Welcome to a discussion of radical, fundamental principles of freedom, rational self-interest, laissez-faire capitalism, and individual rights. The Yaron Brooks Show starts now. All right. We are talking about Hurricane Harvey and the devastation in Houston. I just was looking during the break at some pictures of semi-trucks basically under water and highways closed because of the flooding. It looks like it's a major, major disaster. During the break, I also had a Jordan Peterson moment. Some of you might know who that is, but with regard to the relationship between guilt and weather, I think that if you think about it, this goes way back. This goes back to the Old Testament, right? There is an Old Testament story that connects guilt, human action with bad weather. It's a myth. It's a part of our mythology. It's part of our culture. It's part of the stories that we grow up with. It's easy then, if you will, for the environmentalists to latch on to that and capitalize on it. Of course, I'm talking about Noah's Ark and the story of Noah's Ark, right?  I have to punish them and I have to destroy them.  It's going to rain for 40 days and 40 nights. It's going to flood everybody, so build an ark and you can save yourself. Think about that as a story at the heart of our culture, at the heart of our religion, at the heart of the last 2000 plus years of Western civilization and it basically says, when a natural disaster happens, when the weather is really, really, really bad, it could just be God punishing us and we probably did something bad to deserve that punishment. Now I haven't heard, Jordan Peterson has a whole lecture on Noah's Ark. I need to listen to that in terms of mythology, but it strikes me that this is deep and my guess is Noah's Ark, by the way, is a story that is repeated in many ancient civilizations, mythologies, it's not unique to Judaism, it's not unique to the Bible, it's in many other places, so this relationship between how we act and the weather has a long, long history in our mythology and therefore in our psyche and therefore in our culture and it's not surprising that the climate change people can leverage that, can use that fact to say you're misbehaving, you're boning fossil fuels, you're living well, you're reducing your risk of dying because of the weather and God or nature or Mother Earth or whatever it is is now penalizing you for that fact. I never thought about the connection with Noah, so that's a new thought coming out of today's radio show. All right, hopefully a valuable one, all right, we're going to go to one other point I wanted to make, actually let's go to Skyler and I'll make the point answering Skyler's comment. Hey Skyler, how's it going? Good afternoon doctor, how are you? I'm good, I'm good, how about you? I'm well, I just want to know on your list of the myriad of agencies of the government that need to be dismantled and eliminated, where does FEMA place? Well it certainly places as one of the agencies that needs to go, you know whether it places very high or not, I don't know, I mean it probably is not one of my first things that I would do, although it's one of the easier ones to eliminate, you know there's a whole slew of them from the Department of Education to FDA, FDA literally kills people, FEMA does too but on a much smaller scale, so yeah FEMA should be gone and FEMA's easy, easy to replace and you know so FEMA would be relatively easy to get rid of, but let's talk a little bit about that, let's talk about the government response to crises that somebody asked earlier about this and I think the important point to make here is that the essence of government as George Washington told us I think in his second inaugural address, the essence of government is force, the essence of government is a gun and as such it has no place in disaster relief, it has a place when disasters happen, right? You should see cops everywhere keeping the peace, you should see, you know you should make sure there's no looting like happens sometimes, you know saving lives, if lives are in danger immediately so kind of the emergency aspect of it, so you can see government where force and the equipment of force, helicopters, things like that are necessary and security is necessary then I can see government has a role, but given the government is force, given the government is a gun it shouldn't be in the business of insurance, it shouldn't be in the business of rebuilding, it shouldn't be a business of telling people how and where to live or how and you know it shouldn't be in that business at all, it just shouldn't be there, so you don't need FEMA, what you need is the National Guard out in the streets, I agree completely with that, you need the police full in force and you need maybe the Coast Guard making sure that people are not drowning and can be saved, you know can be saved safely when they're in trouble, but other than that government just doesn't have a role to play when natural disasters hit and I want to explore the ways in which government intervention actually makes these crises worse and that's where I'm heading, is that what you want to talk about Skyler or any other questions? Yes, you answered my question sufficiently, yes sir. Good, good, well thanks for the call, appreciate your listening, so let's talk a little bit about this issue of flood insurance because one of the interesting things that's going to happen out of this politically is that the law that created federal, you know the federal government provides most of the flood insurance in the United States, the federal government has issued insurance, I don't even like to call it insurance because government can't do insurance, but it's a welfare fund for people who get into, you know, whose homes are flooded, they have three trillion dollars worth of coverage, that's what they're liable for by total, five million policy holders, by far the largest insurers of flood is the government. Now some interesting things about this, this agency, the national flood insurance program is in the hole, it's in the red for 24 billion dollars, so it's basically borrowed money from the Treasury, so it works supposedly like insurance, people pay in a premiums and then when a flood happens it gets paid out to them, but since the premiums are nowhere near high enough to cover the actual damages, then since this is a federal agency and it has a printing press in a sense, then what the government does is it borrows money from the Treasury, it borrows money from itself to fund the liabilities, so when a flood happens like now in Houston, the national flood insurance program does not have enough money to pay off even the people who have policies with them and they're going to have to take a loan from the Treasury, now they already owe the Treasury 24 billion dollars, 24 billion dollars, so they are constantly contributing to the increased debt that the federal government has because, you know, imagine if this was a private company, they would have been bankrupt decades ago, this is an agency that's existed since, a program that's existed since 68, they would have been toast a long, long, long time ago, so here's an example of government force, a gun, trying to provide a market service insurance and it's bankrupt, it's been bankrupt forever and it's going to be even more bankrupt after these floods, they're still going to pay out because they'll just borrow money from the Treasury, but they are going to be bankrupt, what makes it interesting right now is that the so-called mandate runs out in September and Congress is debating right now reforming the program before reauthorizing it and it's going to be fascinating to see and you will see how all these so-called, not so-called, all these Republicans who are so-called free market types are going to embrace socialism when it comes to a natural, national flood insurance program in September in order to reauthorize this and recapitalize it with more of your hard-earned tax money. All right, you're listening to the Iran book show on the Blaze radio network, we're going to take a quick break and we get back, I want to talk more about this flood insurance, the incentives it provides and why it's bankrupt, we'll be right back. We're the author, media contributor, this is the Iran book show, the Blaze radio network. You're listening to the Iran book show on the Blaze radio network. All right, we're back and we're talking about flood insurance in the context of what's going on in Houston right now and just awful devastation that is going on over there and look, I mean it's easy to dismiss flood insurance but I think it's interesting to look at the history and look at what it actually does and how damaging, how destructive, how stupid this policy really is. I mean at the end of the day this is massive redistribution of wealth but it's redistribution of wealth in kind of weird directions and it provides very bad incentives and that's what I want to talk about. So the federal flood insurance program was established in 1968, turns out in the 1960s there were a lot of floods and it turned out that a lot of people were flooded in the Midwest and in the Gulf area did not have insurance because they did not buy private insurance and in some cases because private insurance was not available to them and at this point what you saw on television or what you heard in stories is people whose lives have been devastated, whose property had been destroyed by floods, by rain, by you know through flooding and they had no recourse. There was no FEMA in those days, there was no flood insurance granted by the federal government, there was only private insurance and many of these people just didn't have that private insurance whether it's because they didn't buy it or in many cases because it just wasn't available because no private insurance companies would insure them. Why? Why wouldn't an insurance company insure somebody? Well maybe because the risk was too high, maybe because the risk was too high and part of the problem with insurance is, with flood insurance is that the risk is geographically concentrated so to really do flood insurance in a private sector properly you need to be able to do it across state lines in a variety of different geographies, there are regulations that make this difficult but it just is difficult because people who want flood insurance are people who live in flood plains, people who are exposed to flood risk. I don't buy flood insurance in California where I live because I need fire insurance, I need earthquake insurance, I need maybe mudslide insurance but I don't need flood insurance because I'm not going to flood. People with, I'm going to flood, I'm going to want it at the same time and it's going to be a certain concentration of them and you need some good diversification, you need some modeling. Also if you flood all the time, I can't give you insurance. Insurance is not for something that happens every day. Once a year insurance is something for things that are unusual, extraordinary. So instead of saying, huh, if private markets don't provide insurance here, maybe it's because people shouldn't live here because the risks are too high. Instead of that, what government decided and what I'm sure at the time the press and academics said, no, no, this is market failure. Why is it market failure? This is typical of how they use market failure. There's a need, people need insurance and the market's not providing the need. And therefore it's a failure of the market. Yeah, there's a need, but it's an irrational need because the risk is too high and that's why the market's not providing it and nobody should provide it. If somebody wants to live there, let them bear the risk, let them suffer the consequences. But you see, we can't do that, just can't do that. We can't say to somebody, bear the risk, suffer the consequences. Not in a world in which altruism, a morality that says that I'm all responsibilities to take care of our brothers and sisters and neighbors and all Americans really globally, every human being on the planet, you should take care of. A morality that says, no, no, you need to protect them. You need to take care of them. And if they're not going to move, you can't tell them to move.  Who are you to tell somebody to move? And they're going to suffer. Then you need to remedy the suffering. And the way to remedy the suffering is to have the federal government step in and to tax us to take our money so that these people can have it when they suffer. So the solution is a federal program to ensure people that the private market would not insure. And originally that was a certain size population, not a massive population because not a lot of people want to live in very risky areas when they can buy insurance. So when the program is first instituted, very few people are part of the program because it's only those people who are really risk takers and building on these things or people who didn't know how risky their property was. And they're the ones who buy this insurance. Imagine what happens over time. Now I look at that coastal islands in North Carolina and I say, oh my God, there's some beautiful property over there. Yeah, it's on this island that's barely above sea level, but I can build the house a little high. And yeah, it might flood once in a while, but I can now buy insurance from the federal government. And it's actually pretty cheap. And so why not build my home there? And particularly if it's a vacation home and I actually don't live there most of the year. So when the hurricane hits, I'm not going to be there anyway. And what you've seen is massive amounts of growth, massive amounts of buildings in high risk areas for flooding, high risk areas for flooding, primarily by relatively wealthy people who are buying a second home and who then insure it with the federal government. Now you would say some of these homes are uninsurable because they flood the water. Two minutes. But it turns out that it turns out that the federal agency has to provide these insurance policies. They can't say no. I didn't realize this until I started reading up on this. But it turns out that one of the differences between this federal program and real insurance is that they cannot deny coverage to especially risky properties with histories of repeated, extensive floods. So there you go. They have to provide you with insurance. You could buy, build a house. Anyway, right? Some of your floods every year. You can still get insurance and every year that we covered and every year you rebuild and it's completely subsidized. It's unbelievable. This is fraud. This is redistribution of wealth. This is a scam on massive proposal. And so the government is so what's happened is we've seen large increases in the population now living or at least that have homes in places that have massive exposure to flooding. Which is the exact opposite of what you actually want. And the exact opposite of what private insurance would actually do. Because private insurance would not ensure certain homes. And therefore provide them a distance center from building there. And insurance premiums would be very high on homes that had a very high probability of flooding. And that would provide a distance center for building there.  All right. We've got a hard break coming up here. You're listening to your own book show. We're talking about flood insurance. And we are going to take a quick break. This is your own book show on Blaze Radio Network. You're on Brooke. All right. We're talking about flood insurance and, you know, the devastation of the flood in Houston and its consequences at least when it comes to insurance. And we'll talk about FEMA in a little while. So, I mean, this flood insurance makes no sense. Now, I want to make something clear when I emphasize something. I don't blame politicians for this, although, you know, they obviously share in the blame for this. This is us. This is the voters. This is us demanding something be done. And I'm sure in the 60s when the flood happened and the government did nothing because the government had no role at the time. There was no FEMA and there was no, there was no federal flood insurance. I'm sure there was a huge outcry. Oh, my God. People are suffering. Somebody has to do something. And instead of people actually going and writing a check and helping their fellow man out, they demanded federal programs. They demanded the government do something. And I bet you Republicans and Democrats voted for this. This is probably passed with a big majority. This is the morality of altruism. This is the idea that when something bad happens to somebody else, it's your moral responsibility to do something. And since we all know that most of us are too selfish to do anything, we just delegate it to the government to do it for us. Delegate it to the government to force us, to curse us, to take care of the situation. That's how all these programs coming to being time and time and time again. And again, we'll get to how FEMA works in a minute if we have time. So the flood insurance, right? Not only they have to provide it to whoever wants it, but in addition to that, about 20% of all policies are subsidized, explicitly subsidized. There's a government subsidy because there's some rule that says that FEMA is required to subsidize policies for properties constructed or substantially renovated before 1975. And if you have an old place, you get a government subsidy. Instead of telling you to knock it down, or the fact that you have an old place that doesn't meet standards, we can't insure it. No, we do the opposite, exact opposite of what a market would do.  Also, there's all these issues about maps, flood maps, flood zones that FEMA puts out. And where you fall in these maps determines the riskiness for floods, which will determine the rate that you get. And again, this is FEMA doing its own market.  But the idea is because FEMA didn't have these maps before 1975, then it's not your fault and therefore we need to take care of you and therefore we're going to subsidize you. So we're talking about a system that makes no sense. By the way, wealthy of households benefit disproportionately from this program. They own many of the homes that insured. And by the way, for example, in Houston right now, over 80% of the homes are not insured through this program are not insured at all. And part of the reason for that in my view is because of FEMA, which steps in and helps you out after disaster and therefore your incentive to even buy insurance goes down. So this program is bankrupt. It makes no sense. It provides the wrong incentives. It's distorted. And everybody knows this. This is not a secret. You can look it up online.  And now this program is completely already in bankruptcy. And this is going to make it so much worse and the Congress is debating what to do about it. And of course, who's stopping real reform or privatization? Real privatization would be the solution, right? Just give it to private insurance markets. Make sure they're not heavily regulated, that they can function freely and let them determine the insurance rates for all these properties and provide the right rational incentives because that's what markets do. Who's objecting to this? Well, of course, it's Marco Rubio. Marco Rubio, the free market guy, right? From the state of Florida because a lot of these homes are in the state of Florida and God forbid he should vote for free markets. If it's to expense in quotes of some of his voters. Elizabeth Warren, who just wants government to control everything. Why stop at insurance? I don't know. If she's here in this article, it says she's a coastal senator. I don't think Massachusetts gets much flooding. Maybe I'm wrong, but it doesn't strike me as that. Anyway, and because a lot of the beneficiaries of the subsidy and because of the beneficiaries of the insurance are wealthy, they lobby heavily. There's a massive lobby to not reform this program, to not make it market based, to not privatize it. And that's why it ain't going to happen. It ain't going to happen. Add to that the altruism. Add to that that we've got a catastrophe right now where they're going to be pictures of people suffering all over the media for weeks. No way, no way is this program going to be reformed. I don't care who's in the White House. Right? I mean, and Trump, not exactly a free market guy anyway. All right, let's quickly take a call from Jennifer in Michigan. Hey, Jennifer. Hi. Hey, you've got an interesting question about disasters. Yes, about evacuation. I was wondering, do the authorities, do you think they have the right to ask the force you to evacuate? And if you refuse, are they then obligated to rescue you if you get in trouble? Yeah, good question. So my view is no, they do not have the right to force you to evacuate. They certainly should encourage you to evacuate, but not to force you to evacuate. But if they warn you and they say you should evacuate, if there's a so-called mandatory evacuation notice, and you don't evacuate, then you're on your own. No firefighter should risk his life to save you if you were told to evacuate and you did not. No Coast Guard should risk their life to try to save you off of a roof if you were told to evacuate and you did not. So no duty on the contrary. I would say they should focus on those places where they didn't warn them or where people's lives are threatened, but not protect the people who didn't listen to them. Now, sometimes authorities screw up, like it's not clear what people in Houston were told. The governor said evacuate and then the mayor said don't evacuate. So, you know, when the government is that confused and that unclear, then I don't think you can blame people for not having evacuated. So, but if there's a, in California, you call it mandatory evacuation order because of a fire. If that, if they deliver that and you don't evacuate, tough, tough. Yes, I agree. All right, good. Thanks, Jennifer. Thanks for calling. Thanks for listening. And you guys listening to, you're listening to your own book show. This is the Blaze Radio Network. We're going to take a quick break here and I want to when I come back, wrap this up. Talk about FEMA, talk about the rotten incentives they provide, talk about what the alternative to FEMA is. We know what the alternative to government mandate, to government provided flood insurance, but what's the alternative to, you know, marching to the rescue once catastrophe has done? What could replace FEMA? All right. Listening to your own book show will be right back after this. These messages. Clear. This is the Iran Brooks show. The Blaze Radio Network. This is the Iran Brooks show. All right. Listen to your own book show. We're talking about the hurricane that hits Houston, the flooding, the disaster that's happening there and the added disaster, which is the federal government intervening in the whole process through flood insurance and through FEMA. And of course the question is, and remember FEMA by providing assistance after the fact and providing loans and loan guarantees and just outright cash to people. Disincentivizes people from seeking out insurance. And we have the same thing here in California where earthquake insurance is expensive as it should be because it's earthquakes, but part of and part of the problem again is is diversification. You you if you're an insurance company, you can't have all your customers in California because one major earthquake happens in California. It could be a real disaster to a big part of your paying base. So you have to you have to be able to be a national entity. You have to be able to sell earthquake insurance in other parts of the country. Other parts of the country don't have as much earthquake risk. So it's it's it's difficult because it's so highly correlated. So instead the government steps in it takes over earthquake insurance. Most people just don't buy it because they figure FEMA will bail them out. So why even buy it? Now, the government has the earthquake insurance. They haven't gotten enough premiums to pay out. So as soon as the next earthquake happens, they're going to be completely bankrupt, completely bankrupt. And they're going to pay us, but they're going to pay us by taking on debt at the state level. So just wait until the next big earthquake in California could bankrupt the state. The next hurricane in Florida could bankrupt the state of Florida. Because Florida has I think Florida has insured all the insurance companies. So it's just a mess. Come and just stay out of it. Don't regulate. Don't control. Just stay out of it. Markets can handle this beautifully. And this relates to this issue of FEMA. What happens when you have a disaster like this? Who would help people? I mean, people need help. I'm not denying that people really need help. Who would help them if there wasn't a fee or if there wasn't a federal government? Well, a good example of this is the 1906 San Francisco earthquake and fire. The fire followed the earthquake where about 30,000, sorry, 3,000 people died. And about 80% of the city of San Francisco was destroyed. 1906, 3,000 people died. 80% of the city was destroyed. One of the worst natural disasters in American history. I think the worst is the Galveston hurricane that we talked about earlier in the show. And what happened? There was no federal programs. There was no state federal insurance schemes. There was some insurance but not well-developed insurance markets. So what happened? Well, there was a massive private response. A lot of the very wealthy industrialists of the time, those horrible people that we like to call rubber barons, stepped in and wrote big checks to help. So they funded relief efforts provided by organizations like the Red Cross, my private charity. The railroads. Railroads stepped in and landed up evacuating over 200,000 people from the disaster area, free of charge. Johnson and Johnson, which was even then was a big consumer products company relatively new at that time, rushed in with supplies, far faster, far more efficient than anything FEMA can do, because they were in the business of logistical supplies. And in those days, logistics was, whoa, right, horse and carriage. Maybe, oh, well, those railroads, railroads, right? But still, hard stuff, hard stuff. And private charity, Red Cross and other private charities stepped in and helped out. And people helped rebuild the city. Private businesses came in and rebuilt the city because of the value that San Francisco represented, the ports, the location, and it was all rebuilt in spite of the danger of a future earthquake happening again. Without federal help, without billions of dollars, without flood insurance or earthquake insurance for that matter. Right? So in today's dollars, people estimate the property damage from the San Francisco earthquake to be $10.7 billion. Insured losses at the time. So I guess there was a lot of insurance. So I'm wrong. There was a lot of insurance. Insurance industry, socials, tallies, the equivalent of $6.26 billion. Right? So there was. So a lot of it was covered by insurance. And people stepped in and San Francisco is built in one of the most magnificent cities in the world today. So private enterprise, private insurance. All the government has to do is get out of the way and ensure security, what they didn't do in New Orleans, ensure safety. Allow for the Walmart to be able to get there and make sure that they're safe in opening up the stores after a disaster. After Katrina, the first supplies to get to New Orleans. Two minutes. Work from Walmart. So get the government out. The government gun, government force, government coercion. And that's what government is. I'm not attacking government. I believe government is a necessary good, good for what it does well, which is protect us. Protect us from physical force, not protect us from nature. Protect us from physical force. Do the policing, the military and the arbitration of disputes. And there would be a lot of disputes after Hurricane earthquake. I'm sure. But stay out of insurance markets.  Stay out of things that voluntary markets do. Are the only ways and really which we can deal with stick to protecting individual rights. All right. We're about to wrap up here. We're about to run out of time. I want to make this point. The central problem that we face, the original sin from a Noah's Ark perspective is altruism. Altruism makes it possible for government to intervene here. Altruism demands that government intervene here. It's the morality of altruism that creates the demand for big, intrusive, unlimited government. And government can only grow and will only grow. Republicans, Democrats doesn't matter. Right left doesn't matter. 30. As long as altruism is the morality of the land. And altruism is dominant both on left and on right. Right another way in which I am different from left and right. I'm an egoist. I believe in rational long-term egoism. All right. The only place in the world you'll hear this stuff. You're listening to your own book show on the blaze radio network. We'll be back next Sunday at 11 a.m. Pacific time. See you then. Clear? Applying the principles of rational self-interest and individual rights on your radio. Right. On Brooks Show. On the blaze radio network.


Hi, everyone. Thanks for joining us during us today. I find it a bit ironic that I'm presenting on uncommunicable diseases and I'm competing with the sugar and caffeine that's outside right now. But yeah, we'll go with the people that we have here now. I'm very excited for our presenters today to learn a bit more about NCT use cases in country. Yeah, I will just click this here. My name is Brian O'Donnell. I'm a DHS to implementer at the University of Oslo at this center, where I work on the mobile health content and standards team producing packages, for example, and providing other DHS to technical assistance. But I have a few introductory slides to go through. But I will hear shortly from some NCT use cases from both Nigeria and Indonesia. And I will present them in due time. So first, just to set the scene, I want to leave some space for questions. Well, I apologize if I go through this a bit fast. But a sustainable development goal 3.4 said that by 2030, we should reduce by one third premature mortality from noncommunicable diseases through prevention and treatment. I put up this slide here so that everyone is on the same page about what noncommunicable diseases are, how they differ from infectious diseases. And I also understand a bit of the burden. So this is a world burden of disease by cause around the world, using a disability adjusted life, life years or dailies. Sure, most of the people joining us are familiar with these terms. But to understand globally that cardiovascular diseases and cancers are the leading causes of death. But also if you were to break this down by region or by country, then the burden of disease by cause for lower middle income countries, for example, it's actually going down greatly for infectious diseases such as or neonatal disorders or intraday infections. And it's increasing over time for noncommunicable diseases. So you can see that each year more than 15 million people die from an NCD between the ages of 30 and 69 years. And 85% of these premature deaths occur in low and middle income countries. I also bring up this point because while NCD's burden is increasing around the world, our health information architectures were largely designed around infectious disease programs, right? So we still have these different programs for HIV, TB, malaria, collecting data in their own silos and for specific use cases. But as NCD's increase their burden globally, we might see a shift in health information systems towards more focus on burden of NCD's and providing care for patients with hypertension and diabetes or other types of respiratory and cardiovascular disorders. So there was actually a NCD hard talks put on by the WHO just a few weeks ago that said so far the global response to NCD's is a test that we have failed. So it's quite a large step to say that we are failing a test and we need to get back on track. And while tobacco use is down, almost all other indicators for NCD's are on the rise. And I think that we will see a large increase in investments for digital health into NCD's over the next short to medium term because of that. So what are we doing at HISP-UIO as in our partnership with WHO around NCD's? Well, there's an integrated NCD package for HMIS that we are working on with the WHO NCD program, including the heart's indicators of the WHO technical package. And since 2020, we've been putting together a global product for NCD's for collecting data on NCD's at the facility level. And that included a rapid landscaping of the HISP network, which revealed that really the NCD indicators are not included in many HMIS systems that we work with. And furthermore that a lot of the key NCD indicators rely on a longitudinal follow-up of chronic diseases, which are quite challenging to implement. So oftentimes you might find yourself in an aggregate system or an event capture system for infectious diseases. But then for for these chronic diseases, you might need a much longer time horizon to capture data for patients with hypertension, for example, right? And one of the things I'd like to put up there as well is this WHO HISP-N Resolve to Save Lives partnership in Bangladesh, which is piloting, collecting individual level data through another application and then importing it into DHIS2. So all of this talk about mobile health applications being used to track things like blood pressure or diabetes. How can we actually integrate those tools into the health management information system? We also have a rehabilitation package, which is related to NCDs as well, which has been recently published. I won't go into a lot of detail on that, but just a short plug if you're interested. A number of countries have expressed interest in finding a standard set of indicators for personnel density utilization of different products around rehabilitation. But really this session is about learning from country use cases, and that's kind of the same approach that we're taking right now with the metadata packages and our collaboration with WHO. So we have a number of different work streams for informing this package development. We'll hear today from Joseph about the Resolve to Save Lives work on the Hypertension Screening app in Nigeria, and then they also work in Bangladesh. We're also talking with the World Diabetes Foundation about their work around a digital diabetes compass and exploring possible uses of DHIS2 tracker around diabetes screening. And Hispawanda also has a couple of programs that are of interest if you are in the NCD space, particularly around integrating a DHIS2 tracker with the desktop application called CANREG-5, which is used to analyze cancer data and is used in a number of facilities in different contexts. There's also a national NCD screening program that Hispawanda is doing around a number of these different NCDs. But with that I will turn it to our first speaker to give a presentation. Mr. Joseph Odu is a technical advisor for monitoring and evaluation at Resolve to Save Lives, a country office in Nigeria, and he will be sharing a bit about the Hypertension Screening application and the program there. So can I stop sharing here? I don't want to share a screen. So, sorry. Joseph, can you share a screen? Yes, I'm about to do that. All right, thank you. Yeah, we can't see your screen yet. You've added earlier. Yes, I'm trying to get it up and, okay, found it. Great, thank you. Can you say it now? Yes, just put it on presentation mode. Okay, great. I like your presentation because it set the stage for mine and I think most of my background has been taken care of by you. So thank you everyone, good day. And like Grant said, my name is Joseph Odu and I'll be speaking to this presentation titled DHIS2 at the Scale of Hypertension. Lessons learned so far in Nigeria. I'll be speaking on behalf of a team from the Federal Ministry of Health in Nigeria, the National Primary Health Care Development Agency, WHO Nigeria Country Office, HIST Nigeria, and Resolve to Save Lives. And our presentation will take these formats, the background of our projects, our approach for the deployment of DHIS2 on our project, the lessons we've learned, and also our next steps. So the Nigerian Hypertension Control Initiative, which was formerly known as a National Hypertension Control Initiative, was bettered in Nigeria in November of 2020 in Kano State and Ogun State. Those are the two pilot states for this initiative. Kano is in the northern part of Nigeria, while Ogun is in the southern part of Nigeria. This intervention was first piloted in 12 facilities for over a year. And during this time, this initiative was led by the Federal Ministry of Health and the National Primary Health Care Development Agency. I'll talk about their individual roles on the next slide. And during this period, the management of data was primarily paper based, which was in alignment to the national management information system in the country. And why was this initiative bettered? It was to reduce the mobility and mortality from cardiovascular diseases at the primary health care level in Nigeria. For those of you who are familiar with the Nigerian Health Care System, management of cardiovascular diseases such as hypertension is primarily the focus of tertiary facilities and secondary facilities. It was not within the remit of primary health care facilities. However, looking at the burden of hypertension and cardiovascular diseases in Nigeria, where one out of every three Nigerians has uncontrolled blood pressure and also cardiovascular diseases being responsible for 11 percent of the deaths in Nigeria, of which hypertension is the major risk factor. The Federal Ministry of Health thought it wise to bring the management of hypertension closer to the doorsteps of our households in Nigeria, thereby creating an enabling environment to capacitate primary health care centers to manage hypertension. That is one of the major successes of this initiative so far. We've worked with partners to develop a national hypertension treatment guideline and we've also ensured that there is access to high quality comprehensive hypertension diagnosis and treatment using the WHO HATS package. And we've also ensured the availability of validated sphignum anoritas for measuring blood pressure and also availability of drugs. We've also worked with partners such as his to ensure that there is a functional information management system to cater to these hypertensive patients. So who are the players in this initiative? The initiative is led just like I said earlier by the Federal Ministry of Health. We are responsible for the policymaking duty in the health ministry. Then the National Primary Health Care Development Agency who are responsible for the day-to-day running of primary health centers in Nigeria and technical partners are WHO and also his WHO takes so responsibility of providing technical support in service delivery and drug management while his supports with data management resolve to save lives at the funders and also provide technical support to the initiative. Currently we have over 13,000 patients being managed with the help of the HIS-2. We stick out from 24 facilities. Currently we have 104 facilities using the HIS-2 to manage their patients in both Kano and Ogil States. This is a big fit for us and we're excited about this. But before this achievement, what was the case? Just like I mentioned, the prevalence of hypertension in Nigeria is about slightly over 31 percent and so imagine managing patients about 30 percent of the population with a paper-based system and these patients will manage throughout their lifetime as we know hypertension management using the HIS-2 is a longitudinal process. So this has been envisioned to lead to reporting burden at facility levels. In Nigeria we have a National Health Management Information System that manages data for most of the programs. However, we still have some standalone management systems. Our PhDs are understaffed and some of most of the staff are not so motivated. Now, bringing a hypertension treatment program that is being piloted that requires them to use new tools that will be trained on, seem to look like a burden, and also took away from the time required to manage patients. As a result of the increased workload, this affected the quality of the data that was submitted at the end of each reporting period and also delayed availability of data that's been processed for decision makers to inform programs at both state, national, and at the facility level. So these were the reasons why the partnership that's called implementing this National Hypertension Control Initiative decided to come together and see how best to make life easy for the healthcare providers at the facility level to ensure that there's high quality data for decision making and to ensure that we have a good picture of the hypertension burden in Nigeria. So what did we do? We held several meetings. The Federal Ministry of Health, WHO, NPA, CDA East Nigeria, and Results Saved Lives first met to conceptualize the idea and see how best to present this case to stakeholders for their buying. And having had successful meetings and fend off our plans, we met with the Department of Health, Planning, Research, and Statistics in the Federal Ministry of Health, worked with them to come up with blueprints for the deployment of DHS2. First of all, we held a co-creation workshop to agree with implementing partners, development partners, healthcare providers, and even beneficiaries on the indicators we wanted to showcase on this platform because we had simplicity at the back of our minds. So we focused on the WHO hat indicators, following the co-creation workshop, and also because the Federal Ministry of Health was looking towards an integrated program, we agreed on indicators for both hypertension and for diabetes to be deployed through DHS2. Then the prototype was developed by HISP and UIO, which we then took to the field in November of 2021 and showed the healthcare workers. We visited six facilities, three in Oguna and three in Kano, where we talked to 19 healthcare providers, gave them the tools to use in collecting, registering new patients, recalling patient data manually, recalling data using a QR code, and also for entering data for follow-up patients. We observed that on the average, it took about four minutes to capture data or register a new client and a minute to enter data for follow-up patients. So these learnings and all the findings we got, we transferred to HISP and UIO to use for upgrading the device. Following the upgrade to the device, we trained a critical mass of stakeholders at the national level where we had a tiered level of training. So we had a TOT, we trained staff from the Ministry, Federal Ministry of Health, we trained staff from the WHO, National Primary Healthcare Development Agency. And when we got the critical mass of trainers, we rolled down to Cascader down to the states where we trained the states and also the facility staff. Following the trainings, we then deployed DHIS-2 in our initial 24 facilities, 12 in Kano and 12 in Ogun. Following the deployment and a form of secondary pilot, we then rolled out to all 104 facilities on the project. In the design of the DHIS-2 tracker for longitudinal tracking of patients on the NETI, we learned from an existing electronic data management tool called SIMPL, used by RTSL in four countries, Sri Lanka, Bangladesh, Ethiopia. And I think that the fourth country doesn't come to mind now, where they are managing two million patients on the SIMPL app. We asked and tried to find out what was the reason, what were the success factors. We found out that the fact that the app was fast and easy to use, enabled its front uptake. And why was it fast? Because it was tracking very few critical indicators, therefore not inundating healthcare workers with a lot of data elements for data entry and also ensuring that there was priority indicators available for decision makers. And also the fact that the SIMPL app was able to work offline and looking at Nigerian context, where we have operational challenges like limited power supply to ensure that the devices are always charged and unstable internet connectivity. These were the features that we ensured that our DHS2 app had. And we worked with the HISTING to transfer these learnings from SIMPL to our DHS2 tracker. So what did we learn? We've stratified our learnings into two. The first are the potential inhibitors. So we've come here to share with colleagues who intend to use DHS2 tracker for long snort tracking of hypertension cases. That it is very important to have a well taught out and coordinated plan for transitioning data from paper-based tools into the DHS2 platform. Prior to deployment of DHS2, we had about 7,000 patients that were already on the program. And you recall that management of hypertension is a lifelong process. So it is very important that we transfer the legacy data already captured on the paper-based tool into DHS2 so that we can recall or healthcare workers can recall them during subsequent visits and provide appropriate care and potential continuum of care. So one of the lessons we learned is if this handshake between the paper-based tools and the DHS2 tracker is not well coordinated, there will be several technical glitches when the migration has been done and recalling patients when they visit for follow-up will be very challenging. We had some challenges such as this at the beginning and one of such is during deployment we had DHS2.5 version. So it was a version control crisis and that version promptly told us whenever there was a sync error if the data was uploaded. However, when some of those, when the new facilities came on board and they had 2.6, 2.6 was not as, for one of a better word I would say sensitive to picking some of the sync errors and we've been able to identify some of these errors and with the help of his Nigeria and UIO we are trying to sort out these challenges that we faced. So we would like others who want to use DHS2 for this kind of programming to ensure that this handshake is almost flawless, if not flawless, to ensure that you don't have such technical challenges. Secondly, we have the enabling factors. The fact, the lesson we learned from Simple was further buttressed because when we deployed DHS2 considering that we have minimal data elements to go, to be imputed into the device and courage healthcare workers to uptake, I mean to use DHS2 more than we had expected. They were only collecting data on the patients' demography, only on patients' medication and blood pressure, very minimal data. Other data elements were either automated or considered not very important for this and so we made their life very easy. Also, traditionally in Nigeria, when programs use electronic tools or devices, they procure these devices for the healthcare workers. However, during our user acceptance testing, we tried to disrupt this process by engaging the healthcare workers to see if they would allow us to use their devices. Most were excited to do this on the condition that we provided data which we're happy to provide. However, I would like us to know that this was not without challenges because some of the healthcare workers have devices who do not have enough storage capacity and this was a challenge. However, it saved the program a lot of costs and it's an area that the country is really interested in exploring to see how going forward we would leverage devices of healthcare workers based on the learnings we get from this. Another, the last lesson was the active engagement of stakeholders as a very veritable tool in ensuring the success of our implementation thus far. Some of the challenges we had were promptly surmounted because the states were part of the design of this program, they were part of the intervention all through and they took ownership of it. So they supported us in ensuring that most of the challenges we faced were overcome. So overall, these are the three enabling factors that we've learned so far following deployment of GHIS-2 from October 2022 to dates. We would also like to share some of the next steps that we have. We are currently working to ensure that we document all the lessons that we've learned in this process and we hope to share this with UI, OHIS and WHO that this process is something that is scalable, is something that other clients and other countries and other programs can use and we are also going to continue to advocate for the seamless transition to 100% electronic data management of NCD cases where there will be no use of paper, there will be sole use of GHIS-2 because we've seen that it takes the healthcare workers four minutes to collect data and register new patients and one minute to enter data for new, I mean for revisit patients as against using paper tools that are prone to several challenges like we all are familiar with. We would like to show you the interface of our GHIS-2 tracker so you see that it just gets the patient's name, date of birth, I mean the patient's date of birth is automatically calculates the age, the patient's phone number and address so that we can follow up, there's a QR code that can be scanned to recall patient information, the blood pressure reading measurement, the drugs and then the dates for the follow-up visits. So this is what our GHIS-2 tracker data captures, then this is what our dashboard shows, it shows us the number of patients that have been enrolled, it shows us the number of patients that whose blood pressure are controlled and also shows us our cohort control over time. Thank you and I look forward to further engagements. Thanks a lot Joseph, I want to leave a time for the team from Indonesia to present next but is there anyone who has a quick question and then maybe take more questions at the end? Okay if there are no questions then we can proceed to the next one and Joseph if you can hold on in case there's any questions towards the end. But we're now joined by our next speaker, Dr. Guardian Lai Sanjaya is a senior implementer of GHIS-2 from the University of Dajamada in Indonesia and he will be presenting on the use of GHIS-2 Tractor for Disease Registration. So Dr. Sanjaya, off to you. Yeah, thank you Brian. Hi everyone, can you hear my, yes, the screen is already shared, can you see the screens? Yes, we can see your screen. Okay great. Mia and my colleague, Phi Phi will present our works experience experiments to use the day as to tracker for disease registrations and this is really to support clinical research involving different hospitals, especially in Indonesia, third level of hospital in Indonesia and what we want to share is related to these registrations that defined by the clinicians which is relatively different with for example like HIV registry or malaria registry or immunization registry and we try because we already implement the IES2 since 2017 and we would like to use the IES2 as a clinical data management software to facilitate the clinicians to collect the data related to the disease registrations, specific disease registrations and several I think the step is almost similar with others implementation in many countries and we want to specifically share our implementation challenge that maybe we can get input from all of you that already implement this the IES2 as a disease registry. I saw that Rwanda and also other country already developed the similar functions of the IES2 for disease registrations and this is disease registrations which is when we talk with the clinicians they normally call it clinical data management because once the data is actually collected from the medical records either electronic or non-electronics many of hospitals in Indonesia also still are using non-electronic this but not all the data from the medical record is collected for the specific disease because patients with cancer for example they can come to the hospital because of the COVID-19 or because of others disease so the data also can be collected prospectively since the patient comes firstly come to the hospital for example for asthma registry but also can be retrospective data collections in cancer registry for examples they collect data two years after the patient first diagnosed so they cannot collect the data for the first time because the first time is still under diagnosed and still waiting for the treatment waiting for other things so that's why the in cancer registry is most likely is retrospective data collections and sometimes also the disease specifics data is beyond the medical records they can they usually also need to collect the primary data from the patient for example like the risk factors and environmental factors and etc as additional from the medical records and they have also very specific very systematic data quality checks for example like cancer registry the enumerator to collect the data the data manager will review the data and after the data managers and it has to be reviewed by a minimum two of clinicians before it can be used to to be analyzed and to represent populations they need to collaborate with different hospitals even though that the data is collected in the only in the one hospital so they actually have a site visit to different hospitals and collect the data related to for example like cancers and once the data is collected in other hospitals they return it to the main hospital and collect the data in these main hospitals and this is the way in one of the this is registrations in Indonesia but the others requires other hospital to collect data directly from their hospitals not not the way that the plus part mentions and sometimes because the outcomes the output of the analysis is to see the outcome of the interventions and sometimes they need to have specifics analysis for example like survival analysis where the data should be imported but maybe imported in a specific time of period and then they use it to they use different tools to analyze the data using the statistical tools and we saw that the IES2 as a clinical data management software have many opportunities it can cover the server client for multiple centers and even it can accommodate the continuous data collections for example like cancers even though that the data the firstly is collected in the this years and the outcomes can be collected in the maybe another two years or another three years so the clinician I can also monitor through the descriptive analysis that they can do it by themselves it is self analysis and the data the data can be extracted into the Excel format for example or text format that they can import it into the statistical tools to be analyzed more appropriately so that's I think the IES2 give lots of opportunity to to be used as a clinical data management software but we are facing several challenges of course related to the implementations the step for the implementation I think almost similar with other many other countries or many other developing partners to implement the IES2 we start to identify the data elements using the standard form from the global registry disease registry with specific disease registry and then of course there are several local SNITs that we need to accommodate and they are very happy that we can modify the forms modify the option sets directly to the IES2 and then very dynamic data elements that can build from the IES2 and of course we can demonstrate we demonstrate to them and ask for that input to improve the forms and also the data elements this is the registration this is registration that we develop in collaboration with the different departments in faculty of medicines and also subject to hospital it is third level of hospitals in in Yogyakarta province and it's not in the same times the implementations it start from the COVID-19 in children's last years start in April once we show the benefit of using the IES2 and then their colleagues from different sub departments asking about how about epilepsy in children how about asthma in children and so on and we always say that okay let's do it and then showing them about this is the benefit and this is the data you already collected and showing the dashboard or analytics they can conduct by themselves even though this is a descriptive analysis and we starting from a teaching hospitals a third level of hospitals in in Yogyakarta regions because they do have a network with other hospitals in the province and also in other province and they start to involve other hospitals especially in asthma in children's they we are collaboration with the pediatric associations that covers egg teaching hospital centers in Indonesia so basically they they already have the data manager to collect the data or animerators to collect the data and they can see the data by themselves and they can analyze the data and they can yeah it's easy for them to to use the electronic base it's not very we very minor capacity building to with them because they already familiar with the difference electronic form so it's easy for them to follow the the day as to data collection tools and this is examples of the dashboard from the COVID-19 in children's and many other dashboards we develop and they can develop by themselves especially for the asthma and cancer registry what are the challenges during the implementations once synthesizing data from the medical record this is from their part they are not from the the day as to all the technical part because not all the data that already in the electronic and non-electronic medical record it is should be inputted into the clinical data management software so basically some maybe some some of the information should be synthesized by themselves and they have to interpret by themselves which particulars data elements it's sweet that to be collected into the the day as to and the teaching hospital because we work with teaching hospitals tertiary cares where they receive a patient from multiple district and maybe different province as well and when we want to create the visualization in in maps we have to process apparently so we have to put we have to extract it into the aggregate data and then we put it into the province districts levels data entry forms but this is only imported the data not not much effort that to conduct this kind of analysis the clinical outcomes analysis requires specific data query to prepare clean data and important into the statistical tools sometimes they ask about what are the clinical outcomes six months after the first diagnosed for example because each patient is diagnosed in different times and we have to calculate when is the six months when is the one years of the of the data so of each patient data so so it's mean that we have to manage the data very carefully to provide the clean data to the clinician so they can analyze the data using the statistical tools and we have of course limited technical capabilities amongst team members especially we know that there is a we can use the our software into the day as to but up to now we haven't tried that and maybe one of you have experience working with that and very appreciate if you can share also with us how to conduct that part and in conclusions basically the s2 can co-force all the requirements number of clinicals data management even though that is only force but we sure that even though that we add more disease that the s2 can accommodate the requirements all the requirements of the data elements and clinical data management tools should be used partly from electronic medical record because not all the the data from the medical record is should be collected into the the disease registrations because only specific data and and maybe sometimes it's only a specific times data should be collected in the clinical data registries and of course there are many opportunities to extend the functionality of the s2 that we need to learn small and our our challenge is how to facilitate the clinical review process which is more than one steps from the enumerators data managers and also two clinicians should be reviewed the data before it can be done it can be used for analytics yes i think that's our presentations and thank you for the opportunity to share our works in indonesia thank you so much doctor sanjay for that very interesting use case um do we have any questions from the audience or online or if you're on zoom you feel free to type it into the community of practice or zoom no questions i can i can ask a couple and make it maybe try to start some conversation that way um doctor sanjay you mentioned some of these uh advanced statistical analyses that you're also doing with the disease registry um could you uh describe the process uh for performing that type of analysis that you're currently doing and what type of analyses are most essential for your disease registry yeah uh one of the uh analysis is related to the survival analysis and um they want to see the outcomes of the uh treatments yeah uh of specific disease uh disease happens in the cancer registry because the cancer registry actually already have their own systems using the channel like five i think similar like uh rwanda uh but it is a standalone applications that cannot be accessed by uh many users in the different organizations so uh the requirement is how to uh export the data from the first uh uh first times the patient is diagnosed until the uh what's uh the clinical outcomes appears uh for example like um yeah uh it can be that it can be recurrent it can be uh uh many others uh outcome that defined by the clinicians so we have to collect one by one uh we have to uh collect all the data uh i mean import the data into the spreadsheet and then we uh use the spreadsheet to to uh uh to get the specifics uh data that need to be calculated in the survival analysis not all the data uh uh because uh is uh uh used for for uh uh statistic analysis uh because we only uh choose uh specific data and specific point of times uh when the uh the the clinical outcomes uh appears uh that's we cannot do it in the uh the as to at the moment maybe we can we can because we cannot because we don't have capacity to do so uh so that's why we extract the data into the uh excel sheet or or uh comma spirited value to to uh clean the data again great thank you for that yeah maybe that's the next step that we could uh work on in the future together um anyone else with uh questions maybe for the resolve to save lives team um yeah it's the end of the day it's the fourth one i won't uh hold many people for the uh experts lounges which are coming up next but um maybe uh joseph could you um share a bit more about the um the the process now so um did the trainings that you did at the um for these care providers um it's great that they're very speedy we said like one minute for doing follow-up visits four minutes for enrolling a patient but how do you manage uh or balance that um need for speed with data quality and are you finding any data quality issues with this uh very quick enrollment process thanks abrian so um we are um used to the fact that in Nigeria the healthcare workers are transferred from one facility to another and there's also high staff attrition as a result of maybe getting better paying jobs so one of the things we did with hisp and the federal ministry of health was to ensure that the training first of all was done in a cascaded manner to ensure that we always have people with the capacity at the national and state and facility level then also we developed um sop standard operating procedures that we've provided to all the healthcare providers that will guide them in ensuring smooth data entry into dhs2 then all the states have uh WhatsApp platforms and we have staff embedded in this platform that helps to answer queries on the go and then almost every um every week we look at the dhs2 platform and then pull out findings and try to probe deeper to find out why a particular facility is not reporting or why they are not um entering data as and when you so these are measures we've put in place to ensure that there's continuous oversight and quality improvement great very interesting uh process seeds and i can't wait to see the the documentation that's written up that have a review of the process of deploying the dhs2 tracker like this um i uh i think everyone's blood sugar is running a bit low right now um so any more questions great i look forward to hearing more on the community of practice uh let's give it up for our speakers and um thanks again we'll be in touch


It's theCUBE, covering WTG Transform 2019. Brought to you by Winslow Technology Group. Hi, I'm Stu Miniman. We're here in Boston, Massachusetts, across the mass pike from Fenway Park, and happy to welcome back to the program, Mike Berthew, who's Director of Systems Engineering at Nutanix, a good partner of Winslow Technology Group. Mike, thanks for joining us. Well, as always, Stu, it's great to be here. This is number three for us, I think. It's become a bit of a tradition. The third year we've done at this, I've seen you at many of the local user groups here, and, as I say, nice home game after lots of travels around the globe, talking about lots of technologies. For sure, I'll get forward to it. Like, what I always love digging in in a show like this is we've got users. Scott and the team have 189 users. Many of them are Nutanix customers. So, let's start there, is what's top of mind from your customers today? A lot, so there's a lot happening, as we know in the industry. Things are changing, and our customers are trying to figure out what it means for them. But at the end of the day, it's all about IT providing bit value back to the business. I think CIOs, and we're just speaking about this in my session, are really pushing their staff to look at public cloud as a potential option. So, and many of the folks working in the trenches realize that, yeah, public cloud actually does make sense for some things, but not necessarily everything. The true strategy we have to have as an organization is multi-cloud and figure out how to make that work. So, that's really what we're hearing, and the good news is, from a product portfolio, Nutanix and what we're doing, we're really very much in lockstep with that. Yeah, you know, when I think back, you know, when that whole wave of hyperconverged infrastructure, HCI, which Nutanix to its credit never was like HCI, HCI, it was about simplicity, it was about working on the business, and underneath it's that software that drives the company, that there, the founders of the company came from some of the hyperscalers, some of the file system design underneath there. So, when you hear, you know, well, the promise of public cloud is it's supposed to be simple and economic. Well, public cloud we understand is neither simple nor cheap. That's right. Hyperconverged infrastructure did simplify environments and changes the economics of how we think of it. When I've talked to Nutanix customers, it's like, oh hey, I no longer need to do constant care of feeding of this stack of wires and stuff put together, much of it is much simpler. So, you know, you talk about customers, they're going to that multi-cloud, you know, hybrid cloud environment, they're trying to figure out their strategy. Rick Allen in his presentation said something that I thought resonated with me, which is you don't want to end up in hybrid cloud, kind of just you ended up there by mistake without plans, and unfortunately that's where a lot of IT is. I've got lots of projects that I do and I do them as I need them and then I realize, oh wait, somebody's going to manage, maintain and pull all these things together. So, help us understand where Nutanix fits in that multi-cloud story today, which is more than just kind of where people that might not have looked in a couple of years know the appliance. Yeah, sure, and I think from our, and you mentioned before, our roots really come from those big, large public cloud environments like Google and Amazon and others. But when we talk about multi-cloud, and you also made the point that simplicity is probably one of the core values that our customers see Nutanix as being on the forefront there. So I would say that for me, hybrid cloud, and I think the mantra within Nutanix, hybrid cloud is not something that many manufacturers have been able to achieve. It's a lot of separate silos, right? And as soon as you create multiple silos, you're actually creating, you're creating operational disruption and you're actually creating complexity. So if you have to manage public cloud A, public cloud B, your on-prem environment, and maybe your remote offices, and even your edge with all, with different management tools, there's not a ton of value there from a simplicity standpoint. So what we strive to do is we strive to create that abstraction, right? That consistent single control plane that goes between your on-premises, your remote offices, and now truly extend that into the public cloud so I can manage my resources in the public cloud in the same way I would on-premises. Whether that be next generation applications that probably truly do belong in a public cloud, like my cloud native apps, or my traditional legacy applications that have been running in my data center for years. So that's really what it comes down to is being able to provide that true seamless experience for users. And at the end of the day, businesses and users shouldn't really care where their applications are. It should be whatever is most cost effective for the business.  It should be just be able to, it should be available wherever I am. Yeah, Mike, one of the things that's been interesting in Washington Nutanix is not just the growth of the core market, but it's kind of got this three tier architecture. You have a lot of different software pieces, some of which, at least today, are not necessarily directly tied back to the original hyper-converged infrastructure. Where are you with the customers locally, and any kind of proof points you can give us that kind of help us understand the strategy a bit more? I think the majority of the customers running Nutanix here locally in New England, and probably a good majority of the world, are running Nutanix, running kind of the core Nutanix, right? And the value that they're driving from that, they're seeing there is immense, right? They're getting the simplicity, having the ability to run their operations, click one button to do their upgrades without disruption. There is a lot of value there. That's solving many of the issues. Now the higher level capabilities and the higher level features, in order to be able to deliver those in a consistent way, you have to have a solid core foundation, right? So that solid core foundation is our core HCI platform, or our cloud-like infrastructure. One of the things I'll always say to customers is when you look at your Nutanix infrastructure, your software-defined data center, it actually resembles what's running in a public cloud. So whether, if you're running applications in Amazon, for example, you're running in a highly scalable distributed architecture, that's the exact same thing you're doing with Nutanix, and the reason they've been able to deliver those higher value services is because they have that solid foundation underneath it. So if you want to run your environment in a similar way and have true hybrid cloud, you've got to follow their playbook and the technology that you're choosing, and we believe that Nutanix is that right choice. Yeah, and in many ways, we're seeing the blurring of the lines between them. I've interviewed people from Nutanix at some of the Kubernetes show that experience that I have in Nutanix has partnerships with some of the public cloud environments. So we're seeing that location matters a little bit less. Absolutely, absolutely. I think the Nirvana, again, if we can imagine what this is all going to look like five years from now, it's a single portal, a single interface where I'm requesting some sort of a business service or an application, and when I deploy it, it's not going to ask me where it's going to go. It's going to put it where it belongs based on the cost and business logic that I've actually defined in the system. And if it needs to go on Amazon or it needs to go on Azure, the decision is going to be made based on business logic as opposed to technology decision, which I think is where it matters.  And they sell the Dell XC solution here.  So help us understand that dynamic, how that's playing out in your world. Yeah, that's a great question. And I kind of expected the controversial questions as always on the queue, so thanks, Stu. But in terms of that, I mean, I would say that, when you look at Nutanix, the first thing I'll say is all HCI is not created equal. I mean, there's pretty significant differences between the two platforms. Yeah, combining compute and storage, we could loosely define as HCI, but we really can't look at competing solutions as true cloud like infrastructure. Running our controller virtual machine in the user space and having mobility of applications across hypervisors and across clouds on a single platform is something very unique to Nutanix. So we're absolutely seeing competitive pressure for sure, but when we have the opportunity to talk to customers about what their multi-cloud journey really means to them, the discussion usually moves forward in a positive way. So I mean, I think, again, our view, our perspective, you mentioned simplicity, we're all about choice, freedom of choice. We don't wanna lock our customers into any more particular technology. Let's do what makes most sense for the business, whether it's alternative public cloud, alternative hardware, or even alternative hypervisors. We give customers choice. We don't have a religion around any one particular technology. We talk about containerization, for example, in Kubernetes. We give customers the ability to deploy Kubernetes on-prem, leveraging the open source version in Kubernetes. All of the capabilities within the Nutanix platform will run on any of the hypervisors we support, right? So that's an important distinction too. It's not like we're telling you you have to run one particular hypervisor to get X feature. So an important distinction point there is we truly do believe in giving our customers the freedom to choose. Yeah, that's great. Just last thing, Mike, yeah, I gotta imagine your customers are asking you a lot of questions. There's all these new things coming out there that look, sound, or feel a little bit like what Nutanix is doing. So from the big ones like AWS Outposts, Azure, had Azure Stack, now is the new Azure HCI. So what do you tell your customers when they start calling and asking about these technologies? Well, if you look at the history, we've been doing this for a long time now. I've been here for over five years and Nutanix has been doing this since we released our product back in 2011 after a couple of years of development. So we've been doing it longer than anybody else and we also really built our platform around the mantra that we are highly scalable, distributed architecture, enabling choice and providing a level of simplicity that customers won't see in any other platform. So just the amount of development and engineering and focus around our customers and the needs of our customers really makes us stand out. And if you look at just the overall growth of Nutanix and the transition we're making now to more of a subscription-based business model, it makes sense for customers and we've given them the ability to consume in a way that is even more incremental than it was in the past and certainly more differentiated than what our competitors can do. All right, Mike Perth, it's always a pleasure to catch up with you on camera as well as off. Thanks so much for joining us. Thank you very much. Appreciate it, Stu. All right, more coverage here from WTG Transform 2019. I'm Stu Miniman and thanks for watching theCUBE. As I supposed to.


Aaron, you guys managed two runs early, but really weren't able to get anything going there after. Why do you think they struggle to get going offensively tonight? Well, I mean, Gosman's one of the best in the league, so good job of scratching a couple against him. We had a couple chances there in a couple innings after that. I thought we'd put some good at bats on him. Just weren't able to break through and make it a great night against him. But that guy's been one of the best in the American League and just couldn't quite finish off a really good offensive night against him. What makes him so good, so tough? Well, I mean, command. He's probably 200 strikeouts now and 30 walks. So it's really good command. It's good fastball, really good split finger, good slider. He puts the ball where he wants to. He's become a really good pitcher in this league for the last few years. Overall, what did you think of Severino tonight? I thought Savvy threw the ball well again. Had a couple long at bats. I thought Bishop put a great at bat against him there. That long at bat where he's able to work the single. We didn't turn a double play on a ball hit hard against him. And then Waukes-Kirk and Teosker hit one well, obviously, to center. But so he's kind of a victim of the pitch count there. Excuse me, end up throwing 30 plus, 35 pitches there in that fourth inning. But I thought overall, stuff-wise, I thought he threw the ball really well. I thought he had a few walks in there, but I thought he was getting it where he wanted to for the most part. They just kind of outlasted him with some tough at bats. He looked like it was shaping up where it could have been a big moment for Aaron Judge there in that 10th inning. Did you anticipate that he was going to walk him? Yeah, once we saw Maze up, we figured he was getting ready for Rizzo there. And then the next one, is it going to be a first and second situation? And then as soon as they went to the mound, we knew they were going to get Maze at a walk him. And so, yeah, we figured that. Grombo, I'm sure you mentioned that it was hard to let a couple runs. It was really hard to hit that. You think that was a hitter? Is that probably to be played?  I haven't seen a replay on it yet. Like, our iPads have that high home. So it's hard for me to judge, like, what the hop did and things like that. And the Hernandez double, was it right to go to home? Or you could have gotten him maybe at second? Yeah, I think when you hit, as a middle infielder there, and obviously it's very loud, when that ball's hit, you don't even think there's a play at second. That's just a double all the way. So you're kind of getting yourself in position to throw home. The runners got held up a little bit, and it ended up going home. So I think if we were at second, because Taosker wasn't really running, we might have had a play there. Turned out to be a little inconsequential, because that's all they scored anyway. But that's one of those where you try and play as well as you can with your eyes in a loud scenario where it gets a little different than what the play kind of shows. Karen, what went into the decision of pitch to Guerrero with the first basal open there at the end? Kirk on deck. That was just the matchup you wanted. I mean, you don't really like either of those matchups. So it's pick your poison. And with a lot of buchette to that mix, we talked a little bit about there. If once we got Springer, did we put him on to try and set up some kind of ground ball? Once we got that, with two outs there, obviously you're going to pitch careful. But with Kirk behind him, it's pick your poison. When it's late in the game and it's tied in, you know that there's champagne ready to go. Does that go through your head at all, that we're going to celebrate or are you two caught up in the game? Not really. You're two caught up in the game, honestly. Yeah, you're caught up in the game and trying to get through there in a tight game and trying to break through. So yeah, hopefully we can do it tomorrow.  I thought it was a really good baseball game. I mean, really. Clay was once again really good. I thought he was excellent in his last outing, where he gave us two innings. Low was terrific. Low threw the ball well. Efros and Trivi both did their job. So good job overall getting it to the extra innings there, holding their really good offense down. How would you anticipate a DH day for Aaron either tomorrow? No, not necessarily. We'll see. Is it bats tonight? I thought once again, good, gets off to a good start with the base hit the other way to come around and score, work some walks. I thought Garcia did a really good job against him. He got into a good count, 3-1 there, and he really executed some pitches. I thought there were a couple pitches down out of the zone, called against them tonight. But I thought Garcia did a good job and probably got him to expand there a little bit on the 3-2 count, but more good at bats.


Michael Jordan has been dominant on and off the court for almost 40 years now. Throughout this time he has won 6 NBA championships and most people say he could have easily won more if he would have never retired 3 times. And most people know him now and current time for becoming a billionaire and is heavily related to his sneakers. Jordan Brand has currently released 37 different signature models when it comes to his sneakers and over the years the majority of those models have become very iconic, nostalgic and overall just dope. So in today's video we're going to be talking about the top 10 Air Jordan Silhouettes to ever release. Coming in at 10th place we have the Air Jordan 9. Originally released in 1993, retailing at $125 and designed by Tinker Halffield. Michael Jordan was fresh off of his first retirement after winning 3 back to back championships and decided to go play for the Birmingham Barons and we also saw him wearing a baseball cleat version of this shoe, which if you can get your hands on the actual shoe that he wore, trust me, that shoe is going for a lot of money. During this same time, Michael Jordan decided to get player exclusive versions to some of the players that were actually active in the NBA during those same years. We saw notable players like Penny Hardaway, Kendall Gill, BJ Armstrong and Mitch Richmond all wearing exclusive pairs catered to themselves. The Air Jordan 9 was also seen in the movie Space Jam, another iconic film and from a sneaker head standpoint you can never go wrong with this shoe. I would consider putting these a little bit higher up on the list but at the same time there's a lot of good shoes that have come out over the years and either way I'm just happy they're on the top 10. Coming in at number 9 we have the Air Jordan 7. It was released in 1992, retailing at $125 and designed by Tinker Halffield. The Air Jordan 7 has been a very iconic model for many years now or seeing him wearing them that same year on pursuit for his second NBA title. When it comes to this model there's definitely a lot of iconic colorways when it comes to the Olympics, the Cardinals, the Bordos and the dark charcoals also known as the Rafters. This is a sneaker that definitely deserves to be on this list and when it comes to the design elements of this sneaker they were inspired by the West African tribal prints and the sharp lines that you see throughout the upper. Also in 1992 the Harachi was hot on the scene and decided to use the same neoprene technology and fit when it comes to the booty that you see on this model and that also helped decrease the weight of the shoe making these some of the lightest sneakers in the game at the time. Now before we get into the next model I wanted to let you guys know I posted a poll on my YouTube community tab that's where I got all the results from and this is based off of the audience. My views were a little bit different when it comes to this top 10 but I'm going off of what you guys said we had over 10,000 people vote when it comes to this list so I'm excited to show you guys the next model let's go ahead and get into it. And that is the Air Jordan 13 originally released in 1997 retailing at $150 and designed by Tinker Hadfield. Michael Jordan wore these in pursuit for his sixth championship and the shoe was originally inspired by the Black Panther as you can see the different elements from the paw and the similarities to the midfoot of the shoe or the eye of the Panther on the hologram on the side of the foot little did they know Michael Jordan had already been nicknamed the black cat in the league and they ended up using that same black cat nickname on other models that we then saw in the future. Everybody remembers Michael Jordan's last shot in his sixth championship win as he wore the Air Jordan 14s but a lot of people forgot that he actually wore the 13s at season two. The Air Jordan 13 has been reiterated in so many different colorways, collaboration styles, cuts, materials when it comes to the highs and the lows but either way at the end of the day I know for a fact a lot of people love this sneaker. Now when it comes from the sneaker head perspective a lot of collectors say Air Jordan 1 through 14 or Air Jordan 1 through 13. So this sneaker in particular was on that line of people liking and not liking the higher number Jordan models simply because they say if he didn't play in them they don't count even though he re-entered into the NBA later and played in higher numbers like the 18s and 19s but we'll talk about that a little bit later. Now taking into the next shoe that I know a lot of people love we have the Air Jordan 12 originally released in 1996 retelling at $135 and designed by Tinker Halfield. The Air Jordan 12 was designed by the Japanese flag. This is a very clean and simple model that has been easily recreated in a lot of different two tone color blocking patterns and a lot of people love this was the first Air Jordan model to feature a ultra responsive zoom error unit as well as lateral and medial support panels designed to work together to create one of the most durable shoes in the sneaker series. The shoe also had a full length carbon fiber shank plate and these originally released in five different colorways and I can guarantee you to any sneaker head they love all five of them. At least I think so. I do. What about you? Let me know down below in the comment section. Another iconic moment that a lot of people won't forget when it comes to the Air Jordan 12 the flu game. We can't forget to mention in 1997 Michael Jordan also went to his 11th NBA All-Star Game. He won his ninth NBA scoring title. He was named first team all NBA and all defense. Oh yeah. Anyone is fifth championship. So I'm pretty sure it's safe to say there's a lot of history nostalgia and iconic moments when it comes to this shoe that caused people to just naturally love them. And it's a pretty clean shoe to say the least. Next up on the list we have one of my favorite sneakers of all time and I don't know how this didn't make the top five. I did a vote on these later because it was on the cusp of fifth or sixth and it is in sixth place. The Air Jordan six originally released in 1991 retelling at a hundred and twenty five dollars and designed by Tinker Hadfield. Michael Jordan won his first NBA title in this shoe and to me opened up a whole new chapter in his career. And we can't forget to mention a couple of the OG fan favorites of the infrared and Carmine six. Those are some of my favorite. Now those right there chefs kiss. Now a couple of things that made this shoe even more iconic. We saw Vin Baker and Ray Allen wearing these in the 2000 Olympics with Olympic colorway. A lot of people thought that was the OG for Michael Jordan. But that was actually for them back in that time. We have seen different P.E.s from different collectors or images online.  But I think one that a lot of people forget to mention is Jerry Seinfeld. We saw him wearing the Air Jordan sixes and I'm telling you right now that was very iconic to see him mixing fashion and culture on and off the court. Now coming in at fifth place we have another fitting model and placing and that is the Air Jordan five originally released in 1990 retelling at one hundred and twenty five dollars and designed by Tinker Halffield. The Air Jordan five was a statement of Jordan's aggressive nature on the court with a three M reflective tongue and everybody seeing him in the limelight. It was definitely a sneaker that was hard to resist some design elements that people may or may not had known of was Tinker Halffield's inspiration from a World War to P 51 mustang fighter jet. As you see the shark teeth on the side of the foot around the midsole. That's where that came from. Now we had seen the exposed air unit from the previous models of the Air Jordan three and Air Jordan four but one thing that was new to the game the iced outsole. This was the first model that introduced that element and we saw other models repeat that same trend to follow after and we can't forget to mention the iconic colorways of the grapes the metallics and both of the fire red colorways. This may not be one of the most trendy sneakers in the game but I can guarantee you year over year a lot of people love this shoe and they're definitely well deserving of being in the top five. But when you see the next four shoes you'll understand why they didn't rank any higher than this. Oh yeah and for those of you that voted on the Air Jordan fives over the sixes y'all trippin bruh I still think the sixes are the best. All right you guys we got four sneakers left on the list. Now this next one right here I think personally is a number one but the people voted they said it's in fourth place. The Air Jordan 11 originally released in 1995 retailing at a hundred and twenty five dollars and designed by Tinker Halffield. The Air Jordan 11 in my opinion is one of the most iconic sneakers to ever be made Tinker Halffield yet again took innovation to a whole nother level by introducing patent leather on an NBA basketball shoe. Not only did these look stylish on the court they looked really nice off the court and people even considered these as dress shoes. This was a super high performance shoe called the Jordan 11 and this shoe is like I think it's my all-time favorite shoe because there is so much technology in this shoe.  Not only does everybody remember seeing Michael Jordan wearing the playoff 11's after winning his championship or seeing boys to men rocking the Concorde 11's on stage we can't forget to mention Space Jam. For me being a kid growing up in the 90s that was one of the most iconic movies in a moment that I would never forget. The Air Jordan 11 has a special place in a lot of sneaker heads hearts and it's rare that you'll see anybody that just simply doesn't like the shoe at all. Every year during Christmas for the past 10 years we have seen special colorways and iterations or remakes of OG colorways something similar to this with the 45 on the back. We saw this one released a couple years ago but every single Christmas it becomes the holiday sneaker and we know everybody goes crazy for this model. We have seen alternate colorways with the high top model come out in the past and a lot more low top iterations but when it comes to the high top in particular Jordan brand has definitely been very careful about that model and protecting it from being flooded with too many colorways similar to other models that we have seen in the past. Now obviously I have a huge bias when it comes to the Air Jordan 6 because that's my favorite model of all time but when it comes to the Air Jordan 11 I think overall is an opinion for the people it has to be number one right? How could this be placed at number four? But after you see the next three models it just might make sense. Coming in at third place and yet fitting again the Air Jordan 3 originally releasing in 1988 retailing at a hundred dollars this was Tinker Heffield's first Jordan model that he had an opportunity to design himself. Not only did he take designing to a whole other level and create one of the most iconic sneakers ever there were so many nostalgic moments in this time with collaborations with legends like Spike Lee on different commercials and advertisements or seeing Michael Jordan soaring through the air jumping from the free throw line to win the dunk contest or him pulling out the black cement threes during all-star weekend and trust me the list goes on the Air Jordan 3 is definitely a very loved shoe when it comes to sneaker heads people that don't know much about sneakers just people in general they know about the model they've seen it before if they don't know everything about it hopefully I taught you a couple things but either way definitely iconic shoe and I can understand why it made the top three now next up on the list I think snuck its way up over the past couple years don't get me wrong this is a fire shoe for sure I have plenty of pairs of my collection but I was kind of surprised by this one just based off of you know what I thought from like older sneaker head generations to what's going on now and maybe it's skewed by the voters that voted but it is what it is second place the Air Jordan 4 there has definitely been a lot of different factors that may have played to the placing of this shoe don't get me wrong again a classic but there have been a lot of different models and prices being hiked up when it comes to the general releases that have come out to the public over the past couple years and drawing a huge demand behind this model and say at one point during the voting this was actually in first place and I was really surprised originally releasing in 1998 retailing at a hundred and ten dollars and designed by Tinker Hatfield the Air Jordan 4 was heavily known for taking flight with the flight branding on the tongue in this iconic font it became a staple in the game and next thing you know everybody loved them originally releasing in the white cement black cement military blue and fire red colorway this shoe has been hot on the scene ever since although the Air Jordan 4 does show similarities when it comes to the back tab in the Nike Air or they expose the air unit on the midsole this shoe definitely has its own elements and characteristics that took the Jordan to a whole nother level after its original release they decided to retro the black and white cement colorways back in 1999 and they sold out immediately from that point on they decided to introduce new colorways materials and collaborations and because of that we see some models fetching for over $50,000 now before we take it to the final sneaker I want to say thank you guys for watching this video and again don't forget to hit that subscribe button and join the fam if you want to see any more videos like this in the future now I'm excited to show you guys this model I wasn't shocked all the way but I still think that Jordan 11 is the best sneaker of all time it is what it is I'm pretty sure you guys know what it is by now the Air Jordan 1 originally releasing in 1985 retailing at $65 and designed by Peter Moore we saw iconic posters of him wearing the sneaker while he was dunking in his flight suit next thing you know it became the jump man logo or huge commercials about the sneaker being banned and him being charged $5,000 back in 1988 for wearing the shoes on court Nike created a revolutionary new basketball shoe on October 18th the NBA threw them out of the game fortunately the NBA can't stop you from wearing them even though it was the airships which is a whole another story we'll talk about that later but either way the Jordan one came hot on the scene and everybody was loving them soon as they hit the market year over year over year retro over retro over retro colorway over colorway over colorway the sneaker has been around for over 30 years now and has created a huge hype in the game and I can guarantee you any sneaker head out there that collects Jordans especially they got a pair of Jordan ones in their collection and if they haven't gotten a pair yet they plan on getting a pair for their collection because there's just so many iconic OG colorways there are a lot that came out originally plus all the special colorways collaborations releases you name it from the current time now and then obviously the hype behind the Chicago Air Jordan one right here this is a classic iconic colorway something that we saw Michael Jordan bring back on the court later in his career something that we saw on the court at the beginning of his career and one thing that we know about a lot of sneakers collaborations or you name it typically the first ever one that has been created always has the one with the most value the most nostalgia or whatever because if it wasn't for this and the success over time none of the other sneakers would have came so I completely understand why people chose this as the number one sneaker there's a lot of different options all the different factors I know I have my own personal opinions that people voted what they voted I probably would have put these at second place it is what it is but hey you know I'm saying let me know what you think down below in the comment section either way I hope you guys enjoyed this this was the top 10 Air Jordan models of all time let me know what you think down below in the comment section if you want to see any other top 10 videos I would love to hear your ideas and I hopefully I can make them for you guys before you go I just launched my sneaker head Academy where we got everything on the inside I teach you all the stuff that I learned over the past 15 years when it comes to sneakers scaling real estate you name it we talk about all of it in there and there's a eight week program plus a bunch of monthly giveaways I give away shoes literally way too much honestly but either way I'll see you guys on the inside hit the link down below in my description or pinned in the comment section for DJ sneaker head Academy I'll see you guys over there