“By 2019, one in 10 people living in the developing world will have 3D-printed items in or on their bodies.” That is the claim made by research firm Gartner Group. It appeared on screens on both sides of the stage at the 2017 Techonomy conference, focused on the convergence of man and machine, on Monday.  By Catherine Cheney

 

“Let’s remember first that global health starts where you have your feet. Every person on earth is at the center of global ealth.”.” said Agnès Binagwaho.

3D-printed models allowed a surgical team in New York to separate conjoined twins whose heads were fused at the cranium, in just one example of the ways these technologies are already being applied in countries such as the United States. But soon, 3D-printed items such as custom hearing aid shells and bioprinted organs will be available globally, said Vyomesh Joshi, CEO of 3D Systems.

Techonomy, a conference and media company that organizes events on how technological advances are transforming industries and addressing global challenges, announced that its 2018 focus will be on the United Nations Sustainable Development Goals. At its conference in Half Moon Bay, California, this week, sessions covered autonomous mobility, the blockchain economy, and urban innovation, among other topics. One session — “Advancing Global Health With Tech” — narrowed in on the SDGs, capturing how technology is one part of the path to achieving SDG 3 on good health and well-being.

“Let’s remember first that global health starts where you have your feet,” said Agnès Binagwaho, former minister of health for Rwanda, who is now vice chancellor of the University of Global Health Equity, on the panel. “Every person on earth is at the center of global health.”

She talked about the importance of leveraging innovation and technology to create human-centric systems. Following the session, Dr. Agnès, as colleagues call her, spoke with Devex over lunch, with a few interruptions here and there from admirers of her return to Rwanda following the genocide, her work to transform the country’s health system, and her outspoken reputation. She talked about her belief that health is a human right for all, which drove many of her efforts as minister of health, such as training 45,000 people as community health workers.

“Leave nobody out,” she told the audience at Techonomy. “Whatever you do, whatever technology you try to introduce, always think what it will bring to the most vulnerable member of that community.”

She explained that this is why Rwanda’s University of Global Health Equity is based in rural Butaro, not the capital Kigali. The majority of the world lives in rural areas, but the majority of clinicians are educated in the cities, and they don’t know how to work where the needs are, she said.

Democratizing care
“Technology is exciting because it can be distributed globally at relatively low cost depending on how you do it,” said Oliver Hsiang, who leads health technology partnerships at Johnson & Johnson, and formerly worked with Lyft, LinkedIn, and Google.

He said he focuses on those technology partnerships that can improve health outcomes by democratizing access to care. One example he mentioned was Johnson & Johnson’s work with Facebook to deliver critical health information to pregnant women through their Free Basics platform. He also talked about the company’s acquisition of the German software company Surgical Process Institute, which has developed solutions to bring checklists to operating room procedures, lowering costs for hospital systems, reducing variability in surgical procedures, and improving patient outcomes. And he mentioned a joint venture between Johnson & Johnson and Alphabet to bring robots to surgery.

“While there are technologies we can use in the medically developing world now, we’re not using them in the medically developed world,” said Dr. Roy Smythe, chief medical officer for health informatics at Philips.

Most of global health care spending is in developed countries, where the incentives are not necessarily in place to use technology in order to reduce costs and improve outcomes, and much of that money is wasted, he said. “The conundrum is, in order for us to free up those funds to transfer them to the medically developing world, we have to use technology more effectively here,” Smythe said. Formerly a surgical oncologist, he said technology could have done a lot of his work. He talked about the need to eliminate redundant care, phase out unnecessary processes and procedures, and democratize care so that people without medical training can do much of it themselves.

Technology is just one piece of the puzzle
In a follow-up interview with Devex, Smythe talked about what he calls the medical industrial complex, in countries such as the U.S. and beyond, where a lot of care is market-driven rather than value-based. Health care providers are incentivized to deliver care to a large number of patients, not to prevent disease and achieve wellness outcomes. If that were to change, so too would the use of technology. If all countries saw health as a human right for all and made outcomes the priority, then providers would not introduce shiny new objects simply for marketing benefits, unless they also contributed to those goals, Smythe said.

“We’ve done a very poor job of explaining to the general public around the world what their potential really is,” he said, explaining that nongovernmental organizations are uniquely positioned to drive public opinion in a direction that could lead to incentives-based outcomes. “If there was a really concentrated effort to say, ‘This is where you are, and this is where you could be,’ they would demand it.”

Binagwaho explained how technology is a tool, but implementation science is what gets those tools where they are needed. It is not just technology but social capital that results in 93 percent of Rwandan boys receiving 11 vaccines, and 93 percent of Rwandan girls getting 12, including the HPV vaccine to prevent cervical cancer, she said. She traveled to Half Moon Bay from Palm Springs, California, where she had 18 minutes to give a talk on building a health system from scratch at TEDMED.

“Building a health sector is not about how much money you spend, but about how equitable the care is and how good the care is,” she said. “It is about educating not followers, not joiners, but leaders, and never forgetting that what we fight for is the human right to health — which is, by the way, the only way to reach the SDGs we are all committed to.”