September 25, 2019 (Courtesy: US News and World Report)
THE BIG CHALLENGE facing health care is not that we need to do it better, but that we need to do it differently.
Advances in health technology and practice have led to great advances in human health, wellbeing and longevity. But, not everyone has benefited. Inequalities in standards of care persist, and for many they have worsened. Countries with high rates of infectious diseases increasingly also have to cope with growing rates of chronic disease. Countries with mature health care systems find it harder to deliver effective, timely care—in mental health, for example—which makes conditions worse. Meanwhile, global issues such as conflict and natural disaster associated with climate change threaten to widen the health inequality gap even further.
To address these inequalities, we will need to deliver health care in a fundamentally different way.
New Standards of Care Needed
The population of almost every country on earth is rapidly aging. Even as scientific discovery advances, leading to new ways to diagnose and treat disease, environmental, biological and social conditions are creating new diseases and new sources of inequality. Meanwhile, we have learned that keeping people healthy depends, much of the time, on social determinants as well as biology. The quality of our health is determined as much by the way we live as by the genetics we inherit at birth.
But demand for health care as we currently understand it continues to grow. We face a global shortage of 15 million health care workers by 2030, which represents, by the method we currently measure our ability to deliver care, a shortfall of almost 20% in capability. While demand increases and society ages, the aggregate view of population distribution is changing from the shape of a pyramid to a barrel, expressing itself as an absolute shortage of health care workers.Beyond this, many of us will not seek care from the health system as it exists today, even with unfettered access. For example, it is estimated that two-thirds of patients with mild to moderate depression or anxiety will not access the formal health care system because of the stigma associated with seeking care for their condition. We also know that some populations will not seek care because of cultural and language barriers. For these people, self-service or peer-provided care are the only suitable options available.
Innovative Solutions to a Global Problem
Addressing these inequalities in health care will mean leveraging technological advances already familiar to other sectors, but which remain chronically under-used in the health industry. Here are three examples of how digital technology can meet global inequalities in ways caregivers alone cannot.In Kenya, Amref Health Africa (formerly the African Medical and Research Foundation), the continent’s largest health NGO, recognized that the country was heading for a large shortage of skilled health professionals. To fill the gap, it wanted to train thousands of new community health workers, who play a vital role in providing basic health care and education services and linking communities with formal health systems. But traditional training methods would not help to achieve the goal — aside from the cost, other challenges include geographic reach, poor long-term engagement, high attrition rates and an inability to mobilize health workers in times of crisis. The solution was a digital one: a new mobile health learning platform built on basic mobile phone technology. The first phase of the project delivered material successes — a 28% increase in infant immunizations and a 24% increase in skilled maternal delivery.
In the United Kingdom, there is an unmet need for mental health services. As well as a shortage of clinicians, many people are unwilling to reveal to the care system that they suffer from mental illness, fearing broader repercussions. Ireland-based Silvercloud has combined cognitive behavioral therapy and asynchronous care with in-person therapy, demonstrating just how effective smart technology can be in providing meaningful services and boosting productivity—enabling six times more users to receive care. Meanwhile, a social platform, Big White Wall, allows users to anonymously seek and provide peer-based support services for one another in an environment that is curated by professionals. More than half of NHS users with a mental health condition have access to at least one of these technology-based services.
NGOs Are Key
In an even more technically advanced example, the public-private ID2020 project recognizes that one-sixth of the world’s population lacks documented proof of existence and cannot participate in cultural, political, economic or social life. Consequently, these people often cannot access health care or track their medical records. ID2020, whose partners include the United Nations, Gavi, Microsoft and Accenture, created a prototype that uses blockchain technology and biometrics to allow individuals to create a digital identity, which includes their personal medical data, and to decide who can access that information, and ensure that care providers are able to offer appropriate treatment.
One mistake health care stakeholders have made in their digital initiatives is believing they can address inequalities on their own. Closing the inequality gap is best achieved with the help of partners who can share technology and services to solve problems that no single entity could achieve on their own. Project Last Mile, for example, is a public-private partnership aimed at speeding the delivery of medicines in Tanzania. The project’s starting-point was a simple question: “If a bottle of Coke can be found in rural communities across Africa, why can’t we find medicines and supplies in the same places?” NGOs — including the Yale Global Health Leadership Institute, the Gates Foundation and the Global Fund — followed the question to its logical next step: teaming up with Coca-Cola to take advantage of its distribution capabilities. The project aims to repeat its success across 10 African countries by 2020.
Four Issues to Address
Four big issues need to be addressed by health care leaders in order to build on the success of these projects and make progress in addressing inequalities.
First, there must be wider recognition that digital technology is essential. Fast, affordable, reliable broadband needs to be seen as a basic right, rather than something that is simply nice to have. Many places—including in developed regions — still simply lack connectivity. But digital technology becomes less expensive each year and more adaptable than trying to meet these needs through physical care giving.
Second, health policymakers must recognize that quality care depends on more than bringing people to a clinic or hospital when they are ill. To keep costs down and to meet demand, care needs to be delivered independent of location, even “virtually,” and often driven by consumers themselves.
Third, improving the health of citizens is increasingly about addressing the social determinants of care, and not simply medical interventions. This in turn demands the participation of government, industry and civil society, not just health care providers.
Finally, partnership with others is essential. Organizations, alone, cannot solve these problems; it takes a village, or at the very least, an ecosystem.
Addressing care inequalities is a purpose that can unite citizens and governments. But throwing money at the problem is a luxury that is no longer sustainable or even possible. Embracing digital technologies, and making them work on a broad scale, will be essential.