Fingers point to the future of healthcare

SimPrints Scanner Diagram-1

Health workers in developing countries face challenges that are often taken for granted in the developed world, but new technologies have the potential to become leap frog solutions that address such barriers. Major obstacles exist today in the identification of patients, a fundamental issue at the very core of delivery of healthcare in resource poor settings. All too often patients have medical histories that doctors or community health workers (CHW) have no access to. Addressing this difficulty would potentially revolutionise prevention and treatment in a diverse array of public health areas ranging from vaccination campaigns, to prenatal care, to improving treatment adherence in diseases such as tuberculosis and HIV.

Despite this, there has been limited innovation in this area. Most health systems in developing countries depend on paper records, which are easily lost and not immediately accessible. These records also assume a western notion of identification that fail to adapt to cultural variations such as multiple members of a community having the same name, and rural villagers often not knowing their exact date of birth. Compound this with inconsistent access to health care across wide geographical expanses, and it becomes extremely difficult to guarantee that a health worker will be able to identify the needs of her patient during an encounter.

Let’s take the example of childhood vaccinations, one of the most cost effective interventions in public health. One child dies every twenty seconds from a vaccine preventable disease and almost one third of child deaths can be prevented through vaccinations. But the vulnerabilities of paper records make it challenging for CHWs to identify what immunisations a child has already had and which ones they needs during their visit.

SimPrints

In part due to these difficulties, we have only achieved approximately 80% coverage world wide using existing technologies and health systems. A recent study estimated that a scale up of five immunisations in 72 of the world’s poorest countries could save 6.4 million children annually. We have started a social enterprise start up calledSimPrints, which has the potential to contribute towards solving this global health challenge, as well as many others.

SimPrints is in the process of developing a mobile-based fingerprint scanner that instantly connects an individual’s fingerprint to health records such as immunisation records and prenatal visits. This Bluetooth-enabled scanner, allows for real time access to health records, which enables CHWs to instantaneously access critical information necessary to provide care. In contrast to paper records sitting unhelpfully back in the clinic office, this technology would enable a CHW to swipe the mother’s fingerprint and receive an instantaneous update of what vaccines they have received and what needs to be administered that day.

This versatile technology would be compatible with existing mHealth applications and platforms, allowing for seamless integration into pre-existing systems through an application programming interface (API). Many future opportunities exist for SimPrints to become a platform technology that works with other technologies such as rapid diagnostic testing and point of care lab testing, to address challenges in drug adherence, disease monitoring and diagnosis.

Another exciting arena for SimPrints are its potential applications in areas beyond public health. For example, mobile biometrics can address the challenge of tracking refugees and internally displaced persons (IDP). Identifying refugees is a significant challenge since many refugees lack formal identification and may have crossed several national borders. In these settings biometrics offer a powerful tool for aid workers to link refugees to a single unique identification that can connect GPS location, medical data and aid records. This fingerprint identification would transcend time and geography to allow aid workers to adequately supply the camp and facilitate reunification of family members torn apart by war and conflict.

Dr Alain Labrique, Director of the Johns Hopkins University Global mHealth Initiative recently challenged us with the notion that “identification is the holy grail of mHealth”. We at SimPrints are excited to take on this issue and strive to substantively impact on-the-ground healthcare delivery through mobile biometrics.

*Toby Norman [2011] is doing a PhD in Management Studies, Elizabeth Dzeng [2007] is doing a PhD in Sociology and Daniel Storisteanu [2012] is doing a PhD in Medicine.

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Playing to win

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My recently published book, Playing to Win: Raising Children in a Competitive Culture, focuses on American childhood, education, and parenting – specifically on families with primary school-age children who participate in the competitive afterschool activities of chess, dance and soccer [football]. But I’ve received feedback from around the world. Many Asian parents write me to ask what their child needs to do to secure a place at Harvard or a similar school. Other parents, like those in the UK, correctly identify that these types of activities are less organised and prominent there than they are in the US.

Why is this? As I explain in Playing to Win, that US colleges and universities consider admissions categories other than academic merit is rooted in history and is uniquely American. In The Chosen, Jerome Karabel shows how the “Big Three” of Harvard, Princeton, and Yale developed new admissions criteria in the 1920s to keep out “undesirables”, namely Jews and immigrants. This new system valued the “all-around man”, who was naturally involved in clubs and athletics. Karabel explains that the definition of admissions merit has continued to shift over time, and parents’ concern with college admissions for their children is “not irrational, especially in a society in which the acquisition of educational credentials has taken its place alongside the direct inheritance of property as a major vehicle for the transmission of privilege from parent to child. And as the gap between winners and losers in American grows ever wider – as it has since the early 1970s – the desire to gain every possible edge has only grown stronger.”

Other historical reasons for why such elaborate, organized, expensive competitive sporting activities for kids exist in the US outside of the school system are detailed in a recent piece I did for The Atlantic as well: “When Did Competitive Sports Take Over American Childhood?” These reasons include the introduction of compulsory schooling and changes in higher ed like the GI Bill after WWII that made it easier for many to attend college – though this meant fewer available spots at some schools.

Of course, the system works differently in the UK, as described by Lauren Apfel in her thoughtful blog reaction to Playing to Win:

“My husband was a law tutor at Oxford for several years and he ran the undergraduate admissions at his college. The job of the admissions tutor, he says, is to assess intellectual ability and aptitude in regard to the particular subject of study. Unlike how Levey Friedman describes the kind of students Harvard is looking for, ‘ambitious individuals who are not afraid to take risks’ across a whole range of endeavors, what he was looking for was something much more pointed: the kid he wanted to be discussing the constitution with in an individualized tutorial at 9am on a Monday morning. This person, he says, very well might not be the student who was playing rugby or singing in the choir over the weekend. It is more likely to be the one staying in, diligently preparing his or her essay and poring over the law reports… Top-tier education in Britain is about precisely that: education, narrowly construed. It is about mastery of a subject. Accordingly, versatility and a competitive edge are not the axes on which the admissions decision turns, as Levey Friedman characterizes the US system. The goal is not to admit a jack-of-all-trades. Nor is it to admit the future valedictorian.”

Nonetheless, even in Glasgow many children are spending more time in organized activities these days – even if they aren’t competitive. While Apfel’s motivation for swim lessons for her kids isn’t to secure a place at Oxbridge, but to ensure they don’t drown, things do seem to be changing as many of her children’s classmates are engaged in many different classes outside of the school day.

I wonder if this is a reaction to new funding schemes in higher education in the UK, a move toward more American cultural norms, a combination of the two, or something else entirely? And, regardless of the reason, what does this mean for social mobility in the UK? While the US is by no means perfect, upward class mobility remains more common in the States; if afterschool activities do take up a more prominent place in childhood and perhaps in higher education decisions, will this make Great Britain an even less mobile society?

*Hilary Levey Friedman [2002] did an MPhil in Modern Society & Global Transitions and is now a post-doctoral fellow at Harvard through the Robert Wood Johnson Foundation’s Scholars in Health Policy programme, where she is studying youth sports injuries.

The health impact of social isolation

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Liberal Democrat MP Norman Lamb recently suggested that encouraging people to take their elderly neighbours out for the day could improve their health and their dependency on care services. Attempts to tackle social isolation led by organisations such as the Campaign to End Loneliness don’t tend to get as big headlines in the health pages as the importance of getting your five a day, but the two are closely linked, particularly where the elderly are concerned.

In the next two decades there will be a 45% increase in the number of over-65s and an over seven-fold increase in the number of people over 100. Whilst life expectancy is rising, the time spent in chronic illness is increasing. Nutrition plays a key role in healthy ageing. In the UK, it is estimated that around 70,000 avoidable deaths are caused by diets that do not match current guidelines.

The EPIC-Norfolk study is following a population of over 25,000 people in Norfolk since 1993 to study diet and other factors in relation to chronic diseases. Previous research drawing on the study found that individuals who consumed three additional vegetable items per week had a 13% lower risk of developing type 2 diabetes.

What people eat can change, though, and people’s ability to engage in healthy eating is influenced by the social environment. This includes factors such as marriage, cohabitation, friendship and general social interaction.

Isolation

Around half of those over 75 now live alone, and social isolation can affect their health, including whether they eat well. Research shows people over 50 who are single, widowed or divorced eat less healthily than those with partners. Men, people who live alone and those who are socially isolated are most likely to eat a diet with little variety.

This suggests strongly that improving people’s social ties could have a positive impact on health. As part of a Centre for Diet and Activity Research study, we have been analysing the EPIC-Norfolk data to look at the combined influences of multiple social ties in relation to the daily variety of fruits and vegetables eaten, regardless of quantity.

The research adds new evidence about how unique combinations of older people’s social lives can affect their diet. Our results confirmed, for instance, that marital status is an important social relationship influencing diet quality in older people. Compared to older adults in a partnership, single over-50s ate 2.3 fewer different vegetable products per day. Those who were widowed ate 1.1 fewer different vegetable products daily. Furthermore, widows and widowers living alone consumed 1.3 fewer different vegetable products daily than married lone-dwellers. By contrast, widows and widowers living with someone else ate the same number of different vegetable products each day as over-50s who are in a partnership and live with someone.

This shows that it is not solely widowhood but rather the combination of both widowhood and living alone that puts older people at risk of a lower quality diet.

The research suggests interventions which increase the availability of various social relationships are important for supporting a healthy diet. This could range from organising social activities to considering how the design of accommodation for older people might support interaction. The study also suggests that intervention needs to be tailored to include other social factors beyond marital status and to take into account that over 50s are more likely than other groups in the population to experience changes in their social relationships. These moments of change are important to target in assessment and intervention. For example, around the time of widowhood, assessment of risk to healthy eating needs to consider gender, living arrangement and friend contact.

The Campaign to End Loneliness says loneliness is a bigger problem than simply an emotional experience and cites research showing that it has an equivalent impact on our health to smoking 15 cigarettes a day and is worse for us than well-known risk factors such as obesity and physical inactivity. A considered approach to tackle it could have significant health benefits.

*Annalijn Conklin [2011] is doing a PhD in Medical Science. More information on the research can be found here. More details.

Picture credit: worradmu and http://www.freedigitalphotos.net