driven John Casillas, founder and executive director of GlobalRise. GlobalRise is a nonprofit organization building digital food systems in Sub Saharan Africa, India and Guatemala, providing a platform of hope for extremely poor communities to tackle disease, poverty, climate change, and other critical themes. Previously, John served as global health IT fellow for the World Bank and Senior Vice President at HIMSS, after unification of the medical Banking project, and HIMSS. Do follow his work at GlobalRise via www.globalrise.org. And with that introduction, Fred, over to you
Fred Goldstein 01:48
Thanks so much, Gregg. And John, welcome to PopHealth Week.
John Casillas 01:51
Thanks so much, Fred. appreciate being here.
Fred Goldstein 01:53
Yeah, it’s really great to get you on, as you know, we met at HIMSS. It was a fascinating session in the morning, and you presented and it really intrigued me the work you’re doing. So if you could start just give a short introduction, your background, then we’ll get into some of the cool stuff you’re doing.
John Casillas 02:09
Thanks. That was that was a good session for us, we were able to get our story out, which is at that point, you know, when I was talking to the Global Health Equity symposium, I was trying to represent the kinds of people who we are serving now. And, and their plight, they’re the you know, this is this is a segment of society that the world has truly forgotten. And so that’s sort of is where we’re working today.
Fred Goldstein 02:44
And a little bit of your background, the work you did, before you started this.
John Casillas 02:49
Yeah, I, you know, I started a think tank called the medical Banking project, which was focused on helping banks and healthcare technology groups to integrate their, their, their their service offerings, more tighter, it led to policy discussions around HIPAA, which for which we were pretty much well known in the industry. We were acquired by by HIMSS. And at that time, I was asked to form a relationship with the World Bank. The World Bank, had taken a strong interest in medical banking, created a fellowship, and then I became a fellow at the World Bank, to help them with health information technology implementations in various developing countries. And that’s really where I got the taste of being in a developing country, which, you know, a lot of people might run away from that. And certainly, that was in my mind, but I felt, I guess a tug, a tug, to see if there’s anything we can do in these, these poorest of the poor areas. And that led to eventually to GlobalRise.
Fred Goldstein 04:05
Right. And GlobalRise is just fascinating as I heard what you’re doing and how you’re trying to solve a problem. And I thought, wow, this is really like a population health efforts, because you’re going after some of the early early determinants of people’s health, you know, their ability to make a living, their ability to get food, and eat appropriately. And, and all of those things. And so why don’t you talk a little bit about GlobalRise in what you’re doing with that? Yeah.
John Casillas 04:30
And it’s so amazing, because, you know, we, when I started GlobalRise, it was it was I was I joined a board of a nonprofit organization, and they had built four orphanages in India. So they asked me to come over for a strategy meeting. And during the strategy meeting, we nixed bringing a nutritionist over because we couldn’t afford it. And I found that most orphanages in the world can’t afford to have a professional nutritionist look at the Kids. So that’s where the nucleus of GlobalRise started with, why not form a nonprofit that could help with orphanages with this. What we found, though, is that orphanages are, are increasingly seen as foreign silos of donations, and people in the community get jealous of the orphans, and the end the orphanage staff. So it’s important to integrate, integrated the orphanage with the community. So we started to move from developing an orphanage food system, which was very controllable to a community nutrition program. And when you talk about community nutrition, now you’re talking about all those things that you just talked about. And, you know, for being a medical banking aficionado, if you will, from Medical Bank project coming into that world was like, completely completely new thing for me. And we, you know, we had to just look at, okay, how are we going to really, on a long term basis, affect community nutrition?
Fred Goldstein 06:11
And so I understand, as I understand you, ultimately, were able to work and get some nutritionist into these centers, is that right? Through shared work or something like that?
John Casillas 06:20
Well, I actually reached out to a nutritionist when I started, GlobalRise, and she became part of the GlobalRise family. And then we have a global international nutritionist that sits on our board, who has done community nutrition work already, she brought in a group from University of Northern Florida, that are focused on the Center for Nutrition, and food security. And the president of this center became the president elect of now she is the president elect of eatright.org, which is the Academy for Nutrition and Dietetics. She brought in a whole slew. I had a whole army in, you know, nutritionists looking over our shoulder. And you know, nutrition is a very local thing. And but but having this sort of expert layer on top of what we’re doing, really helped to solidify our programming. So the thing that I brought to the table from my board, which mostly were technology experts, was innovation. So we were bringing innovation into this idea of how do we create a sustainable community nutrition program. And when you look at how the people live in the mountains, that’s when your heart leaps. So, you know, there is no roads, there’s a there’s a spider web of muddy paths. We’re talking about in the mountains of southwest Uganda, where orphans are coming in that have been deserted through war, famine, through through disease, and they they’re coming in, they’re living with with with extended families, maybe in Adobe huts. There’s 5.6 children per household.
Fred Goldstein 08:16
Wow,
John Casillas 08:16
there are smallholder farmers, they make less than $1.90 a day, we estimate that they make about 82 cents a day. They’re mostly women, whole woman led households, I would say about 80%. Based on our survey survey, we really to understand the dynamics around eating and nutrition. We did a survey. The survey took us about two months to design with all these nutritionists helps. And then we implemented the implementing of the survey is what really drove new ideas and thinking because we were walking what they were doing every day, and we were experiencing what they were doing every day under the African sun, going to a house using top technology, you know, like GPS to lock into the households we we select we selected statistically significant sampling is based on the formulas that they use in the nutrition world. And it was comprised of 1650 households all together, I’m telling you to walk up and down those those hills was just it just took the life out of me. They live all the way on top of the hill right? In this Adobe hut and they have about an acre and a half each of land that they farm and they’ll take whatever they can carry on their heads on their arms along with the baby on their back down to the market andand sell when selling
Fred Goldstein 09:50
and how far is that market?
John Casillas 09:52
It you know, there’s one study that was done recently 2019 We think it’s it’s it’s too much but it, they conclude that it takes five and a half hours for the average person to walk to that market one way, okay?
Fred Goldstein 10:08
So each day or when they’re going to take food to the market to sell it, they load it up themselves on themselves and walk five and a half hours to then go and sell it and then have to walk back.
John Casillas 10:20
We calculated three hours.
Fred Goldstein 10:23
Regardless, that’s a chunk of walking Oh, my God.
John Casillas 10:27
Yeah. And so you can see just based on mobility, how these guys are just locked, they’re locked. They don’t, they can only make so much selling one jackfruit. Right, which is the primary thing that they sell. And it’s sold for about 3000, Uganda shillings, which is about 80 cents. You know, what can you do? I mean, when you look at that environment, how they live, the fact that there’s a 50% stunting rate in this area. And you know, our mission is to eliminate stunting, we want to we want, we want to a world of healthy kids. That’s our vision. And we had gathered the community, through focus groups, and through large gatherings actually, to determine what is it that they felt would be the number one thing to address to move their community out of poverty, and it was unanimous it was it was nutrition, and in trying to eliminate stunting. So so with the community, we’re thinking, okay, so how do we do this thing. At the end of the day, we decided that we could overlay what they’re doing and accelerate it using drones. Walmart is actually just announced, doing using drones to deliver produce, the company that’s involved with that, the person involved with that is now helping us to this, this this issue. So basically, the drones will pick up the food, instead of the woman walking, they’ll come down to the market, when the food is taken off the drone, the money automatically transacts so that they have it directly on their phone, there’s no cash, it’s completely cash free. It’s, it’s like an Uber in the sky, we did the economics on it, we think that we can, at a minimum, increase their income to $2, at about $2.80 a day, at a minimum, by accelerating product to market. And by reducing food waste. So what happens is, they realize that it takes so long for them to sell one jackfruit, they’ll just leave the jackfruit sitting on the tree, they won’t be able to carry them. So there’s waste that we’re capturing.
Fred Goldstein 12:42
Yes. And I assume that even the folks where the market is, could use more food too. So by doing this, you can help that group as well.
John Casillas 12:53
There is a need for more food, there are there is a need to formalize the marketing transaction in this in this platform. So there might be a manufacturer that’s producing jackfruit juice, you know, which is definitely. So we can we can organize that and and implement it as a contract on the plant. Wow. But we also but yeah, the first thing is just getting into the market. Oh, absolutely. very active, very active. And you’re right. I mean, there’s, there’s there’s a need for for many things.
Fred Goldstein 13:30
Yeah, you know, it’s interesting, I think of all the spin off benefits of that. So you now have this woman who was taking this food for five hours, whatever, a day or eight hours, whatever it might have been, who now doesn’t have to make that walk and can do stuff back in the community, whether it be with the kids education, other work, it’s got to have huge spin offs, I would think,
John Casillas 13:53
exactly. So we use the system of systems approach. And we were guided in this type of thinking through the Rockefeller Foundation, we actually entered our idea into a global vision prize, food systems vision prize, and one semi finalist standing. There were 76 semi finalists from 1320 global submissions. And this is from institutes, governments, from people that have been doing this for a long time. And we’re just coming in kind of fresh to this. They love the idea. The thing is, what we’re doing is we’re connecting the platform to village training, and we’re spending a lot of time right now on village training. So what is village training? Village trading has three components can be a family nutrition, okay? soil fertility, which is very important in the mountains because of climate change, and financial planning. So, we’re, we’re developing these modules and before people can actually take advantage of the platform so they don’t have to walk. They have to go to village training, and the village training is is ongoing in our design. So what we have to do is we have to link the village training to the platform so that people progressively are learning at the household level, eat better, and to use money wisely and to tend their soil better. And that’s what we’re in the process of prototyping today.
Gregg Masters 15:23
And if you’re just tuning in, you’re listening to PopHealth Week on HealthcareNow Radio, our guest is John Casillas, founder and executive director of GlobalRise, a nonprofit organization building digital food systems in Sub Saharan Africa, India and Guatemala to tackle disease, poverty, climate change, and other critical things.
Fred Goldstein 15:45
So it’s like a comprehensive approach. It’s not just hey, we’re gonna fly these things back and forth, and move your product, we’re going to talk about what you’re eating in the house and help you understand that we’re going to help you with the financial issues that you’ll now face, and help you continue to be productive with your current gardens. So I mean, it’s really fascinating. And you know, I was originally looking at this and saying, It’s great from a population health perspective, and it’s good to hear Walmart’s doing and others and I hear we’re gonna may have pharmacy delivered that way and stuff. But it’s really looking at technology to solve a most fundamental problem. And when you think of social determinants of health, and the basic underlying issues that drive healthcare costs in the long term. So it’s really neat to hear how you’ve sort of structured this, that actually does take the newest tech, with this education approach to solve the basis the foundations we need to fix in order to improve overall health, longevity, and livelihood, I guess.
John Casillas 16:43
Yeah, and you know, this this area, they, they really could use it. Like I said, the people are forgotten by the world. They have no one. I mean, no one helping them. And even the government, the government that I spoke to the mayor, and he’s like, you know, John, this is such a pressing issue for us, the poor, the poorest of the poor. So Uganda is one of the top three poorest countries in the world. We’re right at the corner of Uganda and DRC, which is the poorest country in the world. Okay, so now we’re dealing with two of the poorest countries in the world in that population segment with a group that lives up in the mountains that have no roads. They don’t they don’t have access to electricity. And the government’s going, okay, they’re scratching their heads, they thought at first, let’s send mules up there. And the mules could help to carry it. I mean, there was a big research study that was done and they decided, okay, we’re going to send donkeys okay. So, so they tried sending donkeys and people started hunting, hunting them for food. So they stopped the program. So I have, I have an ongoing sort of email with with with people that are helping with the drones and, and it’s called donkeys or drones.
Fred Goldstein 18:07
Wow. And I know you also mentioned that they’re in these mountains, and right across the border, there’s essentially a war going on.
John Casillas 18:13
That’s right. And so in the same mountains the Ruwenzori mountains run 75 miles long, and they drain into Lake Albert, which, by the way, is the source of the Nile, the Nile River that goes viral. Okay, so these bodies of water come together up there. It’s also considered the Great Lakes of Africa, where we’re at. On the DR side of the Ruwenzori mountains in North Kivu province, South Kivu province, down to Goma, there are warring groups, and there’s an estimate of over 100 of these different warring groups, there are fighting proxy battles, and other types of war in the Congo. And, you know, we, we are not equipped to work in a war zone. If, if our place became a war zone, we would have to leave, fortunately, except for one, pretty bad incident, where the governor of I’m sorry, the president of Uganda had to put down a potential uprising in that community Kisese killing 150 people, there’s stability, there’s stability there. So we’re with them. We stand with those people. And every time we come, they realize that we’re a serious player for them. And we want to take so we call this whole thing a digital food system. It’s anchored on good nutrition and using good food as medicine. And then it moves into digital health tools, we actually are going to be implementing the health record as part of our program. So so there are there are digital health aspects about the digital food system that are very important. And that’s why HIMSS, by the way, is now supporting us this on this mission, which is coming up starting in June of we’re going to be back in Africa, we’re going to create a thing called Digital Health Week. So we’ll be scoping it, and really laying the groundwork for in in 2023. Having a health clinic as part of the as part of this program, we have, we have a five to 10 year program here. At the same time, we realized that it has to be replicable to get grant funding and getting the grant funding and other other types of funding, like having the government actually invest in this is important. So we are scoping another area in India, we actually in our Modus of Operations, we start with an orphanage, very symbiotic relationship, we help them with their orphanage food system, bring in professional nutrition expertise, which is the first thing that I spoke about, which kind of generated the idea of a GlobalRise, making sure that there’s good nutrition expertise in the orphanage. But then then we learn the community so that we can evolve a digital foods system in that community as well. So we want to do that three times. In in Africa, in India, and Guatemala, these are red stunting zones, there’s over 140 million stunted children in the world, most of them are in, in India, and, and then and then we want governments to look at those as demonstration projects, and then take digital food systems to other mountainous areas, or other areas, other geographical different geographically difficult areas in the world. So there’s there’s 300 million food insecure people living in the mountains today.
Fred Goldstein 21:47
Do you think this system as you’re structuring it, like the one in Africa could be self sustaining at some point, by moving enough food to do that versus having to ultimately you got to get it kicked off? And there’s a lot of investment, I’m sure. But is that something you see as possible, or maybe some government support ongoing is what you’re looking for?
John Casillas 22:08
We will first of all, we we wouldn’t do it if we didn’t think it was going to be sustainable, because the direction the board is it must be sustainable. So looking at it, if you if you take the economics, how many households are there, what they farm, we in our survey, we looked at the top three, top five, actually top 10 things that they sell, we went to the market and priced out all those things, you put all the data together, and you could have a $32 million economy in the mountains by implementing the system. So our pitch to the government is this is a great tax revenue source, it’s a great way to develop the area. With by the way, Uganda, place number one in the MasterCard, a woman entrepreneurial index in the world. So their women are more entrepreneurial minded than any other place in the entire world. Okay,
Fred Goldstein 23:05
wow.
John Casillas 23:06
So you give them a platform like this and let them grow, let them form cooperatives to meet certain things. There’s, there’s a world class safaris nearby that we could the drones could fly food to the safaris, instead of the Safari is constantly sending trucks out to the farmers market, we can we can fly in fresh food. There’s, Uganda is the third largest refugee hosting country in the world. So there’s refugee populations, which we create new markets, there’s the lake, the Great Lakes aspect, we could create a whole new market with the fish there. So we’re just gonna let the you know, we get the platform to them, and then they’re going to take it the rest of the way in there. And it’s exciting. It’s an exciting thing to watch. If we want to prototype it, and that’s it, we want the government to step in and say, Okay, this is really working, then let the government scale it. That’s right. That’s sort of our plan,
Fred Goldstein 24:06
right, plant the seed, and then let them continue to grow it.
John Casillas 24:09
Exactly.
Fred Goldstein 24:10
Excellent. No. And, you know, I think about that, and I know, we had discussions before this call about, you know, rural United States, you know, you think of some of the places in the Mississippi Delta, or, you know, rural North Dakota, even places like that, where we’re things like this may be really unique ways to solve many of these problems we have. I also find it fascinating that you said, we’re gonna build this digital health platform on top of this thing, which is, you know, it’s not just the money exchange, which I imagine was complicated enough. But getting that digital health platform has got to be something that’s gonna be really interesting to see what it does and where it goes.
John Casillas 24:48
Yeah, the population health aspect of it is very important, as you know, I mean, we have to be able to show results. If you’re going to move a community from from 50% stunting to healthy, you need to have evidence and evidence base to show that that’s actually being done. And so the digital health component is critical. You know, there’s another another piece that we’re we have in our, in our design, which is sometimes when you see children that are severely acute, malnourished, or SAM, they may they may need to go to the hospital. But but there was a study in India where they used ready to use therapeutic foods RUTS. And we have this idea. So RUTFs can be designed in universities in Harvard or Cambridge or wherever, you know, where they’ve already studied the problematic and then they can pack or they can create a meal packs. Okay? Those recipes, by the way, can be sent digitally, to a 3D food printing lab. Lab in Kasese Uganda. Okay, and we can 3D food print the food the RUTS, and then use drones to send them to the to the households. It’s a concept.
Fred Goldstein 26:20
Wow. Well, it’s been you know, John, it’s really been a pleasure getting you on to discuss this. I’d love to get you back on a while and hear how it’s going and what you’ve been able to accomplish. It’s fantastic. So thanks so much for joining us.
John Casillas 26:33
Thank you so much. I really appreciate it. And we’d love we’d love to follow up with you once we have some results.
Fred Goldstein 26:41
Fantastic. And back to you, Gregg.
Gregg Masters 26:43
And thank you, Fred. That is the last word on today’s broadcast. I want to thank John Casillas, founder and executive director of GlobalRise for his time and insights today do follow his work at global rise via www.globalrise.org. And finally, if you’re enjoying our work at PopHealth Week, please like the show on the podcast platform of choice. Share with your colleagues and do consider subscribing to keep up with new episodes as they’re posted. We stream live on HealthcareNOW radio weekdays at 5:30am 1:30pm and 9:30pm. Eastern and for you left coasters 2:30am 10:30am at 6:30pm. Pacific. For PopHealth week, my co host Fred Goldstein. This is Gregg masters saying please stay safe everyone Bye now