--- description: Community health programs Access to healthcare Preventive healthcare Health equity Early disease detection Breast cancer screening Prostate cancer awareness Heart disease prevention Public health initiatives Underserved communities healthcare title: Breaking barriers to health, beginning with the community image: https://static.time.com/v3/assets/bltea6093859af6183b/bltbd622f879d02def4/69fa3bd3e070ce825cb76a14/AAB_1622_bearb_1-1_neu_(2).jpg?branch=production&width=3840&quality=75&auto=webp&crop=16:9 ---  # Breaking barriers to health, beginning with the community  Photo credit: Adriano A. Biondo Photo credit: Adriano A. Biondo _Some communities around the world need their own tailored solutions to meet healthcare needs – whether that’s detecting early signs of heart disease, breast, or prostate cancer. These community-based approaches address barriers to access among underserved populations._ One evening in North Carolina, a woman took her seat in a church hall for what looked like an ordinary service. It wasn’t. The hall was being used to offer a free health screening event. She had come to listen, not to speak. Her mother and sister had both died of breast cancer but, despite the family history, fear had kept her from being screened herself. Yet, during the event, something shifted. She learned about cancer risk and the importance of early detection – and realized that not knowing would not help her. No longer afraid, she felt ready to schedule a mammogram, believing that taking care of herself was the best way to honor her mother and sister. Her story is not unusual. In growing numbers, people across the US are initially reaching the health system not through a clinic but through a church hall, a school gym or a community center. The event was part of a national mobilization and awareness campaign for breast cancer hosted by The Balm in Gilead, a US-based public health organization rooted in faith communities. Events were hosted community education forums in local churches. Its founder and CEO, Dr. Pernessa Seele, has spent nearly four decades on community health – work that began in Harlem in the late 1980s, supporting people through the AIDS epidemic. “The pastor and the doctor are two respected people within our community,” says Dr Seele. “But the pastor comes first in terms of influence. When a pastor tells their own story about a friend or relative with cancer or HIV, people listen. We wanted to utilize the power of the pulpit. The issues haven’t changed in communities over the past decades; they have intensified. It comes down to lack of knowledge among communities, rising healthcare costs, limited access in rural areas and, sometimes, outdated medical practices among those offering treatments. Sometimes patients just need to know what questions to ask healthcare professionals.” **A gap in access to healthcare** The numbers back her up. At community-based primary care clinics in the US, just 45% of patients are screened for breast cancer, according to the American Cancer Society, against 78% nationally. The U.S. Centers for Disease Control and Prevention (CDC) states that prostate cancer kills more than 30,000 Americans a year. Meanwhile, heart disease and stroke claim more than 850,000 lives each year, according to the American Heart Association (AHA), accounting for nearly one in four deaths annually. What keeps people away is rarely one thing: distance, cost, mistrust or the quiet weight of systems that have failed them before. Many never enter the health system at all. Others arrive late. Closing that gap, Seele's work suggests, means meeting people where trust already exists. **Adapting healthcare models that work for different communities** The Balm in Gilead has recently formed a partnership with Novartis, to help deliver the company’s Inclusive Health Accelerators (IHAs). This is a program designed to boost early detection of prostate and breast cancer among medically underreached populations based on data-driven indicators, such as gaps in screening, delays in diagnosis, and other barriers to accessing healthcare. Initially launching in five US cities – New York, Los Angeles, Detroit, Houston and Baltimore – the IHAs aim to improve access to education, free screenings, diagnosis, and follow-up care through tailored and local partnerships. Novartis partners also include the Weitzman Institute, the African American Male Wellness Agency and BlackDoctor.org. The IHAs are just one of three distinct community health approaches Novartis is using to reach patients with heart disease and cancer. The company intends to extend the programs to more than 30 countries by 2030\.  Photo Credit: FourDeep Media **Collaborating for health in low- and middle-income countries** In low- and middle-income countries, the burden of chronic disease is rising fast: the [World Health Organization](https://www.who.int/health-topics/noncommunicable-diseases#tab=tab%5F1 "undefined") estimates that more than three-quarters of deaths from non-communicable diseases – including heart disease, stroke and cancer – occur in low- and middle-income countries. In Rwanda, Vietnam and Bolivia, Novartis has teamed with health ministries, local government and country-based NGOs to design community health programs from the ground up, with the aim of expanding to at least 10 countries by 2030\. Services, particularly in rural areas, are delivered through local networks, and owned by local people. It’s a pathway to health access that is working. In Vietnam, the program now spans 37 provinces. In 18 months, around 400,000 people have been screened and 35,000 linked to treatment in partnership with the Government of Vietnam – among them rural patients who, before the program reached their district, would have travelled hours to a city hospital for a diagnosis they often never received. **Tackling heart health in cities** For mayors of fast-growing cities, cardiovascular disease presents a different version of the same challenge: large populations, stretched budgets, and sharp disparities between neighborhoods. CARDIO4Cities, an approach developed by the Novartis Foundation, an independent charitable organization, uses real-time data to help city governments map cardiovascular risk and target interventions – from prediction and detection through to managing hypertension, diabetes and high cholesterol. It is currently running in 8 countries, including New York and São Paulo. Participating cities have seen three- to six-fold increases in hypertension control within one to two years. **A health systems approach** Yet, the treatment of heart disease, cancer or diabetes requires more than a prescription; it takes someone the patient already trusts, a route to diagnosis, and follow-up that stays after the first visit. Where this exists, outcomes change. For the woman in North Carolina, the Balm of Gilead event was life changing. In her family line, others had lived and died from cancer – but with access to healthcare in communities, the pattern doesn’t need to continue to future generations. 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