Geomarketing for Public Health

Geomarketing is a fairly basic idea. You use a variety of mapping tools in order to make the planning and implementation of marketing activities more efficient and effective. This is not a novel concept in the private sector, and many corporations have long since capitalized on their ability to use Geographic Information Systems (GIS) software to establish and maintain far-reaching and well-stocked distribution channels (from wholesalers to distributors, and retailers). This is exactly how Starbucks makes sure you are never more than 5 minutes away from an outlet in any city or town in the US, and it's also how Coke make sure they get their product to every last village in the middle of nowhere in the developing world. If they can do it, I think we can too!

Here are some of the many ways that mapping tools could help fine-tune public health programming:

- Improve Access: We could overlay maps showing epidemiological information about disease burdens to identify pockets with, for example, higher rates of transmission of HIV, with maps showing all HIV counseling and testing centers, to identify areas with poor coverage.
- Improve Efficiency: We could overlay maps of physical terrain on maps showing available centers for malaria treatment, to ensure that resources are not being wasted on providing services in high altitude areas with lower rates of malaria.
- Increase Effectiveness: By overlaying maps with demographic information on ethnicity and census information on population density, effective behavior change messages that can be customized to local needs can be appropriately relayed through mass media, and interpersonal communication.

While significant resources will need to be invested in acquiring GIS software, PDAs and GPS equipment for researchers to relay coordinates, as well as on training and capacity building for personnel, much can be achieved once these systems are established at scale. Maps can be made public for all agencies to view, and already many easy-to-use software to do basic mapping are being designed and piloted. The key will be to ensure that these tools are customizable, so that a variety of programmatic needs can be met through the availability of a range of research, evaluation and monitoring capacities. Mapping is a way forward, and a it's time the public health world jumped ahead to keep up with efficiently using these tools to market their messages, health services and products!

Vestergaard-Frandsen: A Dream Social Enterprise?

So I'm coming up on two months post graduation from an MPH/MBA dual degree. I'm not going to lie- I've definitely had my moments where I've wondered how I was really going to put both of these degrees to full use in the time to come. As most periods of unemployment are, this has been a time of self-discovery and doubt, a tedious attempt to try to explore all the avenues I could potentially start walking down. The process has been disheartening at times- I don't always see the light, that I know is out there, at the end of the tunnel.

But a few days ago, during one of my many internet searches, I discovered an organization that has shaken me into the realization that I am indeed on the right path. Vestergaard-Frandsen is a Swiss-based, social enterprise with a unique business model- they create and provide disease control textiles to vulnerable populations during humanitarian emergencies all over the world, reinvesting a significant portion of their profits into new research and development activities. Some of their big successes have been:

• ZeroFly, a plastic sheet that acts as a long-lasting insecticide against malaria and other vector-borne diseases, while simultaneously providing shelter
• PermaNet, long-lasting insecticidal nets protecting against malaria, some with improved bioefficacy against pyrethroid-resistant malaria vectors
  
• LifeStraw, a portable water filter in individual and family sizes to protect against common diarrhoel disease
  
• CarePack, a package designed to improve the lives of people living with HIV/AIDS that includes a long-lasting insecticidal net,an instant microbiological water purifier, condoms, a broad spectrum antibiotic and printed educational materials about malaria, other vector-borne diseases, diarrhoea , and sexually transmitted diseases

So it is possible to make money AND do good- world, are you listening?!

Watch LifeStraw at work in Haiti, after the recent earthquake:



Watch CarePack launch a massive social media campaign:



Vestergaard-Frandsen has kept me up really late tonight- I can't stop thinking about the possibilities in this arena. I'm hoping there are many more of you out there, as excited as I am!!

Hilary- 1; Women's Reproductive Health- 100

I'm returning from a brief hiatus from making posts on this blog, but definitely with renewed interest. Much has transpired in the past couple of weeks, but today it became clear to me that I needed to use my blog to spread the word about a fact, that although up until now I believed was undoubtedly true, many Americans have been questioning- reproductive health does in fact include access to family planning and abortion services. Wow--that is genius! Should I be surprised that it took Hilary Clinton to confirm this?

Watch her give a passionate, spur-of-the-moment response on the subject as the House of Representatives moved to end all federal funding for Planned Parenthood.



We need more women to stand up for this cause and do like she did. She took 1 hit for the 100's of American women who deserve to receive affordable, high-quality and easy access to reproductive health care- yes, contraception and abortion included!

National Association for Public Health Information Technology (IT)

The National Association for Public Health Information Technology (NAPHIT) is the dream organization that cares deeply about everything I have on this blog- I'm sort of disappointed that I had not explored them more until now. They came into existence in response to the masses of people that became very concerned about public health emergencies in the likes of bio-terrorism, after the September 11 attacks in 2001. Today they work towards a set of carefully laid out goals and objectives:

• To promote discussion and group action on issues involving public health information policy.
• To assist in the evaluation, selection and implementation of information technology in support of public health programs.
• To encourage professional development of leaders in public health information technology through training, education and the exchange of ideas.
• To further the role of information technology in public health by building relationships and collaborating with federal, state, and local public health agencies and other organizations that share our goals.

They are funded by a variety of organizations such as Microsoft, Novell, Northrop Gummen, Citrix, but two interesting ones among them are Advanced Business Software, an organization that focuses exclusively on developing and implementing information management software solutions for clients in the public health market, and HLN Consulting, LLC, a health information technology services company that provides a wide range of technology consulting services to public health agencies and their non-profit partners, in an effort to develop and support robust technical solutions addressing pressing public health needs. It is definitely a positive sign that many of these business are realizing the importance of combining their efforts and collaborating with one another to fund a national not-for-profit organization to accomplish these goals.

NAPHIT is headquartered in Baltimore, and in March 2009, formed an alliance with the Public Health Data Standards Consortium (PHDSC) to establish a Leadership Forum that is working to design and implement programs and activities that will allow public health IT leaders, public health and clinical professionals, as well as vendors to come together to standardize IT initiatives and allow interoperability between public health information systems and clinical information systems under the National Health Information Network (NHIN).

All of these initiatives are encouraging steps forward in the field of public health information technology. It is exciting to note the progress that has been made so far, and much is to be said about the potential for the future in the US- keeping in mind that many developing nations have yet to even recognize the importance of leveraging information technology to address public health needs. If an organization like NAPHIT is successful at building efficient models to introduce functional IT systems into public health within a highly disintegrated health care system, as is in the US, then there is hope for scalability and the replication of such efforts worldwide.

IT improving preparedness for public health emergencies

Today, we live in a world filled with endless possibilities for both natural, health and terrorism emergencies. Public health preparedness is a key ingredient to making sure our communities are ready to deal with the many tragedies that could easily become a part of our futures- natural disasters like earthquakes, hurricanes and floods; environmental degradation resulting in climate change refugees and drastically shifting weather conditions; health issues ranging from flu pandemics, regions with endemic cholera, malaria and HIV/AIDS prevalence, to new zoonotic diseases; political upheavals like civil war, and finally terrorist attacks ranging from chemical and biological warfare to 9/11 like incidents. These are not small matters, but how are we preparing ourselves for them?

It appears that information technology is playing a significant role in keeping us informed and encouraging us to be prepared. Keeping track of weather reports and following evacuation and alert signals allows us to move quickly and step out of the way of natural disasters coming in our direction. More and more, various states have begun to establish specific e-health preparedness portals to encourage people to keep themselves informed. For example, the Iowa Department of Public Health has started a an Office for Health Information Technology to lead a collaborative effort to plan and promote the use information technology in their public health planning. They have developed a vision, guiding principles and a framework for how health information can be exchanged through public-private partnerships that allow more efficient public health project management.

Similarly, the Vermont Department of Health has established an E-Ready module for public health preparedness to provide resources for families, information about biological, chemical and weather related threats, response plans, a list of response partners, as well as volunteer opportunities and any other information related to Vermont public health preparedness.

E-health endeavors such as these are paving the way for more states within the US to adopt e-friendly technology and resources that make keeping track of threats and responding to them in a timely and safe manner an efficient process that acknowledges the need for communities to prepare themselves adequately, as a priority.

Difficulties using ICT for Coordination of Care in La Romana, DR

La Romana, a city along the south eastern coast of the Dominican Republic keeps a unique but somewhat disturbing balance- wealthy American and Europeans expats enjoy the luxuries of low living expenses, pristine beaches and the tropical sun at the city center, while thousands of Haitian refugees work back-breaking days, at less than minimal-wage at the numerous sugarcane plantations that surround the city. These refugee families live in over 200 settlements, locally known as 'bataeys', where the conditions are less than optimal- 9 to 10 family members squeezed into single-room homes, severe water and sanitation issues , poorly developed education systems and very little access to health care.

The El Buen Samaritano hospital in La Romana has been working for over 2 decades to establish programs that can provide quality and free health care to bataey-dwellers. Their mission is well supported with over 60 volunteer groups visiting them from North America every year, to provide medical care, assist with construction, conduct bible study camps, and provide resources, as needed. However, as can be expected with a situation like this, little to no coordination exists between these groups. Each team brings down experts they believe are needed, and while no team leaves without helping as much as they can, work is duplicated, medical supplies are brought at random, patients seen at the bataeys have no medical history recorded, and the system remains less efficient than there is potential for it to be.

Last week, I accompanied a team of young and enthusiastic clinical and public health specialists, on a 10 day mission to do our part. But this year, we were going to try something different- we wanted to put in place a coordination of care model that would use ICT to provide channels of communication between various mission groups and hospital staff, in order to improve the efficiency with which resources in time, energy, skills and money were distributed, and care was delivered in this setting. We soon realized that while this was definitely a noble cause, it was indeed a difficult one. Here are some of the issues we faced:

• We started a simple, easy-to-understand Electronic Medical Records system that assigned a code to every patient we treated, and attached it to a digital picture, and a brief record of the conditions that were seen and treated- all in a basic excel file. We spent hours trying to figure out the easiest way to get this system started, but realized that without a structured way to get buy-in from all of the stakeholders involved (the volunteer mission groups, as well as the hospital staff), there was no way the system would get off the ground.

• We wanted to develop a website that all visiting mission groups could access before they arrived in La Romana. This way everyone could get a common understanding of the long-term strategic plan at the hospital to ensure that their work was contributing constructively towards it. They could all keep track of the schedule for groups visiting the bataeys and of medical supplies that would be needed to be brought, as they ran out. It was not as easy as we thought it would be. It turned out that there were already atleast 3 main existing platforms, and atleast a few more less known ones that were attempting to do the same thing, but that had so far not had too much success:
  

1. El Buen Samaritano website
   
2. A website developed by an American nurse who has been working at El Buen Samaritano
   
3. A website developed by an American doctor who has spent many years working at El Buen Samaritano

With such a backdrop, would our website make things better, or simply add to the confusion?

• We started a record keeping system to record inventory of medical supplies- we used simple tags like 'none needed', 'need more', and need urgently' to describe the current situation for specific medical supplies, with the hope that we could hand this over to the next team coming, and convince them to do the same before they left. Again, as simple as this seemed at first thought, it has been incredibly hard to get follow through- no concrete schedule exists for visiting groups and without one website everyone goes to, there isn't a common space for an open source update by each group as they come and go.
  

These are just the beginnings of the many problems we foresee as we take our mission forward to use ICT to implement a coordination of care model that will improve efficiency in both theory and practice.

What does e-Health mean to Americans?

We all talk about e-health these days, but what does this buzzword really mean to most Americans? G. Eyesenbach, in an article published in the Journal of Medical Internet Research, explores this topic, in an attempt to develop a concrete definition for this term. He defines the term and the concept as follows:

e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology.

Furthermore, he goes on to suggest that there are 10 e's in "e-health":

• Improve the Efficiency of healthcare
  
• Enhance the quality of healthcare
  
• Make interventions Evidence-based
• Empowering consumers and patients
  
• Encouraging new relationships between patients and health professionals
  
• Educating physicians and consumers through online sources
  
• Enabling the standardized exchange of information and communications between healthcare centers
• Extending the scope of healthcare beyond its conventional borders
• E-health requires new forms of patient-physician interactions that put an emphasis on Ethics- informed consent, privacy and equity issues.
• Reducing the gap between the "haves" and the have-nots" by promoting Equity in access to healthcare
  

I think this is a useful framework. Understanding the meaning of e-health with defined boundaries, allows the millions of Americans trying to decide on the various bills being passed around e-health, to make informed decisions when they cast their votes, and voice their opinions.

Similarly, below is an interesting video created by students at Vancouver University, succinctly describing exactly how Electronic Health Records can benefit Americans, but also how it has the potential to cause trouble. It is simple and easy to follow, and is definitely the way forward with bringing Americans on-board our mission to promote e-health.

E-Health Infographic from Ira Hardy on Vimeo.

(Source: G. Eysenbach. 2001. What is e-Health? J. of Medical Internet Research, (2):e20)