Photo: Ann Aerts, Head of the Novartis Foundation. Credit: Novartis Foundation.

By Elena Astorga

Cardiovascular diseases (CVDs) were responsible for 20.5 million deaths in 2021, the leading cause of death globally. According to the World Heart Federation’s 2023 World Heart Report, deaths related to this type of pathology have increased by 60% in the last three decades.

The death rate from CVDs, however, fell from 354.5 deaths per 100,000 people in 1990 to 239.9 in 2019, according to the same report. But this decline has been significantly uneven across regions: for example, the mortality rate in Sub-Saharan Africa went from being 1.2 times higher than that of high-income countries to 2.1 times higher during this period. According to the World Health Organization, at least three quarters of deaths related to cardiovascular disease occur in low and middle-income countries. The detection of these pathologies is later and access to quality health services is lower. In other words, the inhabitants of countries such as Mongolia, Senegal or Brazil are more likely to die of cardiovascular disease, and at a younger age.

That is why the three aforementioned States were selected by the Novartis Foundation, the philanthropic arm of the Swiss biopharmaceutical company Novartis, to implement its CARDIO4Cities pilot program. Ulaanbaatar, Dakar and São Paulo were the testing grounds for a methodology that uses data and analytics to study, predict and prevent cardiovascular disease in large urban populations. And the results have not been long in coming: it is estimated that the initiative has managed to prevent, respectively, up to 10%, 3% and 12% of heart attacks in these cities within one to two years of implementation. Ann Aerts, head of the Novartis Foundation, shares the milestones, challenges and strategies that will mark the future of the fight against CVDs.

The CARDIO4Cities initiative has proven to have a significant positive impact on cardiovascular population health. What technologies does this approach rely on, and how does it contribute to reducing the incidence and mortality of cardiovascular disease?

We wanted to demonstrate that you can rapidly improve cardiovascular health in a large population by focusing on early detection and on better quality of care, which meant to standardize frontline care by using data and digital technology. The results were similar in all cities: we were able to triple blood pressure control rates in about one and a half years of implementation, which then translated into a reduction of up to 13% of strokes, which is a lot of lives impacted.

We were successful, on the one hand, because the initiative was driven and owned by the local authorities. Everything we did, including the design, the definition of the first interventions and the progress and impact measurement system, was co-created with them, so the local partners felt engaged from the beginning. Consequently, we used real-time data to periodically check in with decision makers in order to redesign interventions where needed. We collected the data in different ways in each of the cities, but always integrated in the local health information system. In São Paulo, for example, we screened for CVDs in subway stations or football stadiums, using Bluetooth technology to automatically refer those who screened positive to the health system. In Vietnam, we trained shopkeepers of small stores such as manicure salons or barbershops—where people generally spend a lot of time—to measure blood pressure, with the results being automatically transferred to the health system as well.

The Novartis Foundation now aims to replicate the CARDIO4Cities approach in other cities in collaboration with governments and other local partners through the CARDIO4Cities Accelerator. What are the challenges when it comes to public-private collaboration in implementing digital health technologies?

The main condition for the successful replication and scaling of this population health approach is that local authorities are in the driver’s seat. There must be a real demand and willingness from policymakers to address cardiovascular health as a priority. Our experience is that the approach also has to be needs-driven and user-centered, while all players need to be strongly aligned behind the same goal. In addition, we start by setting concrete targets at the start of the partnership, as those are very tangible for the people who must do the work.

In some places, resources are limited, and the beauty of the CARDIO4Cities approach is that you can deliver the data that demonstrates what works well and what doesn’t so that those scarce resources can be allocated to where they are needed most.

The AI4HealthyCities Health Equity Network aims to improve how cities tackle heart health inequities, with New York City being the first to implement in the initiative. How can big data and advanced analytics help to inform city leaders’ approach to healthcare policies, especially in addressing inequities in quality and access?

We truly believe that we should tap into the potential of the large amounts of data available nowadays to progress our understanding of what most determines people’s health. With the incredible computational power in our hands and current data science capabilities, we can combine data from the health sector with that of health influencing sectors and identify the true drivers of population health. Currently, we know that only 20% of our health is linked to the healthcare you access, while the other 80 % ties into the conditions in which you are born, grow up and age. Until now, there has been no true attempt to use the possibilities of big data and AI to understand the combined impact of all these social, economic, environmental and cultural factors on our health.

We hope that, using these data driven insights, we will be able to design a new paradigm that changes our current reactive care systems into proactive, predictive and ultimately preventive health systems, that keep people healthy. With AI4HealthyCities, we bring together data from different sectors influencing health, be it air quality, noise pollution, traffic, food access, health system performance, physical exercise opportunities, housing conditions… So that we can quantify their contribution to health outcomes and better address inequities. Once we have the insights of what are the best or the worst combinations driving population health, we aim to translate that into action by offering decision-making simulation tools for policymakers.

The Novartis Foundation collaborates with Microsoft’s AI for Health, a $60 million (around €53,6 million) philanthropic program to empower nonprofits, researchers, and organizations tackling some of the toughest challenges in global health. How does collaboration with leading tech companies help put the potential of the latest technologies at the service of public welfare?

It’s instrumental. We lack the computational power or the data science capabilities needed to undertake an ambitious initiative such as AI4HealthyCities, and the tech sector lacks our health expertise. Combining both leads to very nice innovations: for example, a first part of our partnership with Microsoft’s AI for Health resulted in the creation of AI4Leprosy. Leprosy is one of the oldest diseases known to humanity, but no diagnostic test exists and about 200,000 new cases are still detected every year. AI4leprosy is a tool that scans skin lesions and can calculate the probability that they are leprosy with an accuracy of 92,5%. We hope that we can accelerate leprosy detection thanks to this newest technology available, and make this ancient disease history once and for all.

Currently, our partnership with Microsoft focuses on AI4HealthyCities, a win-win partnership: for our part, we could not carry out these comprehensive, ambitious data analytics without their capacities, and for their part, they would not be able to bring together all the partners needed to translate the results into impactful action afterwards.

Together with the Norrsken Foundation, the Novartis Foundation has funded the HealthTech Hub Africa, located in Kigali, to help drive the development of health technologies in Africa. What are the challenges in incorporating innovations in public health systems in the region, and what is the role of accelerators such as the HealthTech Hub in connecting startups, investors and governments?

The HealthTech Hub Africa is a good example of how HealthTech can revolutionize the way we address healthcare in a setting such as Africa. The Hub has hosted two cohorts so far, and we are mentoring 67 startups and scaleups to strengthen their business plans and connect them to investors and other stakeholders. This has resulted in most of the startups now scaling their solutions to many different countries.

One of the challenges in African settings is that public health systems are not that agile in approving and introducing tech innovations. At the Novartis Foundation, we are working with several African governments to understand what the roadblocks are, and how we can support setting up the right regulatory and legislative processes. In addition, public health systems work with scarce resources, especially for innovation, and startups have to create attractive business-to-government business plans.

We are now bringing all these learnings together in a blueprint for fast-tracking HealthTech solutions into African public health systems. Some governments are very open to this; for example, Rwanda is already pioneering several of our startups, as is Senegal – and these establish the first use cases for us to develop the blueprint.

The 30 startups selected in the first cohort raised more than USD 14 million and created over 300 full-time jobs across Africa. What are some of the most promising projects being boosted by the accelerator?

 Lifesten Health [winner of the Foundation’s Cardiovascular Kigali Health Challenge 2022], for example, is a lifestyle app that provides healthy recommendations, but also screens users’ health risks with AI. WeCare, led by a woman innovator from Ethiopia, is an online-based healthcare service provider that won our #Play4Health challenge (which asked startups to focus on children’s vascular health) together with Medtech Africa, which has developed a medical platform that enables caregivers to access timely patient data from heart monitoring devices.

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