Bashshur Global eHealth

Social Requirements for Global eHealth : 

Social Requirements for Global eHealth Rashid Bashshur, Ph.D. Hasan Sapci, M.D. Gary Shannon, Ph.D. University of Michigan Health System Presentation at the Arab Health Congress, Dubai, January 2003

Health care is complex : 

Health care is complex About 10,000 known diseases 3,000 drugs 1,100 lab tests 300 radiology procedures 1,000 new drugs and biotechnology medicines in development 2,000 individual risk factors

Technology will increase this complexity : 

Technology will increase this complexity More information will be generated, in genetics Genetics has increased potential drug targets from 400 to 4,000 Computing power accelerated screening and testing of new compounds

Complexity is not bad! : 

Complexity is not bad! Diagnostic and treatment innovations will extend life, reduce disability

In medicine, genetics is the next dominant language! : 

In medicine, genetics is the next dominant language! Gregor Mendel (Austrian Monk) invented genetics in 1850s Not much happened till computerization In 1974 the cost of sequencing a single gene was estimated at $150 million (Average gene has 27,894 pairs) In 1998, it was $150 In 2001, it was $50

Biology is now driven by applied math, statistics, computer science and robotics : 

Biology is now driven by applied math, statistics, computer science and robotics Evolution of biology: In vivo - focus on study of organisms In vitro - test tubes, petri dishes In silico - automated chips and machines

People in societies that understand the genetic alphabet are likely to live longer and get richer : 

People in societies that understand the genetic alphabet are likely to live longer and get richer Pharmaceuticals are likely to become tailored to individual genotypes Eventually, we will build "nano subs" the size of a virus that travel to diseased parts and deliver molecular doses of medicine We will understand the operating code for cholera, malaria, pneumonia, gonorrhea, TB What we are seeing is just the beginning of the digital-genomics convergence

There are wide variations in medical and health care knowledgeWithin and between countries : 

There are wide variations in medical and health care knowledgeWithin and between countries These variations produce significant differences in: Individual health seeking behavior Treatment modalities in health care Medical errors in treatment Health outcomes

Globally, the digital divide is still very wide : 

Globally, the digital divide is still very wide One-half of the world's population never made a phone call! There are fewer phone lines in all of Africa than in Manhattan or Tokyo Disparity in wealth production between richest and poorest nations used to be around 5:1. It is now 390:1. It will soon be 1000:1 Average US citizen works 7 minutes to buy a Big Mac; Canadian 8, Mexican 60, Indian 137, Brazilian 215

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About 1.3 billion people in the world survive on less than $1 dollar a day Nearly a billion are illiterate Over a billion lack access to safe water About 840 million go hungry Nearly 1/3 of the people in least developed countries do not reach 40 years of age

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Selected Statistics on Arab Countries Source: Statistical Office of the European Communities, Statistics on Communication and Information Services, Feb 2001, Luxembourg

GDP and Internet in Arab World : 

GDP and Internet in Arab World GDP per capita (US$) 2000 Internet Users per 10,000 inhabitants 2001

World GDP and Internet Use : 

World GDP and Internet Use

What does it take to reach global ehealth? : 

National purpose Techno-centric development Integration of techno training into education Partnering with international organizations, other governments, and the private sector Common standards and protocols What does it take to reach global ehealth?

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(1) National purpose National strategy is essential Democratization; free access to information Investment in the infrastructure Example: The Dubai Internet City Foreign investment Regional networks

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(2) Techno-centric development Countries relying on technology are growing their economies faster and acquiring more wealth than countries relying on natural resources or other products Examples In 1990, not one of the 10 world's wealthiest was American In 2000, 6 out of 10 were American. Jeff Bezos was worth $10 billion on his 35th birthday. He sells books on the Internet In 1950 Singapore was an isolated, poor island, not even a country before 1965. Malaysia did not want to absorb it By 1999 Singaporeans were 2% richer than the Brits

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(2) Techno-centric development (continued) Future wealth will be based on knowledge generation We don't know the name of the largest company in 2020 Much of the world's new wealth is created by knowledge generation

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(3) Integration of techno training into education Start with the young Integrate IT into elementary and secondary education Professional education Vocational and on-the-job training

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(4) Partnering with international organizations, other governments, and the private sector Provide incentives for others to participate Provide support for institutional resources for R & D Seek external sources of Internet connectivity and multi-national initiatives e.g. I2 memorandum of agreement

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(5) Common standards and protocols Source: Global Reach Language

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Regional Language Networks Connectivity Basic digital divide is decreasing in quantity But increasing in quality Clinical Practice Uniform nomenclature Common practice guidelines

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Regional Language Networks (continued) Public Health Every country's future health will depend on its ability to understand public health issues By 2025 more Africans would die from smoking than AIDS, TB, Malaria, car crashes and homicides together Emphasis on public health: Health promotion/disease prevention Environmental quality Equity in health services