NCD: "It", an English Lord and Mark Zuckerberg
You can’t see “it”. You can’t touch “it”. “It” tends to creep up on you unnoticed. Every year “it” kills tens of millions and costs billions. “It” destroys households, communities and even nations. "It" has been described as "the biggest threat to the 21st century.”
“It” is chronic non communicable diseases (NCDs): cancers, cardiovascular diseases, respiratory conditions and type2 diabetes, four of the biggest killers that have emerged as one of the greatest social and economic development challenges of this century.
In December 2012, the Lord Crisp, representing the All Party Parliamentary Group on Global Health, introduced a debate in the Atlee Suite of the London Houses of Parliament on NCDs. Drawing on his experience as a former CEO of the UK’s National Health Service he suggested that the global NCD burden may only be successfully addressed by changing the way healthcare is delivered. Other speakers emphasised the complexity of global health issues.
From a global health perspective, NCDs now account for more deaths every year than AIDS, tuberculosis, malaria and all other causes combined and result in roughly two out of three deaths worldwide. Mental illness, which has significant health, social and economic implications, is also considered by some as a NCD, but rarely leads to mortality.
A 2011 report produced by the World Economic Forum and the Harvard School of Public Health, argues that, “Over the next 20 years, non communicable diseases will cost more than US$30 trillion, representing 48% of global GDP in 2010 and pushing millions of people below the poverty line. Mental health conditions alone will account for the loss of an additional US$16.1 trillion over this time span, with dramatic impact on productivity and quality of life.”
NCDs are often viewed as diseases of affluence as their prevalence is highest in wealthier countries and are caused by bad diets and sedentary lifestyles. The economic impact of NCDs in rich nations is compounded by the ageing and shrinking of their populations and extends beyond the costs to health services since they affect economies, households and individuals by reducing labour productivity, increasing medical treatment costs and lost savings. Over time developed economies have accumulated knowledge and expertise to treat and manage NCDs. In developing nations, however, NCD's are a relatively recent phenomenon, but currently, they are growing exponentially and each year kills millions at dramatically young ages. This is because developing economies lack the knowledge and expertise to treat and manage the diseases and their policy makers show little interest in the prevention and control on NCDs.
This knowledge gap between developed and developing economies exacerbates the global NCD burden. Narrowing it entails capturing and organising relevant healthcare knowledge from wealthy nations, transferring it to developing countries and distributing it to where it is needed the most. Such narrowing of the global NCD knowledge gap will help significantly to reduce and manage the global NCD burden, but this will only be achieved by widespread use of cost effective healthcare technology.
What is the most ubiquitous healthcare innovation? . . . . . . . . . . . . . . . . . . . . . . . the mobile telephone and the smartphone, which combines telephony and computing. Although operationally relevant, such devices are underdeveloped healthcare applications. In today’s world, the implementation of any global healthcare strategy should not be contemplated without leveraging telephony and computing technologies. As the reduction and management of NDCs is increasingly about scarce information and connectivity, these technologies and mHealth should become increasingly important.
Despite its underdeveloped status, over the past decade, mHealth programmes, which use mobile telephones to distribute health information, have increased significantly in developing economies, especially in Africa. They are suggestive of scalable, cost effective strategies to help reduce the NCD knowledge gap and address the growing global burden of NCDs.
Recently, the FDA has approved a number of mobile phone-based medical imaging and data monitoring devices. One is a $99 electrocardiogram, which allows remote patients to monitor their heart rhythms at anytime from anywhere. The mobile app gives immediate feedback and data can be simultaneously relayed to a cardiologist anywhere in the world for a specialist opinion.
Microsoft is taking advantage of mobile telephony’s broad reach in Africa to develop an integrated healthcare information service, which serves both health workers and the general public. The system uses mobile phones to allow health workers to capture, store and process, transmit and access health information. Importantly, Microsoft has demonstrated that this lowers costs and enhances efficiency by eliminating redundancy and reducing the amount of time devoted to health information input. The public can also turn to the system for information: individuals pose frequently asked questions about health issues via SMS messages and receive replies straight to their mobile phones. Despite a high proportion of the users being poor, migrant, illiterate rural workers, Microsoft is convinced that its African mHealth service has the potential to become a valuable tool and is increasing its scope.
A study, published in the American Journal of Managed Care, concluded that mHealth can improve the management of diabetes and other NCDs while reducing visits to clinics. It argues that personalised healthcare is an under-represented feature in the management of NCDs and suggests that social media concepts developed by Facebook might be used in the self-management of NCDs and merit more consideration.
The International Telecommunications Union estimates that mobile subscribers worldwide reached 6.5 billion by the end of 2012 and is projected to reach eight billion by the end of 2016. Cheaper handsets, ever-decreasing data charges, the improvements in phone web browsers and increased 3G coverage have fundamentally changed the way we use our phones, resulting in smartphones increasingly becoming used as healthcare devices.
According to Strategy Analytics, in Q3 2012 the number of smartphone users globally rose to above a billion and the current paths of mobile technology and social networking are inextricably linked. Currently, some 650 million people globally use their mobile for emails and social networking. Although smartphone users make up only 13% of the world’s mobile users, they generate two-thirds of the world’s mobile traffic. Over the next five years this data traffic is expected to increase by 700% on average per user. By 2015 the number of smartphone users is expected to reach 1.4 billion, which will represent about 30% of total mobile subscribers worldwide.
Today, Australia, UK, Sweden, Norway, Saudi Arabia and UAE each have more than 50% of their population on smartphones. The US, New Zealand, Denmark, Ireland, Netherlands, Spain and Switzerland have greater than 40% smartphone penetration. All these countries have an escalating burden of NCDs. Mobile phone penetration across Africa is around 70%, but smartphone penetration in Africa is only 10% to 15%. Nigeria is the leading African country in smartphones with a penetration 41%, followed by South Africa with 31% and Kenya with 7%. However, the costs of smartphones are falling and telecom companies, such as Huawei and ZTE, are aggressively driving smartphone sales in the developing world’s rapidly modernizing consumers and looking to lift smartphone penetration in Africa closer to the 70% level. In February 2011 Huawei partnered with Safaricom, to offer the Android-based Ideos smartphone to the Kenyan market for US $80. Huawei is now attempting to build on the Ideos’ momentum in Nigeria.
These trends suggest that there are significant opportunities to reduce and manage NCDs by healthcare programmes piggybacking on existing global and local mobile networks. Narrowing the global NCD knowledge gap requires targeting risk factors and promoting healthier lifestyles. This means focused prevention efforts while mitigating the impact of NCDs on economies, health systems, households and individuals. Such a strategy must involve individuals, households and communities because the causal risk factors are deeply embedded in the social and cultural framework of communities. This will require a significant change in the way healthcare is implemented: a move away from diagnosis and treatment towards prevention and the promotion of wellbeing.
To reduce premature morbidity and mortality caused by NCDs, governments will need to invest in mHealth strategies to improve patient awareness of their own health and encourage them to manage their own wellbeing. Over time, this should free up resources that can then be focused on the patients most in need, while relieving the economic burden of NCDs on society as a whole and eventually leading to increased productivity.
The Lord Crisp is right to suggest that the global NCD burden will only be successfully addressed by changing the way healthcare is delivered.
The “complexity” of global health issues, suggested by speakers at the London NCD debate, is more a function of the forces protecting the status quo rather than the issues themselves. Mobile networks are ubiquitous. mHealth is operationally relevant. Governments are slow to address effectively the NCD burden. Is the missing part recruiting the help of Mark Zuckerberg?
