Why CBIO? A Census-Based, Impact-Oriented Approach to Community Health

The Census-Based, Impact-Oriented (CBIO) Approach is a practical, community-centered approach to improving health outcomes through systematic information about communities, evidence-based action, and measurement of results. 

This short introduction explains why the CBIO approach matters and how it can help communities and organizations move from identifying health needs to achieving measurable improvements in health. 

CBIO Initiatives for Global Health promotes and advances the CBIO Approach by providing training, technical assistance, research, and practical implementation tools. We support community-centered, evidence-based health initiatives, particularly in low- and middle-income countries, and seek to collaborate with governments, academic institutions, development partners, and local organizations. 

Learn more about CBIO Initiatives for Global Health: 
🌎 https://cbioinitiativesforglobalhealth.org/ 


My source:

Dear Peter,

In rural Kisii County, Kenya, a CBIO+ program cut under-five mortality by 80% and neonatal mortality by 78% between 2017 and 2024. Most of that decline came in the first three years. Would you like to see this sort of impact in the programs with which you work or that you support?

For more than four decades now, I have been working with Impact Global Health Alliance (IGHA, formerly Curamericas Global) on CBIO+, the Census-Based, Impact-Oriented Approach to helping communities improve their health. 

Please watch our short introductory video entitled “Why CBIO?” Then feel free to explore our new website which has a wealth of information about CBIO+. Our aim is to help you implement CBIO+, with mentoring from CBIO Initiatives for Global Health, or in partnership with IGHA.

We are convinced that this approach deserves wider recognition – especially now when global progress in health improvement is languishing and countries need to do more with less. Global health initiatives have spent billions fighting diseases. They have spent far less helping communities fight for their own health.

We believe that we need a stronger emphasis in global health on community-oriented public health, whose goal is to partner with communities to help them improve their health. The people themselves constitute our greatest untapped resource in global health, and we need new ways to work with communities to help them turn this potential into health gains.

Community-oriented public health is a much needed complement to vertical, disease-control programs (disease-oriented public health) and to health care delivery programs (services-oriented public health). We can think of them each forming a leg of a three-legged stool. Having a stronger leg for community-oriented public health will make the seat of the stool, the platform of public health, much stronger.

We hope you will find CBIO+ to be worthy of your attention and application anywhere in the world.

Watch “Why CBIO?” today: https://youtu.be/d8SEze-6gsY (8 mins)

Best wishes,

Henry--


Henry B. Perry, MD, PhD, MPH
Founder, CBIO Initiatives for Global Health
Co-Founder, Impact Global Health Alliance
hperry AT cbioinitiativesforglobalhealth.org

Senior Associate, Health Systems Program
Department of International Health
Johns Hopkins Bloomberg School of Public Health

'PROTOCOL(s)' For a missed opportunity?

As ever, when in London doing the bookshops, the subtitle of Prof. Huberman's book 'Protocols - An Operating Manual for the Human Body' caught my eye. 

It was in the foyer of Foyles, so hard to miss. Especially as I'd just picked up Buckminster Fuller's, Operating Manual for Spaceship Earth from 1969. There's been a slew of them since. 

When I saw the subtitle, the chip on my shoulder was activated. OK, so another contrib. to the operating manual genre. 'Human body' nailed what I saw as a mechanistic bias. 

But, even in the title, where would you place a protocol in Hodges' model?

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INTERPERSONAL : SCIENCES             

HUMANISTIC ------------------------------------------------ MECHANISTIC

SOCIOLOGY : POLITICAL   

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	PROTOCOLS: c/o Penguin

As is oft the case (not buying the book and reading it) a look in the index, revealed no mention of 'conceptual framework' or 'model'. A great shame and omission imho, surely an essential requirement to underpin, and act as a foundation for any manual worthy of the name? Metacognition is not listed, even as there are tools to assist in the challenges which our health presents. So too for reflection, and critical thinking. Again, not listed. I did not have much time, but cognitive behavioural therapy & cognitive skills are in there. The focus is behavioural. By all means, please correct me?

I asked Google; tried to access the index. No joy. I queried: 'what proportion of the book deals with the psychological, the mental?'

Approximately three-sevenths (or roughly 43%) of the core structure of Protocols deals directly with the psychological, cognitive, and mental side of human performance. [1]

While Dr. Huberman emphasizes that the mind and body are fundamentally linked through the nervous system, the book's contents are categorized into seven primary pillars. Three of those pillars focus explicitly on psychological state, focus, and mental growth: [1]

• Stress Control: Managing acute and chronic psychological stress through real-time nervous system resets.
• Focus, Motivation, and Learning: Rewiring cognitive attention, sustaining mental energy, and optimizing the brain for deep concentration.
• Personal Growth: Building long-term habits, shifting behavioral frameworks, and leveraging neuroplasticity. [1, 2, 3]

The remaining four sections focus primarily on environmental and physical baselines: Sleep, Exercise, Nutrition, and Light. However, Huberman's core philosophy is that these physical pillars serve as the direct biological foundation required to regulate your mental state. [1, 2]

As a nurse (still - just) I still worry, that once again the wellness industry continues to dilute medicine, nursing, healthcare as a discipline. In a sense though the wellness advocates are correct. If our initial frame of reference is prevention, health promotion, being and staying well then what should we expect!? We need to be wary of tech solutions, within the tools and 'AI slop'.

For an operating manual surely this warrants an addition or two - three in any 2nd edition?

I'm surprised Cornerstone Press did not see this as a publisher:

'a home for big ideas with practical applications. Publishing expert voices in areas including psychology and popular science, health and relationships, business and economics, our books help you build the foundations of your life – whether you’re looking to change your day-to-day patterns or understand the world in which they happen.' 

But, then oh hum!

My source: Foyles, Charing Cross Road

Previously: 'well-being' : 'metacognition'

Order theory - in Hodges' model?

Continuing to try and see Hodges' model as a mathematical object (yes, I clearly don't know), I'm revising the past (N) summer's draft. Rather embarrassingly, shared with a couple of people. In my defence it is a vanity project, a personal indulgence, to deal with the 'trauma' of my maths education and inadequacy as a child. So the draft is a brain dump, trying to use the literature in near darkness. The hope is there is a project here for others more skilled and versed in mathematics than I, who can ask the questions.

Many years ago I posted about binary classifiers, that is for human learning - not just machine. There was a post about a child's toy. I thought that Hodges' model was like a Sober toy; a flat one.

The basis of triage, is order. Fail in this you are not doing triage. This drives the categories of 'reason for referral', 'main problem'. It is not long until that main problem becomes: 'Patient's problem', 'Initially assessed'.

nLab suggests at least that order is deserving of attention:

• 1. Idea

Order theory, the study of orders, is one of the main branches of mathematics, but it often gets short shrift.

Government: policymakers & APPGs need Hodges' model

Press release Nov. 3

Child Trust Fund injustice to end under Government plans

Young people lacking the mental capacity to make financial decisions will finally have easier access to their Child Trust Funds. 

Young people lacking the mental capacity to make financial decisions will finally have easier access to their savings, ending a long-standing injustice that has created unnecessary barriers for families. 

Following years of campaigning and legal difficulties faced by families, new legislation will be introduced by the Government to allow simpler access to Child Trust Funds, replacing the complex and often costly Court of Protection process.  

The reforms are expected to allow parents and carers to go directly to Child Trust Fund providers to access savings, solving years of unnecessary anguish for an estimated 63,000 to 126,000 young adults. 

Child Trust Funds were introduced in 2005 to provide children a financial boost as they start adulthood, but the scheme made no provision for 18-year-olds who lacked the mental capacity to manage their finances without a straightforward way to access their savings.  

Campaigners, disability charities, and the financial services sector will help shape the new process, protecting young people while pulling down barriers that have frustrated families for years. 

Justice Minister, Jake Richards said: 

Young people who lack the mental capacity to make financial decisions should be able to access their savings as easily as possible – especially when this money was put aside by loved ones to help them take their first steps into adulthood. 

This is simply an injustice that we’re finally putting right and as campaigners have argued for years, change is long overdue. This legislation will ensure this group of young adults no longer face difficulty from accessing money that is rightfully theirs.

Continued ...

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INTERPERSONAL : SCIENCES             

HUMANISTIC ------------------------------------------------ MECHANISTIC

SOCIOLOGY : POLITICAL   

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Mental capacity Consent Disability - Learning Disability	Accessibility Childhood - Adulthood Processes - Systems
Families Social (in-)justice Activism	Child Trust Funds Policy making Policy

My source: BBC Radio 4 Today 0700-0900 7th Nov 2026

Previously: 'consent' : 'mental capacity' : 'APPG'

Paper: 'Lost for words: anxiety, well-being, and the costs of conceptual deprivation'

Dr Munch-Jurisic's paper provides many points that can help demonstrate the holistic bandwidth of Hodges' model. When I read 'conceptual deprivation' in the title, it reminded me of a question. Can Hodges' model inoculate the user against conceptual deprivation, to a degree (at least)? Student nurses have a conceptual framework which highlights the political realm. The model is taught with the point that student's need a metaphoric sword and shield. The sword because they will encounter power, and the politics in health, and health in politics. 

A lack of holistic bandwidth may also result in a lack of integrated, holistic care? 

Aged 17, on my first mental health ward, a mixed-sex admission ward. I was 'lost for words' when as a nursing assistant, a patient, who was very quiet asked: how on earth I thought I could understand her problems? A woman in her 80s at least, I was stopped in my tracks. We agreed finally I could try. 

There are other points for all users of Hodges' model about the literacies in Hodges' model. Once again that means all of them. The student unfamiliar with being away from family, let alone from a remote, rural to an urban environment, exposes them to all sorts of experiences. Substance and alcohol misuse, are never confined to cities (county-lines UK). The first-use of cannabis might reveal a psychotic-like reaction. Working in Manchester I had a few students on my caseload, working through this difficult - with family, friends and early intervention in support. I'm still reading ...

Abstract 

A range of contemporary voices argue that negative affective states like distress and anxiety can be morally productive, broaden our epistemic horizons and, under certain conditions, even contribute to social progress. But the potential benefits of stress depend on an agent’s capacity to constructively interpret their affective states. An inability to do so may be detrimental to an agent’s wellbeing and mental health. The broader political, cultural, and socio-economic context shapes the kinds of stressors agents are exposed to, but it also delineates the hermeneutic equipment they have available to interpret their stress. To explain this specific problem of conceptual deprivation, philosophical theories on wellbeing and anxiety need to move beyond individualist perspectives. 

Keywords: Stress · Distress · Discomfort · Affect · Anxiety · Well-being

Munch-Jurisic, D. M. (2021). Lost for words: anxiety, well-being, and the costs of conceptual deprivation. Synthese, 199(5/6), 13583–13600. https://www.jstor.org/stable/48691612

Paper: Metacognition as a Mental Health Support Strategy for Students ...

Weight and Bond provides insight into an arena of great relevance for Hodges' model in the paper below. 

In addition, the reading group this late afternoon, noted the use of group approaches to philosophical counselling, and practice. Plus, efforts to engage children with philosophy, which also reminded me of the book Sophie's World. 

I still have the question of the approprite age to introduce Hodges' model to children.

As per the paper's conclusion, there would be a way through PSHE [Personal, Social, Health and Economic education], but the Association, which has a conference was busy last year.

Hodges' model is open, (as per other writing) in terms of the labelling and language employed. So Hodges' model can be adapted according to the intended audience. This also applies of course, when the model is shared explicitly with patients/clients and carers.

Today's papers, reading and discussion was very constructive. Philosophical coaching was also highlighted. I'll post something from the 2nd paper soon.

Abstract

Mental health issues can have a profound impact on school performance, with anxiety creating significant challenges in the classroom setting. As teachers work to address barriers to learning, schools must develop a system to fully address the growing needs of students with anxiety. The purpose of this study was to examine the relationship between metacognition and its use as a mental health support strategy for students suffering from anxiety. Results of the study showed a statistically significant relationship between the use of metacognition, self-regulation as a component of metacognition, and teacher confidence level in supporting students with anxiety. This study works to further advance the growing body of knowledge regarding the teacher’s role in the support of mental health needs of students.

 Keywords: barriers to learning, mental health, metacognition, student anxiety

Weight, K., & Bond, J. B. (2022). Metacognition as a Mental Health Support Strategy for Students With Anxiety. Journal of Education, 202(4), 452-462. https://doi.org/10.1177/0022057421996242

With thanks to Dr Weight for my copy.