Globalization: Information and Communication Technology

In my previous blog, I discussed methodology to evaluate the efficacy of a community health radio program. I discussed the flawed nature of many of the ways that community health radio programs are evaluated. The use of surveys as a stand-alone indicator of a differential knowledge outcome is insufficient to evaluate the efficacy of a radio program. For instance, a program could have sparked a dialogue about HIV/AIDS in a family living, where the sensitive had not been broached before. This would be a success in and of itself; however, it would not be reflected in the results of a survey that evaluated a person’s understanding of how HIV/AIDS is transmitted. However, there are many different social change indicators that can be observed over time in order to ascertain whether a community radio has been successful. These social change indicators are discussed in the Department for International Development’s report on Radio Broadcasting for Health.
In this report, Dr. Andrew Skuse wrote that the example indicators relevant to health broadcasting include: expanded public and private dialogue and debate; increased accuracy of the information that people share in the dialogue and debate; the means available that enable people and communities to feed their voices into debate and dialogue; increased leadership and agenda setting role by disadvantaged people on issues of concern resonates with the major issues of interest to people’s everyday interests; linked people and groups with similar interests who might otherwise not be in contact. All of these indicators are based on dialogue that is stimulated by the health radio broadcasts. If health radio broadcasts successfully create dialogue, by continually reinforcing key points about critical health issues, there will be resulting action. An example of the type of action that could be taken as a result of listening to a radio health broadcast would be an increase in individuals engaging in healthy and health seeking behavior. An example of healthy seeking behavior would occur, if after listening to a series of broadcasts on the importance of HIV/AIDS testing, there was an increase in the number of people visiting a nearby HIV/AIDS testing site. An example of the positive influence of a public health radio station on a community was documented in the 1994 Save the Children United Kingdom study in Mali on HIV/AIDS, where they found that of the 2000 people surveyed 47% of the people had heard about AIDS through the radio.
Researchers should include an evaluation of the social change indicators when evaluating the efficacy of a community health radio intervention. A way to do this is through qualitative interviews and focus groups. Both of these methods of research can utilize protocols, which allow people to describe behavior change that occurred as a result of the introduction of health radio broadcasts. Unlike surveys, which are typically used to evaluate the efficacy of radio health broadcasts, interviews and focus groups go beyond an evaluation of a person’s knowledge about critical health issues.

References
Booth, Isobel. “Radio soap for health education: lessons learnt by Health Unlimited Rwanda 1997-2003.” Health Unlimited (2003): n. pag. Print.

Serlemitsos, E. A., U. Bharath-Kumar, J. A. Nyambe, B. Mukwatu, and R. E. Carty. “Building community mobilisation skills at scale: The synergy of radio distance learning and the roll-out of a national curriculum for health workers in Zambia.” Proc. of International Conference on AIDS, Thailand, Bangkok. N.p.: n.p., n.d. N. pag. Print.

Skuse, Andrew. Radio Broadcasting for Health: An Issues Paper. Issue brief. N.p.: Department for International Development, 2004. Print.

In a lecture given my Paul Wise at Stanford University, it was pointed out that in order for true and lasting change to occur in global public health, technical interventions had to be paired with social change. This is necessary in order to provide a social context for technical care that is accessible universally. It follows naturally, that the evaluation of any technical intervention is extremely important, if it is to be a successful counterpart to social change. In these difficult economic times, funds to support international health interventions are even more limited. It is important for potential interventions to be evidence-based. Research supporting the efficacy of said interventions is critical, if funding is to be directed towards international health interventions. The role of international aid specialists has widened, including not only the financing of international health interventions, but also the evaluation of the efficacy of their efficacy.

Dr. Wise explained that access to interventions was dependent on the efficacy of the intervention. If an intervention is highly effective, than people’s access to a health care provider or insurance will determine their access to the intervention. If the intervention is ineffective, than people’s disease burden will determine their access to the intervention. The most desirable situation would be the implementation of highly effective interventions within the context of a health system that is open to all people. In order to create a situation like this, researchers must evaluate the efficacy of interventions, so that they can be paired with social change (i.e. physicians/public health practitioner working with international policy makers/lawyers/politicians) to improve international health.

It follows, that there needs to be an evaluation of the efficacy of community health radio programs. If funding to support the development of future community health programs is to continue, there must be research that shows that the community of people listening to the community health radio program became more knowledgeable about critical health issues because of their exposure to health broadcasting. Researchers should employ a differential outcomes study, in order to ascertain the efficacy of a community health radio program. A differential outcomes study evaluates whether the intervention changed the behavior or knowledge of the audience. An example of a differential outcomes study for a community health radio program was done in Zambia in 1991 to evaluate the effectiveness of a radio drama program in improving a community’s understanding of HIV/AIDS. Researchers gave the audience a survey asking them general questions about the transmission, treatment, and prevention of HIV/AIDS before and after they introduced the radio drama. There was no difference in terms of the knowledge that the audience had about HIV/AIDS. But this does not show that the drama had no positive impact, but it does mean that the instrumentation used to measure the impact of the radio should be improved. Focus groups could be used to supplement these surveys. Focus groups are a much more organic research method, allowing people to build off of each other’s ideas and cumulatively produce an original idea that they would otherwise not have thought of in an individual survey. It is important to continue improving research methodology, so that community health radios can continue the important work of providing rural communities with critical health information.

References
Booth, Isobel. “Radio soap for health education: lessons learnt by Health Unlimited Rwanda 1997-2003.” Health Unlimited (2003): n. pag. Print.

Serlemitsos, E. A., U. Bharath-Kumar, J. A. Nyambe, B. Mukwatu, and R. E. Carty. “Building community mobilisation skills at scale: The synergy of radio distance learning and the roll-out of a national curriculum for health workers in Zambia.” Proc. of International Conference on AIDS, Thailand, Bangkok. N.p.: n.p., n.d. N. pag. Print.

Skuse, Andrew. Radio Broadcasting for Health: An Issues Paper. Issue brief. N.p.: Department for International Development, 2004. Print.

I introduced the topic of using the radio to train community health workers in an earlier blog that was focused on how health broadcasting could support HIV/AIDS prevention. This topic was extremely interesting, so I have decided to explore the themes surrounding radio communication intervention that supports health workers, in more detail, focusing specifically on SMS texting as the new radio. In much of the developing world, physicians are scarce. The “brain drain” phenomenon describes the recurring removal of physicians from resource poor locations to resource rich locations. In many developing nations there is training for Doctors, however, once a Doctor has been trained there is a very low likelihood that they will continue to live in the resource poor location. For this reason, many health organizations, such as Partners in Health, have touted community health workers as the future for health in developing nations. However, although community health workers do provide a very compelling solution to the brain drain problem, they are still challenged to work at low-wages, without centralized support systems, and within scattered communities. Health communication technology must be paired with community health workers in order to improve their efficiency, support, and retention rates.

A good example of a health communication technological device that can support a health worker (other than the radio) is the cell phone. In sub-Saharan Africa, studies have shown that the rates of cell phone use have gone up by 60% for the last 5 years. Cell phones have pre-existing infrastructure (unlike the internet), are low cost, and have many benefits that can be used to support health workers. SMS texting has been called the new radio, because it can be used to transmit health information to many people. Text-for-Change is an example of radio as SMS. Text-for-change allows community health workers to send out mass texts informing people about things like HIV/AIDS testing sites and follow-up drug care. Radio as SMS has allowed health workers to improve drug adherence, communication with patients, and communication with other health workers. Like the radio, SMS allows the transmission of information to a recipient who would otherwise be unable to access health services and information. Unlike the radio, SMS texting allows the listener/audience to transmit information back. Unlike SMS texting, radio can send more extensive and detailed information to a wider audience, reaching hundreds of thousands of listeners. Radio and SMS texting can be paired together, to help maximize the efficiency of community health workers who are working in resource poor countries with scattered communities. This summer, I will be working with FACE AIDS to create a community health radio program and text-for-change hotline in Rwanda. The natural pairing of these two global health communication technologies, will hopefully, improve many rural Rwandan’s understanding of HIV/AIDS. I will be evaluating the efficacy of each of these health communication technologies independent of each other, and also together, to determine the best way to maximize the positive results of SMS texting and community health radio programs.

References
Booth, Isobel. “Radio soap for health education: lessons learnt by Health Unlimited Rwanda 1997-2003.” Health Unlimited (2003): n. pag. Print.

Serlemitsos, E. A., U. Bharath-Kumar, J. A. Nyambe, B. Mukwatu, and R. E. Carty. “Building community mobilisation skills at scale: The synergy of radio distance learning and the roll-out of a national curriculum for health workers in Zambia.” Proc. of International Conference on AIDS, Thailand, Bangkok. N.p.: n.p., n.d. N. pag. Print.

Skuse, Andrew. Radio Broadcasting for Health: An Issues Paper. Issue brief. N.p.: Department for International Development, 2004. Print.

Community health radio programs provide a unique way to introduce an audience to information about how to avoid getting infected by HIV/AIDS. A community health radio program can bring information about how to prevent HIV/AIDS infections, which would otherwise be inaccessible, especially in rural areas of developing nations, where communities are scattered and resources are limited. In Zambia, 16% of the population is infected with HIV/AIDS and 50% of the population is not within normal walking distance of a community clinic or hospital. This makes it impossible to do diagnostics at the point of care, increasing the already important role preventative treatment plays in combating HIV/AIDS. In Zambia, John’s Hopkins University helped to develop and implement a 26-week, 30 min session radio distance-learning program to train health workers to address HIV/AIDS in their communities. The researchers went to the various scattered communities in Zambia and organized Neighborhood Health Committees (NHC). These NHCs were responsible to listen to the radio distance learning scripts, in order to be equipped to address HIV/AIDS in their communities. The program was extremely successful; it supported community mobilization and helped provide scattered communities with access to preventive HIV/AIDS treatment. The results of this effort could have been improved if the NHCs were connected to centralized clinics and hospitals for support and advice.

Soap operas are another method of introducing information about HIV/AIDS prevention through the community health radio. In Rwanda, “Uranana,” which means “hand in hand” is a popular radio soap opera that addresses women’s health issues and HIV/AIDS. HIV/AIDS prevention information pertaining to abstinence, being faithful, and condomising, is introduced in conjunction with dramatic plots and thrilling cliff -hangers. The content of these dramatic productions is often audience-led. The themes used in Uranana were developed after researchers asked about the critical health issues that locals were interested in learning about. HIV/AIDS was consistently listed as a concern. In Rwanda, for every one television, there are 101 radios. The dominance of radio, as the primary mode of communication, allows soap operas to have a wide reaching affect, informing many people about how to avoid contracting HIV/AIDS. These soap operas overcome problems of illiteracy. In Rwanda, a 1996 study by the government showed that there was an illiteracy rate of 48.3%. This is a gendered issue, because of that 48.3%, 68% are women. Soap operas that address women’s health issues and HIV/AIDS are especially powerful, because they incorporate women into a dialogue about HIV/AIDS. Women, who would not otherwise be able to get information about HIV/AIDS from a book, can now gain access to information about preventative treatment.

Another way community health radio disseminates information about HIV/AIDS prevention is through public service health campaigns. Simple catchy phrases like “take the test, take control,” have been used to remind young people to inform themselves about HIV/AIDS. These public health campaigns push the use of protection, using background sounds such as a baby crying, to illustrate the consequences of having unprotected sex. These public health campaigns have encouraged HIV/AIDS testing, wearing a condom, and being faithful. They’re not only used in developing nations, they’re also used on MTV and BET, two channels that attract a wide teen and young adult audience in the United States.

References
Booth, Isobel. “Radio soap for health education: lessons learnt by Health Unlimited Rwanda 1997-2003.” Health Unlimited (2003): n. pag. Print.

Serlemitsos, E. A., U. Bharath-Kumar, J. A. Nyambe, B. Mukwatu, and R. E. Carty. “Building community mobilisation skills at scale: The synergy of radio distance learning and the roll-out of a national curriculum for health workers in Zambia.” Proc. of International Conference on AIDS, Thailand, Bangkok. N.p.: n.p., n.d. N. pag. Print.

Skuse, Andrew. Radio Broadcasting for Health: An Issues Paper. Issue brief. N.p.: Department for International Development, 2004. Print.

Community health radio allows an audience to have the unique opportunity of listening to the stories and experiences of fellow community members who are infected with HIV/AIDS. A very important component of community health radio is it’s ability to engage in meaningful dialogue with community members, by giving them a space to share their own experiences with personal health and the healthcare system with the people living around them. These personal stories bring make each community radio program uniquely tailored to reflect the shared experiences of a group of people. The community health radio is a unique social space, where people who are infected with HIV/AIDS have the opportunity to influence the de-stigmatization of hundreds or thousands of people. By sharing their personal experiences, they are providing a powerful example of a person who is living with, not dying of HIV/AIDS.

All too often, HIV/AIDS is view as a disease that leads to death, isolation, and shame. When community members who are infected with HIV/AIDS, courageously share their experiences own exeeriences, they are breaking downthis stigma by providing audience members with a very real and compelling example of a human being who is finsding ways to live with HIV/AIDS. However small the detail, from sharing how they began taking antiretroviral drugs, to the larger experience of getting tested for HIV/AIDS, the simple act of sharing how to live, cope, and even thrive with HIV/AIDS brings back a sense of “humanity” to those who are infected with the disease. In many places around the world, especially in developing nations where women have limited social, political, and ecoomic rights, community health radio provides people infected HIV/AIDS with the opportunity to “deconstruct” the de-humanizing identity that has been placed, on people, especially women, who are infected with HIV/AIDS. Instead of being viewed as the “other,” a living dead who exsist in isolation and shame, community health radios, allow those infected with HIV/AIDS to share their very real, and very human experiences. Ultimately, by sharing these experiences they reduce the social distance between themselves and their community members, introducing a dialogue about how to support and empathize with those with HIV/AIDS .

In many developing nations in sub-Saharan Africa, such as Rwanda, there is little to no dialogue about HIV/AIDS, because of it’s connection to one’s sexuality. Community health radio provides a way to introduce into the home, conversation about HIV/AIDS, which might not otherwise have been had. Hopefully, these conversations will have a transformative power of removing the shame associated with HIV/AIDS. Hopefully, community health radio programs will help people understand the difficulties faced by those infected with HIV/AIDS, encouraging empathy, rather than disdain. Another important element created by increasing conversation about HIV/AIDS in the home, is to create a sense of solidarity among those infected with HIV/AIDS. Hearing someone else talk about an experience that you are going through, helps one to understand that they are not alone. Community health radios can help create a powerful support system for people infected with HIV/AIDS, by bringing those who are and are not infected with HIV/AIDS, into a more empathetic, collaborative, and supportive role.

The past few weeks I have looked at specific examples of how the internet has played a role in the global health arena’s move toward the future. From Paypal to digital medical files, it seems like everything that we do is taking on new and more advanced ways for people to access it.

Donations are no longer dependent on seeking out physical people or mailing sums. Now there are buttons all over the internet that can collect money from you instantly. The internet’s ability to spread published and first-hand accounts of disease and other health issues rapidly also makes your everyday American more likely to be knowledgeable on a health crisis, and more likely to get involved by donating both time and money to a cause. This increased presence of the internet has also upped the stakes in public health disaster reporting - both by rallying entire nations at the drop of a hat, and also having the potential to create epidemic scares and other misinformation pitfalls. Even when looking at a more clinical example of internet’s emerging role in healthcare, there are pros and cons to be considered. The movement of health files from paper to electronic raises issues both of convenience and of privacy.

In all of these cases presented, the internet has shown the massive potential for increasing both awareness and involvement on all sorts of global public health issues. The main drawbacks have come up as issues with misinformation, global panics and privacy concerns. However, the sheer volume of people that can be reached through the growing internet makes it an incredibly attractive venue for global public health to move towards. 

While the drawbacks are potentially unattractive, so far nothing disastrous has happened to severely curb the steady march toward globalization via the use of the internet. If anything, people are putting more and more trust in this system as the years go by - not much unlike previous internet activities, such as shopping, trading stocks and banking. If Americans can trust the internet to guard their savings, then the move to the internet will continue to grow and expand, reaching more people and tapping into more resources on a scale that was never thought possible before.

For this week’s blog post, I had difficulty selecting a topic that I feel like would wrap up the various topics I chose regarding information and communication technology as it applies to globalization and health.  Instead of just choosing one topic, or summing up the various topics, I am bringing up three different examples of different applications of information and communication technology: one that has already occured and was successful, one that is undergoing right now, and one that has huge potential in the future.

In a review of what has worked when it comes to ICT, I want to look at the case of Singapore.  Singapore has had a lot of success when it comes to public health campaigns, ranging from decreasing the smoking rates, decreasing the rates of dengue fever, and increasing awareness of SARS.  As a result, Singaporeans appreciate a quality of life and health that is different from other countries in South-East Asia.  In the case of dengue fever, Singapore’s “Campaign Against Dengue” really focused on raising awareness and tackling the root of the problem by preventing the Aedes mosquitoes from breeding.  This was done through grassroot efforts and a lot of public health information conveyed to the public in the form of education campaigns on how to prevent mosquito breeding, such as getting rid of still-standing water and fumugating areas every week.  Additionally, the Singaporean government placed a fine on still-standing water where mosquitoes could breed; however, the emphasis is on prevention for the safety of every individual.  When traveling or living in Singapore, one cannot go for too long without seeing some information about dengue, either on billboards, public health ads and commercials, and informational posters on subways and busses.  With this flood of information through different media sources, it is hard to forget to dump out any still-standing water.  Another example of a successful public health campaign in Singapore is the anti-tobacco program.  Since the 1970s, Singapore has been able to decrease the rates of smoking from 23% to about 11-12% now.  This was done through a variety of methods, from legislation to public education messages.  This public education took many different media forms as well, from television to advertisements on the streets and newspapers, and even on the cigarette packages.  In Singapore, all cigarettes that are sold MUST have huge warnings on the boxes, in addition to gruesome pictures of health outcomes from smoking, such as oral cancer, birth defects/miscarriages, lung cancer and emphysema, etc.  It’s disturbing sometimes to walk by and see the cigarette packages lined up at the cashier with all of these images of diseased organs facing the customers, but this method has worked.  In addition to the multiple public education messages from ICT, Singapore supplemented the campaign also with communication programs with schools, workplaces, health centers, and community centers.  These face-to-face programs provided a strong addition to an already strong public health campaign.

Looking at what’s going on now, I want to talk about a topic that I was originally going to focus this blog on until I saw that it was the focus of another blog already.  For this case, I want to look at the topic of Health Information Technology in the U.S., something that has gotten a lot of attention and news in the media recently.  The arguments for electronic health records (EHRs) were that they would save time, and could improve the quality of care with more efficient use of physician time.  In the stimulus package, a substantial amount of money was invested in HIT, ensuring that it would be implemented within this adminstration’s time.  Rather than go into the details of a topic that has been looked at extensively by another classmate and has been in the news a lot, I will voice some potential negative unintended consequences of this mass movement to HIT in the U.S. healthcare system.  These include: “additional work for clinicians; unfavorable workflow changes; never-ending demands for system changes; problems relating to persistance of paper records; changes in communication practices with false assumptions; negative emotions established with changing established practices; generation of new type errors (”e-iatrogenesis); loss of ordering autonomy; and overdependence on new technology.”  Nevertheless, with the large investment in HIT, many of these unintended consequences may not be major, as long as it is properly implemented.  To me, I feel that the biggest challenge facing HIT is that with all of the hype surrounding how effective it will be at lowering costs of health care and improving quality of care, it has the potential of not fulfilling the expectations if it is not implemented correctly; in my opinion, in order to appreciate the full benefits of HIT, there needs to be some standardization across the board so that different health institutions would be able to communicate with each other.  Essentially, HIT is a hugely promising field at this time in improving access to health care and decreasing the costs of health care.  The current trend of HIT is a positive one for the role of ICT in public health in the U.S.

Going from the U.S. development of HIT, one future project that I feel like has a lot of promise is the Palestine-Israel Health Initiative.  This is a project that has taken off recently and aims to promote “peace through health.”  By allowing for communication across borders, especially with a common topic and goal of improving health, the organizations involved hope to promote peace.  The increase in communication is planned to happen through a collaborative project on a health website, a sort of e-commons for health information, similar to how our CDC website works.  By working together, and having outside non-governmental sources facilitate, the ultimate goal of the project is that by building a strong website and communicating on health information and sharing “best practices” information, there will be a better understanding of the “other side,” promoting peace.  This is a promising program that will be interesting to look at throughout the coming years.

To tie these different cases together, a common thread through the effectiveness of ICT in public health is effective communication and use of different media sources.  As we have said in class, it is essential to look at the needs of the community - for example, in the case of Egypt, part of the reason the campaign for ORS was so successful was because of the explosion in the number of households with television, so that that form of media could be properly utilized, whereas BRAC had to rely more on door-to-door information and public health education in Bangladesh.  In Singapore, the multiple media used for the campaigns have been reflected in the high success rates.  It is clear how ICT can improve the health of individuals - awareness and prevention can be increased, access can be improved, and information can be shared to promote efficient medicine (such as in the case of HIT).  In summary of this blog, I think that regardless of the fact that every community is different and may have different needs and resources, the different case studies and topics relating to ICT in this blog indicate that ICT is an extremely valuable tool in public health, and it will be interesting to look at how it further develops over time to improve the lives of individuals around the world.

http://archinte.ama-assn.org/cgi/content/full/169/10/924

I have decided to change my topic for this week from talking about the Palestine and Israel Health Initiative because it is a project that is still being set up and there is not much information on it besides why it is necessary.  Instead, this week I will look at the role of public education and public health campaigns, and how they are/aren’t effective, and possibly why.

First, I want to look at a campaign that was targeted at an important issue in this country.  Currently, between 16-33% of children and adolescents are obese (about 9 million children over the age of 6 years old are obese).  Unhealthy weight gain from poor diet and lack of exercise is responsible for about 300,000 deaths per year; also, the cost of obesity to society is very high, estimated annually to be about $1 billion dollars.  Furthermore, there are very many comorbidities that come along with obesity, especially if the obesity begins as a child.  Thus, it is essential that obesity is curbed in the beginning - obese children and adolescents are much more likely to be obese as adults.  Because of this important obesity epidemic that this country faces, I want to look at a campaign aimed at children to promote healthy exercise behaviors - I’m sure you’ve seen the ads from this campaign before - the VERB campaign.  These ads were multimedia, and were targeted at kids aged 9-13 to try and encourage them to be more active.  The ads took form of paid advertising, community programs, and Internet activities.  The major outcomes that were examined were “awareness of the campaign and self-reported free-time and organized physical activity sessions.”

In the study, it was found that after 1 year, about 74% of the children knew about the or had heard about the campaign.  Levels of reported physical activity increased in some subgroups in this population: younger children (9-10), girls, children whose parents had less than a high school education level, children who lived in densely populated urban areas, and children who were rarely active at baseline.  What’s interesting is that out of these subgroups, only those who were rarely active at baseline had an increase in organized activity - the other subgroups increased their free-time physical activity.  Essentially, this VERB campaign was able to achieve high levels of awareness just within 1 year, and that child focused advertisements are effective.

Looking at the implications of this study, and how it relates to other similar studies and campaigns (some of which I will look at next week, such as many of Singapore’s effective public health campaigns and the Truth anti-smoking campaign for teenagers in the U.S.), I think the overall message is that these public education campaigns can have a huge impact on the public health of a society.  By using a multimedia approach in this world that is increasingly wired and technoly-savvy, many of th epotentials of information and communication technologies can be met.  The VERB campaign indicates that even though physical activity, something that many know to be essential to reducing rates of obesity and something that is required in many schools, can be improved on.  In my blog on Egypt and it’s use of ICT, the campaign was to get people to know about the importance of using ORS - in this case, people for the most part know that physical activity is good for their health - it’s interesting that a public health campaign can still be so impactful.  One hypothesis that this study makes me consider is that the use of multimedia increased activity rates in the subgroups specifically because it allowed for the information to be received by more people, so that younger children, girls, those in crowded neighborhoods, and those who had less educated parents would get this healthy point emphasized.  Basically, it might be because these subgroups have a more restricted access to physical activity for a variety of reasons, and the public education campaign might have overrode the reasons, increased the parents’ understanding, or encouraged the children.  This analysis then leads me to the statement that ICT and multimedia presentations of an idea, while there might be issues of access, can also increase access to quality care because it allows for groups that might not have access to certain types of information all the means to understand the information in an easy, accessible way.  I feel like the subgroups who did have an increase in physical activity may have been the subgroups that had restricted access to higher quality care and information about physical activity, and the multimedia public health campaigns narrowed the information gap between the groups.  In this sense, ICT is decreasing the resource gap because of the multimedia approach, rather than increasing it by providing information only to those with TVs, etc.  The results of this campaign are promising, and it should demonstrate to other public health campaigns how important it is to analyze who the target audience is and how to best cater the ICT approach to the target population.

http://www.aacap.org/cs/root/facts_for_families/obesity_in_children_and_teens, May 2008.

http://www.iom.edu/Object.File/Master/22/606/FINALfactsandfigures2.pdf, September 2004

http://pediatrics.aappublications.org/cgi/content/full/116/2/e277

My last several blog posts have introduced various examples of ways in which information and communication technology have intersected and impacted the realm of global public health. I have discussed problems of inequality caused by differences in ability to gain access to the Internet, the creation of an open and democratic Internet, the role of cell phones and text messaging in enhancing community healthcare efforts, the role of various organizations in supporting mobile health, the inequalities created by the use of copyrights on the Internet, and a more in-depth analysis of a specific initiative to create a democratic Internet. To wrap things up this week, I wanted to bring the focus directly back to the issue I raised in my first post – the digital divide and what is being done to bridge it.

So in considering the realm of global public health, the digital divide is clearly a distinctive feature. The differentials in access to the Internet, and by proxy, information, have a lot of implications for people’s health. The Internet makes available a vast array of resources but when people cannot get online, then what purpose does it serve that these resources even exist? (Although that is by no means meant to imply that the Internet is futile as so many people can and do get online. As I mentioned in my first post, websites like WebMD get a huge number of hits everyday from people trying to gather health information or make self-assessments of their health statuses. But how many people in the developing world actually have the capability and wherewithal to search WebMD in these situations? That is not even to mention the fact that sites like WebMD may not even exist in these regions. This is where issues related to legal obstacles like copyrights or linguistic barriers come into play…)

But information and communication technology have revolutionized various elements of health and healthcare. Take the role of cell phones, for instance. The text messaging capability of cell phones has improved speed and efficiency of healthcare delivery in countries like Malawi and provided a means by which people can seek and attain health-related information (such as diagnoses, dosage inquiries, symptoms, check-up and appointment reminders, etc.). It has enabled community healthcare volunteers in rural villages to become more available to respond and focused in their provision of care. It seems that here the only challenge would be setting up the infrastructure to support this sort of mobile healthcare system. A system like this requires a mobile phone network that extends to the rural villages from a centralized location such as a city hospital. And of course, the actual physical cell phones themselves would need to be provided. But perhaps this is where an NGO or other such organization could enter the picture. They could focus their efforts on creating a project to collect old or discarded cell phones from people in developed countries to then ship to those in more rural communities who could benefit from the cell phones.

In bridging the digital divide, I think it is most important for NGOs to come up with creative ways to respond to areas of need. As in the cell phone example, these creative responses need not be complex. But they must address the problem of lack of access to certain important resources. I am greatly disturbed by the thought of how much wastefulness occurs in certain societies with time, money, and other resources. We need to find a way to channel these facets into creative, productive, and perhaps even collaborative energies that will contribute to this “bridge-building” effort.

In several of our lectures in class, we learned about the importance of getting the local communities involved and empowering them to help themselves. I agree that this is an essential characteristic to any solution that could possibly materialize. Sure, there may be a stark difference in available resources and know-how, but these must be imparted in such a way that change will be beneficial and sustainable. Globalization has made the exchange of resources and information between different actors much easier than in previous decades. I am optimistic that the digital divide will eventually be bridged.

“Imagine if you could interview a family about their health, enter the information into a PDA, and sync the data wirelessly to a database in an office miles away, ready for real-time analysis – all while sitting in the middle of one of Africa’s largest slums where homes are made of mud and open sewage lines the walkways. Or imagine if you could deliver health alerts with text messages to tribal chiefs across rural Africa who do not have Internet access but do own a $20 mobile phone. And that same chief could send a text message to report a suspect case of a dangerous infectious disease to health authorities using the same $20 phone. “

-Anant Shah, Center for Disease Control

In his article in the Yale Journal of Public Health, Anant Shah puts into perspective the benefits of using mobile technology in healthcare. As an employee of the CDC, he focuses on two programs in Kenya that are currently being employed by his organization; but, as we now know, there are many similar programs being implemented all around the world. Many of these programs focus on 4 different sectors of mobile technology: surveillance, outbreak updates and monitoring, training, and spreading messages about healthcare to the general public.

In the past 8 weeks, I have explored 4 initiatives that involve one or all of these concepts. The first initiative that I highlighted, Project Masiluleke, focuses on sending out mass messages concerning HIV/AIDS in Sub-Saharan Africa. It also provides training for officials to interpret at home HIV testing as well as to become supporters on the HIV Hotline. Voxiva, based here in the United States, provides a means of data collection and allows users to subscribe to alerts about their health and factors that may affect it. The Empower Foundation in Thailand works to promote the health of sex workers by utilizing SMS in order to inform the sex worker population of dangers in the community as well as to monitor their lifestyles and health. Lastly, the Murdoch Institute’s Centre for Adolescent Health incorporates mobile technology into their mental healthcare by tracking symptoms and feelings through a mobile device.

These examples are just four of the vast number of programs that have been implemented in various corners of the world. Mobile technology is an example of how healthcare is advancing with globalization. As technology moves forward, the manners in which it can be implemented do as well. In this case, a few years ago, nobody would ever have thought that a mobile device or PDA would be an important source for healthcare information, in both developed and developing countries. Now, many NGO’s use mobile devices as their sole means of data collection and communication. As has been demonstrated over the past quarter, this technology has served a multitude of different purposes, ranging from providing information to obtaining information and everything in between,

As amazing as this new technology is, it is always important to remember its drawbacks. First of all, many of the mobile technology programs revolve around this idea that mobile technology is easier to use because it does not require people taking care of their health problems face to face with a doctor. For example, it is argued that in some parts of Africa, people do not get tested for HIV because of the stigma attached to seeing the doctor in the clinic. Although the mobile technology promotes testing, it does not erase the larger problem: the stigma attached to this disease that is so rampant in those nations. True, these technologies may help us get around the problem of stigma, but are we really solving anything in the long run if we are not working to change the mindset?

In addition, many programs that utilize these mobile technologies diminish face-to-face care with an actual doctor. I have said this repeatedly before, but I think it is so important for people to obtain care from a real person. The relationship that develops between a doctor and a patient is irreplaceable. There are many places that do not have doctors, so these mobile programs are definitely a step up. But they should be seen as a stepping-stone towards a working clinic, not a replacement for one.

Although mHealth does have its downfalls, it is a great example of how globalization and information technology are being applied to public health. The fact that this new use for this technology has sprung up so quickly and helped so many already is promising. We live in an era of change, and I cannot wait to see what improvements will be made to the world of global public health in the future.

Source:

http://www.cdc.gov/news/2007/03/images/mobiletech.pdf