The biggest problem that I face in designing a solution in healthcare is in providing customer delight. This is because, my entire education and training has revolved around finding the correct answers and the thought that something maybe suboptimal or even incorrect is akin to a loss of manhood.
As a medical student, I often wondered what the fuss was about in optimally treating people, but more than two decades of clinical experience has taught me that medicine, especially human behaviour is not always exact science and it is only empathy and continuous iteration will move us in the right path towards success.
Success to me is a simple, long term solution to a very complex problem, which alleviates the pains of the patient and the person, easy to use which delights the client that he now encourages other to use. The biggest problem that we face in healthcare is the inability to dissociate the patient from the person. It is the fine line between care and intrusion when breached that causes resistance and rejection. How clear do we need to stay from that line is a matter of judgement which is ruled by extremely personal reasons and has nothing to do with either the socioeconomic or educational attainment of the person. To find a solution of both subjective and objective needs of a person and working in an extremely sanitised legal framework is a challenge. The question of course becomes more difficult when extrapolated to a wider population context.
With the ubiquitous availability and encouragement to build more technology, we are developing a tendency to leverage more and more technology in healthcare with perfectly good intentions. Some of these should definitely stand the test of time. But many may enjoy initial success, but the long term viability maybe questionable. The most important question is to understand that the bulk of the problem lies in dealing with the chronically ill person. In this group, sometimes dealing with the person becomes more important and the challenges are daily over a lifetime. Many of us are happy seeing good 5-year data, but from an overall perspective what is 5 years in the life span of a person with diabetes.
So, the investment and design needs to be like developing infrastructure where the real returns are over a much longer period. It is more important to develop processes, thoughts and culture which will create the environment for further innovation. This will also help innovators understand client behaviours better and clients will also be tuned to a slightly changed style of practice. The difference in healthcare is that though necessary, innovation directly affects the human body and lives. Greater effort is needed to win the confidence of the person and in most cases ill or potentially ill people, who may have different psyches. Another issue is that a solution means instant relief and gratification for some, which is difficult to fulfill.
In my personal experience, I`ve learnt more about ill people outside the clinical setting, when they opened up more and really began to understand what really ailed them and their illness was not always the primary concern. Secondly, different people`s response as well as approach to disease are different. People communicate about their problems differently, some are open, some would only speak to certain people, so even extensive research may not provide accurate results.
So there are no right or wrong answers in healthcare and a rocky road awaits all those who chose to tread this path. But that is the thrill with a cause.
The primary focus of diabetes management is centred around medical and behavioural modifications However, factors which determine outcomes in diabetes sometimes revolve around where people are born, live grow and age. As much as influencing medical and behavioural factors are important, it is also vital to address factors like income, education, housing and access to nutritious food, employment insecurity, low educational attainment and poor living conditions as these have a huge bearing on the results of the disease. These factors are collectively called social determinants and are central to the development and progression of diabetes.
Individuals with lower income and less education are 2 to 4 times more likely to develop diabetes than more advantaged individuals. This works in a cyclical process and constant pressure to make ends meet leads to chronic high levels of anxiety and stress leading to unhealthy behaviour like smoking, drinking, use of illicit drugs, self-destruction and neglect. Coupled with this is unhealthy eating and lower levels of much needed exercise, all of which contribute to deleterious consequences. Chronic stress by itself is a harbinger of further health problems.
The disadvantaged person further may not be able to access health related resources which are necessary to manage diabetes in a strict manner and this may lead to a further downward spiral. In health care systems that are not able to effectively support people with diabetes, sourcing of medications like insulin maybe an issue which eventually is fatal. Further limitations in employment opportunities and less productivity along with low educational attainment may further preclude opportunities to access resources.
Social determinants have assumed more importance as in this day and age, we do live in a more `obesogenic environment`. This consists of a more sedentary lifestyle and availability of more energy rich foods. Leading a healthy lifestyle is more expensive. In addition, poor women are more vulnerable to poor nutrition during pregnancy which can raise their child’s vulnerability to the risk factors for diabetes later in life. Since the prevention of type 2 diabetes centers around behavioural and lifestyle modifications of diet and exercise, economically disadvantaged people have less access to it. This leads to a vicious cycle.
The consequences are far from ideal as this puts considerable amount of strain on the already stretched economy as poor health leads to poor productivity and a lower GDP. Though this is glaring in the developing world, the developed world is far from escape. Increasing unemployment with the shift in global economic dynamics have left thousands in the lurch who will be difficult to manage.
The problem with diabetes is that it is a lifelong disease and is severely affected by a person`s day to day activities. It is a difficult disease to manage on the long run, with huge numbers being undiagnosed and presenting late in the cycle. So even with astute clinical and behavioural management, if the social determinants are not taken care of, then the outcomes maybe poor.
The solution is not simple and needs cross functional coordination across government bodies, private players, organisations like WHO, IDF etc. Mobile Health does have a role to play here in improving accessibility to healthcare, keeping in mind the buying capacity of economically disadvantaged people. But the hidden cost of poverty which lies in travel and paying premium for facilities which is taken for granted for more privileged people will far offset the cost of mobile health. Up scaling of mobile health will definitely drive costs down making this more and more affordable. With the current ever expanding penetration of mobile internet even in areas previously `communication blind` will open up opportunities for healthcare. Secondly, targeted education of the population using innovative strategies is of immense value.