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Smart Technology

In early January, I attended a function at the Peabody Library, a beautiful building given to the people of Baltimore by philanthropist George Peabody. When the library building opened in 1878, access to information was difficult. Peabody knew that by collecting books in one place, he would be promoting the educational, economic and social development of the city that had helped him build his financial empire.

When I was a medical resident in the early 1980s, information accumulation and sharing wasn’t much different from Peabody’s day. I went to the library, photocopied journal articles and organized them to create ready access to the latest information.

Since then, of course, the digital revolution has changed everything. Better technology has flooded us with data. We have oceans of data from genomic, epigenetic and proteomic analyses. We have second-by-second data on how the brain functions during sleep. And we gather libraries worth of data from imaging studies, laboratory analyses and other sources.

Of course, extracting knowledge from the profusion of data represents a huge challenge. That’s why we depend on biostatisticians to develop new methods of analysis—data are useless until we separate signal from noise. With the right statistical methodologies, we can better understand the architecture of sleep, uncover the links between air pollution and mortality and discover disease-gene associations that heretofore went undetected.

Technology offers incredible opportunities to improve health, but we must apply it wisely.

The pervasiveness of technology hits me in the face whenever I travel to low-income countries. Because of the lack of preexisting infrastructure, many have leapfrogged over us. I have written before about HIV clinics in Africa that use text messages to track prescriptions, for example. And our faculty bring technology with them. In Macha, Zambia, and Rakai, Uganda, for example, our researchers utilize advanced equipment to generate laboratory data in the field. The miniaturization of lab equipment and training of local technicians and investigators has allowed us to do research in situ while building the capacity of local scientists and technicians. At the same time, we avoid the difficulty of shipping specimens and dealing with export restrictions and cold-chain transport.

Such technology is a huge benefit, but only successful if it is socially and culturally appropriate. Let me give you an example. A longtime staple of malaria diagnosis is the blood smear. You draw blood from a febrile person and examine the blood under the microscope for malaria parasites. It’s straightforward, but in some African cultures people resist a blood draw, worrying their blood could be used in witchcraft. Thus, a simple technology may not be culturally appropriate. (Two of our investigators at the Johns Hopkins Malaria Research Institute, Sungano Mharakurwa and David Sullivan, are working to solve this problem with saliva- or urine-based alternatives.) Similarly, you also see lots of devices that are used in wealthy countries without a second thought, but they’re not appropriate in many places because they require sustained electrical power.

Technology also has permeated our educational mission. Thanks to the Web, we now can bring the School’s storehouse of knowledge to thousands of students, working professionals and others worldwide. In our MPH program, 250 students learn face-to-face here in Baltimore, while more than 400 have joined our Internet-based, part-time program. Over the past 15 years, our School has pioneered innovative ways to teach public health, allowing us to reach people in ways never before possible. Distance Education courses offer flexibility and are of such quality that more than 40 percent of the enrollment in online courses is by full-time students. As the demand for public health education grows, distance education will help to fill that need.

Technology offers incredible opportunities to improve public health—as attested by the articles in this special issue. That said, new technology alone will not solve the world’s health problems—effectively managed programs, serious political will and sufficient money also are needed to save lives.

So how we use new tools is what matters: We must continue to gain insight into determinants of health, design cost-effective studies, test innovative interventions and develop rational policies based on evidence. When we employ technology this way, it will help us dramatically advance our public health mission.

Comments

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  • Rafael Hernandez

    San Jose del Guaviare, Colombia 03/02/2012 02:04:03 PM

    Dear Dr. Klag,

    Thank you for sharing your thoughts on the growing importance of new communication and information technologies in public health. I have been delivering health care to indigenous communities and other remote populations living in a vast and remote region of Colombia.

    Technology, including radio, cellular phone, mobile x-ray units, portable microbiology analysis equipment, laptop computers and satellite communications among others, have allowed me and my team to improve the quality and coverage of our services. However, much more needs to be done, and as you have wisely underscored, it is essential to make use of technology in a socially and culturally appropriate manner.

    We are trying our best to also transfer knowledge and technology so that adequately trained local healthcare workers can continue performing and reporting essential diagnostic and monitoring tests. This has been key for malaria, tuberculosis and other infectious disease management programs.

    Currently one of our main challenges is to attract graduates of health disciplines to work in remote areas. Security concerns used to be one of the main reasons for them to consider jobs elsewhere, but it has improved dramatically in the last decade, thanks to the successful policies of the former and the current administrations.

    Despite the many odds that you can imagine, many young graduates are willing to contribute to address the needs of low income communities in remote areas. And although the salaries that we have here are not the most attractive (my monthly salary is about $1,500, mind for instance the payment for recently graduate MD colleagues, nurses and microbiologists in my team), the main deterrent is the lack of access to sources of continued education.

    For this reason I was wondering if the Johns Hopkins School of Public Health is considering to make freely available some of the graduate training courses that are being used by your graduate and postgraduate students.

    One one hand, it would become a global public good immediately, as an enormous contribution to improve the knowledge of healthcare professionals working in very remote locations around the world. And secondly, it would become a strong incentive to recent graduates who are interested in working in such places but are worried about not being able to access to the evolving knowledge in basic and clinical sciences and related disciplines.

    We currently share online subscriptions to the New England Journal of Medicine, Lancet, British Medical Journal and a few other publications, but it is hard to find a non-profit center where we can update our knowledge on basic and clinical sciences.

    JHU is a globally respected institution and it would be a natural place to lead such an effort if it is not yet in the making.

    Looking forward to hearing your thoughts.

    With my best regards,

    Rafael Hernandez MD San Jose, Guaviare Colombia

  • Brian W. Simpson

    JHSPH 03/09/2012 04:33:50 PM

    Dr. Hernandez, Thank you very much for your thoughtful comment. We would like you and others to know that the Bloomberg School is on the forefront of providing "knowledge for the world" through our OpenCourseWare site. OCW provides access to the content of more than 100 courses at the School. We hope this is the kind of knowledge-sharing that you envisioned. Please visit the site at http://ocw.jhsph.edu/. Again thank you for taking the time to add to our magazine's discussion. Sincerely,

    Brian W. Simpson Editor, Johns Hopkins Public Health Magazine

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