My service-learning experience in Bogotá, Colombia

 With Dr. Angela Maria Pinzon Rondon and her family,
who hosted me during my stay in Bogotá, Colombia.

I recently travelled to Bogotá, Colombia to spend time with one of our very talented former students, Dr. Angela Maria Pinzon Rondon, a physician who did her post-doc Ph.D in Maternal and Child Health here at the University of Maryland School of Public Health.  I am interested in exploring the possibilities for collaboration and exchange between our school and the Universidad del Rosario, where Dr. Pinzon is a physician, teacher, and researcher. I want to share an experience I had on one of the days I was there, which I recorded in a journal style.  I will likely follow up in other entries on other experiences I had while there. For the remainder of this entry, I will refer to Dr. Pinzon as Angela.

August 11, 2011:  Angela designed our plans today to expose me to the efforts addressing public health in the high-risk communities of Bogotá. 

We started the day by visiting Dispensario Santa Francisca Romana. Franciscan Nuns from Rochester, MN started this school almost 40 years ago for upper class children.  Since that time, they expanded their efforts to the surrounding communities of need and focused on one specifically - El Codito.  El Codito is a town of 38,000 people who are incredibly poor and underserved.  More on El Codito later.

The Dispensario has become a wonderful primary care clinic to the community.  Each Wednesday, they bus 100 seniors from El Codito to the clinic where they participate in group activities, receive needed primary care including dental care, and receive legal and other advice as needed.  To serve the many seniors who need this kind of assistance, they've created a rotation strategy that ensures that all seniors can participate in these Wednesday sessions.

Disabilities of any kind limit the capacity of El Codito’s seniors to be mobile – and prevent them from being engaged socially or receiving services of any kind.  By happenstance, we encountered a group of faculty and students visiting Bogotá from University of Alberta, Canada whose focus was on functional life challenges for people with disabilities.   There were faculty and students from three disciplines - electrical engineering, occupational therapy, and rehabilitative medicine.  They are working with the severely disabled in El Codito and searching for unique solutions to health care utilizing web and mobile technologies. This was a wonderful excuse for me to talk about something I am passionate about – the role of technology in health promotion – and we all toured the clinic facility together.

Visiting El Codito 

Then we set off for our trip to El Codito where students and faculty from the Universidad del Rosario are working.  Here’s a little background about El Codito.

A look down the hill side community of El Codito to the city of Bogotá below.

Angela referred to El Codito (English translation – the little elbow) as an invasion city.  It sits on a very steep mountain-top on the edge of Bogotá. Poor families started building this community on the mountain-side 35 years ago, essentially as squatters since no formal ownership transactions took place.  It was originally built without necessary infrastructure such as sanitation, sewers, electricity, or roads.  Over 35 years, some of that has been delivered, but it is still a very poor and underserved community.  Many live in astounding squalor, without basic services, and with a high rate of gang-driven violent crime.

Because of the steep hill-side, poor infrastructure, and poor road structure, disabled people who need a wheel chair have almost no way of using one.  So it is not uncommon for a physically disabled person to spend most of their time in bed for months or years at a time - unless someone provides services that address their issues.  So, I set out with Angela and Sofia (a public health nurse that works in El Codito) to visit some of the people they serve, and to witness the depth of their commitment to public health.  Before we left for El Codito, Angela paid to fill up the back of her truck with more than 20 bags of groceries, including chicken and other meats that she would distribute to each of her community people of need.  She told me she never wants to go there without leaving something of value.  This is one of her strategies for building community trust.

Most disabled people in El Codito are bed-ridden because of the lack of infrastructure needed to get around in a wheel chair.

We first met an 80-year old man in an alley sitting in a chair. That's were he spends his day. He was an alcoholic thrown out of his home by his wife.  This gentleman asked a friend if he could move in with him.  Shortly after doing so, his friend died - so he's living in a room in a shack with his late friend's wife.  She is not happy and wants him out.  He has major health problems and has nowhere to go.  He depends upon food and health service aid from the programs of the University - as does the woman he lives with.  They have no gas in the shack so they've put a stovetop on some rocks outside the shack and burn wood and coal to cook on the stovetop.  Before we left, Angela gave him two bags of groceries.

I thought the first stop was a poor area until we got to the second stop. This was to see a 17-year old boy who was hit in the neck by a stray bullet when he was 11.  He has been paralyzed since that time and in bed most of that time.  There is actually no way to get him out of bed without building infrastructure.  But in the shack he lives in with his elderly mother, there is no wall or footing structure that would support such infrastructure, and the space he lives in is not large enough for a wheel chair to move.

Having said that, he was a delightful man who did not complain.  He enjoyed seeing Angela who he's known for several years.  Angela talked with him about his care, tested his arm strength to assess whether he was doing his prescribed exercises and then we left a few bags of groceries.  No matter how many pictures I have seen of the world's poor who need our attention, I have never seen anything quite like this setting and this young man.  I later found out that he has an interest in law - so part of the commitment to this boy is to have law students visit with him on Saturdays to spend time with him and talk about law.  I’ve provided two photographs here – the first is the view entering the shack where this young man lives and the second a view leaving the shack.

Our next stop was on the steep side of the community.  We had to climb down several flights of makeshift concrete stairs that no one would consider a staircase. When we got to the level we were looking for we entered another shack where a women in her 30's was in bed, two children were in the shack, and an elderly woman was there also.  The women in her 30's fell from a roof when she was 12 and became completely disabled.  She has basically been mostly in bed for 26 years.  Angela talked with the woman, did a basic assessment, asked about medications, and watched as the 15 year-old administered an insulin shot to the woman.  Several more bags of groceries, several more tears of thanks, and we moved on.

We were led to the next stop by a 10 year-old who brought us to a home on the side of the mountain.  As we entered, we were met by a young woman whose 11 year-old son had cystic fibrosis.  It was a dramatic case because they had been unable to get needed medication and other services. Angela and Sofia again assessed the situation, decided what was needed and made a promise that it would be provided.  Several more bags of groceries were left.

Angela and Sofia took me to two clinics that serve El Codito.  At the first, we met a woman who was a community leader.  During the conversation, Angela turned to me and said I should sit down because there was an unanticipated problem that had to be dealt with.  The woman asked Angela and Sofia to do something about her 18-year old daughter who was an alcoholic since her father started her drinking at 12 years of age.  Her drinking was getting much worse and she asked that Angela and Sofia attempt to get her into a program.  Angela agreed and the woman asked the daughter to join us.  Angela was not able to do much but to discuss the importance of getting help - and then promised to accommodate an appointment with psychological services in the program Angela is part of.  The girl agreed to follow-up if psychological services contacted her with an appointment time.  Two more bags of groceries left, and on to several more stops like these before leaving El Codito.

Saturday 8/13 - Returning home

I'm on Continental Airlines flight 1004 about 90 minutes from landing and reflecting on the week I just had.  It was an incredible experience and I hope it will not be the last time I travel to Colombia.  But there are some things I'm taking away.

I am reminded that the students who go through our programs can also be great teachers and mentors.  Dr. Angela Maria Pinzon Rondon is an incredibly accomplished physician-researcher and the kind of public health she practices comes from the heart with the skills of a formally educated practitioner who also has years of experience.  She is a remarkable human being who taught me a great deal; and I'll look forward to continued lessons in the future.  I have for some time thought about retirement built on teaching service-learning courses in order to contribute to making a difference in underserved communities.  This trip convinced me that I can't wait until retirement to do this kind of work. 

I also have to figure out a way to create more opportunity for our students to have experiences that result in their having out-of-the-ordinary learning experiences that go beyond the typical classroom.

Summer thoughts

I recently got back from a wonderful vacation in Alaska and am still trying to catch my breath.  As a result, today’s post is a collection of disparate topics, beginning with the “quantified self.”

The Quantified Self

As promised last time, I want to begin with an introduction to the concept of “quantified self.” Many of us researchers spend a great deal of time looking for ways to improve our strategies, measures, and analytic techniques to understand the health of populations and the interventions designed to influence their status.  We also gather varying amounts of information about ourselves – but I’m guessing use these same techniques less effectively on ourselves than on the populations we study.  An intriguing new pastime is beginning to capture the imagination – using “gadgets” to track and analyze our own bodies, moods, diets, behaviors related to spending, and just about every other thing that can be measured.  There is significant controversy about the value, benefit, and strategies involved, but expect to hear more about the quantified self.  I want to share a brief introduction by journalist Gary Wolf in a 5-minute TED talk called the quantified self and refer you to a website very supportive of this issue – QS: Quantified Self, Self Knowledge Through Numbers, as well as an opposing view – The Quantified Self:  Making the Personal Public.  These are just two sides of a growing phenomenon.  Undoubtedly there are many other views, but regardless of yours, it’s worth learning more about.

Children’s Mental Health

I am just catching up with a publication from last year from the National Center for Children in Poverty (NCCP). Their important April 2010 policy brief, Children’s Mental Health: What Every Policymaker Should Know, is based on the premise that a child’s mental health is a key component of healthy development and that the current mental health systems do not meet the needs of children and youth.  The report provides significant detail on how widespread children’s mental health problems are in the U.S., and shows that most children and youth with mental health problems struggle to succeed in all aspects of their lives, many of the most affected do not have access to needed services, and the public mental health service delivery system is largely ineffective.  Included in the report are recommendations for effective policy strategies to enhance mental health for children, youth and families.

NCCP is a “public policy center dedicated to promoting the economic security, health, and well-being of America’s low-income families and children.”  Their website highlights some quick facts about children in poverty that are always striking and heart-wrenching.  Among them:  1) 21% of children in the U.S. live in families that are considered officially poor; and, 2) Child poverty rates are highest among black, Latino, and American Indian children.

Global Tobacco Epidemic

The Tobacco Free Initiative (TFI) of the World Health Organization (WHO) recently released the third in a series of reports on the status of global tobacco control policy implementation.  The report contains updates on data representing countries’ achievement for the six MPOWER measures related to tobacco control.  The report focuses on two primary strategies for providing health warnings regarding tobacco use: 1) labels on tobacco product packaging; and 2) anti-tobacco mass media campaigns.  Also contained in the report is a comprehensive overview of the evidence base on warning people about harms related to tobacco use and country level data on the status of these warnings.  The report is entitled - WHO Report on the Global Tobacco Epidemic, 2011: Warning about the dangers of tobacco.

MPOWER’s six strategies:

• Monitor tobacco use and prevention policies
• Protect people from tobacco smoke
• Offer help to quit tobacco use
• Warn about the dangers of tobacco
• Enforce bans on tobacco advertising, promotion and sponsorship
• Raise taxes on tobacco

National Prevention and Health Promotion Strategy

In June, the Obama Administration, led by HHS Secretary Kathleen Sebelius, Surgeon General Regina Benjamin, and Senator Tom Harkin, released the National Prevention and Health Promotion Strategy.  This strategy was envisioned as a critical component of the Affordable Care Act and focuses on four strategic directions:

• Building Healthy and Safe Community Environments:  Prevention of disease starts in our communities and at home; not just in the doctor’s office. 
• Expanding Quality Preventive Services in Both Clinical and Community Settings: When people receive preventive care, such as immunizations and cancer screenings, they have better health and lower health care costs. 
• Empowering People to Make Healthy Choices:  When people have access to actionable and easy-to-understand information and resources, they are empowered to make healthier choices. 
• Eliminating Health Disparities: By eliminating disparities in achieving and maintaining health, we can help improve quality of life for all Americans. 

For more, see the press release, or download the full National Prevention Strategy report.

How We’ll Stop Polio For Good

In closing, I want to share another opportunity to view a great speech about an incredibly interesting and critical issue – the eradication of polio.  This is a 23-minute talk by Dr. Bruce Aylward, a Canadian physician and epidemiologist who heads the polio eradication program at WHO, the Global Polio Eradication Initiative (GPEI).  Highly recommended.

Health and Technology

Today’s blog entry is about technology, one of my true passions. I’ll begin by sharing some information about a new report on mHealth, the practice of medical and public health supported by mobile devices. Then I will provide an overview of a very unique person and a speech he recently made, and I will close with information about an event I attended in Washington, DC at one of the most impressive technology settings I have ever seen.

A new report on mHealth

The World Health Organization (WHO) recently released a report titled “mHealth:  New horizons for health through mobile technologies.”  This report is based on findings from WHO’s second global survey of its 112 member nations regarding these technologies. The survey found that at least 83% of the member nations report mHealth initiatives in their country, generally focusing on one of six initiative types: 

1.      Communication between individuals and existing health services
2.     Communication between health services and individuals
3.     Consultation between health care professionals
4.      Intersectoral communication in emergencies
5.      Health monitoring and surveillance
6.     Access to information for health care professionals at point of care

For those interested in technology and health, this report is a must-read that has specific illustrations in many different settings globally.

Dr. Daniel Kraft – an innovator for health and healthcare

If you’re a regular reader of this blog you probably know that I enjoy watching great speeches. In April, Dr. Daniel Kraft made a presentation at TEDMed Maastricht entitled “Medicine's Future? There’s an app for that.”  This presentation is as good as it gets in terms of presenting a tightly crafted and cogent overview of the future(s) of technology, health and healthcare. I believe it is well worth a 19-minute investment of your time. Enjoy and imagine!

Dr. Kraft is a physician-scientist who chairs the medicine track for Singularity University with a stated mission to “assemble, educate and inspire leaders who strive to understand and facilitate the development of exponentially advancing technologies in order to address humanity’s grand challenges.”  He is also the executive director and curator for FutureMed – a program that explores the potential of innovative technologies for impact on biomedicine and healthcare.

The Kaiser Permanente Center for Total Health

On June 9, I attended the Health 2.0 Developer Challenge – DC Code-a-thon. This is a one-day meeting that brings designers and developers together with organizations and agencies that have both data for and the need for exciting new applications that have the potential to improve health and health care. The day typically begins with the developers being provided an overview of current issues, tools and data sets. They are then given the rest of the day to design and prototype new tools. They are encouraged to use OpenGov and in particular Data.Gov as resource bases for their activities. This event was only part of a full week of related activities called Health Innovation Week, including:

•  HealthCa.mp/dc - with a focus on understanding the opportunities available in vast arrays of existing data.
• The Health Data Initiative - organized by the Institute of Medicine and USDHHS / National Institutes of Health to encourage innovators to use health-related data for applications designed to raise awareness and ignite community action to improve health.
• The Healthcare Innovation Summit - organized by the Centers for Medicare and Medicaid Services, the Office of the National Coordinator for Health Information Technology, Kaiser Permanente, and Vangent. This day was focused on presentations and discussions on how to improve health and health care through innovation.

The Center for Total Health.

Overall it was a great week for people interested in technology innovation and health, and I recommend to any reader of this blog to make an effort in the future to attend one of these events.  They are held several times a year in a variety of places throughout the country. Before I leave this topic I would be remiss in not congratulating Kaiser Permanente for creating the Center for Total Health – which was the host site for most of the week. The Center is located in Washington, DC near Union Station and contains exciting displays and technology demonstrations related to health and health care. The same technology gurus that helped develop the interactive displays at the Newseum and the United States Holocaust Memorial Museum designed it. 

The Center for Total Health is a must see. When you walk in the door you see the largest interactive touch panel display you’re likely to experience anywhere now. It is an 80-foot exhibit entitled “Every Body Walk.”  Remarkable exhibit, remarkable location. The Center features many interactive exhibits, displays and a conference center, which makes it a public place to gather around health and health care. Read more about the Center here.

Next time- the quantified self and a few surprises.

World Health Organization Initiatives

In 1987, I had the good fortune to spend several months at the World Health Organization for the Division of Adolescent and School Health of the U.S. Centers for Disease Control and Prevention. It was one of my most prized experiences and was capped off by spending several days attending the World Health Assembly in 1987. That meeting occurs every year in May. At that time we were still early in the days of the Global Programme on AIDS and Tobacco Control, and several resolutions and initiatives emerged from that meeting.

As a result, this week I’m thinking about the World Health Assembly, an annual meeting held every May in Geneva, Switzerland, hosted by the World Health Organization (WHO). The WHO website describes the World Health Assembly as “the decision-making body of WHO. It is attended by delegations from all WHO Member States and focuses on a specific health agenda prepared by the Executive Board.” More information on the assembly and can be found at the WHO Media Center website.

The main theme of this year’s assembly is the global non-communicable diseases (NCD) burden. There are many people, both within and outside the field of public health, that believe NCD’s are a major problem in the affluent or aged. It is becoming increasingly clear that these boundaries do not describe the breadth of the challenge with these conditions. We now know that the four non-communicable diseases, cardiovascular disease, cancer, chronic lung diseases and diabetes, kill three in five people worldwide while also creating a great socioeconomic burden. And, surprisingly, this particularly true in developing nations. A PDF version of the Global Status Report on NCD, published by WHO in 2010 is available here.

WHO has also published an interactive map that allows users to see the global distribution and challenges from NCD on its website. When you look at this map you may be surprised by what you see, 36 million of the 57 million global deaths in 2008 were due to NCDs; 29% of NCD deaths in low- and middle-income countries in 2008 occurred before the age of 60; and, 80% of premature heart disease, stroke and diabetes deaths can be prevented.

For those interested in the global burden of NCDs and the challenges of addressing these issues, WHO has identified three high-level meetings this year – two of which have already occurred and one that is going to be held in New York City in September. The upcoming meeting at the United Nations will be the second global meeting sponsored by the UN focusing on global health. Here’s more information from the WHO News website on these meetings:

• WHO global forum: Addressing the challenge of noncommunicable diseases
27 April 2011 -- Moscow, the Russian Federation
• First global ministerial conference on healthy lifestyles and noncommunicable disease control
28-29 April 2011 -- Moscow, the Russian Federation
• United Nations High-level Meeting on noncommunicable disease prevention and control
19-20 September 2011 -- New York, USA

There is also a Twitter hashtag feed (#worldhealthassembly) for the World Health Assembly for those who have Twitter accounts and would like to follow. The opening remarks of the Director-General, Dr. Margaret Chan are available in both transcript and streaming audio. This speech, “Remember the People,” is worth reading and listening to because it carries a warning that the World Health Organization is so overextended and underfunded that it may not be able to continue delivering programs, technical assistance and other services at the level expected. A brief video report detailing some of these issues can be found here on the WHO YouTube Channel.

In closing, I want to refer you to the address given by Bill Gates, co-chair of the Bill and Melinda Gates Foundation. In this address he talked about his vision for the next decade. He has pledged to give up to $100 billion dollars of his personal fortune to influence our global health and education efforts. He talked about the eradication of polio, the creation of five or six new vaccines available to the nations of the world at affordable prices, and a world in which there are systems available to deliver vaccines to every child, all within the current decade. Read his keynote address to the World Health Assembly or listen to the address here.

“Together, we can make this the decade in which we take full advantage of the technology of vaccines,” Gates said. “When we do it, we will build an entirely new future based on the understanding that global health is the cornerstone of global prosperity.”

Health Literacy Today

For today’s entry I’d like to focus on the issue of health literacy.  “Two decades of research indicate that today's health information is presented in a way that isn't usable by most Americans. Nearly nine out of 10 adults have difficulty using the everyday health information that is routinely available in our health care facilities, retail outlets, media, and communities. Without clear information and an understanding of prevention and self-management of conditions, people are more likely to skip necessary medical tests. They also end up in the emergency room more often, and they have a hard time managing chronic diseases, such as diabetes or high blood pressure,” according to the U.S. Department of Health and Human Services National Action Plan to Improve Health Literacy.

The Herschel S. Horowitz Center for Health Literacy is one of the most distinctive elements of the University of Maryland School of Public Health. The Herschel S. Horowitz Center for Health Literacy was established in Fall 2007 and joins other related organizations and entities such as the Health Literacy Studies Group at the Harvard School of Public Health and Health Literacy Missouri to address the major public health problem of poor health literacy and its effect on health outcomes. The Horowitz Center for Health Literacy is the nation's first academic based health literacy center and is devoted to improving health through the lifespan, with emphasis on closing the health disparities gap. Research is needed to establish the nature of the causal relationships between and among the various factors including culture and society, education systems, health systems and health outcomes and costs and to develop effective interventions and health policy.

Many of us know the phrase health literacy. Its most common definition is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions, according to Healthy People 2020 and IOM 2004. In terms of operational clarity, I prefer this definition as provided by Hassan and colleagues found here – “Health Literacy” emerges when the expectations, preferences and skills of individuals seeking health information and services meet expectations, preferences and skills of those providing information and services.

The National Action Plan to Improve Health Literacy is of critical importance now, and it is something all public health practitioners should read and have some familiarity with.  This national action plan seeks to engage organizations, professionals, policymakers, communities, individuals and families in a linked, multisector effort to improve health literacy. Cynthia Baur, in a presentation made at an Institute of Medicine Workshop entitled "What's New In Health Literacy Research,” outlined the vision for future efforts in this regard:  Provides everyone access to accurate, actionable health information; Delivers person-centered health information and services; and Supports life-long learning and skills to promote good health.

Dr. Baur went on to summarize the seven goals of the national action plan, including to:

1. Develop and disseminate health and safety information that is accurate, accessible and actionable.
2. Promote changes in the health care system that improve health information, communication, informed decision-making and access to health services.
3. Incorporate accurate, standards-based and developmentally appropriate health and science information and curricula in childcare and education through the university level.
4. Support and expand local efforts to provide adult education, English language instruction, and culturally and linguistically appropriate health information services in the community.
5. Build partnerships, develop guidance and change policies.
6. Increase basic research and the development, implementation and evaluation of practices and interventions to improve health literacy.
7. Increase the dissemination and use of evidence-based health literacy practices and interventions. 

The Office of Disease Prevention and Health Promotion of the U.S. Department of Health and Human Services developed a site called Health Literacy Online. This guide provides guidance on how to create web sites and content for consumers with limited literacy. This website is an important tool. 

I’ll simply add that for those of you who use Twitter, you will find a very active group of entries related to health literacy there as well. To close I’ll reiterate how important the issue of health literacy is to all public health and healthcare professionals and encourage you to send your comments based on your experience in this area.

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.