Applying mHealth

I saw a presentation by a colleague over 20 years ago that included these comments, “Imagine an array of strategies and tools that facilitate the active and systematic engagement of populations in defining and dealing equitably and intersectorally with their real issues and concerns. Imagine also collaborating in real-time with partners anywhere, sharing data and ideas, being able to monitor the thoughts of others in real time, and documenting the processes and content that contribute to our goals. Imagine if we could actually apply the technology capacity we already have available to us.” As a public health practitioner, researcher and teacher, the breadth of this capacity intrigued me.

Ray Kurzweil

Ray Kurzweil, a pioneer in artificial intelligence said, “Now imagine that the computational power of your cell phone is a million times cheaper, and a thousand time more powerful, and about a hundred thousand times smaller than the main computer at MIT in 1965. What was housed in a building in 1965 now fits in your pocket. What fits in your pocket now will fit inside a blood cell in 25 years.” (NPR, Ray Kurzweil, April 3, 2009)

In this entry I’d like to share some of my thinking and items I have been reading about mHealth. The term mHealth refers to the application of mobile technologies such as cell phones to address health problems. Since the 1970s I have been a vocal advocate for the application of advanced communication technologies to the training of public health professionals and to public health interventions designed to address appropriate public health needs. We are in a very unusual position today as a result of the widespread availability of mobile devices, principally smart phones, around the globe. For those unfamiliar with the term mHealth, there is some reasonable background found on Wikipedia, and I recommend a quick review of the material there as a start. This short video on mHealth may be an even better introduction.

Besides the extensive deployment of smart phones and related technologies, there are a few other elements that make this situation particularly opportunistic: 1) Over the last few years there has been an incredible rise in participatory culture around social media; 2) The devices’ incredible power packs an extreme opportunity in a small, portable package; 3) While very sophisticated and powerful, they are easy to use; 4) The programmatic cost for the technology is relatively inexpensive; 5) Their location awareness adds capacity not found in most desktop and laptop computers; and 6) There’s ample evidence that irrespective of culture, age, gender or geography, people are willing and able to use these technologies.

The mHealth Alliance, a partnership hosted by the United Nations Foundation and the Vodafone Foundation that supports research and advocates for broader use of mobile-based or mobile-enhanced solutions to complex maternal and child health issues around the globe, has driven a major effort around mHealth.

Over time I will provide more entries to this blog about the use of mobile technologies for health, but I’d like to recommend two readings before I finish this entry. The first is a United Nations Foundation Report titled mHealth for Development. This report was released near the end of 2009, and it is a detailed overview of the potential for mobile health technologies for promoting health and preventing disease globally with primary attention to maternal and child health issues. The focus of the report is on the developing world, but it is relatively easy to see how the concepts underlying the application of such technologies can be applied anywhere, including in middle and upper income countries.

Brian Dolan

The last piece I’d like to add is based on a presentation made on March 16, 2011 at South by Southwest (SXSW) in Austin, Texas. Four panelists outlined what they called “landmines” in the way current developers and professionals use mobile health technologies. Brian Dolan, editor of MobileHealthNews, did an excellent job of summarizing and critiquing what John DeSouza, president and CEO of MedHelp; BJ Fogg, head of the Stanford Persuasive Technology Lab; Margie Morris, clinical psychologist and senior researcher at Intel Labs; and Jane Sarasohn-Kahn, a health economist at Health 2.0 Advisors, presented at the meeting. You can find Dolan’s summary in the March 16, 2011 edition of mobihealthnews. I suggest that you consider that these “landmines” are not limited to just mhealth interventions but could also be applied to public health interventions in general.

I want to close by referencing a meeting that anyone interested in these issues should consider attending. The mHealthSummit will take place from December 5 to 7, 2011 at the Gaylord National Resort and Convention Center, Washington, DC. Many people in public health may have missed the 2010 mHealthSummit because it overlapped with the annual meeting of the American Public Health Association. This year the organizers have changed the date to allow public health practitioners, researchers and policy-makers to attend. I highly recommended this meeting.

What I'm Reading Now-

Saving the lives of 25 million children

This entry brings together three items that are of particular interest to me. I gained interest in the subject of the first entry in 1987 when I was fortunate to be asked to serve a consultancy at the World Health Organization in Geneva. The U.S. Centers for Disease Control and Prevention’s Division of Adolescent and School Health was interested in becoming a WHO Collaborating Center and some background work needed to be done in Geneva. While there, I was exposed to an emerging theme at UN partner organization UNICEF called the child survival revolution. The child survival revolution was mostly a result of hard work and advocacy by Jim Grant, the executive director of UNICEF from 1980 to 1996. This became a major effort that resulted in significantly reducing child mortality. 

It may be time for us to take another look at an out of print book, Jim Grant – UNICEF Visionary now that it is available for free download in .pdf form. In a recent post to the Bill & Melinda Gates Foundation blog, Bill Gates said, “I recently came across a book that tells the amazing story of Jim Grant, whose influence in making vaccines widely available in the developing world is credited with saving the lives of 25 million children. Because of the work the foundation is doing on vaccine-preventable diseases, I’ve read quite a bit about the history of global immunization. But until I read Jim Grant—UNICEF Visionary, I didn’t appreciate what a remarkable visionary and results-driven leader he was.”

Jim Grant is responsible for the launch of the child survival and development revolution. Former President Jimmy Carter wrote the book’s forward and it contains eight essays written by Grant’s colleagues. Each essay reflects Grant’s achievements in a variety of ways. This book is worth reading, find it here.

Five Fictions About Social Media in Public Health and Health Care

The second piece is about one of my favorite things to tinker with – social media.  More importantly it refers to a blog entry by an exceptional writer and visionary on social marketing.  Craig Lefebvre’s blog entries will frequently be referred to here, and this is a particularly compelling entry because of the extent to which many think social media can overcome some of our most challenging barriers to reaching out to our constituencies.

Craig Lefebvre is a terrific writer and someone who has served as a visionary for the field of social marketing. He is also quite adept around new technologies, particularly social media. There are few others who can give such a considered analysis of the role social media can play in social marketing. Here Lefebvre warns us what social media cannot do by identifying what he calls five fictions: 1) We can reach audiences with social media; 2) We can change people with social media; 3) Health behaviors are the focus of our social media efforts; 4) We have target audiences who use social media; and, 5) To use social media effectively we need to be on Facebook and Twitter. If these “fictions” sound provocative to you (and they should), read Lefebvre’s post here.

The future of Global Health Journalism

I’ll close today with an item that may not be mainstream for those in public health but which is nonetheless a critical concern. I believe that effective public health journalism is essential to the health of our profession. However, as an art and a profession, journalism is struggling. I highly recommend a new report by the Kaiser Family Foundation regarding the current state of public health journalism. 

The report is called “Taking the Temperature: The Future of Global Health Journalism.” Most of us are aware that in recent years journalism has struggled economically – not only in the U.S. but world-wide as well. There have been major workforce and budget reductions that have influenced the ability of journalists and journalism outlets to cover critical stories as they once would have done. This report is based on interviews with 51 stakeholders in global health journalism, including reporters, editors and producers of a wide variety of media. This report “provided a window into what was happening in global health journalism in the U.S. and in select outlets abroad. How were challenges they faced influencing the type and amount of global health coverage available to the public and policymakers? What were the most important trends in reporting global health issues and what could they portend for the future? With mainstream journalism mired in economic trouble, what were the prospects for funding independent journalism going forward?”

If you’re interested in global health you understand the critical contributions of journalism to our efforts. This report summarizes these interviews, outlines some common themes and issues, and raises some critical questions that must be addressed in the coming years. Download the report here.