In recent weeks suicide has been written about extensively in the United States, with high profile individuals giving a renewed focus to the tragic loss of life, taken by one’s own hands. And while advocates and educators of mental health care are doing their best to use these tragedies to save countless other lives, the conversation appears to get continually lost in the sordid details of celebrity and scandal.
But with new data just released in the U.K. and global efforts garnering traction in the most wide-ranging geographies in the world, it is time to take a step back and refocus on the global epidemicthat is suicide. Especially among the world’s young people.
Here are some key takeaways for better understanding how large of a global health problem suicide really is:
- According to the CDC, the link between suicide and mental disorders - in particular, depression and alcohol use disorders - is well established in high-income countries like the U.S. However, “many suicides happen impulsively in moments of crisis with a breakdown in the ability to deal with life stresses, such as financial problems, relationship break-up or chronic pain and illness,” in all countries in the world, and are on the rise.
- Suicide is the 2nd leading cause of death globally for 15-29 year-olds, and at record breaking levels for students in high income countries, especially among students. Researchers concluded that the suicide rate among U.K. students has risen by 56% between 2007 and 2016. Although it is important to remember that the number of students has also changed in that period, making it difficult to accurately know the increase.
- An alarming 78% of suicides occur in low-and middle-income countries. Moreover, it is estimated that around 30% of suicides in low- and middle-income countries are via self-poisoning with pesticides. Most of which occur in rural, agricultural areas.
- The Japanese, despite being a very high income country and having a population less than half the size of the United States (126 million compared to the United States' 275 million), has the same number of suicides annually.
- In 2017, former Surgeon General Vivek Murthy asserted that loneliness was a growing health epidemic related to loss of life. He cited a study that contends social isolation is associated with a “reduction in lifespan similar to that caused by smoking 15 cigarettes a day,” or long-term illness.
- The U.K. has just appointed the world’s 1st Minister for Loneliness. The country leadership was stunned when reports came out last year from the Jo Cox Commission on Loneliness, more than 9 million people in Britain alone (about 14% of the population) admitted they often or always feel lonely. And, that the impact costs U.K. employers up to $3.5 billion (USD) annually, in addition to high levels of suicide across age groups.
Although any and all efforts to curb mental and physical health problems associated with suicide are important, it is clear that around the world, efforts are collectively falling short. The taking of one’s life is not a rich or poor problem, nor is it a cultural phenomenon. It is pervasive across every society and region of the world, and only getting worse. It’s time we stop thinking about suicide as individual acts, and begin thinking about the health of the human race.
In recent months, small amounts of information about the state of the North Korea's health system have made their way out of the country. And the data points have gone from bad to worse to revisiting accusations of massive human rights violations. While there is no more vital diplomatic effort in the world today than the denuclearization of North Korea, there is a second deadly force at play for the country’s more than 25 million citizens: health. And that means health security concerns for the rest of the world.
North Korea, officially the Democratic People's Republic of Korea, has undoubtedly faced many natural and man-made disasters in recent decades, but the greatest of which appear to stem from the economic collapse in the 1990s and subsequent deterioration of the citizens in the country. Since that time there has been a sharp decline in life expectancy – 12 years less than their genetic peers in South Korea. The North Koreans are also estimated to be 1-3 inches shorter than South Koreans, primarily due to chronic malnutrition and extreme poverty. At The Center for Strategic & International Studies (CSIS), experts contend that health decline is a direct result of choices and priorities made distinctly by the Kim family to create politically defined castes and introduce famine to the masses so that military efforts could be funded.
So, despite claims from North Korean media that the country developed a cure-all drug that had eradicated HIV/Aids, Cancer and Ebola from the entire country, the truth is that there are millions of lives hanging in the balance, needing access to basic necessities like clean water, food and vaccinations. And without those, an estimated 60,000 children will starve, millions of adults will live with communicable diseases other regions of the world have eradicated, and the world will continue to fight weapons that are only a part of the larger problem.
But why is global health so important for national security?
To understand a culture and a people, you must understand more than the military – which is what most of the world seeks to understand about North Korea. Nuclear and biological weapons are of global security priority. But the focus cannot be limited to those weapons alone. It must also be on the status of the citizens, culture, economy, and most importantly, what happens during and after the Kim dynasty? What happens to North Koreans now, could have global implications when they leave their country’s boarders in the near future.
There is a joke in China that the North Korean’s have two weapons of mass destruction, nukes and tuberculosis (TB). And not just TB, but multidrug resistant TB, which knows no boundaries or borders, and is spread person to person through the air. The country is also experiencing exceptionally high rates of malaria and hepatitis B. While many health-related organizations have been able to skirt restrictions about entering the country for the purposes of health care, all signs point to a growing number of destructive diseases and shrinking number of professionals that can help. Which in turn means a growing body of diseases and human destruction just waiting to spill over the North Korean borders.
In fact, multiple sources have confirmed over the years that the political regime had strategically used food and starvation as tactics to control the people and get the United Nations and other visiting personnel to see whatever the North Korean elite wanted them to see. However, an early 2018 defector gave the world some insights into the status of the people, including the military, as it stands today. The soldier in question was cared for after crossing into South Korea with multiple bullet wounds. But what doctors found inside the man shocked even the most experienced doctors: dozens of parasites in his intestines and roundworms up to a foot long. It is believed that because North Korea does not have chemical fertilizer, farmers use human excrement – infamous for spreading parasites like the ones in the defectors stomach.
Can diplomacy make a difference?
Though humanitarian exemptions are written into all sanctions against North Korea, recent years have seen mass exodus (ie: voluntary departures and expulsion) of nonprofit, nongovernmental and aid organizations because basic principles of humanitarian action were forbidden. Even banking transfer systems have collapsed. And it’s been consistently reported by organizations like Medecins Sans Frontieres/Doctors Without Borders that for decades medical supplies and food aid were not delivered to those who needed it. As recently as last month (April 2018) commodities funneled through China have been met with resistance, and the Global Fund reached a breaking point, declaring that it will be pulling out of the country within weeks.
When more than 40% of citizens (10.5 million people) are considered undernourished, and millions more have little food, humanitarian aid could go a long way in fighting the health decay of North Koreans. Further, it could foster a cultural revolution – and build trust - within the common people, as well as lead to health, education and job opportunities to help increase the average yearly income is North Korea – currently just over $1,000 a year. But as it stands, neither South Korea or China are really prepared for the health insecurity, ramifications of North Koreans crossing their borders. That said, so long as North Korea focuses
However, as President Trump and Kim Jong-Un prepare for a potential meeting to discuss nuclear disarmament, the implications for global health hang in the balance. Without a meeting, and without compromise, the situation is North Korea will likely grow worse. UN and humanitarian efforts will continue to be scaled back (meaning even less food, clean water and medical aid), and multidrug resistant TB and malaria stand to spread rapidly across the nation. Conversely, if diplomacy prevails – or talks are even allowed to advance – sanctions against North Korea could be decreased, and a flood of humanitarian aid and health care could enter the country.
Although North Korea’s health decay appears to be truly horrific and dangerous to the outside world, the truth is that for most of the country, health data is not available. Hopes are that in the coming months, real change is possible, and the world gets a better understanding of life, death and disease in North Korea.
The introduction of smart devices and connectivity has made many of life’s activities easier. However, sharing ones information – even through one device or app – means that many third-party organizations and potential threats have access to information they previously did not. Digital medicine has grown leaps and bounds in the last five years, and the next five are unpredictable. Yet, the one thing we can count on is that as technology moves into the body and brain, the data we collect and share will become more and more valuable, as well as more and more accessible.
This will introduce a whole new assessment of what privacy means, and how to secure the information collected.
The Risks Are High
Security and privacy are a foundational component of digital medicine’s future, and we must begin looking at the wide-range of implications that data and technology will have in the health arena. When telecommunications and remote monitoring are pillars of digital medicine’s ease of use and improved patient adherence, we know the trends are here to stay. And, as new technologies emerge, they will certainly be faster, cheaper and better for patients. But they will also be ripe for hacking and disruption as communication channels increase exponentially and storage moves to the cloud.
In addition to individual data collection, we cannot forget that hospitals, clinics, communities and governments collect data about our day-to-day activities through the same devices. Recently, several hospitals across the U.S. were hacked using RansomWare – leading those hospital systems to pay large ransoms to get their own patient data beck.
With sensors, ingestibles, remote monitoring and cell-based data looking like leaders of the pack in the near future, consumers (patients, providers and payers) must be concerned about the amount of information that is at risk. And those recent attacks have proven that our care providers are not prepared.
Partnerships Are Key
Health providers must make data security a top priority, but so too must entrepreneurs in the health space. Digital medicine companies need a business strategy to ensure their innovative ideas will get to market while protecting their users. Because of the ever-changing nature of health technology, working with other industry stakeholders to protect information will have the biggest impact.
Connections and collaboration with various decision makers and investors from the life sciences sector can make all the difference. In January those attending the Digital Medicine Showcase in San Francisco and CES in Las Vegas will get a taste of what those best alliances could look like.
One of those forward-thinking partnerships was announced this week. Qualcomm has linked the American Heart Association (AHA), the American Medical Association (AMA), DHX Group, and the Healthcare Information and Management Systems Society (HIMSS) to revamp a multi-stakeholder collaborative nonprofit – Xcertia - dedicated to improving the quality, safety, and effectiveness of mobile health apps. Xcertia's membership and governing board will be open to broad representation from consumers, developers, payers, clinicians, academia and others with an interest in the development of guidelines, best practices and security of mobile health tech.
Solutions Are Limited
At present, health technology is evolving so fast that regulating bodies and practitioners cannot keep up. Further, closed systems means that pharma, med device and research organizations do not share their information in ways that lead to collaborative data protection.
However, as open source technology increases, government agencies require shared information, and new partnership models emerge, the ability for new problems to appear also mean new solutions will arise. One way for protecting telecommunications and data is the emerging 5G – a network system that is much faster, has a higher capacity and much lower latency than existing systems. But again, this is not currently available to all.
Although data glitches, breaches, hacks and loss are nothing new, the potential threats of the coming five years are unparalleled. Greater amounts of information – no matter how convenient - mean that consumers must be acutely aware of the impact that violations could have. As 2017 begins, thought leaders and innovators need to turn their attention to security and privacy in all new ways. And patients need to hold their providers accountable, while simultaneously being proactive I protecting their own information and health.
The health care sector does not behave like other industries when it comes to money. First, attracting investors – especially in the early stages - is minimal, and the odds of capitalizing on a blockbuster drug or device is becoming ever slimmer. Second, because the U.S. health system does not incentivize it, payers do not rush to financially support or reimburse the waves of new technologies flooding the market. Third, companies entering the market often fail to stand out from the noise of competitors, meaning that getting noticed by investors or being able to commercialize well is near impossible.
In fact, according to Asher Rubin, Global Head of the Life Sciences and Healthcare Industry Team of Hogan Lovells, when separating the tools from the toys in digital medicine, some of the first questions asked by potential investors are, “How will it be approved, or not? How will it be reimbursed? And will the industry even care enough to pay?” Therefore, health investors remain risk averse - and if the recent past has taught us anything, it’s that there are far too many options and an ever-changing industry that will ensure this trend continues.
Because landscape transformations due to technological advancements and policy shifts have made health care financing a Wild West compared to other industries, products and devices of real value have a hard time communicating their importance above the noise. The upside is that the products, devices and apps of impact have led to digital health and medicine progress in the last five years, attracting potential investors and payers. But the downside is that there are so many new items making similar claims, even the experts can’t determine the difference.
At the recent Digital Medicine Connect conference in Boston, VC’s claimed they see the value in getting ahead of growing trends like digital health and mobile medicine. But, they are taking cues from third-party payers like insurance companies (particularly in states with one primary insurer like Blue Cross Blue Shield or Kaiser) to see where the returns might come from.
They are also searching for products that are ready to be commercialized to the public, and past the R&D trials, as they are more likely to succeed. This means being funded early is very difficult for startups. That is, unless they embrace the new world where M&A is replacing R&D, and the startup is willing to go in as a partner with the investor for commercialization. And we’ve been seeing this more frequently as larger company’s like J&J and Google are willing to put money into supporting health startups, but also partnering with them to roll out packages of products.
While VCs have never played in the health sector the way they traditionally do, the importance, interest and potential gain in the emergent health tech space is proving that they make good partners. And for startups, partnering with investors in novel ways can create all kinds of new opportunities to learn from their expertize. Not only from financial investment, but also mentorship, network, intellectual property and contributions to help make commercialization successful in today’s market. Which in turn decrease the risk for third-party payers and those who reimburse for new technologies.
With the Midwest relying increasingly on foreign-born healthcare professionals to fill critical labor gaps, a new study by the Chicago Council on Global Affairs finds that urgent immigration reforms are needed to ensure the future vitality of the healthcare sector. Updating visa allocations for foreign-born graduates from US medical schools, removing H-1B visa quotas and caps for healthcare professionals, and streamlining credentialing processes for foreign-born professionals would help the United States, and the Midwest in particular, mitigate acute shortages of healthcare workers just as the aging baby boomer population is expected to demand increasing resources.
The healthcare sector, which is fundamental to the U.S. economy and livability, is under strain:
A continued political stalemate on immigration reform means these issues will only grow in urgency. The report argues that Congress should work urgently with the next Administration to update policies to:
As gamification and game mechanics gain popularity in the healthcare space, so too does the need to understand primary motivational factors that influence human behavior. Gamification itself uses game elements and digital game design to address common business dilemmas and drive social change, and has been very popular with the military, airlines industry and even higher education institutions. However, the ability to influence action with gamification is only now gaining traction in the health industry.
Although gamification is here to stay due to factors that include vast U.S. utilization of smart phones, a tech savvy 18-34 population (38% of the uninsured) and advancements in the field such as augmented reality, the underlying motivators to change human behavior are not new.
Behavioral economics differs from traditional forms of economic study – which generally assumes unbounded rationality, unbounded willpower and unbounded selfishness – because it recognizes that individuals are bound by many factors that inhibit decision-making. We see this daily through activities such as smoking and drunk driving. Further, in the healthcare and health insurance sectors, neither patients nor providers know the true costs of care.
Without knowing actual costs of care and fully understanding the various options available, especially in moments of panic, rational decision-making is near impossible. Therefore, departures from rationality materialize in people’s beliefs and in their choices.
With a youthful population in the US that lives a significant portion of their lives online, and are accepting of new technologies in the health space in exchange for ease, the growth of applications and services that target health behaviors is developing at lightening speed. Further, these applications give rewards that motivate change. Most gamification methods in health and wellness are presently built around the notion of positive reinforcement. This is true both in engaging and monitoring patients and engaging and motivating providers. The same principals that incentivize humans to be active in their own health incentivize practitioners to provide better care, leading to better outcomes for patients, and therefore a hospitals bottom line.
As the new landscape of healthcare in the United States takes root, gamification technologies and advances will play an integral role in transforming health and care. Using smartphones, tablets and other mobile devices game mechanics will become more prevalent in almost all parts of the health ecosystem, from education to accountability and monitoring.
Gamification Elements of Vital Importance in Health Technology:
Using long-held behavioral and economic understanding, the ability to improve health outcomes through engagement and interaction has never been greater. Gamification has been a driving force in many sectors of business and social interaction, with healthcare prime for this kind of change. Pathfinder is optimistic that gamification and digital game design techniques, patient-centered care will see great growth.
Send along your stories on behavioral economic, incentive and gaming tactics. Pathfinder would love to learn more about what your company is doing and help connect with others in the space.
When confronted with a health system that is expansive beyond comprehension, very complex and severely flawed it is no wonder patients are often passive observers. Providers and administrators often do not know how to navigate the environment themselves, let alone a patient who infrequently touches the system.
This is further complicated by the ever-changing world of health care practices. While adoption rates are often very slow in the clinical setting – taking on average 17 years between research findings and clinical adoption – the transition for consumers is never-ending, often leaving those administering care and those needing care on very different paths.
Despite this, we know that when a patient is involved in their own health, better outcomes are experienced. Provided with the right tools, we know that many patients will use those tools to their advantage. We also know that new Affordable Care Act and Meaningful Use policies target the creation of better engagement and satisfaction methods and metrics for patients.
With that model in mind, how does a provider get a patient to be “engaged” in their own care and stay on course with their prescribed care, all while being compliant in a new world of health reform and get reimbursed? Perhaps it is getting a patient to exercise regularly, take medications properly, or something interactive and different. While no one answer exists, there are steps that can be taken to improve engagement that lead to patients feeling informed enough to take positive action in their own care. Further, with a growing body of literature and new policies, reimbursements and standardization are beginning to coordinate.
When only 10% of consumers are estimated to be “very confident” in their own abilities to find high-quality care and 6% to “affect the cost of care,” it speaks volume about the distance US-based systems need to go to empower those we care for.
Outcomes are a reflection of the pathway that the patient takes, and it is necessary to understand that each person has a different level of understanding, set of resources and faith in their own knowledge. However, patients want to be involved; they want to help.
Providing basic information and ways to seek and find the answers patients need is paramount Virtual coaching, online nursing and secure plan management are also increasingly more important tools that can be employed immediately WITH patients.
Whether it is drug adherence, follow-up rehabilitation or making initial care decisions, improving individual perceptions, understanding and abilities is a key component of improving outcomes and creating a strong foundation of patient engagement.