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| India Event1 #409694 Notes from Professor K. Srinath Reddy, President, Public Health Foundation of India – shared by Anil Srivastava. | - While considering the potential contribution of people centred public health and health care, it is clear that some of the present uses will be scaled up and new pathways of application will open up. The use of internet for empowering people and patients with easily accessible and sufficiently jargon-free health information is already evident. As is the growing use of e- consultations and e- prescriptions in clinical practice. A variety of e- helplines also exist to assist with counselling services. As internet access and e- literacy increase across the world, many healthcare consultations will take place across the net. The net will also foster democratisation of health care by reducing the asymmetry of information between the 'professional' care provider and the patient as well the patient's family or other lay care providers. Health care will become more participatory than prescriptive and management decisions more consultative and conjoint. Continued care will be patterned on a sustained partnership model rather than sporadic interactions. Perhaps such a relationship may build more trust, create shared responsibility and reduce litigation.
- Beyond all of this, there is a great opportunity for linking personal health to public health. With anonymised electronic health records of millions of individual patients,and even of healthy persons undergoing routine health checks, creating big data sets, epidemiologic analyses can be be conducted on a much larger scale and lower expense than the limited sample size studies now possible through research grants. These can yield valuable insights into risk associations with disease, interactions between risk factors, diagnostic and prognostic indicators and gene- environmental interactions. Preventive, diagnostic and treatment strategies will be better informed than at present.
- Such analyses can also provide tools for simplified Bayesian algorithms for self- assessment of risk status (based on pre-test probability, test result and estimate of post- test probability). This will enable people to take appropriate measures for self care based on a better understanding of probabilities.
- Through health promotion, patient education, better clinical practice by evidence guided physicians and distant consulting, the internet can reduce health care costs- reducing out of pocket expenditure for individuals and overall national health care budgets.
- Surveillance systems also will become more efficient, with 'participatory epidemiology'. Reporting, from and by the community, of cases with fevers or other suggestive symptoms, can provide early warnings of an outbreak and also help to track its course more efficiently. Crowd sourcing of such data will provide real time data and wide coverage - far better than the formally organised surveillance structures of the health system. Even mapping trends in over the counter sales of anti-fever drugs (anti- pyretics) will provide early signals of an outbreak of influenza or dengue. The internet can help to create more robust health information systems, integrating data from several sources, with cross- validation.
- The internet also can provide a new paradigm and platform for trans- disciplinary research and fresh impetus to muti-sectoral action. Public health poses many problems which require several disciplines to closely collaborate to find non- linear solutions that complex systems demand. Many academic institutions are are still limited by siloed departmental structures and narrow funding streams which act as barriers to trans- disciplinary research. The internet can break through such barriers and create a true knowledge commons that easily brings together ideas and insights from multiple disciplines- biomedical, social, economic, political, management, engineering, law (to name some). Such a knowledge platform can bring together researchers and practitioners across different institutions and countries to ideate on major public health challenges of the time and collectively contribute to barrier breaking solutions. It can also engage and excite young minds to spur innovations.
- The internet can also enable better monitoring and evaluation of health programmes, not only by creating better health information systems but also providing for public participation ( citizen reporting) and civil society monitoring (watch dog role of NGOs).
- The internet is also a powerful medium for health professional education. MOOCs on a variety of health related topics have greatly expanded the scope for knowledge dissemination and opportunities for self directed learning. This is especially helpful for low and middle income countries, where there is a shortage of well trained health professionals. The internet also supports continued medical education across the professional life.
- The internet can create and sustain communities of practice, among health professionals, public health practitioners, advocates and educators. Patient groups can share experiences and learnings, improving the ability to better participate in care related decisions and even undertake self care more effectively.
- The internet can strengthen the articulation of health as a human right. A broader public discourse on health equity, universal health coverage and patient rights will help move public health and health care to a more ethical and equitable framework of service delivery. The net can spark debates on issues like the impact of trade treaties on public health, catalyse campaigns on issues like drug prices and create coalitions for collective advocacy on threats like secondhand smoke or advertising of junk foods to children.
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