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Robin Coupland

Medical Advisor to the ICRC
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Robin Coupland is a medical adviser in the International Committee of the Red Cross (ICRC).

He joined the ICRC in 1987 and worked as a field surgeon in Thailand, Cambodia, Pakistan, Afghanistan, Yemen, Angola, Somalia, Kenya and Sudan. He has developed a health-oriented approach to a variety of issues relating to violence and the design and use of weapons.

A graduate of the Cambridge University School of Clinical Medicine, UK, he trained as a surgeon at the Norfolk and Norwich Hospital and University College Hospital, London. He became a Fellow of the Royal College of Surgeons in 1985. He is the holder of a Graduate Diploma in International Law from the University of Melbourne in Australia.

As part of his current position he has focused on the effects of violence and weapons both conventional and non-conventional. He has developed a public health model of armed violence and its effects as a tool for policy-making, reporting and communication.

His current work has two tracks: first, the feasibility of an ICRC operational response in the event of use of nuclear, radiological, biological or chemical weapons; second, improving security of health care in armed conflicts. He has published medical textbooks about care of wounded people and many articles relating to the surgical management of war wounds, the effects of weapons and armed violence.


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joined 11 years, 4 months ago

Henry Dowlen

Surgeon Lieutenant

Henry works as a Doctor in Emergency Medicine, and as a National Lead for Health Informatics. He has served with the Royal Navy and Royal Marines, mainly concentrated in Afghanistan where he worked alongside the Afghan Government in assisting the reconstruction of community medical provision. He is currently a Deployable Civilian Expert for the UK's Stabilisation Unit and an officer in the Royal Marines Reserves.


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joined 11 years, 5 months ago

Alan Gelb

Senior Fellow, Center for Global Development

Alan Gelb is a senior fellow at the Center for Global Development. His recent research includes aid and development outcomes, the transition from planned to market economies, the development applications of biometric ID technology, and the special development challenges of resource-rich countries. He was previously director of development policy at the World Bank and chief economist for the bank’s Africa region and staff director for the 1996 World Development Report “From Plan to Market.


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joined 11 years, 5 months ago

Mike Farrar

Independent management consultant

Mike Farrar is an independent management consultant and former Chief Executive of the NHS Confederation. He joined the organisation in May 2011.

Mike was chief executive of the North West England SHA from May 2006 to April 2011. He was previously chief executive of West Yorkshire and South Yorkshire Strategic Health Authorities, chief executive of Tees Valley Health Authority and head of primary care at the Department of Health.

Mike was also a board member of Sport England, and in August 2009 was appointed as National Tsar for Sport and Health. Mike was also awarded the CBE in 2005 for services to the NHS and is an honorary fellow of the University of Central Lancashire.


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joined 11 years, 5 months ago

Michael Marmot

Professor of Epidemiology and Public Health at University College, London and Director of the UCL Institute of Health Equity

Sir Michael Marmot is Professor of Epidemiology and Public Health at University College, London and Director of the Institute of Health Equity (UCL Department of Epidemiology & Public Health).

Professor Marmot has been awarded honorary doctorates from 14 universities and has led research groups on health inequalities for 40 years. He was Chair of the Commission on Social Determinants of Health (CSDH), which was set up by the World Health Organization in 2005, and produced the report entitled: ‘Closing the Gap in a Generation’ in August 2008.


At the request of the British Government, he conducted the Strategic Review of Health Inequalities in England, which published its report 'Fair Society, Healthy Lives' (aka The Marmot Review) in February 2010. This was followed by the European Review of Social Determinants of Health and the Health Divide, for WHO Europe in 2014. He chaired the Breast Screening Review for the NHS National Cancer Action Team and from 2011-2004 was a member of The Lancet-University of Oslo Commission on Global Governance for Health. He is currently Chair of the PAHO Commission on Equity and Health Inequalities in the Region of the Americas.


He set up the Whitehall II Studies of British Civil Servants, investigating explanations for the striking inverse social gradient in morbidity and mortality. He leads the English Longitudinal Study of Ageing (ELSA) and is engaged in several international research efforts on the social determinants of health. He served as President of the British Medical Association (BMA) in 2010-2011, and President of the World Medical Association (2015-16) and he is President of the British Lung Foundation. He is an Honorary Fellow of the American College of Epidemiology, a Fellow of the Academy of Medical Sciences, an Honorary Fellow of the British Academy, and an Honorary Fellow of the Faculty of Public Health of the Royal College of Physicians. He was a member of the Royal Commission on Environmental Pollution for six years and in 2000 he was knighted by Her Majesty The Queen, for services to epidemiology and the understanding of health inequalities.


Internationally acclaimed, Professor Marmot is a Foreign Associate Member of the Institute of Medicine (IOM), and a former Vice President of the Academia Europaea. He won the Balzan Prize for Epidemiology in 2004, gave the Harveian Oration in 2006, and won the William B. Graham Prize for Health Services Research in 2008.


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How do you develop a patient centred healthcare system that serves vast numbers of transient poor people? India has an answer: Rashtriya Swasthya Bima Yojna (RSBY), which has won plaudits from the World Bank and the United Nations as one of the world's best health insurance schemes.

RSBY combines state-of-the-art technology and incentive structures. It is paperless, does not use cash and provides affordable health insurance to millions of people. The overwhelming majority of who, are illiterate, transient people living below the poverty line.

RSBY employs cost effective, scalable technologies to help satisfy the health needs of a significant proportion of India’s poor. Enrolment of families into the scheme, biometric smart card generation, pre-authorization of admissions, as well as claim submission and approval, all occur electronically. Beneficiaries can use their smartcards in any empanelled hospital across India and therefore travel is no barrier to receiving healthcare. Patient data are transferred electronically between empanelled hospitals and insurance companies and claims are settled automatically. The scheme lowers costs, increases efficiency and reduces fraud.

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A&E is the barometer of the NHS.  In 2012 some 22 million people attended A&E in the UK. A 50% increase in the last 10 years, while the UK population only increased 7% over the same period.

The Royal College of Surgeons has warned that the knock-on effect of this is last minute cancellations of planned surgeries. Official figures show that for the first three months of 2013 some 20,000 planned operations were cancelled.
 
Transferring resources out of hospitals
Minded of the seriousness of the A&E challenge, the Academy of Medical Royal Colleges, the NHS Confederation and the patient group National Voices combined to report that the NHS urgently needs to transfer resources out of hospitals and into the community by expanding GP surgeries, health centres, district nurses and social care.
Such a significant transfer might be helped by enhancing the ways that health providers engage people about their health, which is about improving communications while reducing face-time with health professionals. This is important if Matthew Parris is right. Writing in The Times, recently he warned that patients' allegiance to traditional health providers is weakening. Online communications technology has the potential of strengthening this.
 
Both health professionals and patients have embraced health technology as transformational. Doctors are in love with iPads, consumers are loading wellbeing apps onto their phones and patients with chronic diseases are using smartphone attachments to measure and monitor their vital signs.
 
Exploiting technological trends to improve healthcare
However, technology alone is not the answer. Technologists have an undying faith in technology, which they view as the primary driver of change.  This is mistaken because people select, install, develop and manage technology. It is therefore people and the choices they make, not technology, which is the primary driver of change.  

Already health professionals are making choices to help transfer healthcare out of hospitals and into communities. They are successfully harnessing the propensity for people to play games to improve patients' cognitive skills, especially after stroke or the onset of dementia. Health workers are exploiting telehealth to provide patients with remote access to healthcare professionals as well as using social networks to improve the connectivity of health workers and enable patients to play a more active role in their own healthcare.
 
What patients want
Communications between health providers and patients benefit by an understanding of patients' healthcare needs and preferences. In today's world of interconnectivity, we know what patients want. 
Sixty six per cent of patients want answers about specific disease states, 56% want information about treatments, 36% want to find the best place to be treated and 33% want information about payment.
Further, 80% of all patients search online for health information and, if they cannot get face-time with their health professionals, they prefer online video answers to their questions directly from doctors. Video has become the preferred medium for content consumption by patients.

However, we also know that 90% of all doctors provide patients with information in pamphlet form. While this difference describes a communication challenge, it also suggests the answer: more doctors should use online solutions to communicate with patients.
 
A new online solution for health providers
Currently, there is no easy solution for patients to quickly and easily obtain reliable online answers to their questions in video format.  Also, there is no easy solution for doctors to post answers to patients' questions in an online video format.

Dr Sufyan Hussain, a specialist registrar and honorary clinical lecturer in endocrinology at Imperial College London, has participated in a beta test of HealthPad, a new free and easy-to-use web-based communication solution for non technical health professionals to create rich media publications for their patients and colleagues: www.healthpad.net.

Doctors post short and easily understood video answers to frequently asked questions about the prevention, symptoms, diagnosis, treatments, side effects and aftercare associated with different disease states and also about wellbeing. The videos are aggregated and stored in a cloud, linked to biographies of contributing doctors on HealthPad and can be easily accessed by patients on smartphones and tablets at anytime from anywhere. 
To-date, Dr Hussain has accrued a substantial personal video content library, which addresses frequently asked questions from his patients who, "don't always have to attend a hospital for reliable information to help them manage their conditions".  According to Dr. Hussain, using HealthPad, "can reduce valuable doctor face-time with patients while improving doctor-patient relationships and patient compliance by helping them understand their condition and treatment better".
 
Video healthcare libraries
Video healthcare libraries, similar to the one Dr Hussain has created, play a significant role in the US to communicate premium, reliable and up-to-date health information to patients and their carers. An important difference with pamphlets and WebMD is that people feel an allegiance to personalised video content in a way that they do not for pamphlets and the written word.
 
Psycho-social benefits of video healthcare libraries
US evidence suggests that patients feel a greater allegiance to health professionals who provide them with sought after information in a format they like and understand and deliver it personally to their smartphones.

Dr Whitfield Growdon, a cancer specialist who teaches at the Harvard University Medical School and has a gynaecologic medical and surgical practice at the Massachusetts General Hospital also participated in HealthPad's beta test and, like Dr Hussain, accrued a significant video comntent library, which he now uses with his patients. "Videos", says Dr Growdon, "personalise medicine and have positive psycho-social effects. Patients feel that they know me before we have even met and are less inclined to be swayed by discordant and often incorrect medical information they encounter on the internet that can create misperceptions and fear".

Video healthcare libraries connect doctors directly with patients and inform about medical conditions and treatment options. They are cheap to create, cost little to operate and develop, they can be quickly and easily updated and accessed 24-7, 365 days a year from anywhere at any time.
 
Significant opportunity for UK health providers
Seventy per cent of patients who search online for health information become confused and frustrated.  

HealthPad, the new platform which Drs Hussain and Growdon contributed, aggregates premium reliable health information in a format demanded by patients and represents a significant opportunity for health providers to transfer medical knowledge out of hospitals and into the communities.
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