The role of tech in decreasing health inequities, improving access, and strengthening resilience

hey chris hey vikram so chris you've been a go-to person at microsoft research um to to focus on mission mission-driven problems and and on applying that type of a research approach uh combined with uh great technology uh to solve scale problems when we are thinking about societal resilience and health resilience and how to have a transformative effect on what is needed by the world right now um how are you thinking about problem selection what is the motivation that you apply uh in choosing problems that you go after yeah i mean our mission is empowerment right microsoft mission you know every person every organization on the planet to achieve more and so we think about this context right we're in the seemingly endless pandemic misinformation is everywhere and we just recorded the hottest month july ever recorded in history and so what what started from my perspective as this response to kovid how can we be of service how can we pivot and and be you know sort of relevant has now shifted to an expectation and the expectation is that these kinds of crises that are severe are going to become more frequent and therefore we need a different approach we approach to research that focuses on things like anticipation and mitigation and adaptation it's like all of a sudden people are like call the scientists and and we have to be ready to answer that call and i feel like that requires a bit of a new approach so if you if you think about building resilience at every level of society and um and actually really wanting to move the needle here there has always been this notion of technology being a hammer in search of nails what's different about how we are approaching the the situation right now well for me personally anyway the pandemic it surfaced so many challenges and also opportunities with science many of the challenges were really realizations of limitation and of the you know non-optimality of focused isolated um separate work that to be a societal scale requires building and learning and amplifying and convening it requires multi-stakeholder perspectives it requires uh problem selection and design from that that point of view bringing expertise from different fields to make advances as opposed to focusing on one and and that to me has led to principles like the need to do collaborations the need to involve communities the need to build for reusability from a design engineering perspective and and that lets us start to think about the the context of our evolving society and the opportunity to address problems at the scale and speed that they're happening at and in the in the context of health resilience what are areas or problems that that have come up in in this journey and and how are you thinking about that and uh what what's what's been motivating um in that our approach to research involves now thinking about societal scale problems societal level problems and what does that mean it means for starters we have to focus beyond the laboratory we have to bring advances from different disciplines together and we have to think about the complexity of systems and people and institutions that are relevant to solving problems today at societal level take for example the pandemic in the u.s at least the last year and a half has been extremely challenging with things like data access and matching up basic resources with basic requirements and at the same time there's been incredible advances with messenger rna and so this advancement of science and then this need to adjust practices has kind of all happened at this this very fast pace and so from my perspective to be relevant at the societal scale which means to be relevant to many people it requires that we bring together these different backgrounds things like social theory health care expertise with technology expertise with the ability to scale infrastructure and then together we can maybe solve problems more effectively with more lasting impact and that involves principles like durability and reusability as an engineering principle as opposed to efficiency that may lead to very purpose-built brittle build type solutions at least principles like uncommon collaborations and multi-stakeholder collaborations because we know that we need a tech expertise together with a domain and a subject expertise together with an understanding of public and private for the context in which technology meets the real world and we and we know that we need a perspective around communities especially with respect to healthcare access healthcare equity and resilience we know that community leaders community participation is something that's been challenging during the covet response in fact the the coveted response has stressed our systems and shown in a way just how fragile some some communities are and so by by approaching to work with those communities and build with them maybe we can build something more reusable something that's more multilateral and something that can be you know more useful for the next crisis yes as we talk the the terms and the words that you know stand out for me are things like collective things like multi-stakeholder things like integrated um and and cross-disciplinary so there is a theme here uh around how important it is to bring people together how important it is to center anything that we do around making that difference to the individual and then individuals farm communities communities farm societies and so forth so we have a panel coming up that is about the role of technology in improving health equity in in affecting health access and and laying the foundation for health resilience tell me more about how you think about um how we learn from from people who are on the ground and uh what makes you optimistic about where we are headed i am optimistic i think i'm optimistic because partly all of us are talking about these things we're revisiting our motivation for research we're talking about problem selection within greater context of inclusion we're identifying the problems that are affecting parts of society that are maybe disproportionately affected in these kind of healthcare crises and and we're doing it with kind of an eyes open approach that business as usual isn't isn't going to work right and part of that business as usual is the is this the natural indirection of technology it's kind of abstract it's kind of distant um and so you know the panel you know people that are that are face to face with this uh that kind of domain and subject matter expertise is just totally critical in my very limited experience in a crisis environment i found that that that was just necessary that if we try to design for people if we try to anticipate how things are going to work when they when they deploy technology we're often very very um you know our assumptions are not quite accurate and so instead by involving people in the process um as participants as designers as developers i feel like we're much more likely to have a good outcomes outcomes that are not based on assumptions but are based that are beneficial and they're reproducible and that that's on you know on strong legs of like transparency and open source software on on relationships built on trust um and on long-term engagements um and i guess that's to me the optimism is that that in a way you know software what we're working on we're developing here software is the most malleable tool ever invented there's never been a greater demand for it in the history of the world and we have an opportunity to bring together different expertise to do collective problem solving and that's to me is something that only a place like like microsoft can can really push forward and so i'm very very motivated because we know that when when the world wins microsoft wins and and when people can use technology in a more resilient fashion uh we're more likely to be as successful in the long term yeah that optimism is infectious i have to say and um it's very exciting to be thinking about how people are coming together in order to tackle this and in the opportunity space of bringing together health equity health access and resilience learning from people who are on the ground trying to serve the needs of people who are being affected it's been a wonderful journey and i'm looking forward to what we can accomplish together and with that i'm going to turn it over to our colleague desmond creary who will be kicking off the panel hey everyone thank you for joining us and i would like to say before we get started uh would like to send a shout out and a thank you to both chris and bikram uh getting us started as we enter into what i believe is an important panel discussion been excited about this one all day um and just to bring you up to speed we're going to continue the discussion on the role of technology in decreasing health inequities improving access and strengthening resilience across geographies and to have this conversation i have the privilege of being joined by three gentlemen and we're going to spend the next 60 minutes uh digging into some of these topics we've got some great questions going to hear directly from people working um in this environment with these issues working on real solutions and so let me do this i'm going to first introduce myself and then i'm going to come to the panel so you can get to know the gentleman you'll spend the next 60 minutes with my name is dez creary i am the regional lead of the americas here at microsoft healthcare i also have the privilege of serving as the co-health equity league globally and again i have the privilege to be joined by three of my colleagues to have this important discussion so let me go go ahead and kick us off reverend baker i'm going to start with you would you mind giving us a quick introduction yes good good afternoon uh i'm bobby baker i am the chief community engagement officer for christ community health systems i'm also the creator and designer of the congregational health network along with my colleagues uh also i am a 30-year community pastor the work that we have been doing here for the last 15 years is creating partnerships with congregations to affect the outcomes of health care we believe that if you can align and leverage community assets in our case congregational community assets we can address health disparities at the point of the disparity and also create pathways for those in the community to actually have access to the resources that are available to them oftentimes we find that is the availability of resources are not really the problem uh the problem is creating pathways for access to people to a set access those resources thank you for joining reverend baker always good to connect glad you're here to have this conversation with us and isaac you are up next hi thank you for the invitation to join you today i'm excited to be here my name is isaac coleman and i'm a clinical assistant professor at the university of washington my affiliations are in the department of global health as well as the department of human centered design and engineering i'm also a co-founder and chief research officer at a nonprofit organization called medic we build open source software for health workers in the hardest to reach communities the main open source project we support is called the community health toolkit it's over the last decade supported a little over 57 million carrying activities it currently has about 37 000 end users and most of them are in africa and south asia a little bit about my personal journey you know when we were starting medic in 2010 i spent the first few years first in malawi and then in kenya at a time when the mobile infrastructure mobile telecommunications infrastructure was really just starting to go in in the the rural parts of eastern sub-saharan africa so it was a very exciting thing changing many industries and aspects of society and at the time there wasn't really an established market or an idea that you could use digital technology really in these hardest to reach communities in health systems that were facing a whole range of challenges and yet really see improvements in the way care is delivered and in the care experience for patients and in health outcomes so it was a really exciting time and i spent those first few years living out of a suitcase traveling hospital to hospital and designing some systems that initially focus just on messaging just text messaging among health workers and the care teams that support them so it was a really exciting period in 2012 i started graduate school at the university of cambridge and my research is really focused on human-centered design and how we can apply human-centered methods in designing digital health systems in a global health context and that's work i carry forward today as medics chief research officer so again it's really a pleasure to be here and i'm looking forward to the conversation hey thank you isaac and and again thank you for joining us uh we're pleased to have you as a part of the panel uh and now last but certainly not least uh kp i would love if you could introduce yourself uh to everyone out there tell us a little bit about you um and again welcome to you great thank you so much i really appreciate the opportunity to be here with all of you my name is kapama yalpala i go by kp i'm the co-founder and ceo of inon health and also the chairman of access mobile international what we do at in on health is um we do basically what we call digital health communications with the focus on underserved and vulnerable populations and really our focus is on how to reach people on particularly multicultural and vulnerable populations through the communications channels that they engage with the most which typically has been text messaging for us i'm very much like because how isaac has mentioned what they do um in kind of the origin story of their organization um and then it moves across into other channels um in terms of some background we started this work in sub-saharan africa in uh 2011 2012 um we were um using text messaging to get people access to their drugs to see their doctor so on and so forth um and now we work in south africa fast forward in 2018 we took the lessons learned from sub-saharan africa and started applying them here in the u.s for our vulnerable populations and that's what we do today through in on health i'm working across the country from rural america to places like atlanta and colorado so really focus on digital inclusion last but not least here in colorado i'm on the e-health commission which governs health technology for our state and i'm the digital health equity lead um here in colorado thank you so much so let's jump right in uh the first question is and and reverend baker i'll ask you to please kickstart us here so how is your organization tackling health equity access and resilience would love to have your thoughts well like christ community health systems our model of healthcare delivery really branches out into the community we have uh health centers in different communities all over the the city and each of our centers is kind of a self-contained health center in that we have primary care behavioral health uh pediatrics ob dental and all of that is in one setting so that access is there in the community where the patients live so we're breaking down the barriers of transportation and sometimes it's child care so that kind of access really creates a convenient pathway for our patients to get the care in the community that that they need and they can get it in the community where they're living with the minimal amount of travel thank you reverend baker really appreciate it kp would love for you to build on top of what reverend baker just shared please jump in so um when we think about what we're doing at in on health in the um as i mentioned like our focus has always been multicultural and diverse populations and as we all know if you look at our census the us is becoming incredibly diverse across many different types of dimension dimensions race ethnicity gender gender identity urban rural context and so our focus has been when you think about digital tools like so much investment has gone into digital innovation and health care but i think where some of the risk is is how do we ensure that those technologies serve everybody and not just those who are already having access to health care today right and so our view of health equity is really through the lens of you know coming through this kova 19 pandemic we all know there's been record levels of investment in telehealth and remote diagnostics all these things but what you also find is when you look at vulnerable and multicultural populations they're not typically using these tools right and so while we see a lot of promise with the use of digital innovation to support access to care and more inclusion at the same time we see a lot of risk that people are going to get left behind um and so a lot of our work when we look at health equity in the us is thinking about it through that lens you know at medic we work with community health systems around the world and you see a lot of variety from place to place but some of the principles reverend baker was just speaking to are really consistent in community health around the world it's about bringing care to where the people are rather than waiting for people to get to you and that often includes health centers that are closer to marginalized communities that help address equity gaps it also in in many of the health systems we support at the center of that care delivery model is a community-based health worker these are often people who are recruited from the communities they serve so they have strong local relationships and they receive on-the-job training to provide the kind of the front line of care and in some settings it's things like child health assessments they may be doing family planning counseling they may be doing pneumonia or malaria testing and treatment in other cases there's a real focus on coaching people to be more engaged in their own care and to understand how to navigate the health system as it is and so the the main thing medic does is we build open source software and then partner with health systems to deploy it to use these open source building blocks to build custom applications that are tailored to the needs of that particular health system so that's that's really our focus as an organization by and large the team i lead medic labs is focused on research and development so we're building on top of this digital infrastructure it's it's been uh you know for for around a decade now we've been investing in improving in it and we're exploring new opportunities that might over the course of three to five ten years from now enable us to make new breakthroughs in how care is organized and delivered and how we address these equity and access gaps that are really the the focus of our mission great thank you for the thoughts everyone a second question reverend baker will again start with you so what unique solutions do you believe have the potential to generate impact in increasing health outcomes and then what barriers if any do you see in achieving this well i really really like what uh isaac presented there just in terms of designing particular interventions that are unique to the specific situation and the specific population that you're trying to address um one of the things that we did here was the congregational health network and i believe that the first thing we did that made it successful was its asset based uh we took a look at the community and assessed what are the assets of the community what what's what already exists that we can connect to other community health asset to actually make a difference when we connect the people to these resources uh the second thing is it has to be contextually and uh population appropriate uh we use congregations here because we took a look at uh hospital data and found that more than 70 of the people who came to the emergency room said they had been in the house of worship in the last 30 days so so we knew that the appropriate context uh that we were attempting to address health care issues was was congregations uh the next thing is um you know the social determinants of health are out there and we as an organization have to look at breaking down the boundaries extending into the community uh no longer sitting behind the walls of of uh health care institut institutions waiting for people to access what we have but extending an invitation uh meeting people people where they are which is really a biblical construct that we go into the hedges and the highways and invite people into the place of health and nurture uh the other thing that uh i've heard in our conversation is that we have we have to be able to address issues at a community level but also we have to be able to scale them across institutions so they don't exist in silos and then the other thing that we we attempted to do is we want to empower institutions that are already doing the work doing the ministry in the community to be successful at what they're doing and so we seek to empower congregations to be community health assets and actually recognize themselves as community health asset and have the community recognize them as community assets as well reverend baker thank you for sharing isaac we want to come over to you i would love to get your thoughts here want you to pick up on on anything reverend baker talked about maybe you've seen something similar but what unique solutions do you believe have the potential to generate impact um in increasing health outcomes you know reverend baker your your observations just absolutely resonate with my experience and maybe i'll start by saying my work is is mostly focused on digital health and digital interventions and so when we're building an application that's tailored to a particular community there are some common components of these applications often they involve messaging among health workers and patients often there's a task management or a work management component they can make sure help people make sure they're reaching the right person at the right time with the right service there are decision support tools that we provide that help people you know guide through step by step the the care protocols they need to support longitudinal records are an important part of these systems you know where you can pull up a profile for somebody you're about to meet and see you know when was the last time i had a visit with this person what was the last time they visited a clinic or a hospital and then finally these tools generate a lot of data and there are different uses of that data for the health workers themselves sometimes the patients and often the supervisors and the health system managers that are involved in making sure these systems all come together so that's kind of in general those are some of the common types of solutions that we work with but i think the you know if i could build on what reverend baker was saying the these technologies do very little if they're not designed in a human-centered way that gets people in in a particular community involved and saying what are their needs like what are they experiencing and how is your solution going to need to speak to that particular need and sometimes these are you know what are the health issues that that an individual or a community is going through maybe tuberculosis is really an issue that's hit this particular community hard a lot of them are institutional you know what are the assets that our local institutions here have what are the assets we're currently missing and you know if i could if i could share an idea that i often use to summarize all of these social and institutional factors it's the idea that the solutions we need are complex and and by complex what i mean specifically is that they don't have outcomes that are perfectly predictable because you're taking technology but then you're serving humans right and you have all these social and institutional factors playing a role and what that means when we look at the the medical evidence for these interventions is that you find some digital health interventions where the evidence is so good and the value for money is so good that you have gold standard randomized trials showing that they have almost the level of value for money as vaccines and then that same intervention that same technology gets implemented in another community and it doesn't have those same impacts and whether or not you're gonna have those impacts when you replicate again and again is fundamentally unpredictable and that's that's what makes these interventions complex so in my view the best way to be proactive about that complexity to get the the best outcomes as consistently as possible is to realize that implementing some new solution is going to be a fundamentally human-centered process and you need to to engage all these stakeholders along the way that that reverend baker was speaking to very eloquently yeah i think thank you yeah please reverend if i could what i hear isaac saying is he's providing a means to hard-wire the relationships that we're building in the community and that's the challenge that that we have we know that 80 of health outcomes are determined in the community not really in health care and so how do we hardwire you know we have a lot of soft relationships person to person but how can we hardwire those relationships to where they work automatically together how can we hardwire that community health worker into an electronic medical record so that the work the community health worker is doing in the community that is very valuable uh is accessible to the clinician in the health center those are the the things that i believe will break down the barriers and uh also provide greater health outcomes yeah you you you pick up on a really important point so when we talk about getting hardwired into the community and making these connections this is a part of what's really hard so even when we're trying to introduce tech solutions into the equation to solve some of these problems you still need the deep community involvement the connection for many many reasons but this is what makes it hard and isaac is you're in the at the state of washington uh dr baker you're in tennessee the communities are different and so what it takes to hardwire and plug in also very different uh really fascinating conversation i'm going to move us to the next question here and so as we talk about this being very hard a very hard problem to solve or issues to tackle let me get to the next question in that complexity um we all are we all know and are familiar with different levers that are available for all of us to pull and not only different levers but at different levels so the question is is what do you see as the key levers at a community or organization or government level to increasing the access of quality healthcare and isaac we'll start with you and then we'll go right to reverend baker sure sure so first of all you know if i could talk a little bit about more about medics context as an organization we're about 100 people around the world and our largest office is in nairobi so that's kind of headquarters and we have teams in kathmandu in dakar and kampala and then a little over a third of our team is working remotely from all over the world so even before covid you know we were like a lot of open source communities we had a substantially remote team and um the work that we do what the key levers are varies kind of with every health system it also varies in some pretty substantial ways specifically with the shift of looking at a low income setting or a least developed country and looking at a high-income country like the united states and so when we are looking at community health systems in say sub-saharan africa one of the observations that's in my view very consistent across settings is that there's under investment in the building blocks of a robust community health system and we have pretty good evidence about what those building blocks are it starts with you need to equip health workers in the community people who are who are from that community and and know how to navigate it well you need to give them good training they need regular supervision they need to get paid a living wage they need to have equipment getting for example personal protective equipment in the context of covid has been very very challenging getting vaccinations for health workers in most of the world remains very very challenging right now and you need other equipment like diagnostic tests and essential medicines and then you need a good supportive digital tool and so often i describe these building blocks and and i hear you know that that doesn't really seem like a software problem but my view is that it's absolutely a software problem if you have uh supervisors who aren't receiving their salary and therefore they don't check in with the health workers and so you see lower engagement you see it in the data that people aren't using your digital tools uh to the greatest effect that they that they could and so i think that when i try to think about that across levels across community across organizations that deliver health care across organizations like medic that support health care with a specific product or service and then all the way to high-level government policy what i think you need is is these different types of institutions in the public and private sectors working together with some agreement about what the building blocks are you need to be strong on fundamentals and when you do that the evidence is actually really good community health interventions have great evidence for improving health outcomes in a range of areas if you're strong on those building blocks right i certainly echo uh what isaac is seeing there uh i i tend to say that on a community level we have to recognize that people are the pathways i mean we've been there's been an oral tradition throughout the beginning of time and so the people have become a pathway for communities things that get passed down from one generation to another ways of addressing issues get passed down from one generation to another so that there are those natural pathways that people provide so investing in the people who are in the community that we're trying to serve is really one of the best ways that i think we can increase the quality of health care again as isaac is saying uh those people who are on the ground actually doing the work uh we have to realize that there's a blended intelligence there they know the community you know we we may have clinical data and clinical statistics but they have an intelligence about the community that allows that clinical intelligence to be incorporated into that context so investing in the people who are the pathways uh a wage that's viable for them uh bringing technology to them not assuming everyone has a a smartphone or access to a smartphone and again um understanding that is person-centered that everybody's pathway everybody's journey is not the same uh i think one of the things that that institutionally we get caught up in with organizations is credentials credentialing from you know healthcare organizations to government organization uh we've got to find a way to actually give credence to the people that you might call the boots on the ground and recognize the importance of of non-traditional community health assets you know congregations barber shops beauty shops all of those places where it's not traditionally looked upon as a healthcare apps asset but there's an old tradition going on there where information is exchanged and also when we come right down to it every community health worker needs to be able to build uh they need to be able to charge insurance companies uh government providers they need to be able to do that and again that's the people being the pathway so i reverend baker i love the the people being the pathway and uh you mentioned bringing technology to the people and i'm paraphrasing a bit now but using technology as an enabler in the pathway my next question in kp i'm gonna i'm gonna bring you in on this one as we've been having this this discussion the next question is is dovetailing off of what reverend baker and isaac had just shared and that question is as you're implementing technology in these communities um as an enabler what are some of the barriers to that implementation so if you want to introduce technology and you talk a bit about some of the the barriers there so kp will we'll start with you and then isaac and reverend baker please jump in yeah so i think um again because everything i do comes with this lens of health equity and digital inclusion and what's interesting to me is that you know as reverend baker has mentioned in terms of community models and boots on the ground technology alone is not a panacea when we really think about community impact we think about vulnerable populations we think about better health access and wellness for all there has to be an on the ground component right so again with the promise of digital innovation there's so much that can happen but if we don't have a compliment in really strong models driven by community intervention by people of the community serving people in their communities and then technology being an enabler of that and we're going to fall short so also when i hear isaac talk about you know the work they've been doing in sub-saharan africa it's very similar actually when you think about those contexts when we look at african countries there is limited infrastructure when it comes to you know a lot of the things that we take for granted in the us but everybody has a mobile phone and there's mobile infrastructure everywhere so i think some of the models isaacs has talked about bridging technology and community-based intervention in his context actually relate one-to-one to what reverend breaker is talking about when we talk about boots on the ground and really innovating at that grassroots level kp i'm gonna spin off that question uh because i like the i like the the boots on the ground idea and it seems rather simple when we say you know we want those who are closest to or in the community we need to engage them to help the greater community what what's a barrier to that what seems like such a very simple you know idea to start to tackle some of these issues why can't we scale it like what's the barrier there so i think when it comes to healthcare part of it is that how we traditionally think about healthcare access is through healthcare providers right so typically when we think about solving a health problem we think about the physician we think about the physician's office or those type of contexts but when we even look at kova 19 response today it's really required using trusted organizations and trusted individuals in the community to drive response and that is not necessarily always through our healthcare provider so what reverend baker's talked about is churches or you know isaac's models working with other community organizations so i think it requires us to expand our notion of the ecosystem of organizations that are involved in delivering health and wellness and they also need to be resourced right so if we only resource healthcare systems we'll still fall short because they aren't the only actor involved in delivering health and wellness we've talked a bit about barriers to technology and again loving people as a pathway can you talk a bit about what that looks like practically in the community what are some of these barriers that we're dealing with when you're trying to implement and use technology well i think disparate patient records is one of the things that we're going to have to get our arms around across the continuum of care so you know you've got a pcp hospital state records we're going gonna have to come up with a way to have a complete record that's person-centered for that individual so so addressing you know disparate patient records um and everybody needs to have access to it so there there are a lot of different uh directions you can go in that uh you know then you have urgent care and er and all those different things that the patient or the person can access that create separate really identities for that individual and you know there's there's just a lack of integration of those things across the continuum of care so uh i would lift that up as one of the larger berry thanks thanks for having baker isaac any thoughts yeah yeah that's certainly a barrier you know i've seen in our work at medic and it's an important one the the first one i'd share is maybe to zoom out a little bit when we were getting started at medic i think it would be fair to say that in the least developed countries there was a market failure for digital health there was not a sense of who might pay for digital health in a way that could make for viable companies government for their part wasn't technically prepared to build these kinds of systems and from civil society mostly what we saw was researchers smaller innovators doing interesting exploratory pilots but a lot of efforts that were not sustainable or didn't see replication in scale and so these bunches of little pilots came to be talked about critically as like a pilotitis like it was a disease of all these pilots in digital health especially in the african context and in my view the biggest barrier for for that early period as this market was forming was that people would say things like you know how can you invest in like a digital technology it's going to be innovative but it's going to be expensive in a health system that's struggling to pay for essential medicines or to pay for health worker salaries and while i'll acknowledge i certainly wouldn't want to spend money on smartphones when you don't have antibiotics i also think that that's a total failure of imagination and what we were able to show was that if you make smart investments in technology that make it easier and faster and more efficient to deliver care that is higher quality you actually yes you spend money on digital but you save money for example on paper and on fuel of going out on motorbikes and trying to find people and you get people more engaged in their care and the health system can be functioning better and what you what you show over time is is that it's not a either or it's not either technology or drugs it's we need the right level investment to solve the problem and and the risk with a failure of imagination like that is if people can't imagine a solution if they can't picture it sometimes they don't even want to work on the problem and so the in the early period the the biggest buried overcome was people believing we could do this and now we're in a phase where i think people really do you know even in the least developed countries there's really good evidence that not only the digital health can improve care but actually that these systems are scalable and i think that to overcome that we needed to find creative ways to pool investment and it needed to be you know in places like kenya or malawi where i've done a lot of work not just pull it nationally but you needed regional and global collaborations so so the the kinds of organizations that are set up to solve these problems that can build the right kind of engineering team need to be global or at least international but then at the same time as we were talking about earlier you need local ownership in order to get institutions involved address the human complexities and make these systems sustainable and so the reason i think this market failure existed for a long time is how do you pool investment and have local ownership and open source communities have really emerged as playing a very important role in particular technologies that are developed as a public good and what we're seeing now is that once you have some core infrastructure that's developed as a public good governments know how to get involved and support these systems policy wise the private sector both locally and the global private sector has new ways to engage and then all the civil society organizations that are actually the boots on the ground are delivering health care they're getting better systems at a much lower cost so so that's in my view the biggest barrier that our field has been able to overcome in the last 10 or so years is around using public goods to catalyze these initial barriers to creating a functioning market great great thank you so we're nearing the end here and i've got i've got a couple more quick questions for you um but very interested in this next one which is where do you see the most promise for progress in the next five 10 20 years when you scan when you scan the environment you know it's interesting um if you asked me that question maybe two years ago i would have responded differently but where i am today is that when we think about health disparities you think about health equity and really moving the needle a lot of our challenges are actually data problems so let's take the state of colorado for example and i know this is an issue across the country when we think about data that tells us about race ethnicity and language for our population at scale or or data that tells us about sex gender gender identity at scale we have huge gaps and so frankly you know my view is you can't change what you can't measure so if we don't have complete data on race and ethnicity then how are we going to effectively measure reducing disparities through that lens and so i think some of the biggest promise i see and some of the things that i know colleagues are working on across the country and that we're working on here in colorado is how do we capture that data scale more readily how do we make it available to everybody organizations so on and so forth so that we can be accountable because ultimately to me that's the biggest opportunity is that we can create more accountability towards reducing disparities you know so on the one hand in our panel we've heard a lot about boots on the ground and innovation around community-based models but if that's happening in a fragmented way and we don't have a picture at scale of how we're moving the needle then it's really hard to move towards that like systemic social change and so to me i see that as the biggest opportunity in the next five ten years i'm in conjunction with what we've heard from our great panelists about community-based innovation i think for sure it's going to be in community health if if we're going to be able to address healthcare issues they have to be done at the community level has to be done with the blended intelligence of community and clinical and perhaps it's even more so we're going back to the future going back to where healthcare really existed years ago before we got into the acute care model there was a community care care model that existed so i think technology can enable us to get back to that communicate care model where communities were involved in the care of people communities were involved in the social construct that allowed people to flourish health-wise and so i i think it's definitely going to be in the community and the technology that's being developed that kind of ties community together with health care institutions and really brings the health care institutions into the community i think that's where the progress will be i'd echo that as well i i think that smart investments in community health systems are going to continue to be some of the most exciting opportunities in health generally and in digital health in particular you know when you have health workers who are out in the community their work is different than the physician at a hospital their work is more logistical they're finding people they're meeting people and they don't have 10 12 14 years of medical training and so the value of a really supportive digital tool is greater i think it's a more highly leveraged opportunity to use technology to improve care so that's that's really exciting and i think the period that we're in for the next five years is that these systems which are working in isolated pockets they're scaling up and i think we're seeing that in places across the us and i think we're seeing it in africa and south asia and around the world which for me is really exciting when we look ahead a little further say 10 years out i think that's when the innovations that we're incubating right now they start to scale up if we're doing our jobs well they're scaling up in 10 years and some things that that we're really following closely you know device ownership it's mostly phone ownership is getting higher in communities around the world and so we're seeing new opportunities to have health systems reach out to patients and home-based caregivers directly give them new ways of accessing information and opportunities to engage in their own care my hope is that these channels for health information will stay well grounded in the care delivery system so the the place you reach out on your mobile phone will be connected to the health worker who might show up at your front door that's my hope another big focus for us is around new applications of data science and i'll just say that what i think we're learning so far is that building and applying useful algorithms is much much easier than doing so responsibly in a way that thinks through all the risks and potential unintended consequences particularly when we're doing this in a international context when we have a real patchwork of different data protection regulations and different expectations from health workers and patients around the world about what's being done with their data so so building these systems in a way that really does scale globally while being responsible with people's data helping them feel secure and that they're having their privacy respected i think is a big challenge but a big opportunity and then you know sort of the the 20-year time horizon is basically predicting the future that it's really hard to do but i i love those kinds of questions for my part i think if we're looking that far into the future one thing we know is that climate change is going to be one of the the great problems of our time and a lot of people don't yet see climate change as a health problem but from where i stand when we're talking about adaptation of climate change the communities that are going to struggle the most with adapting are disproportionately not communities that have created the problem and when we just talk about adaptation you know we're seeing major droughts already in parts of kenya for example really unseasonal weather patterns when we just ask people to adapt we're really asking people who didn't cause this problem to bear the brunt of it and so i think as we we talk about climate justice we're going to need to realize that climate justice is about justice and health and as we respond to climate change we're going to need to address the range of health issues like malnutrition like secondary affections like the range of health issues that emerge when there's civil conflict when there are natural disasters like floods all these range of health issues are going to increase in certain communities and not others and i think investments in community health systems are a big part of how we're going to need to respond to climate change in the next 20 years i'll stop there thank you great uh thank you i i think we we could do another full hour on what you both just shared um in in your last two answers last really quick one uh we've talked about this work being complex we've talked about the need to get into the communities we've talked about barriers and different levers to pull it's hard so given that it's hard what motivates you to continue your work to tackle these challenges in terms of health equity and access and resilience well for me it's first of all calling you know i feel called to this and i think that's what a lot of community health workers do they feel called to it that's why their commitment is so strong and then i see myself as having the ability to stand in the boundary i can stand in the boundary uh between the two communities and that kind of gives me a a different insight being a community pastor and working in the health care system for over 20 years kind of give me a dual perspective i know what my congregants are dealing with i know what's happening in the community i'm involved there but i also see the health care side of it so it allows me to to stand in the boundary and bridge the gap and i think that's there's a great need for that again i feel called to do that isaac for my part you know i i'd say that i love getting to go to nairobi meet with our team there and as a designer as a human-centered designer a lot of my work is about getting out and meeting the people who use our technology one of my favorite things in the world is to to go with some of our designers some folks on our research team and meet up with a community health worker and do house visits and i learned so much at those house visits and a lot of what i learned is about what motivates the community health workers you know why do they keep showing up some of them have been community health workers since i was a little kid and and they're still doing it and it's a remarkable thing when you have an opportunity to do a house visit where a kid was was recently treated for malaria for example and they're better now you know i had a a grateful mother want to give us oranges one she had a fruit stand by her house and she wanted to give us oranges another thing that's happened repeatedly you know we talk for a while and then it's time to get up and go and the family asks if they can pray for us to send us on our way that's a remarkable thing to get to be part of that kind of interaction in a community a world away from my own yet very humanizing in a very familiar way i love that and i don't get to do it as much during covet i don't travel for work as much but it's a big touchstone for me having been in this work for some time that i think you get to have those moments and over time it does build your resilience to stay involved and stay committed to these issues one more question which i think is an important one because you along with all of our panelists when i think about the work that you've done um and the work that you're continuing to do it's important that you stay motivated so what motivates you kp to continue your work yes it's it's um it's deeply personal for me so you know my parents are from ghana in west africa i was born in the us so i'm an american with ghanaian heritage so issues of health equity to me are not just about our society in the us and that i believe deeply that we we need to ensure that we can make health and wellness something achievable for all and that people don't live in fear that they can live their best life but for me having immigrant parents that also folds into a global narrative right about how we think about global health and global disparity and that's why you heard earlier we've you know my background is having done this work both in the us which is home for me but also internationally where i have a deep connection because i have immigrant family so to me that's what motivates me is deeply personal i want the world to be a better place for my kids um i want to see the needle move like i don't just want to see us talking about this and writing policy i want to see measurable change and that's what motivates me every day gentlemen i'm i'm going to end where i begin and i'm going to say thank you again your work is truly inspiring we appreciate you spending time with us uh sharing your your perspectives and also your experiences um you are welcome back anytime um to not only work with um alongside uh but also to keep these conversations alive so thank you again we really appreciate your time thank you for having us pleasure to be here thanks thank you so much

2022-02-11 08:58

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