人类数字健康的面孔

After spending the first five years of his life in Bihar, one of India’s poorest states, Vishwajeet Kumar got to travel the world. He kept coming back home every year – and that back and forth was a big part of how he came to see healthcare differently.

他说：“我正处于两个没有互相交谈的世界的交汇处。”“西与东方。”

Kumar now works to weave the best of those worlds together. He is critical of the kind of biomedical training he says leaves little room to value the cultural models and social norms in the communities doctors work in.

一个例子是体温过低。这是15年前Kumar设立新生婴儿死亡的原因之一Community Empowerment Labin Uttar Pradesh, a state that accounts for该国新生儿死亡的四分之一。Yet 16 months after the Lab’s work began in rural Shivgarh,mortality droppedby 54 per cent.

库马尔说：“如果我只是看政府以减少死亡率的努力，这比[[]的速度快了几乎17倍。”区别，he says, is simply to start by listening to people, and seeing them as part of the solution.

但是，随着数字技术在医疗保健中成为中心舞台，低技术，以人为中心的护理注定要留在外围 - 还是比以往任何时候都需要更多？

Plugged in

Behind the achievements of Kumar’s Lab was the introduction of community health workers who do the listening, and help design solutions with the people they serve.

These workers provide the magic of human interaction. They’re also a bridge between patients and the health system. Healthcare staff “provide a two-way flow of information for those who struggle to reach a facility”,saysHana Rohan, assistant professor in social science at the London School of Hygiene & Tropical Medicine in the UK.

That function often comes with the support of digital tools. One example is Mobile Kunji, an audio app that was2012年在比哈尔邦推出, which helped workers raise awareness about family planning, according to Rohan. “This was a job aid combining a deck of 40 colour-coded cards with illustrations and a supportive audio IVR [interactive voice response] system,” she says.

There’s no shortage of healthcare apps. Over the past 20 years, the field of mobile health (mhealth) has evolved from the simple beginnings of emergency response and telemedicine to data collection tools, and eventually more sophisticated apps now beginning to be used at scale. In May this year, the World Health Assembly passed aresolution on mHealth- 承认其作为医疗工具的权力的标志。

Bigger, more integrated

Patricia Mechael, co-founder of the non-profit organisation HealthEnabled, explains that health apps have so far been largely disconnected from the healthcare system. But there are signs of a shift, she says, with apps increasingly getting integrated into electronic systems that manage healthcare information, for example, or disease surveillance. “There is a fair amount of activity that's happening throughout the world to move in this direction.”
Although others see slower moves towards integration, there’s agreement that governments are beginning to take the lead to develop standards, architectures and policies to connect digital health tools and scale up their use.

Part of the appeal is that without integration, countries won’t see the benefit, says Mechael – and that includes the data being captured by digital tools. But data protection policies aren’t developing quite as fast as the technology,raising privacy concerns。

“It is more than a technical issue (of encryption etc.),” says Elaine Baker, a digital health specialist with PATH in Tanzania. “It involves thought being given to exactly which health workers and other data users have access to – which types of data, about which clients, in which circumstances.”

Simpler, more human

Yet, the drive towards ever-more digital systems also raises questions over the human factor in care – how to put the needs of patients and health workers first.

Algorithms will simplify and standardise, but medicine is subjective, says artist and Bellagio resident Asim Waqif – and that makes having a relationship with a doctor even more important at a time when technology puts a vast amount of information on anyone’s fingertips.

“Ultimately even quite complex algorithms still come down to [the] individual skills of the practitioner who’s looking after the patient,” says Ian Lewis, a psychiatrist at Groote Schuur Hospital in Cape Town, South Africa.

How to get the best of both worlds

Mechael说，最有效的工具通常是更简单的工具。她说：“很多时候，我认为我们急于使用应用程序空间中的新闪亮对象，但即使仅仅通过手机通过语音进行通信的能力也不足够。”

对于刘易斯来说，使用常规手机通常比应用程序更有用，尤其是在像家人背景信息很重要的精神病学这样的实践中。他说：“另一个低技术只是向人们发送短信，以提醒他们服药。”这与诸如高血压或结核病等慢性疾病的药物合作。“这显然是机密性的风险。”

美国加州大学伯克利分校法学院人权中心执行主任Alexa Koenig说，高科技解决方案通常是违约。但是有时简单的行为改变更有效，我们需要开始欣赏全部解决方案。“什么时候可以使用低科技解决方案，甚至没有科技的解决方案？”她问。

“关键是要聆听要解决的问题，然后提出一种解决该问题的解决方案，”阿根廷FundaciónInvap的执行董事Veronica Garea说。“也许它没有光泽，不是浮华，它不够性感，但这是人们需要的。”



There is also a tendency to wipe out conventional methods when innovations come in, according toCosmas Bunywera, coordinator at Peek Vision in Kitale County, Kenya.

Another problem is that tech designers don’t necessarily factor in cultural differences, saysBunywera。“原因是有时它们离技术使用的地方很远。”

贝克认为，卫生专业人员之间的分离和IT开发人员加剧了这一点。“人们可以设计解决问题的解决方案的工具，而不是真正专注于以可持续方式解决这些问题的健康问题和工具。”

Back at the Community Empowerment Lab, Kumar echoes the sentiment. “Many at times I feel there are solutions looking for a problem. We're saying, can we reverse it?”