Global Disasters, Mobile Health and Blockchain (PART I)
Start with this new piece of information: the U.S. Centers for Disease Control and Prevention (CDC) just announced that it is cutting off funding used to prevent infectious-disease and epidemics in 39 foreign countries. According to the Wall Street Journal, $582 million in funds designated for work with countries around the globe after the Ebola crisis in 2014 and 2015 will run out at the end of fiscal 2019.
That decision is, in two words, shocking and incredible. As a general matter, public health disasters are not stopping at country borders and certain outbreaks of epidemic diseases once thought controlled will be re-emerging. The impact of the CDCs decision takes on added significance in the context of natural disasters, ratcheting up the likelihood of diseases occurring and spreading.
Ironically, as these CDC cuts take hold, they stand in contrast to the growing efforts to use existing and newly developing health information technology for both disaster planning and disaster responses. We are confronted, then, with conflicting policies, attitudes and actions with respect to the health and well-being of those who inhabit our shared world.
By way of example, at the December 2017 annual meeting of the United States Department of Health and Human Services (HHS) Office of the National Coordinator for Health IT (ONC), there was an initial review of existing and improving efforts on how to make electronic health information systems available to Americans. Thereafter, with the growing national disasters in the US and beyond, the usefulness of eHealth solutions to save lives in natural disasters was explored in detail. Coordination of government and private sector e-Health efforts in US disaster regions were described, most particularly technological interfaces between hospitals and first responders. There was general consensus that we have growing capacities to help individuals, and with each disaster, our technological efforts improve.
Our Slow Implementation of Existing Technologies
But, for reasons both explicable and inexplicable, we are remarkably slow at moving to actual, timely implementation. The challenges confronting the population of Puerto Rico post-hurricane Maria are a case in point. Luis Belen, the leader of the National Health IT Collaborative for the Underserved (NHIT), described his professional and personal challenges in helping those in Puerto Rico at the December meeting. Luis, who grew up in a walk-up apartment building in New York City in a Puerto Rican family, had spent his early career helping NYC address drug wars and poverty; he then found himself in the center of national policy and planning for using advanced and emerging health IT designed to reach the populations affected by some of the world’s worst natural disasters.
Yet, despite his professional expertise, Luis struggled to help those stranded in Puerto Rico due to Hurricane Maria, including members of his own family. To personalize the story and showcase the challenges, one of his relatives died due to the unavailability of healthcare for chronic conditions, while a second died in result of a cardiac condition for which no proper health services or health IT tools were accessible related to the storm event. It is ironic and sad that the person trying to help could not save his own family members.
Stated most simply, the current challenges to population health from natural disasters has outstripped the capabilities of nations around the globe to respond adequately to emergencies and to bounce back to wellness with all deliberate speed. Breakthrough interoperable health IT innovations are not being made available to populations in need and we are not testing out new technologies quickly nor considering adoption of blockchain mechanisms that can also contribute to overcoming barriers to more effective use information in healthcare delivery with trust and security. (More on the potential uses of blockchain in emergencies in particular and healthcare more generally in Part II). I suspect that our healthcare failures have also been exacerbated by people’s incapacities to communicate effectively their own health data, receive quality healthcare in the first instance and engage with quality health services and providers.
The Scale of Destruction
Given the plethora of global disasters, we do not have time to wait. And the CDC cutback only exacerbates an already difficult situation. Look at these data.