Why is ICT so important for Global Health?



Oh thank you for coming this is the first in the second series of talks in the global health Academy in the University of Edinburgh it some some of you trying to bring together pis are the groups across the university to try to speak to each other from little France from George Square from King's buildings from the center of town to understand better about what each people would want you to dip in groups through we're hoping on time to build up the numbers of people so in creating more collaborations and more relationships across the university because we are quite dispersed and we don't has a school of global health to give us a basic center so I hope you go away from this talk today infused we'll come back in a month's time with at least five friends I'm sure there's some social media where you can do this to increase there were people coming from more than P is coming and so the first speaker of this series is dr. Karen cloud in patio party area yes who's the leader leaves any group on health and we talked about her work also have leadership of the MSC in thank you good thanks I don't have a little a sort of slide clicker but Lisa's going to help me here thanks very much indeed I'm pleased to be able to open this latest seminar series and thanks to Liz a grant and Lisa wood for inviting me if you go back the yes I think it seems to be having a life of its own there I did give a version of this presentation at one of the large events around infectious diseases that was organized in May so some of you may have caught that on YouTube so I hope I hope I can add a little bit of a different slant on it for you today I know that many of you won't have been there as we're hearing we've launched an MSC in global eHealth now which is focused on taking our work in ICT for health and extending that across the world as we were becoming more and more involved in campaign working in Africa in particular using different types of mobile technologies studying electronic health record systems and other types of information systems it it seemed appropriate to take our degree program in health informatics and consider it with a more of an international perspective and it fits very well under the global health Academy program so why is ICT important for global health we'll just make a start it's it's a no-brainer to some extent but let's have a look at the challenges we face many long-standing challenges as we all know you will be familiar with the Millennium Development Goals we're doing quite well on achieving some of them not so well on achieving others and there are many questions about why that would be and that they are in the case of health we're talking about particularly maternal health care challenges and the HIV epidemic they're probably being attracting the greatest attention at neonatal deaths are still very high at the same time we have to consider as has been recognized in the global challenges and Global academies initiative at the University that the health is not an isolated thing it happens in the round health is affected by many other aspects of development or lack of development it's also affected by things like international conflict and poverty and all of these things environmental change it can't be considered purely in isolation and that's the same for many other challenges in ICT and in health next slide please so those are challenges but we all have some long-standing challenges that don't tend to get talked about so much in the context of global health which tends to be identified with resource poor countries with low high levels of infectious disease and lots of maternal death from from poor services but there are long-standing challenges in other parts of the world as well and in all of the richer countries in the world our biggest problems are that we are getting Fator and as a consequence of getting fatter we're getting more long-term conditions and of course a good side of our of our health is that we are getting older as well but likewise as we get older our propensity to to get long term conditions increases and so we're now being faced with a ticking time bomb as many of the politicians call it where the sort of the burden of long term conditions will soon overtake the capacity of health services to cope with them so this is very much the dominant agenda in Europe and to some extent the United States at the moment next slide please and of course there are new challenges all the time we the last time I gave a talk on this topic to global health Academy the Ebola crisis hadn't really kicked in people weren't really talking that much about the Ebola crisis and that really wasn't very long ago it's just a few months ago now it's the major issue some of the students on our MSC program were actually involved in international in programs dealing with the Ebola crisis doing emergency response medicine emailing and sending images back and so forth and coordinating services through ICT and likewise our colleagues in and the likes of medic mobile mobile health organization who we had give one of the global health talks last year also heavily involved in this sort of situation and so any world health organization issuing travel advice and so forth which also has implications for the issue of globalization global transit global movement of populations we're getting cases now appearing in places like Spain and United States next slide please and just to put some more context around it we are in an environment with not only with sort of diseases spreading and famine natural disasters warfare the consequence of this is that people are moving the global migration is increasing a lot now what does that mean for a stable health system what does that mean about your personal health information and where you take it with you there are new challenges about the management of information about populations and about information from patients and individuals and another challenge is around the lack as I'm sure those of you who are in the global health Academy will be well aware the lack of trained medical practitioners in countries with very high health care needs if you look at this map at the tops not very well displayed there it's showing physicians per head of population and really in parts of Africa we're talking sort of one clinician for thousands of people in comparison with our own sort of luxury system which we complain about all the time if we can't see our GP within you know within two days we tend to sort of get quite upset imagine if you are one of thousands of people having to deal with one person absolutely Jacklyn and the other thing is that once they do get trained in America often or in other richer countries we're often providing scholarships for global development what happens they take off they take off and they go and work in other countries they don't necessarily go back to their own countries of origin which also means that the problem is it's not necessarily solved but there are ICT methods of slightly getting around that which I'll come to shortly now this area of health globally health sits within a broader framework of ICT for development and I know some of it some of you maybe it may have been working in this area in other contexts we there's an MSc collab or a module in this from the School of Social Sciences for example and this is around the development of of society if you like the building of infrastructures the building of capacity in poorer countries through the investments in ICT information and communication technologies which we are many people regard as a natural resource it's not just in the under 25s in high-income countries that believe they can't live without the internet anymore there was a recent survey which seems to suggest our young people you know they would rather turn off the water supply than give up their internet connection or their mobile phone contract it becomes essential it's like the lifeblood fear my son can plays if I cut off his his mobile phone allowance or is his disaster whereas of course when I was growing up there was never any such thing and it was queuing for the telephone which was more of a a priority increasingly were recognizing that these issues around communication and around information exchange of fundamental building blocks of strong systems not just health system to all sorts of systems government systems business systems educational systems and a lot of advanced investment has gone into all of these areas over the years in this field which is duval evolved for some for some years and that's just a recent reference and a little Model S's it's not taking place alone the next place but the area of that's what global eHealth many people have have seen as as being at the intersection I don't know how well you can see this but between global development engineering because it involves technologies and machines global public health because often involves large populations and users and communities and of course medicine at the top and I think this is quite a nice way to represent it really next slide please and it's quite a lot of also activity out there on the internet any any Google search will bring if you if you configure it correctly will bring up a number of new blogs and policy report industry ports reports from small development agencies local local case studies looking at the ways in which ICT has been deployed for health this is one from the IT International Telecommunications Union and they have been quite active in this area the whole era of global health for some time Global Health and they have produced this nice report very recently in fact just on a health and achieving the MDGs next please Oh duplicates like this is actually comes from Rwanda and it's an example of it's just electronic health record implementation I think it was a it was from the Rockefeller Foundation who've invested in this area next please so let's consider this we have global health challenges but we also have many green shoots and the green shoots come from the penetration of the Internet as I said Internet is now being regarded as a natural resource like water like air like greenery internet gives us strength it helps us it helps to connect us and connects us to one another and it connects us to information and it enables us to self-manage and it does all sorts of other things as well and it's increasing all over the world not just in North America and Western Europe but pretty much everywhere we're having increasing internet penetration next slide please here we are this is just another example and this is interesting looking for a report earlier on this year and it just shows the ways in which we're using the Internet in the various forms that we using it and who's using it urban and rural populations but critically we're gradually using it more and more on our mobile phones and our tablets in fact many people are getting rid of standard computers many people likewise are getting rid of their phone lines and they're going straight to mobile mobile is especially with the penetration of tablets and smartphones and phablets as the latest one which is your tablet and your phone combined I've just ordered my first one I'm very excited and that is creating a whole new generation of uses of the Internet and one of the things people do it for as well is for social networking and that just doesn't mean just calling up your friend in a one-to-one it means collecting communities joining at Twitter sending out little messages across the cyber sphere crowdsourcing other people's ideas about what you said generating your own databases or information with your Facebook profile and your particular needs going on to specialist websites that contain information but also allow you to connect with other people with health conditions like you now you can see how that might be helpful in a global context the internet doesn't respect borders the Internet is a universal phenomenon ok so I could just as easily socially network with someone who has a good internet connection in gabon as I as I can do with someone in Dundee potentially so it has great great great potential there and I'll come back to that in a moment next slide please ok this was just just indicating this point I made earlier about how much time we're spending on our mobiles now next slide please we know just coming back to the uses now of a health or ICT in health using again mainly higher income country examples to start with but we know that people go on to the internet to find medical information generally we know this in high-income countries we even know medical professionals will go on to resources on the internet to find their information that's well-established now that information may be a supplementary add-on to our well provided health systems in the West but it might be a vital lifeline for someone in a poor country it might give them information it might give them videos which help to demonstrate how they might want to self care or or if there are a community health worker how they might want to use a piece of medical technology that they otherwise we're not trained to do for example very very useful and as I said connecting people to connecting individuals with health care practitioners who can give them advice showing them images and and videos of other people self caring in certain ways or talking about their illnesses and giving them some sort of social support and also also seeking seeking support for their own particular health needs for example is there a community group that deals with terminal illness or something nearby that I can speak to for relatives of people with terminal illness who are who are not coping well is there a specialist group and that brings me to the point about segmentation what's great about the internet and social media is that you're able to with a little bit of searching quickly find very very specialist groups that suit you perfectly they're not just a generic NHS website they're they're they're very useful but sometimes you want something very specific so patients like me is a site in the USA I say site but actually as a whole enterprise coming into or which was designed to allow people to find other people like them particularly with rare conditions and this is now extended to all sorts of other conditions and people began looking for social support they began looking for maybe suggestions on medical solutions to their rare condition that may be established medicine didn't have an answer for they then started self-organizing into groups and crowdsourcing funding and recruiting scientists and organizing controlled trials and sharing their data so they move from the point of being an eye selected individual with a sick child with a rare condition that no one could help with into part of a community into a self-organizing scientific system isn't that wonderful so there's great potential for that to happen on a global level so there we are that's just the Internet information is just one thing that's please and of course a lot of this though is down to strategy when it comes back to health systems I've been talking about the the general ecosystem of personal care and the citizen back to governments what are government's doing about this well some governments are doing very well they have very well organized eHealth strategies or what they call health information strategies or health information technology strategies some of them spend billions and billions of dollars and pounds on these things we had a national program for IT here which unfortunately was criticized as being the most expensive failure ever but actually wasn't that much of a failure because it has translated into benefits for infrastructure and technologies in the UK in the United States the moment they're investing millions billions of dollars trying to get electronic health systems health information systems into primary care into hospitals to try and join up the health system which was very fractured before very disaggregated this is a way of enabling data to flow between organizations so all very good and these are parts of large national strategies elsewhere in the world strategy and policy can be a bit more challenging partly your government's often are not necessarily as lined up in some parts of the country of the world than in others where your government might be very very well organized structured have very long-standing governance arrangements hierarchies of power cetera good information systems underpinning them elsewhere you might be in a country it's a new country or countries overcoming war so how what's the advantage of policy that policy is hard to do and we know from the global observatory for health that the world health organisation or organizes that you know they're trying to push forward recommendations for effective strategy any health recommendations for not only designing and where there's your strategy but also being able to implement it and is achieving some success it is helping to to standardize practice to an extent but there are challenges and many countries get neglected countries that sometimes don't get neglected they get don't get integrated because it was a crisis so for example Rwanda mass genocide completely Saul most a kind of social scorched earth now one of the most highly functioning health information systems in the whole of Africa fantastic why is that international investment incentives for change recognition that like providing sanitation providing good ICT infrastructure can't help you to manage resources can improve your information governance can reprove your governance of your health system by making things much more Trance much more transparent and accountable and that's not to say money hasn't disappeared down a magic hole it has but nonetheless more of it can get swept up by this vignette we call information governance so I think there's a lot of potential then you could welcome to read some more about that obviously their next slide please oh yes I mentioned this before there are other concerns that maybe one could put on the map as a global issue this is just a little bit of a distractor right now we don't quite know how it's going to pan out but I was discussing this with my students just last week and they were had quite a vibrant discussion about this there's a sort of plan by ICANN the intern organization that is charged with managing Internet domain names to basically got a big auction to sell off loads of Internet domain names and amongst those are health-related names and there was some research that indicated that might mislead people into thinking they were going to a bona fide his site when actually they were going to some snake oil salesman and the World Health Organization got very upset about this and they still are and they've been agitating for change and trying to get ownership of these really important high-level domain names as because they think it's a you know health is a fundamental human right and they're the organization charged with preserving this fundamental human rights and information and control of the internet represents one form of that and I think they are gaining some traction and have managed to get some some ownership of certain domain names so there that's a sort of you know we're working in a whole digital economy here and we can't decouple health from that another slide please okay back to why we want to use ICT in health well I talked about connecting people I talked about connecting services and managing systems and a lot of that has to do with having an effective infrastructure just as we have telephone exchanges and just as we have sewerage systems and and so forth certain underpinning infrastructures are essential to make our societies and our function well alright stop everyone falling out because they're people is throwing their toilets out of the window like they used to do in sort of it out of the windows in the old town in the past that no longer happens because we have an infrastructure and that's quite good is less less people getting upset because something was thrown on their head just to boil it down to the simple simple things well we need infrastructures for all sorts of things and information infrastructures or what some people have called info structures have been really at the root of where the big investments the big government invest have gone and the purposes of that is mainly to connect up health systems to and on top of producing cabling and Wi-Fi networks it's also about things like standardizing data so making sure that the information contained in one system is structured and formatted in a way that it can be shared by another system that the software in one system can be shared with an can share messages with another system that's called health information exchange and it's sounds simple but it isn't because this we're working in an environment in which many different organizations have bought different products from different providers who have sewn them up into contracts where they can't buy other people's technology and as a as a consequence sometimes those systems haven't been interoperable they haven't been able to speak to each other and this is has stopped us from really strengthening our health systems through this integrative power and that is now changing so we're integrating information and process about processes people flows of medicines costs bed uses personnel patient health issues outcomes of data outcomes of different types of health interventions and importantly a good infrastructure allows us to coordinate healthcare as well because for example it allows several providers caring for a person with a complex condition to be aware of the other conditions they have or even if they're suffering from diabetes there may be several practitioners needed in order to manage that same patient and they need to share information but also it coordinates services as well so things like responding to emergencies you know if there's a national catastrophe for example a bomb blows up you need to be able to coordinate you do that through so you're strong systems and the other good reason for big systems and you'll have heard this term big data getting bandied around a lot big data and just really means large quantities of data from large systems often complex systems and it's also valuable for these other global health purposes and one is surveillance now if you imagine your system allows you to conduct a surveillance of you know who's getting flu this year what drugs might be needed you might also know a bit about risk factors for for-4 that might lead someone to to end up in a long-term nursing care like a fall or something like that and they might be predictable from their records it's quite good you can surveil you can understand what's going on you can maybe do some prediction those systems can some elements of them can be global they can connect to other systems now obviously if everyone has a strong healthcare infrastructure and those are all connected you have a wonderful so big global information world you can share information about you know who's moving where with Ebola or whatever it happens to be and how patterns of health and disease change where you might need to invest your resources send your people the survey nurses is absolutely vital for health conditions and likewise as I've said it's about research as well so why do we know what investments deployed where under what conditions I like you to produce the most cost effective benefits for patients for example whether they are in terms of hospital building or whether there are new medicines or whatever happens to be and likewise for planning ahead we have our infrastructures we have our information systems we have the insights we have the analytics also a trendy phrase at the moment that allows us to predict so this is this is why there's so much attention on this and we're getting quite far ahead in Scotland on this because we have the benefit of something called a community health index number which is a single number which is a is applied to every single health transaction which means your computers can all start it to link their health information and it's good for research and it's good for patient care yes please so yes this is just a status report on different countries and what they use their systems for some for gathering health surveys they may be collecting data from community health workers mobile phones or from regional health centers and regional health information systems and bringing them together and also social surveys surveillance patient monitoring of course in hospital and outside and registration of vital events so next slide please this is something also I wanted to mention technology costs money and the people who put together technology very often are doing it for business purposes and a lot of countries can't afford that a lot of people can't afford that so there's been no great movement in the ICT for development world in open software and open systems and these are very often donated in a sense by people working collaboratively in their own time or at low pay or you know collaborating anyway to produce technologies which are not pinned down which their software code is made freely available there's no license you don't have to pay for it you can maybe customize it to your own setting and this has been very successful and one of the the best examples is open mrs medical medical record system and this has been deployed very successfully across many parts of africa and one of our global eHealth speakers who came last year and Hamish Fraser was involved in this is also tutoring on our course and and that's who I got this slide from and it's been so popular the fact that people in a low-income country can take something which is actually a perfectly good electronic health record system software and deploy it and customize it themselves and if they've got a problem they can network using the internet to somebody who can help them with that and there are developers all over the world able to help them with that so this is spread out now is in clinical you in over 40 developing countries now if you had gone to one of the big expensive providers that we pay for you've been talking millions and millions of dollars and pounds on these things it doesn't have to be that way and I think we're going to see some changes globally on that even in high-income countries but I mean they're not the most sort of sophisticated systems but they do the job and that's what counts next slide please now there's some interesting things going on in global health surveillance that you might not necessarily thought about we've talked about health infrastructures these big systems that collect data from people that turn up at a health facility something's recorded it goes into a database those databases a share data and you understand things generally and that's how we get most of our National Vital Statistics or health statistics for most population health purposes however a lot of the time you can find out what's going on in people's health across the world and in populations by looking at what people do on the Internet and there's been a great deal of attention focused on mining searches of Google and things like this to look at what people are looking for and there was some work you can go to the next slide I think we know you have to go back again Thanks there was there's been some work particularly Google has been quite active on this and they produced this thing called Google Flu which became a real sort of flagship project for global health surveillance because what they found and it's slightly less reliable as then it was but it's really cascaded to other conditions what they found was that people searches on the internet for the word flu or words that were flu-like correlated very well with what data had been collected in national health information systems ok the official data sources collected by doctors and nurses and put into databases what's the other advantage of having of looking for these signals on the internet on people's google searches time it takes quite a long time for you to actually take data collect it in the health facility sometimes it's got to be handwritten in some health facilities some part of the world and then sent on someone in a motorbike who goes to a regional health information system and then code it on the computer and then takes a little while before it goes to a national reporting system okay and that happens to us too it takes time now what happens if you have something that's breaking out quickly you might not be able to gather that information straightaway now we know from this work with Google and others and there's been Twitter mining work and so forth that there are quite good associations or correlations between these internet searches and what you're seeing in official datasets so that's actually quite advantageous when you come to looking at these infectious disease outbreaks has been used currently next slide please some of the data are from these internet searches and some of them are from devices so this is from the SARS outbreak and there have been many other examples show the Ebola crisis is a great example I was talking about mobile earlier Mobile's come a long way since this crisis had Mobile is now the Internet in your pocket before was a phone okay the things happen very very quickly but the fact of the matter is people and this habit also the the earthquakes in Japan was another example people had a New Zealand their mobile phones they are they're physically present when something is happening their their health someone has fallen or they find a working working toilet or a hospital with supplies in it that hasn't been you know that hasn't fallen to the ground in the earthquake or or they see someone who looks like they might be suffering from this agent flu or whatever it happens to be or and they're able to report that to some global surveillance system or some local surveillance system using their mobile phone rapidly signals turn up rapidly you start to get heat maps of what's going on and you can respond to that and this was used very successfully as one of the early examples back in the day of the SARS epidemic in China Hong Kong I just like that just now next slide please I'm we're at the time well oh yes yes that's just some people shedding a little cynicism on the Google Flu phenomenon but I think that's been addressed now next slide please okay I've come to this already I've talked about people connecting with one another in cyberspace often using their mobile phones social networking crowdsourcing support for one another crowdsourcing solutions to their problems I've talked about mobile phones being used to capture things in real time while they're happening and report them back to a central surveillance system but there's more going on in this area some people don't like the term crowdsourcing I don't mind it it just means going to populations that are distributed in ways that are sometimes not always intended but there are these the I would just recommend anyone wants to read a bit more there's a recent review on crowdsource research so this is research that can take place when you ask people you're basically asking people to report on various health indicators for example or to try something it's becoming quite quite popular now but crowdsourcing also works in other ways there are also innovations around poverty alleviation using microfinance on mobile phone mobile phone micro payments for example can help with health because it can help particularly women in sort of small businesses to get a leg up in the world and and this allows them to purchase more health fair healthcare so there's very much a theory out there that poverty is being reduced with these microfinance it doesn't always work sometimes as misused but generally it seems to be quite positive and in some parts of the world where there is no sensible way of paying medical staff there might be a kind of Health System of sorts but very often doctors are getting left without any pay from at a time how to get rather how do you still you still manage to work well there these new micro financing systems coming up so health professionals signing up to micro financing financing agreements I'm not quite sure how they get the money but the point is people are aggregating their activities that aggregating information they are trying to work collaboratively so it's no longer just you on your own the doctor who's not been paid the whole load of other people out there that have ways of getting money and maybe you can pool that resource so at least you know you're gonna eat that month quite quite good here at next and of course here's research and some of those systems are being used successfully to to incentivize not just pay at professionals and patients this was this was an example from text to change it's one of the mobile health programs and they provide a micro payment to a doctor when they do something they're supposed to do and they can verify it using their mobile phone in this case it was for TB and they did some creative things with patients as well by integrating a means to a urine testing strip that allowed you to verify that the patient had taken their TB medication that day and when the patient did take it they got a mobile micro payment and so rate of compliance rates of actual accurate identification and treatment of patients increased amounts of professionals and the patient's compliance increase so quite creative and I think we'll be looking at more and more of those mobile digital incentives in Western countries as well and I can see more of it coming in next slide please and I mentioned this at the beginning but I think it's just worth pointing out again that a lot of health systems suffer because they're poorly managed and because they're corrupt and the corruption comes from poor management poor transparency poor accountability and increasingly technology's better infrastructures allow you to assess you know what what payments have led to what products have led to what interventions have led to what outcomes and who's had access to what that's helpful but likewise social social curation is also vital so increasingly in some countries patients and doctors themselves are being enabled with mobile phone apps that allow them to report when someone has stepped over the line when someone has been engaged in some corrupt practice like allowing people to jump a queue in a hospital because they because they've paid a little bribe so they can be named in shame now and there's evidence that that did seem to be cleaning up systems of governance policing even in India was was one example government corruption but critically medicine and so it might be a tool to improve equity simply through the fair distribution of resource and I would say it's well worth looking at that and there and here was a there's an international network for economics and conflict and they are reporting on a new app for fighting corruption in Ghana using this method quite interesting I'd like to know more about that if anyone's got any ideas next slide please I think maybe this is just about mobile health and and all the things that we could do next slide please oh yes it was just really to illustrate the point that because mobiles are small and light and they're getting cheaper we're able to disseminate them and provide healthcare services in places which previously it was unimaginable so remote villages in different parts of the world where you're miles and miles away from the nearest health care practitioner able to get your phone to use for multiple purposes and these give people opportunities and a lot of people have said well really the advantage and it is true most advantages from these systems in terms of health have come from cheap phones ordinary phone mobile phones with SMS technology now SMS is extremely powerful the big technology companies don't want you to know that because they want to sell you who is he fancy apps that will cost you a lot of money actually sms's is a hugely powerful and cheap almost free tool very useful having said that there are questions about the digital divide still arising people have said oh well poor people will never get mobile phones and therefore and computers therefore they will never be as you know as well-off in terms of information as the rest of the world and their health disparities will will grow as a consequence of this not so people started getting these mobile phones the latest sort of incarnation of that is this you of smartphone apps around apples products and services now the latest release of Apple's eye health platform I think is called eye health health platform and it's designed to ensure that all the developers are all the different health and medical apps that concludes things for monitoring your heart rate or checking how many steps you walk today or helping with your depression management all sorts of things will be able to send data into Apple's platform now they're promising that that will be secure and therefore people will be able to create dashboards of their health and it will all be good and and there has a lot of potential but of course it led a lot of people to say well that's going to increase health disparities even more because the rich of people not only have better health care they're better sort of a nutrition they're better off anyway now they've got more information they have more information through the getting the internet earlier so they were able to know more about health and now they've got this self-help tools as well so that they're gonna get so much better off and everyone else will stay down to the bottom well as it happens Google also released a phone in India about two weeks ago there's also a smart phone cheap smart phone I'd like to get what's only a hundred dollars which maybe is not so cheap when you live in some of these countries but kind of but verging on the affordable with all the Android apps able to work with that so it's not simply a high-income country thing and I I think whilst penetration of smartphones and apps is still fairly fairly weak in many parts of the world it's not going to be long before they become endemic parts of our society everywhere and and I really think there is an opportunity to bring people up you can self-help you can source help using your mobile phone which will bypass some of that need that was left behind by the lack of medical practitioners so I'm quite optimistic and there hasn't been enough research in it yet next slide please these are just examples someone testing with what was a PDA you know it's worth seeing a lot of the health care and in poorer countries is provided by community health workers who are usually untrained or little trained and unpaid or little paid but they can still be there their skills and their ability to form a you know well-functioning health care role is all commented greatly by having technologies they are they they this will create almost expertise in a little box okay and they give people confidence as well next slide please and increasingly there's all of this with a tiny digitized point of care testing technology being linked up with mobile phones as well it's been a lot of investment in that recently so increasingly people will have a laboratory on a chip as it were or little devices that can quickly gather what until quite recently involved large machines and satellites no longer they can involve little things that you can take with you on your bicycle and you can and you can test with there are you know disease monitoring tools for infection and also heart monitoring and other kinds of bio medical sensor systems and diagnostic systems and I think that's that's again going to permeate into the lower-income countries soon yes oh yes I was just saying that the really HIV has been one of the success stories in mobile health a big chiefly through SMS reminding people to take their drugs and to turn up for their appointments you know you wouldn't think something could be so transformational but probably more useful than then then the drugs actually at the moment in terms of what the drugs obviously have a partner in this but behavior behavior is what got people into this in the first place and that behavior supported by mobile phones will I think helped to get us out of it so next slide please and increasingly yes maternal and child health are being greatly supported with these as well mothers being guided in what they should do how their symptoms you know what their symptoms indicate at what stage of pregnancy other watch they should be eating and for their babies when they might be due to receive their immunizations and so forth and and there was there's some suggestion that some of these are engineering and empathy as well they're creating communities they're not just providing you with information they're providing you a sisterhood they're providing you with some sense of of belonging in some sense of just general social support next slide please and of course in our own higher income countries we're all getting sick from long term conditions and this is shed it's moving over to the to the developing countries now long term condition management is very much a matter for ourselves because of the shifting burden of health care and the the the greater proportion of need to provision of medical care the more tension is coming down to the individual all the time to self care to self manage to be their own doctor to be their own nurse to to manage that themselves and these devices which allow this is a diabetes self testing tool should links to your mobile phone allows you to do that and increasingly we're working into it so that's the latest in the wearables world you might have heard of Nike Fit bands and all of these sort of jawbone things these wearable technologies have really really taken off this year and in fact they're almost moving beyond that now people are talking about going from wearable stick to Invisibles and the Invisibles will fit be things that you either hide inside your clothes or you actually of embed inside your body and they can be monitoring you all the time or things that live in your home and sort of monitor you in some way and give you various helpful advice so it's quite a it's definitely worth watching and I think the point of it really is that we're not simply leaving people to their own devices we're not simply saying we can't cope with you therefore you're on your own we're saying well here's a way for you to be able to manage yourself in between seeing us and and that will help to reduce the burden if society all cooperates next slide please but there are few challenges out there and this is just stolen from another slide they're questions all of this relies on data information information coming about you from the from your doctor surgery or from your mobile device from your tele healthcare remote video consultation with your doctor data is information and some of that is quite private okay you wouldn't want everybody knowing about it all but we need the data in order to do these surveillance exercises in order to do the research it will lead to new innovations so there are challenges there and some people feel okay there's a common good argument is one and the individual privacy that little tussle between those two camps but in terms of global health there's been some concern that these issues around privacy and confidentiality and information protection have not been given the same weight in some poorer countries partly because the need to receive health care was greater than the need to protect privacy whereas we're all in a well catered full world where we worry about our meta needs it's things like how how happy we are today or how much our digital privacy has been protected if that's important to us but if we were living without food and sanitation and and illness all around us actually getting the information from A to B that might help us might be more of a priority but that doesn't mean we should neglect information privacy and there's also been some suggestion I had again a discussion with my students about this last week that there might be some sort of data colonialism going on some idea that that there might be a Big Brother in a pharmaceutical company somewhere in the world or or genomics company is is basically hoovering up data from people that don't quite realize what its value is and repurposing it for sell for selling on elsewhere and so these are the sorts of ethical dilemmas that we have I think maybe that's a taking it a bit far but I still I do agree with the principle next slide please and some of the terms that are out there in our own environment in Scotland in Edinburgh we've had these large data centers now we're doing integrated data research data linkage research but some of the terms that are being used out there in the media in the business sphere in government whirring data exploitation is my favorites because that you know exploitation doesn't sound very nice does it and some people feel they are being exploited and if you look at the global picture I think we have we've got I've still got a few issues to concern ourselves with next slide please but we are doing various types of public engagement around that to try and make sure that we know what's acceptable and unacceptable to people in the sharing of their tele-health data in the sharing of their electronic health records for assert what you know what what are people willing to put up with and not and for what benefits in return and that's been quite useful but I would say it's time for a global project on that so I'm just putting that out there if anyone would like to fund this next slide please and just finally a plug for our MSC in global health which we're really delighted liz is the co-director of the course and we're really delighted about this because we've had a really lot of interest internationally on this a far more interest than there is funding ere that then people have that have funding so we are seeking funding for some of these brilliant people often in low-income countries but we've got a good crop of students involved in some really amazing work some of them in low-income countries and high-income countries integrating health information systems providing emergency response to Ebola all sorts of these all sorts of things mobile health systems international databases for people that travel various various programs of activity so we're optimistic about learning as much from our students as as they are from us and it's creating a great community which supplements the research and development we're already doing in global health so if you want to know more about that please just have a look at the website or give us a room yes thank you

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