E-health and development

28 05 2012

Maria Cristina Rosas

Professor and researcher at the Faculty of political science and social of the UNAM. mcrosas@tutopia.com

Advances in medical science have helped to improve the quality of life of millions of people around the world. A quick look at the evolution of the longevity of persons corroborating: in 1900, the hope of life on the planet was only 31 years and even, among the inhabitants of the more developed countries not lasted beyond the 50 años; in the mid-20th century had already raised, in promediomientras than in, a 48 años, While in 2005 came to the 65.6 años, and to the 80 in some nations such as Japan. It is estimated that in 2030 the life expectancy of women in countries such as United States wilyearse to 85 años.

Other accomplishments that exemplify the benefits of scientific research applied to medicine include the eradication of smallpox; the virtual elimination of leprosy; the reduction of polio cases with a view to its complete abolition in the coming years and the possibility of reducing in 40% the death of children under the age of 5 years in the following five years.

With everything, much remains to be done. This year will die 10 millions of children before their fifth birthday because of any infectious disease that could be prevented. Of the 136 millions of babies that are born each year, 4 million die before the first month of life. Also, a few 70 millions of moms and babies are excluded from the health systems in the world. Another daunting figure is that 530 thousand women die during pregnancy, When dan light or shortly after childbirth, year after year. To make the scenario more complicated should be noted that as the world population increases their life expectancy, one of the greatest challenges for the health systems of countries is dealing with more cases of non-infectious and chronic diseases of adulthood and aging. It is known that a 24 millions of people suffer from dementia now and every year joined 4.6 millions of individuals with this disease, being in developing countries which have with the 60% of all cases.

To meet these challenges is required, In addition to material resources, qualified personnel in this category there is unfortunately a significant shortage of doctors, enfermeras (os) and support staff. The World Health Organization (WHO) points out that missing a few 4.3 millions of doctors, enfermeranurses others in order to provide health services to all people. Also, prevailing unequal distribution of global health professionals, given that the 30% of the 59 existing million are concentrated in United States and Canada, While in sub-Saharan Africa is only the 4% the doctors and nurses (os) available on the planet, Despite being the region that concentratesI 25% of all existing diseases.

Given the magnitude of the challenges described, needed to improve societies access to health services and it is here where the technologies of information lie in option that could contribute to the strengthening of the well-being and quality of life of human beings.

Telemedicine at the e-health

The e-health has its roots in telemedicine, This is, the practice of health care based on the use of audio communications, video and data, for the purposes of diagnosis, query, treatment, education, and transfer of medical information, among other servicios.1 here the interactions occur doctor doctor, either, from doctor to patient.

The practice of telemedicine is part of telehealth, concept covering all uses of telecommunications, with the help of computer, and that goes beyond the clinical aspects of health care. The concept of telehealth was promoted by who in 1997 (e) involving doctors, Administrators, patients and family and the population in general. As program, Telehealth typically includes remote diagnosis, the teleadministracion, the tele-education, and the General. One of the great advantages that telemedicine and tele-health is its contribution to overcome the distance, so promoting equality of access to services that are not available in remote communities, rural, and even urban, either where the physical coverage, for various reasons, It is not feasible. In this sense, through telemedicine and tele-health seeks to transmit data, voice, images and information rather than physically move patients, health personnel and educators, What would improve, in principle, access, the timeliness and convenience, decreasing, also, travel costs. Is considered that through telemedicine and telehealth, users of health services could become active participants monitor their own well-being with greater ease, Amen that would be able to access educational programmes to foster their knowledge about various health aspects in their daily lives from the comfort, convenience and safety of their own homes or very near. Another aspect to consider is the use of telecommunication among health professionals when they provide health care, or even for purposes of training or other.

As a result of the development of telemedicine and telehealth is the e-health, also known as digital health, concept referred to the use of new technologies applied to the management of health systems. WHO refers to the e-health is defined by the use efficiency and security of the information and communication technologies (ICT) in favour of health and related fields, with a view to contribute to strengthening and improving systems and health outcomes.

WHO also explains that "the e-health can contribute to the strengthening of the health systems of several modes": improving availability, the quality and the use of information and data through the strengthening of health information systems and public health surveillance systems; perfecting health workers and improving their performance, because the obstacles that create distance and time thanks to telemedicine and medical training shall be deleted; improving access to existing global and local information and knowledge; "and promote positive changes in the way of life to prevent and control common diseases."2 It should be noted that the concept of e-health was driven in the World Summit of the of the information society held in Geneva, Switzerland, in 2003.

Priorities and realities

For who, then, the e-health is a priority and therefore from 2005 instituted the Global e-Health Observatory (Global Observatory for eHealth) It seeks to provide the States members of information and guidelines on practices, policies and standards in this area. Whereas at present who has with 194 Members, the scope of this initiative are promising. However, so the cibsersalud fulfill its fundamental purpose, requires, among other things, infrastructure. In this respect, in a survey in 2006, the who found that since he began this century, the e-health has experienced considerable expansion, situation that contrasts with the previous decade, When was its development very slow. With everything, Despite its rapid growth in the new century, There is a correlation between the level of income of the countries and the development of the sector, so the e-health is much more evolved in the richest countries, status alert with respect to another digital divide, This time around a crucial aspect for human life as it is the salud.3

A daily occurrence, When commitments it comes, the great distance between what is promised and what is being done and in the case of the e-health there is a lag both in policy formulation and its management by Governments. A closely related to the above point is the role of Governments as guarantors of the equity and the protection of citizens, the promotion of multilingualism, and aspects such as competitiveness and standardization. This is a relevant issue given that various actors are involved in the e-health, In addition to Governments and societies, for example, the private sector - highlighting the pharmaceutical companies-, whose interests do not share the assumption that health is - or should be - a global public good.

To this must be added because the e-health resting in the information technologies, It should not lose sight that unequal access to the same is, not only globally, but within the same country, for economic reasons, ethnic, education, age, corruption, and so on. This digital gap tends to widen since in many countries has been more emphasis on access to technologies than on competencies that an average person should have to use. Also, the awareness of the need to use new technologies is not developed equally among the members of society, which limits the spectrum of the benefits of the cibsersalud. Suffice it to mention that in the "civilized" and "technologized" European Union, the 30% its population has never used Internet.4

The challenges

Input, the e-health, in its simplest meaning, are you confronted with the - traditional - notion of the relationship between doctor and patient. Therefore it is important for the doctor to explain clearly to the patient during the contact that is set within the framework of the e-health, who has the responsibility to monitor their health and medical care. Supervision of the physician in protocols is necessary, conferences and review of medical history at all times. Also, your doctor should be able to immediately contact technicians who are not physicians and providers and patients. It is equally important that your doctor clarify responsibility for the patient with any other health workers involved in the patient's care. In addition, the legal responsibility of health professionals providing assistance through e-health schemes must be clearly defined by the appropriate jurisdiction and regulations.

The above must be hand of privacy and respect for human rights as fundamental criteria for the exchange of data and electronic medical records within countries and among them. WHO says that effect use increasingly e-health services need a legal and ethical regime that guarantees the protection of data and its private and confidential character. This is a very delicate issue, especially in the light of several actions included in the concept of cyber crime, that you may have, in the field of the e-health, a vein to act with tremendous impunity in the absence of standards and mechanisms that guarantee the security and privacy in the handling of this type of information. Already in the film network warned about the deliberate manipulation of medical studies that led to the Secretary of Defense United States committed suicide.

Another scourge that at least for now exists around the e-health, It is the prevailing lack of coordination among the participating entities. In the European Union, for example, which Brussels has very few powers in health, There is a misuse of human and material resources, every time the tests are repeated, health professionals do not share information, and there is also an evaluation to measure the performance of the sistema.5

The next challenge, already referred, It has to do with the fact that e-health services depend on, to a large extent, collaboration between various actors, including the private sector. It is therefore, partnerships are required to safeguard the rights of persons, serve to provide safe and high-quality assistance and benefit both sides. The who has warned these actors to elaborate principles and frameworks for the management of e-Health Alliance, that facilitate both national cooperation and the international exchange of e-health services, promote research and development in information technologies applied to public health and to encourage the donation of material and programs 6.

As well as there is a deficit in the global health professionals, There is also a lack of skilled human resources in the information in the service of health technologies. As suggested above, information technologies can be used to significantly improve not only the methods of training of professionals of the sector health through specific programmes for e-learning, but also the effectiveness of the services of, especially in areas where there are not enough health workers. Part of the solution to this problem is to incorporate training in the information technology in health education programs, which would ensure at least, that new generations of professionals are aware of, benefit and apply the criteria of e-health in their jurisdictions and areas of action.

In the case of Mexico, where it is necessary to improve the coverage of health services, the e-health already has a biting way that, However, You can improve. Suffice it mention that the Institute of security and social services for State employees (ISSSTE) It already has pilot programs and successful experiences in the field and the usefulness of the e-health is out of the question.

Now well, consider the following: According to the Mexican Institute of Social Security (IMSS), of each 10 consultations of the first level of care provided, seven correspond to the elderly, what refers to the aging of the population and the challenges that this entails for the health system. It is well known, older persons have a decline in their abilities, among them, the lack of memory and reduce their self-sufficiency. In United States, for example, It is known that from the 65 años, una de cada cinco personas desarrolla el llamado mal de Alzheimer, and that after the 85 años, the figure includes one of every two people. This situation makes them dependent, causing strong pressure for relatives. Often the dependant loses his job, is isolated socially, waive recreational activities, you get sick of stress and in extreme cases could die before the person who cares for. This situation can be solved through technological support, so that people who suffer from various conditions that limit their mobility or other capabilities, they could tell, they and their caregivers, medical support at a distance, What would improve their quality of life.

At last, with regard to the issue of infrastructure, It should not lose sight that the e-health requires, among other things, a satellite network, which, in the case of Mexico, is at the limit of their service life - theme addressed in this space makes some months-,7 which greatly reduces expectations for development of this sector - and others, relevant all national life.


1 Diagnostic and clinical purposes only.

2 World Health Organization (30 in August of 2010), Africa has to adopt and use the e-health, Brazzaville, Organization World of the health/Regional Office for Africa, p. 1.

3 World Health Organization (August of 2006), Establishment of infrastructure for the e-health. Progress made by the Member States, Geneva, WHO Global Observatory for e-health, p. 2.

4 The country (11 in June of 2010), "The digital divide and the coordination", "challenges for the future of the e-health", available at http://elpais.com/diario/2010/06/11/sociedad/1276207206_850215.html

5 Ibid.

6 World Health Organization (1 in December of 2005), E-health: instruments and services offered, Geneva, WHO, p.

4, available in https://apps.who.int/gb/ebwha/pdf_files/EB117/B117_15-sp.pdf

7 Maria Cristina Rosas (26 October of 2010), "México": out of orbit??"in etc", available at http://www.etcetera.com.mx/articulo.php?Article = 5404

Etcetera.com.MX [en línea] Mexico (MEX): etcetera.com.MX, 28 de mayo de 2012 [REF. 21 in May of 2012] Available on Internet: http://www.etcetera.com.mx/articulo.php?Article = 12702



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