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April 2014

mHealth: For Richer, for Poorer
By Lindsey Getz
For The Record
Vol. 26 No. 4 P. 8

As health care increasingly becomes consumer focused, the mobile health field—or mHealth—has exploded with opportunity. Patients are using tools such as mobile apps not only to track their own health data but also to communicate with providers in an effort to receive better overall care and better outcomes.

While mHealth offers great opportunities for already well-served populations to improve their health and live even healthier lives, the technology’s ability to impact the well-being of the underserved—both here and abroad—generates even more excitement.

“Today, consumers, developers, entrepreneurs, and medical professionals alike are discovering new ways in which mobile information and communication technology can be leveraged to track behavior, collect health data, and provide health services and information to improve health outcomes,” says Jon Dimsdale, MPH, director of programs and research for the eHealth Initiative, a nonprofit that brings together health care leaders. “Patients and their caregivers, friends, and families are spending less and less time within the traditional four walls of a doctor’s office or hospital, creating a huge gap for mHealth to fill and help people learn about their condition or treatment as they manage their health.”

Who’s Using mHealth?
Dimsdale notes that because mobile phones and smartphones first were adopted primarily by the affluent and younger, urban populations, the devices may have developed a reputation as being a tool for the elite. However, mobile phones have rapidly penetrated other demographics as the market has matured and prices have continued to fall. In fact, mHealth is reaching almost everyone. “Today, approximately 90% of Americans own a cellphone, and 60% own a smartphone,” Dimsdale says.

“I can say without a doubt that mHealth is a great equalizer,” adds Joseph C. Kvedar, MD, founder and director of the Center for Connected Health at Partners HealthCare. “As far back as a decade ago, we were watching people in developing countries buying and reselling minutes and making great use of mobile tools.”

While the marketing of certain health apps and tools may have created a perception of mHealth as technology for the wealthy, the truth is poorer populations are a key demographic, says Donato J. Tramuto, chairman and CEO of Physicians Interactive and the founder of the nonprofit Health eVillages, noting that the goal is to expand mHealth’s reach to underserved areas. “This is a burgeoning market not just for technology companies but also for telecommunications companies that provide the channels of communication,” he says.

In the United States, Tramuto says the move toward a pay-for-performance, outcomes-based health care model under the Affordable Care Act will create a strong need for mHealth solutions. For example, mHealth may be a means of closing care gaps, particularly in underserved populations. “Smartphone adoption among the poorest patients in the Boston area is currently hovering around 65%,” Kvedar says. “One of the reasons we started working in mobile health at the Center for Connected Health is because we wanted to reach an underserved demographic. While almost none of the underserved population could afford high-speed broadband Internet access throughout the home, they likely could afford a mobile phone, so we started a texting program.”

Around the World
But mHealth isn’t changing lives only in the United States. “In India, a country of 1.2 billion people, 50% don’t have toilets, but 75% have mobile phones,” Tramuto says. “That is a tremendous market opportunity that the parties vested in mHealth cannot afford to ignore. In the work we have done throughout Health eVillages, we have collaborated with organizations like the Lwala Community Health Center to provide mobile health to the poorest sections of East Africa with extraordinary outcomes. mHealth is about moving the needle from the practice of medicine to the science of medicine.”

Alain B. Labrique, PhD, MHS, MS, director of the Johns Hopkins University Global mHealth Initiative, says even before any formal mHealth systems were developed, populations in developing countries had been using mobile phones’ most basic function—the voice call—for health purposes. Labrique’s research shows that mobile phones were used in remote, rural communities of South Asia to call providers, mobilize financial resources, request medical advice, and arrange transport.

Further research revealed that 71% of households in a resource-poor northern district of Bangladesh owned mobile phones even though only 23% reported having access to electricity. “Nearly a quarter of homes reported using their phones for an emergency health purpose, again, absent of any formal mHealth systems,” Labrique says. “Everyone is taking notice, from governments to global health agencies, of the possibilities which mobile connectivity brings to public health connecting people, compressing response times, and creating new opportunities to engage and improve health.”

Looking Ahead
The future looks bright for mHealth, Tramuto says, noting that the technology should continue to reshape the lives of the underserved. “As mHealth technology continues to evolve, the price of mobile devices and apps is going to continue to come down, making them even more affordable for the poor around the world,” he says. “The ability of a person to have a positive impact on their quality of life will improve as the gap in the point of care continues to shrink between patient and physician through mHealth. With better health comes the opportunity for a person to contribute more to society, even in the most underserved areas around the globe.”

Labrique agrees, adding that as mobile technologies continue to grow in sophistication and shrink in cost, it will fuel new possibilities. “We can imagine, in the not-so-distant future, a mobile phone being part of the core set of tools provided to every new community health worker or a temporary phone connected to essential downstream services and health information being provided more readily through mobile communication,” he says. “Through these visions and the research that accompanies new scientific breakthroughs, we build on the legacies established by public health giant John B. Grant, whose work established the models for training China’s ‘barefoot doctors’ in the 1960s and 1970s, and Carl Taylor, founder of the academic discipline of international health and proponent of the vision that empowered communities and frontline health workers to shape their own futures. Without mHealth, these leaders changed the delivery of care to disconnected populations across the globe. Just imagine what may be possible to accomplish under a new paradigm of universal connectedness.”

Education is critical to the effort to expand mHealth opportunities across economic lines. However, education may not come in its traditional form. “In many of these underserved areas around the world, knowledge of modern medical practices can be very limited and limiting,” Tramuto says. “We are seeing this even more in the tumultuous regions of the world, such as Afghanistan. The Taliban are destroying medical textbooks but not devices, so making textbooks available on mobile devices can help those medical students in Afghanistan have the most up-to-date information available.”

Labrique adds: “From Kabul to Kentucky, health information is becoming accessible to families when and where they may need to access it. The democratization of information may lead to an Arab Spring in health care, increasing accountability and improving outcomes.”

— Lindsey Getz is a freelance writer based in Royersford, Pennsylvania.