The Pew Hispanic Center and the Robert Wood Johnson Foundation released a report today that is required reading for anyone interested in a more nuanced picture of the e-patient population: “Hispanics and Health Care in the United States: Access, Information and Knowledge.”
This report is a comprehensive look at the Hispanic health care market (key words: diabetes, uninsured vs. insured, reasons for poor treatment, getting care outside the U.S., folk healing, usual health care provider…) but I honed in on Figure 8: Latinos’ Sources of Health Information on p. 27.
The survey question was, “How much information about health and health care did you get over the past year from a doctor or other medical professional, family or friends, the radio, the Internet, television, a church or community organization, newspaper or magazine?”
Not surprisingly, Latinos are less likely to be online and therefore less likely than the general population to cite the internet as a source of information: 35% of Latino adults say they got health information from the internet in the past year (compared to two-thirds of all adults). Anyone who is trying to serve this market should study the results of the survey to find out where else Latinos are looking for health advice.
I believe .. patient power can heal a sick healthcare system
The Indian healthcare system has become sick. In the private sector, doctors are no longer held in high regard; the doctor-patient relationship has deteriorated; and patients believe that the medical profession has become commercialized. The dismal state of the government’s healthcare services for the poor and the middle-class has also been extensively documented. The knee-jerk reflex has been to train more doctors ; set up more hospitals; and force corporate hospitals and doctors to provide subsidised medical care. This is simply a form of ” band-aid medicine”. The only effective solution will be to rely on the one resource which is almost inexhaustible—the people themselves. The principle is simple – educate them so they can manage their own health problems.
The reason that India is shining today is that we are in a demographic “sweet spot.” India’s major strength is its middle-class, with its millions of educated young adults , and protecting their health should be a high priority. Unfortunately , healthcare remains a neglected area , because of which millions of working years ( and billions of rupees ) are wasted on preventable illnesses . Medical absenteeism exacts a huge toll , but because it is hidden from public view, we have not addressed this problem effectively.
This is a daunting task, and the challenges are enormous. However, the biggest mistake we make is to assume that people are incapable of tackling their own medical problems; and that we need to look to doctors for solutions. We need to change our focus. Instead of trying to provide sophisticated healthcare services ( blindly imported from the West) , which need expensive technology, fancy machines and highly trained specialists, we need to tap the people themselves. People are smart and motivated , and are capable of remaining healthy, if we give them the right tools and teach them how to use them.
Doctors are illness experts – and not healthcare experts. Healthcare needs to learn from the revolution which has occurred in microfinancing. When given money and the freedom to use it as they see fit , even very poor people have come up with remarkably innovative ideas which could never have been planned, designed or anticipated by the traditional experts – bankers!
Information Therapy – the right information at the right time for the right person – can be powerful medicine ! Ideally, every clinic , hospital, pharmacy and diagnostic center should have a patient education resource center, where people can find information on their health problem .
The key is to develop patient-friendly materials which people will want to watch and can learn from. Most of us are visual learners, so this should be in graphic format. Modern technology has made creating and sharing visuals easy, so each community can build its own customised health video libraries with ease ! A simple example would be to find an articulate doctor with excellent communication skills, and to record a doctor-patient consultation with her about the top ten common clinical problems. A library of such videos could then be published online as “open source content” ; and patients and doctors could download and dub these in local languages . This version can again be uploaded to the web and shared with other patients from all over the country. Web 2.0 technology empowers patients to form support groups and communities where expert patients can help others. As the technology improves, it will soon be possible to deliver this graphic educational content on the third screen which is quickly becoming universal – the cellphone. Patients will find these videos much easier to relate to, since the videos are in their own language; deal with their immediate personal concerns; use local characters they can identify with; and provide local solutions which they are familiar with .
Information Therapy enhances patient autonomy by putting patients first; promotes patient-centered healthcare; respects the fact that the patient is the expert on himself; emphasizes personal responsibility for health; reduces the risks of medical errors; improves patient compliance with therapy; reduces the risk of litigation, because the patient has realistic expectations of the treatment; empowers patients to make their own decisions; and allows the intelligent use of integrative medicine, ( such as yoga , homeopathy and ayurveda) , so people can explore what works best for them. It creates expert patients and allows patients and doctors to form a healthy partnership, by improving doctor-patient communication. Finally, it saves money on medical care , both by promoting self-care (thus encouraging patients to do as much for themselves as they can, and not become dependent on doctors) ; and helping them with veto power, so they can refuse medical care they don’t need, thus preventing overtesting and unnecessary surgery .
Is educating people about their health and medical issues too expensive ? In fact, it’s too expensive not to do it ! Human capital is India’s most precious resource and we cannot afford to squander it. Information Therapy is free ; has no side effects ; and provides a terrific return on investment. We should insist that doctors dispense information therapy every time they do a consultation; advise a lab test; or prescribe medicines. In fact, both the government and insurance companies can make prescribing information compulsory . Information Therapy can be Powerful Medicine – let’s make the most of it !
Dr Aniruddha Malpani, MD
HELP – Health Education Library for People
Excelsior Business Center,
National Insurance Building,
Ground Floor, Near Excelsior Cinema,
206, Dr.D.N Road, Mumbai 400001
Thank you Dr. Malpani — that is more of a manifesto than a comment and I appreciate your taking the time to post it!
Congratulations for all your research reports. With the amount of data you have since 2000, what do you think are the most remarkable issues about eHealth and digital divide?
Thanks for your question, which I took a couple of days to ponder, esp. b/c the word “remarkable” could imply something of high concern (education and literacy continue to affect all Americans’ pursuit of health) or something inspiring (motivated e-patients joining together to share knowledge and resources).
“Latinos Online” is the report that I think of most often when I am asked questions about the differences among groups (aka “digital divide”). My co-author Gretchen Livingston & I were careful to present not only the topline results of our survey, but also the contours of the populations we discussed: non-Hispanic whites, African Americans, and Hispanics. Gretchen did the statistical analysis necessary to isolate the most likely factors of the differences among the groups: education levels and English-language proficiency. Those are the two most remarkable forces at work, in my opinion.
Thank you for your answear. I would like to share with you some findings about Catalan population (post at http://www.ictconsequences.net/2008/08/27/the-digital-ehealth-divide-or-the-e-patient-paradox/ )
In one of the chapter of my thesis based on a telephone survey to a representative sample of Catalan population 2000 phone calls were done. The results reveal that 42,4% of the Internet users (24,3% of population) have looked for health information or have made a procedure related to health on the Net. Those results are still far away from 80% of American Internet users who use the Internet with health proposes.
When I have characterized the people who use the Internet with health proposes I have found that those have a better education, a better job position and they are younger than the rest of he population. These variables are very related with the determinants of health status so as It was expected the e-patient group was also healthier.
Here goes the e-patient paradox, the people who have more probability to be in worse health status are those who have also more probability to be dropped out of the Internet. Our empirical analysis shows a clear digital divide related with age, education and job position. These variables also configure the components of what could be called the digital eHealth divide.
Congratulations for your wonderful research reports.
I am thrilled to have a new site to explore — I just left a comment on your article that sums up what I’m thinking about this fall. Thanks so much for starting the conversation!