“Medicine still overpowers public health, which never recovered from being ‘relegated to a secondary status: less prestigious than clinical medicine [and] less amply financed.”
Paul Starr, Sociologist
A functioning, just society cannot sustain itself without public health. But the unfortunate product of a society with modest levels of commitment to the social contract and a jaundiced opinion of massive government budgets is underfunding and mistrust of public health. One might ask what could enhance public health without requiring comparatively huge budgets or much active participation by the public. The answer, as with every corner of modern society, is technology. Not just any technology, however, as the digital health tools available to large medical centers are prohibitively expensive for public health and not necessarily what public health needs to do an effective job. So, what would empower public health agencies and professionals?
Public health’s primary goals focus on protecting and improving the health of communities. Public health technology helps reach these goals with greater efficiency. When applied to public health situations, tech provides public health professionals with advanced tools to obtain accurate, detailed population data in real-time. This data can help them build more effective actionable health strategies covering a range of scenarios, from individual care strategies to coordinating support systems that can address widespread disease outbreaks.
Technology encompasses everything from life-saving devices to data-gathering tools, meaning that the synergy between technology and public health is multifaceted. While the following examples demonstrate this interaction in vastly different ways, they are all united by the goal of improving community health.
Geospatial Technology – Geospatial technology has a range of health care functions. Still, perhaps one of its most interesting might be its ability to provide information that can help improve public health. Geospatial technology collects information about several factors, analyzes the data, and displays the results on a multilayered map. For example, geospatial tech can provide in-depth information on disease penetration within a specific region, health risks by age demographic, care delivery logistics, and other social factors that influence population health. These multilayered maps can inform and educate professionals and the community about an area’s actual state of health care and allow decision-makers to improve the locations they govern.
Twitter Monitoring – Don’t laugh. Twitter has much more to offer than celebrity gossip and enticing food photos. Health care professionals are using the popular microblogging platform to monitor the spread of infectious diseases, including COVID-19, and predict disease activity. During flu season, researchers at universities across the country analyze millions of tweets containing the word “flu.” These researchers have found Twitter to be a more accurate monitoring tool for the disease than those used in the past, such as public laboratories and Google searches. According to health experts, the real-time information gleaned from Twitter is also more helpful because it is timelier. By receiving information nearly earlier, researchers can more accurately chart disease activity. Doctors can also access the information to make better treatment decisions during a health epidemic.
Wearable Technology – Wearable fitness bands allow users to track their movements throughout the day easily. Metrics such as total steps taken, heart rate, run or ride pace, or the amount and quality of sleep each night help individuals better identify, track, and achieve their health and fitness goals. For those who regularly use a wearable monitor, this information can be a reference point when communicating with health care providers about general wellness goals or other health markers. Health insurance providers have also taken notice and have built incentive programs to encourage the use of wearables. For example, UnitedHealthcare’s UnitedHealthcare Motion program allows its members to earn money toward out-of-pocket medical expenses by reaching walking goals. This metric can be monitored with a wearable device. Beyond fitness, wearable technologies are advancing to monitor vital statistics such as a user’s heart rate, lung function, blood oxygen level, and blood sugar. They are even being developed to track and alert the onset of degenerative conditions such as Parkinson’s or Alzheimer’s. A user could have the level of medication in their blood regularly monitored according to a physician’s plan and be reminded to administer their next dose when its level drops below a certain threshold.
I know what you are probably thinking. Wearable devices are pretty expensive. So how can they be used to support public health programs? There are ways to incorporate wearables into public health initiatives that don’t require a significant investment. One of the organizations that I love is called Recycle Health. RecycleHealth is a 501(c)(3) charity based out of Tufts University School of Medicine. They collect and refurbish fitness trackers to provide underserved populations with a method to maintain health and fitness. They’ve collected over 5,000 trackers over the past four years. They come from individuals who have unwanted trackers, as well as from vendors, organizations, and workplace wellness programs. They are sent from all over the world. RecycleHealth prides itself on finding trackers and new homes with people who benefit from their use but would not usually be able to afford or seek to purchase one. They provide trackers to underserved populations, including older adults in lower-income communities, veterans, homeless populations, and programs serving intellectually disabled adults. The work Dr. Lisa Gualtieri and her team are doing is critically important in providing these devices to people who would benefit from them. Organizations interested in donating or receiving devices can visit their website for more information.
This author also participated in a program within the local community where I live to solicit donations of recycled mobile phones, wearable devices, and Amazon Echo devices to support underserved communities during the pandemic, albeit on a smaller scale than Recycle Health. I can tell you from personal experience that they made a massive difference in helping people maintain their health, contact care teams to ask questions and receive treatment advice, and connect with loved ones and community support organizations to reduce loneliness and ensure that they were getting meals delivered.
3D Printing – At first, this might not seem like an appropriate choice for a public health application. 3D printing also became a vital asset in the public health response to the COVID-19 pandemic. Various 3D-printed devices and tools have been created to alleviate supply chain shortages, from swabs used for COVID testing to splitting devices that enable multiple people to use a single ventilator. While this technology might seem cost-prohibitive to some, the costs continue to decrease, and sharing the devices across various settings can even lower implementation costs.
This is another technology where the cost has come down dramatically. And, just as mentioned above, it can be done as a partnership play instead of a direct purchase. Public health organizations are partnering with technical colleges in their area to ensure they have access to 3D printers and can do so at little to no cost.
Telehealth – Cell phones, mobile devices, and PCs are helping connect patients with their practitioners. People too ill to attend a clinic, without adequate transportation, or without spare time can video conference with a trained health care practitioner through apps such as Doctor on Demand and NowClinic. Additionally, the health insurance industry’s significant players offer some form of telehealth in their health coverage options. Data amassed by Pew Research indicates that around 5 billion people worldwide have mobile devices, more than half of which are smartphones. Data from research firm Statista also shows that even people in lower annual income cohorts own and use a smartphone. (See graphic below).
And, as Recycle Health does with wearable technology, that’s exactly what a Maryland nonprofit organization called Secure the Call does. This organization has a mission to provide the millions of Americans who need phones for emergencies get them coupled with an environmental mandate to keep as many cell phones out of landfills as they can. Secure the Call says that they are the middleman by collecting the phones, processing them, and then getting them into the hands of the organizations that can distribute the phones where they are needed. Secure the Call works with 425 community partners to get the phones to the people who need them the most. Besides domestic abuse victims, the nonprofit also provides phones to seniors.
This demonstrates that telehealth can reach patients that traditional forms of health care do not.
For those interested in exploring the topic of connected communities of care, the best resource by far is this book: Building Connected Communities of Care: The Playbook For Streamlining Effective Coordination Between Medical And Community-Based Organizations by Dr. Keith Kosel, Vice President, and Dr. Steve Miff, President and CEO of Parkland Center for Clinical Innovation (PCCI). This book proposes a novel approach to the coordination of medical and social services through the use of people, processes, and technology, with the goal being to streamline coordination between medical and Community-Based Organizations and promote true cross-sector patient and client advocacy. The book is based on the experience of Dallas, TX, which was one of the first metropolitan regions to develop a comprehensive foundation for partnership between a community’s clinical and social sectors using web-based information exchange. In the five years since the initial launch, the authors have been able to provide seamless connection, communication, and coordination between healthcare providers and a wide array of community-based social service organizations (a/k/a Community-Based Organizations or CBOs), criminal justice entities, and various other community organizations, including non-collegiate educational systems. This is, in my opinion, the best resource to understand how to build a program that delivers the best outcomes for the communities you serve.
Geospatial technologies, social media monitoring, wearable tech, 3D printing, and telehealth are just some of the tools that medical professionals are employing to improve patient care and outcomes. While time will tell what other high-tech tools will revolutionize public health in the future, each of these current and evolving public health technologies has the potential to impact a community’s health and well-being profoundly.