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Global Study Finds Majority Believe Traditional Hospitals Will Be Obsolete In The Near Future

A global study was released at the new year by the Intel Corporation indicating that around the world people’s health care wants and needs are principally focused on technology and personalization. The “Intel Health Innovation Barometer” found a consistent theme: customized care. At the intersection of health, care and technology, communities around the world consistently said they wanted to see their biological makeup and individual behaviors used to make receiving care more effective and efficient. This unsurprisingly was described by people through means such as telehealth, mobile health and the sharing of health information in real time. However, surprising methods of care were also common themes throughout the world such as ingestible monitoring systems and care that involves no utilization of hospitals.

Eric Dishman, Intel Fellow and Global General Manager of Health & Life Sciences at the company says the findings indicate that, “workflow, policy and culturally focused care are the most important ways we can improve health care.” Making care convenient, universally available and efficient through technological innovation is seen as more promising around the world than increasing the number of physicians or funding more academic research.

According to Senator Ron Wyden (D-Oregon), “People always talk about disruptors in terms of various kinds of practices in the American economy,” but “there’s nobody who’s done more disruption for the right reason than Eric Dishman.” With that kind of support to understand and advance the health care system, the Intel Health Innovation Barometer was conducted online by Penn Schoen Berland in Brazil, China, France, India, Indonesia, Italy, Japan and the United States. It was conducted among a representative sample of 12,000 adults aged 18 and older with a margin of error of +/- 0.89 percentage points.

Surprising Findings:

–       Traditional hospitals, according to 57% of people, will be obsolete in the future

–       Majority of people (84%) would be willing to share their personal health information to advance and lower costs in the health care system

–       More than 70% of people are receptive to using toilet sensors, prescription bottle sensors and swallowed health monitors

–       72% of those surveyed would be willing to see a doctor via video conference for non-urgent appointments

–       66% of people say they would prefer a care regimen that is designed specifically for them based on their genetic profile or biology

–       More than half of people (53%) would trust a test they personally administered as much or more than if that same test was performed by a doctor

–       About 30% of people would trust themselves to perform their own ultrasound

While wearable monitoring devices are commonly accepted in the US, global readiness for ingestible and sensory systems far exceeds that of Americans.  Acceptance of non-hospital care is also more appealing to those living outside the US. In remote areas of India, for example, extremely high percentages of people said that there is no need for traditional hospitalization.

Although in the US, a growing desire to care for the elderly at home gives hope to Eric Dishman that there could soon come a day that hospitals are obsolete. He cites changes in care seeking behaviors, policy and payment reform as incentives to move away from traditional hospitalization care. “The moment you signal pay for performance, people start thinking about how we misuse hospitals every single day,” says Dishman. That misuse of hospitalizations, and lack of formal hospitals in other countries, contributes greatly to the number of individuals worldwide who think the archaic system is not sustainable in the future.

Emerging Technologies For Innovation

Intel has been doing qualitative and quantitative research around the health care industry for many years. To date, the Intel Barometer is the most extensive survey it has conducted, and did reveal shifts in people’s increased desire to have access to emerging personal technology tools to become more active members of their care team.

Specifically, the Intel R&D teams are using ideology like Dishman’s to seek clarity and recognition of health advancements that unburden people from having to travel to a health care provider. “Care must occur at the home as the default model,” says Dishman. “It was also interesting,” he says of the survey, “to see people in emerging markets such as Brazil, China and India trusted themselves to use health monitoring technologies more than those in more technologically advanced economies like Japan and the United States.

Intel’s team of ethnographers used research in more than 1,000 homes and more than 250 hospitals across 20 countries to better understand the everyday lives of people, including those receiving and giving care.

The technologies that Intel’s survey received novel feedback on include items such as wearable and ingestible monitoring systems. While these hi-tech possibilities are new to all markets, the potential benefits could be felt across the entire health care arena as more thorough and patient-centered data is collected, driven by patient approval and demand.

Eric Dishman’s Personal Mission

In his pursuit of better health care technologies and home health care, Eric Dishman has been driven primarily from his in depth involvement with the health care system. As a student at the University of North Carolina, Dishman was told that he had months to live due to a rare kidney disease. Over twenty years later he has received a new kidney from a colleague at Intel thanks to sequencing his genes and finding that his diagnosis had been wrong his entire life.

Further, his grandmother’s progression of Alzheimer’s Disease drove his pursuit of innovation to keep her safe in her own home.  He found that keeping her health and dignity was a group effort. According to him, “Improving health care is a team effort, including patients and their families. Intel’s research shows that when people see benefits for them and their wider community, they are open to sharing sensitive information in an anonymous way.”

His approach seems to be gaining support based on the Health Innovation Barometer, which found that a higher percentage of people (47%) were willing to share their personal health records than their phone records (38%) or banking records (30%) to aid innovation.

If Dishman and Intel have their way, the new survey will move them to the head of the class by proving to health care leaders around the globe that massive disruption to the health care system is possible and supported by the large community. Smart devices that can connect patients and care givers in their home can lead to all kinds of health and policy change. Payment reform, independence and equal access might all be possible in the near future if individuals around the world are willing to use their own bodies and surroundings to educate and innovate the larger system.

 

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Lasting Effects: Health Impact On First Responders

September 14

The days after September 11th, 2001, the city of New York was enveloped in a blanket of ash. Rescue workers spent hours, days, even months without rest sorting through rubble and dust, exposing themselves to all kinds of physical dangers. These images are well documented in newspapers, television images and museums. But the haunting images from the aftermath, including the one of firemen I keep in my kitchen, do not tell the ongoing story of the men and women who risked their lives, physical health and mental health to dig the magnificent city out of the ash.

Despite the immediate coverage of heroism for the country’s rescue workers, very few have taken time in the last 12 years to fully research the physical and mental toll taken on those individuals that risked their lives on September 12thand the following days. According to the City’s Department of Mental and Physical Hygiene “thousands of individuals—including rescue, recovery and cleanup workers and people who lived, worked or went to school in Lower Manhattan on September 11th—have developed chronic, and often co-occurring, mental and physical health conditions.”

Understanding The Impact

Most of what is known about the issues affecting thousands of domestic and international rescuers has been collected by the New York City HealthDepartment’s World Trade Center Health Registry. This Registry, which allows health professionals to track and investigate illnesses and recovery related to September 11th also helps create guidelines that can save lives and reduce injuries in future disasters.Dr. Robert Gillio, who is significantly responsible for its creation claims that, “The Registry was not part of any preplanning. Nor was the care of the New York Police Department (NYPD) or construction volunteers. I got a panicked call from someone that knew I had developed a middle school lab kit enabled laptop with curricula for how to measure heart and lung function and learn how to protect them. It was something I created for my four daughters to make health and science education more interesting.”

Following that creation, Dr. Gillio says, “When I joined up with a team of volunteers screening NYPD officers, this early telemedicine app was used to create health records. We had the presence of mind to realize the vast differences in the levels of exposure and decided to create questionnaires for what is called risk stratification.”

From that point forward the Registry has providedguidelines for domestic and international health care providers to care for those who volunteered in the aftermath of September 11th by creating flow charts, tracking systems and symptom coordination for individuals who may be experiencing conditions related to World Trade Center exposures. The database has collected information on more than 70,000 people over a decade and includes not just the official heroes of September 2001, the NYPD and the Fire Department of New York (FDNY), but also the volunteer and paid professionals that tended to health care at the site, search and rescue teams, demolition and hauling teams, those who cleaned apartments and residents that moved back into the neighborhoods.

First Responders

All of these individuals took health-related risks, risks that are hard for many of us to understand, but none more so than the first responders. I certainly would not be one to run straight into the face of danger, despite that being in my genes. Growing up in a family of firemen meant that we came to terms early on that loved ones would risk their lives to save others. However, the honor and pride these men have shown throughout our lives often leaves us in fear. My admiration for my Father’s inherent need to help others gave way at times to fears of losing my hero to saving the lives of others buried in ashes. When asked why he chose to become a fireman, my dad, Rodney Fender, humbly said, “It’s just who I am. I want to help people.” He went on to describe the feeling that overcame him as a fireman, the one to rush into danger, saying his logical reaction to the call was, “How the hell do I get in there, and how do I get them out safely.” His immediate response has never been to think about himself above others.

When asked about this innate desire to risk oneself, it became clear that my father, like many rescuers simply react in a way that brings out the best in human nature. A mentality of our heroes following September 11th, who were still there working through the ash and rubble, was best summed up by my grandfather, Michael Fender, also a fireman who said, “It’s just your job as a person to help other people.” He went on to explain that first responders have a mindset like his, “You do what you can, when you can, how you can. That’s just how we work.”

Lifelong Effects

September 11th was a day that changed American lives forever, one that shook our faith in humanity to its core. Like all US Citizens, mental health and safety were altered in significant ways during that time of fear. For the rescue workers though, the risks of danger did not end with the last plane crash or the decision to go to war. For the first responders, volunteers and health care professionals and researchers, September 12th marked another day to face physical and mental health risks to save the lives of others.

The image of an ash covered park in New York City with firemen working tirelessly in the background has been in my kitchen for many years, and serves as a daily reminder to the resiliency of this country, its citizens, and especially its heroes. Although their images are almost invisible in that photograph due to the devastation surrounding them, they are there, digging the city out of the rubble and piecing the lives of others back together.

In a similar vein, Dr. Gillio sat down soon after the attacks to write Lessons Learned at Ground Zero, an essay to, “Help explain to my daughters why mom and dad were away at Ground Zero when planes were falling out of the sky near us in PA. That book found its way to the White House and lead to a request for participation in a series of discussions there regarding the role of the average person or local organization in disaster preparedness, response and recovery. Those lessons in 2001 changed my career from one that treated preventable disease to one that finds ways to discover who is at risk and to intervene to prevent a chronic disease or acute injury and to empower the individual to be the health hero for themselves and their community.”

His message, and that of my father and grandfather, is correct. The terrorist attacks in 2001 changed American life forever. But as health care experts, providers, researchers, policymakers and first responders, it is our duty to take the lessons we learned from those horrific days, weeks and months to build a better system of care. Our job is to use our skills and passions to improve our communities as a whole and prevent, as well as care for, one another as best we can.

For more information, the 2009 World Trade Center Health Registry Report and Findings can be found here: WTCHR.

 

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Health Inequality And Modern Day Slavery

“They never took me to the doctor when I was ill.” These are the words spoken by Merieme Mint Hamadi when asked about her life as a slave. Merieme, one of an estimated half a million people in Mauritania who are enslaved, lives in some of the world’s worst conditions. Her country, which has a population estimated to rival Chicago, was the last country in the world to make slavery a crime. However, since that 2007 law was passed – almost 150 years since Abraham Lincoln issued the Emancipation Proclamation in the US – only one person has been successfully prosecuted for owning another human in Mauritania. The health and human rights violations that exist there today have led to the UN ranking Mauritania at 155 out of 187 countries on its 2013 inequality-adjusted Human Development Index.

The UN estimated that in 2012 for every 100,000 live births in the country, 510 women die from pregnancy, with significant disparities between the death rates of Black slaves and Arab owners. Of even greater concern is that due to female slaves being forced to have children with owners, an estimated 71.3 births per 1,000 live births are to adolescents who suffer extreme mental and physical abuse. In John Sutter’s captivating CNN coverage of oppression, Slavery’s Last Stronghold, he reports that, “In Mauritania, the shackles of slavery are mental as well as physical.” He goes on to describe the political and societal methods through which the lighter-skinned Arabs maintain their ownership of the dark-skinned peoples.

Kevin Bales, an expert on modern day slavery, wrote in his book Disposable People that even if someone of bondage attempts to leave an owner, “for most, freedom means starvation.” He claims that because slaves are, “immediately recognizable by color, clothing and speech” they will not be given shelter or proper care by others. Further, Mr. Bales asserts that on the streets of Mauritania, “ there are already a good number of beggars, many of them disabled, to remind slaves of where they almost certainly end up” if they were to leave their masters.

“Mauritania is a country with scarce resources – including access to medical care. The health needs of slave owners come first in Mauritania; the health needs of slaves come last. Slave children are chronically malnourished. Slave women are frequently victims of sexual assault by their owners and the devastating health problems that result.” says Sean Tenner, Co-Founder of the Abolition Institute, an organization focused on ending Mauritanian slavery and a veteran of numerous public health campaigns.

Despite the country’s open system of ownership, to date, the US has not taken a stance against the practice. The country, located on the western fringe of the Sahara, is not densely populated, and therefore practices of the owners are not easily monitored by the government. Further, the country’s ruling elite makes no attempt to fight slavery, as they claim to the UN that slavery does not exist.

However, what is most surprising in 2013 is not the lack of Mauritanian action against their own traditions, but the lack of American recognition and action. At a time when the US tries to face its own challenges with inequality, health, human rights and foreign policy, it is saddening to know we also neglect others.

Mauritania is also deeply divided by access to basic human rights such as health. In 2000, it was estimated that only 37% of the country had access to safe drinking water and 33% to adequate sanitation. Life expectancy has hovered around 57 for both sexes for many years, but with great disparities between the slaves and owners.

The US has done nothing to date but overlook the unlivable health conditions and human rights violations in the region for those that are born into bondage.

In the United States however, one group is taking action to make Americans aware of the atrocities faced by the Mauritanian slaves, and the health and human rights violations that exist. The Abolition Institute, founded in Chicago by Mr. Tenner and former Mauritanian slaves, was recently formed to end the practice of slavery in Mauritania, and bring freedom to those suffering under the inhumane circumstances of maltreatment, malnourishment and abuse.

The organization does everything from educating the public on the religious aspects of modern day slavery to informing about the living conditions and health of slaves through noting disparate practices such as “gavaging” in Mauritania, where women of Arab decent try to gain weight to show that they are wealthy elite and not poor slaves with emaciated frames.

However, the devastating effects of slavery run much deeper than the physical effects. The extreme consequences the effects of slavery have on mental health know no bounds.

In Slavery’s Last Stronghold, a leader of an abolition group tells Sutter that many similarities exist between modern slavery in Mauritania and that in the United States before the Civil War, but that the one fundamental difference between the two in his mind is the use of physical restraint. “Chains are for the slave who has just become a slave, who has . . . just been brought across the Atlantic,” Boubacar said. “But the multigeneration slave, the slave descending from many generations, he is a slave even in his own head. And he is totally submissive. He is ready to sacrifice himself, even, for his master. And, unfortunately, it’s this type of slavery that we have today” — the slavery “American plantation owners dreamed of.”

 

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