The next generation of public health won’t involve the medical world

I received my Masters in Public Health from Johns Hopkins in 2006. I took a course on transportation safety where we focused on designing roads for safety, making airlines safer, and decreasing the risk of medical helicopter crashes.

In 2007, I worked for Public Citizen, Ralph Nader’s consumer advocacy group. Ralph’s book, Unsafe at Any Speed, forced the automobile industry to focus on converting their cars from steel death traps to smart machines teeming with airbags, safety belts, and crumple zones. As a result, millions of lives have been saved all over the world and automobile companies now advertise and compete based on safety. And in just the last fifteen years, our highways have gotten much safer:

The next generation of public health wont involve the medical world

But what struck me most in my public health training was the deep codependent relationship public health has with the medical world. Understandably so, public health has traditionally been mostly about epidemiology, biostatistics, and medical services. In fact, the accepted definition of public health is:

the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.

But the next generation of public health won’t involve the medical world. We’re currently seeing large companies like Google enter the health space. Google Health believes that “better health comes from better information” and “you should have easy access to your own health information – anytime, anywhere.” While this is a worthy mission, Google is very much missing the mark. I’m not aware of any evidence that access to medical data or everyday wellness data changes long-term behaviors or a population’s health outcomes.

But Google is working on a much, much more important initiative that, if successful, could be one of the greatest contributions to public health the world has ever seen– data-driven, crash-proof “brains on wheels“– self-driving cars that aware of the road, of other cars, and of passengers. Imagine a world where the highways are as safe as the skies (45,000 planes take off and land every day in America).

This is Public Health 2.0– data-driven, technology-enabled, real world solutions that take an active risky everyday behavior and turn it into a passive, nearly error-proof experience. Public health innovation won’t come from your local woefully underfunded and understaffed public health department. Public health revolutions will come from tech companies that have almost zero connections to medical care.

Jay Parkinson is a pediatrician and preventive medicine specialist and founder of The Future Well. He blogs at his self-titled site, Jay Parkinson + MD + MPH.

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  • http://Abnormalfacies.wordpress.com Jim

    I may be nitpicking, but I disagree – innovation will certainly come from without, but where will the direction and evidence come from?

  • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

    I’m not sure I understand.
    Mr. Nader’s book was an expose on the lack of safety in cars. He may have highlighted the problem, but he did not provide any innovative solutions. Those came from the auto industry, i.e. from professionals in the field.

    I agree that computers are part and parcel of everything we manufacture today, but unless you have expertise in a particular field, you have no idea how to apply computers to that field.
    I don’t know what Google is doing about self-driving cars, and that may be a misquote in the post, but I am fairly certain that Google on its own will not improve health, or cars for that matter.

    I think there is reasonable agreement that the greatest threat to population health (in the US) is overeating and underexercising. The only way I can see a technology company being able to solve this problem is by manufacturing an implantable miniature computer that will quickly zap you whenever a Big Mac comes into close proximity, and zap you again starting at a preconfigured time every day until it senses that you are working out for the prescribed amount of time. Of course somebody will have to legislate a mandate to have those devices implanted in people and somebody, no doubt a technology government contractor, will have to remotely manage and control the devices.
    Who needs intelligence when you can have implantable Artificial Intelligence (AI), which I assume is why Google is mentioned here.

    • John

      I must respectfully disagree with your comment that overeating and underexercising are the greatest threat.

      The obesity epidemic is not only over-discussed, the medicine side is overexposed and not particularly well developed. There is currently absolutely no biological linkage between weighing more and health related diseases. The best that exist are weak correlations through epidemiological studies. Suggesting that obesity is the greatest threat is simply an exaggeration of a minor problem.

      This is not a mere philosophical quibble. Obesity is one of the largest health related industries either in research, public health, or private industry. As a result, there is an increased dependency on feeding this industry to ensure all parties are paid. Only in extreme cases is obesity a serious health hazard. Unfortunately, in the current state of affairs the common statistics-66% of citizens are obese, etc- are misguided attempts to corral a larger than necessary population into believing that its “sedentary” lifestyle is leading it into oblivion.

  • http://www.bryantsstatisticalconsulting.com Donald Tex Bryant

    I believe that a revolution of information will be coming to our local health departments soon, information which will empower these departments and the CDC to greatly improve the work that they do. One of the meaningful use requirements in the Federally funded EHR reimbursement program for physicians is that data be shared with health departments. This requirement is not in place yet but should be in a year or two. Armed with data from physicians and hospitals in their service area, health departments will be much better able to monitor health trends and take preventive action where necessary. Overall, I believe that the capacity of health departments will greatly improve over the next few years with this new data source.

    • doc99

      Pardon me, but once this “data” gets out, there’ll be no stopping it. Sic transit gloria HIPAA.

    • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

      And what “data” might that be? What is it that the CDC and health departments cannot get from insurers and commercial labs that is held in a physician EHR?

      They have all diagnoses, all meds, all procedures and all lab test results, already in structured format ready to be analyzed. Payers are basing the entire financial future of their corporations on this data and doing very well, so it must be rather decent data. So why aren’t we mandating that payers and commercial labs report to CDC and health departments?
      What are we spending billions of dollars on? Social Histories? The stories in HPI? Is this really about informed decision making?

  • Karen Harker

    Actually, only a small portion of the improvements in lifespan and health of people over the last 150 years can be attributed to medical care, and only slightly more to immunizations. Improvements in sanitation and hygiene have made the largest contribution. Medicine has the advantage of having relatively immediate effects and “miraculous” results are more remembered than its failures. Public health is a multidisciplinary field, taking knowledge from engineering, chemistry, biology, information science, sociology, anthropology, psychology, probability & statistics, and medicine. This is public health…

    • ninguem

      Exactly.
      “The next generation of public health won’t involve the medical world”

      I’m not sure if it’s fair to say the PAST generation of public health involved the medical world.

  • ErnieG

    The next generation of public health should involve the dismantling of the western diet. I’m not sure the federal government is ready for this task- too many times it sides with the business interests of food-like substance producers rather than the interests of the American individual, promoting easy access to refined packaged caloric sugar rich foods and grains, rather than promoting healthy eating. I think Michael Pollan is right.

    • http://Abnormalfacies.wordpress.com Jim

      I whole-heartedly agree with each of those statements. In many ways, the government created this monster.

      What’s funny is that the core of Pollan’s message is so very simple, but dietary guidelines are so confusing. It’s no wonder people throw up their hands in frustration when it comes to this subject.

      • John

        While your answer seems a bit more nuanced, I would like to take a moment to suggest that obesity itself and overeating as well are not the reasons why our society’s current health status is as poor. Much as you stated, it is more due to the types of foods we eat than over indulgence itself.

        • http://Abnormalfacies.wordpress.com Jim

          John,

          I think we’re on the same page there. I’d like to attack all of those problems, but if forced to choose between simply weight reduction and a dietary overhaul for a patient, I’d choose the latter. Of course, one may follow the other…

          Let’s not kid ourselves, though: over-indulgence (as a product of our complete detest for delayed gratification) is the root of a lot of problems in our society.

          (In my opinion, at least)