Technological Innovation in Reducing Health Disparities

Robert S. Gold, DeanUniversity of MarylandSchool of Public Health

Prepared for40th Anniversary Celebration

and Annual MeetingNovember 1, 2007

Eta Sigma Gamma

Vision: High Quality Interventions

How do we maintain and improve on the efficiency of current public health interventions without dramatically increasing cost?

How do we contribute to the reduction in the disparity in morbidity and mortality for underserved populations?

How do we take appropriate advantage of advanced technologies to accomplish the first two?

Before we begin . . .

If we can decode this

Why can’t we decode this?

If we can figure out how to read this

Why can’t we figure out how to read this?

If we can land here

Why can’t we land here?

If we can build this

Why can’t we build this?

If this is a cultural phenomenon

Why can’t we figure out how to effectively apply this kind of technology for education?

If we have so many best practices

Why can’t we figure out how to get educators to use them effectively?

How do we get there?

Recognize challenges Apply effective technology strategies &

tools Use interactive and appropriate

learning strategies Generate a plan for strategic

deployment

Which technology is best?

We should focus on critical outcomes, not technology.

Key to effective interventions is: focusing on the needs of the populations the requirements of the content, and the constraints faced by the practitioner,

before selecting a delivery system.

Technology givens!

Continuous and rapid change

Regularly redefining effective and best practices

Benefits realized only when effectively integrated into lifestyle and practice

We are not always prepared Source: http://www.oswego.org/ocsd-web/tech/techplan/staff-dev.htm

What we do!

My philosophical orientation!

We must remove all barriers . . .

Caveat

We don’t always need more powerful hardware

Sometimes we need: Better pedagogy More effective application of learning

theory Discovery, exploration, user generated

automata

My fears revolve around:

Individualism ~ Dehumanization

Content focus ~ Technology focus

Concerns

Cost Access

Functionality

The technologies:

Visualization technologies

Biomedical technologies

Communication technologies

Data technologies

Educational technologies

Science fiction technologies

Visualization technologies

Transform information into a visual form, enabling the viewer to easily understand the information using interactive graphics and visual design

Although an old idea, two things create new opportunities Increasing computing power Increasing amount of information online

Visualization – new techniques

Scientific visualization Visualization of text Visualization of histories Visualization of data - GIS Visualization of social networks Real-time visualization Visualization of concepts

Scientific visualization

Molecular models Bioinformatics Medical imaging

A technique to organize information allowing analysis

Text visualization

Explore the fabric and meaning of text in context

A technique to organizing information to enhance comprehension

Visualization of “histories”

A mechanism to graphically illustrate and explore relationships between people, events, concepts

A technique to organize information to see relationships

Geographic Information Systems

Tracking disease Overlaying population

group and geographic data

Evaluation of change over time

Social Network Analysis

Diseases are often spread through social contact

Contact information is often key in controlling an epidemic, man-made or otherwise

There is a long history of the use of DM tools in the study of social networks: Social networks as graphs.

*Center for Discrete Mathematics and Theoretical Computer Science / National Science Foundation

Spread Of Opinion

Of relevance to bioterrorism. Dynamic models of how opinions spread

through social networks Your opinion changes at time t+1 if the

number of neighboring vertices with the opposite opinion at time t exceeds threshold

Widely studied Relevant variants: confidence in your opinion

(= immunity); probabilistic change of opinion

*Center for Discrete Mathematics and Theoretical Computer Science / National Science Foundation

Social networks

NEJM – social network analysis and spread of obesity

Network analysis

Source: Christakis NA, Fowler JH (2007) The Spread of Obesity in a Large Social Network over 32 Years. N Engl J Med. 357(4):370-9.

Biomedical technologies

Bioengineering

Genomics and Epigenetics

Nanotechnology

Bioengineering

Thought controlled smart prostheses

Biomechanics of blood flow

Biomechanics of muscle and soft tissue

Engineering molecular biosensors

Genomics and Epigenetics

Functional genomics

Epigenetics

Nanotechnology

Applied science working on the atomic and molecular level

Nanomedicine e.g., bioavailability

Communication technologies

Data technologies

Computer clusters

Grid computing

Educational technologies

In this environment we have: Access to national online networks and data Data mining and visualization tools Knowledge based approaches / knowledge

management Simulation and modeling Grid-based computing Other non-hardware based strategies

Educational technologies

Self-paced interactive multimedia tailored to educational diagnosis

Simulation technologies Expert systems / decision support systems Knowledge management systems Groupware Data technologies / techniques GIS Other – the brain

Appropriate technology can revolutionize:

The delivery system of products and services

The way we communicate The way we use and view

television The way we individualize and

personalize education The way we internalize,

understand, and use massive amounts of data

Science fiction technologies

Personalized medicine?

I believe

that all thought, memory, feeling, and emotion are the result of biochemical reactions.

If true, then all behavioral choices are also chemical reactions

Therefore, what is the future of health disparities research? Public health education?

Two universal principles

Virtually all diseases / health states have a genetic component

There are no perfect human specimens All of us carry a significant number of

DNA glitchesFor us, next three pillars of genomic futures

Genomics to biology Genomics to health Genomics to society

Source: Francis S. Collins, MD, PhD, National Human Genome Research Institute, NIH

Genomics to biology

Define the structure of human variation Sequence lots of additional genomes Reduce the cost of sequencing Identify all functional elements of the

genome Identify all the proteins of the cell, and

their interactions Develop a computational model of the cell

Genomics to health

Define genetic and environmental risk factors for all common disease

Develop a strategy for individualized preventive medicine

Develop gene-based therapeutics for single gene and complex disorders

Educate health professionals Define causes of health disparities

Genomics to society

Ensure genetic privacy and protection against genetic discrimination

Define genetic factors that influence behavior

Ensure appropriate patenting and licensing practices to benefit the public

Understand the relationship of genomics, race, and ethnicity

Define boundaries of the appropriate application of genomics in the non-medical arena

What’s next

2010 – mainstreaming of individualized preventive medicine Predictive genetic tests Interventions to reduce risk Pharmacogenomics is standard of care

But Will access be inequitable? Will

disparities persist? Will genetic discrimination be allowed?

2020 – genomic therapeutic revolution in full swing Gene-based designer drugs (diabetes,

alzheimer’s) Gene therapy standard of care Sequencing a complete human

genome costs $1,000 But

Intense debate underway on non-medical uses of genetics