The global disease profile is shifting from one largely of communicable diseases to one dominated by chronic illnesses. The World Health Organization ascribes this shift to the collision of an aging population with rapid unplanned urbanization and the globalization of unhealthful lifestyles. And most of the deaths from chronic diseases-almost 80%-occur in low- and middle-income countries. Rio de Janeiro, Brazil, typifies the health challenges faced by many other large cities in this regard: an aging population, changing dietary habits, and increasingly sedentary lifestyles, all complicated by the financial constraints and inadequate access to health care services that lead to chronic illness.

Figure. A health care worker from the Santa Marta Clinic in Rio de Janeiro conducts a home visit as part of the New Cities Foundation's Urban E-Health Project. Photo by Marcelo Pizzato.

To tackle the problem in Rio de Janeiro, the New Cities Foundation partnered with the city, GE Healthcare, and the State University of Rio de Janeiro to try out a technology-based project aimed at improving access to primary health care in the poor urban community of Santa Marta. The partnership's Task Force on E-Health supplied health care providers, including nurses, with high-tech backpacks containing tools to measure health indicators like blood pressure and blood glucose quickly and efficiently during home visits to the elderly.

The program documented lower prevalences of stroke, heart failure, and kidney dysfunction in the patients participating in the project. Among the outcomes, too, were cost savings, including an estimated $200,541 per 100 patients per year in prevented kidney dysfunction, a growing problem in Brazil.

Although several challenges remain regarding provider training and the pace of data collection, those are being addressed. The task force sees the project as a means of substantially reducing chronic disease morbidity in an urban population. The report (available at http://bit.ly/11S20cK) recommends that the program be expanded, both technologically-the backpacks have greater technological capacity than was employed in the pilot program-and in size, and used in other locations where there is great need.-Gail Pfeifer, MA, RN, news director