Event Background:

The mHealth Summit originated from a conversation between colleagues at Microsoft External Research in 2006. The founding members aimed to explore technology’s role in providing low-cost healthcare to underserved communities, both domestically and globally.

Initial Funding:

Tom Healy and the speaker engaged in initial, somewhat random, funding of mHealth projects for about three years. Their focus ranged from the diffusion of technology in developing countries to mobility for healthcare targeted at global public health. In 2007, they released a Request for Proposals (RFP) targeting the use of cell phones for healthcare delivery, awarding $1.4 million to 14 global projects.

Attention and Collaboration:

This modest initial investment caught the attention of the National Center for Minority Health and Healthcare Disparities and other organizations, leading to further partnerships. Collaboration with these organizations broadened the impact and reach of the mHealth projects.

Evolution and Growth:

The mHealth Summit grew beyond initial expectations, from a small workshop to a larger venue, attracting public and private funding. The event was considered at an inflection point, prompting research and investment into mobile health technology.

Microsoft’s Interest:

Microsoft Research, though primarily a core computer science lab, extends its mission to address challenging social issues like healthcare. The interest in mHealth aligns with Microsoft’s broader goals, especially as inspired by the company’s then CTO, Bill Gates.

Goals:

The key goals for the summit were to grow mHealth as a research area, coordinate funding, and ensure the scalability of research outcomes. These aims tie into a broader vision to bring healthcare to more than 4 billion people currently without access.

Bill Gates’ Influence:

Bill Gates, who was Microsoft’s CTO at the time, significantly inspired the team at Microsoft Research. His focus on impactful projects has been a motivating force behind the summit and other initiatives aimed at social good.

This segment provides an overview of the mHealth Summit’s evolution, its focus on leveraging technology for healthcare in underserved communities, and Microsoft’s role and interest in this initiative.

Introduction:

The primary speaker, Bill Gates, discusses the role of computing technology in healthcare, particularly how mobile phones could be advantageous over preceding computing technologies. Gates, renowned for his philanthropy in global health, presents a nuanced view on the technology’s role in healthcare, especially in disadvantaged communities.

Computing Technology in Medical Research:

Bill Gates asserts that the main contributions of computing technology to healthcare have been in research. Tools like the internet, digital databases, and collaboration software have transformed medical research. He points out that technology has significantly aided the development of drugs and vaccines that cater to diseases affecting impoverished populations.

Role of Mobile Phones:

Although mobile phones have the potential to be directly involved in patient care, especially in remote or under-staffed clinics, Gates advises caution. He notes that internet and data connections are often lacking in disadvantaged areas, and timing is crucial when dealing with sickness, which might make mobile technology less impactful in certain cases.

Key Applications for Mobile Health:

The speaker outlines several key applications for mobile health. These include reminders for taking medication, improving the supply chain of medical goods, and maintaining digital records. One of the most impactful would be the use of mobiles for registering every birth and tracking immunizations effectively, especially in regions where vaccine coverage is low.

Metrics for Success:

Bill Gates emphasizes the importance of having robust metrics to measure the impact of these technologies. He uses the metric of reducing the number of children who die under the age of five as an example. The goal of employing any new technology in healthcare, according to Gates, should align with achieving measurable improvements in such key metrics.

Summary:

Bill Gates presents a balanced view on the role of technology in healthcare, acknowledging its significant contributions to medical research while also pointing out its limitations in direct patient care. Mobile phones have potential but must be used thoughtfully, keeping in mind key metrics for success in improving healthcare outcomes.

Two Types of Grand Challenges:

Bill Gates describes two distinct Grand Challenges programs. The first, established eight years ago, aims to address large-scale issues in global health, like vaccine delivery and drug resistance. Grants of $10 million and above are given for these challenges. The second, termed Grand Challenge Exploration, focuses on smaller exploration grants to encourage innovative and “wild” ideas.

Review Process in Exploration Grants:

The process to get an exploration grant is designed to encourage a variety of applicants and ideas. Applicants submit a two-page document outlining their idea. Reviewers receive about 30 applications each. If any reviewer picks an application as their favorite, it is funded, regardless of other reviewers’ opinions. Extra weight is given to applications from developing country scientists.

Role of Mobile Technology:

Bill Gates acknowledges the role of mobile technology in healthcare, particularly in diagnostics. By using the mobile phone’s existing capabilities like power, communication, and screen, only sample preparation and signal detection need to be developed, leading to cost-effective solutions. He hints that mobile tech could play a significant role in diagnosing diseases like malaria and TB.

Impact of Smaller Grants:

Though the smaller, $100,000 exploration grants may seem insufficient to make a significant impact, Gates notes that they have been surprisingly effective. About 10% of these grants proceed to a “phase two” level of funding, ranging from $1 to $2 million.

Focus on Metrics and Deliverables:

Regardless of the scale or scope of the project, Gates emphasizes the importance of focusing on key metrics, such as reducing the number of children who die under the age of five, to evaluate the effectiveness of these programs. This metric-driven approach ensures that the projects have tangible impacts on global health.

Importance of R&D:

Bill Gates emphasizes the critical role that Research and Development (R&D) plays in preventing future disasters and addressing global challenges. He notes that the world generally underfunds research. The reason is that those who invest in and carry out research do not usually reap the full benefits, leading to a shortfall in investment from the private sector.

Capitalism and Government:

Gates points out the limitations of capitalism in fully supporting research and catering to the needs of the world’s poorest. Government intervention, particularly in the United States through programs like the NIH, helps fill this gap. Government funding aids basic research, which then is leveraged by companies to develop products and solutions.

Global Trends in Innovation:

Despite underfunding, Gates is optimistic about the ongoing innovation in fields like energy, biology, and software. He credits the rise of middle-income countries in producing more engineering and science graduates, helping to fuel this innovation.

Urgent Problems:

Certain challenges, such as health crises in poor countries or climate change, cannot wait for gradual innovation and require immediate, directed research efforts. Gates suggests that for challenges with almost a deadline, rapid innovation is imperative.

Interplay of Product Development and Research:

In terms of blending product development with research, Gates cites Microsoft as an example. He highlights how the two aspects can be complementary when managed efficiently, implying that a balanced approach can be very effective.

Population Growth and Health:

Gates addresses concerns about population growth, particularly in urban slums. He argues that improving health outcomes, specifically reducing child mortality, actually leads to reduced population growth rates. This is because parents opt for smaller families when survival rates for children improve, a phenomenon supported by academic studies and real-world examples.

Long-term Impact:

Finally, Gates underscores that solving global challenges is much more feasible with a stabilized population growth rate. His foundation, thus, focuses on global health as a means to achieve multiple favorable outcomes, including manageable population growth.

Challenges to Foreign Aid:

Bill Gates opens by discussing the budgetary constraints facing foreign aid, particularly for healthcare. Since the financial crisis, governments in the rich world have been reducing their budgets, often disproportionately impacting foreign aid, which lacks a strong domestic constituency.

UK as a Positive Example:

He lauds the UK for setting aside and even growing their aid budget from 0.5% to 0.7% of GDP, despite other cuts. Gates expresses concern that aid could be further reduced in the U.S., impacting the support available for new initiatives.

Importance of Vaccines:

Gates emphasizes the life-saving potential of vaccines such as pentavalent, pneumococcus, and rotavirus. These not only save lives but also prevent long-term health issues like cerebral malaria and malnutrition that impair brain development, thereby affecting productivity in adulthood.

Funding Gaps:

Gates notes that even existing programs, like polio eradication, are underfunded. He mentions his role in fundraising the final $800 million needed to complete the last three years of the polio eradication campaign.

Technology’s Role:

Gates highlights the emerging importance of technology in aid work, pointing to the benefits of digital transactions through systems like M-Pesa in Kenya. Mobile phones facilitate transactions and enable direct payments to recipients, significantly increasing the effectiveness of aid.

Interconnected Solutions:

Finally, Gates suggests that there is great payoff in addressing these issues, as reducing mortality and morbidity in children through vaccines could be interconnected with other forms of development like agriculture and finance, making aid more efficient and impactful overall.

Flaws in Government Payment Systems:

Bill Gates starts by highlighting the inefficiency in existing government payment systems where the intended recipients often do not receive the funds, which instead may get stuck at the village head level.

Success of M-Pesa:

He elaborates on the success of M-Pesa, a digital currency system in Kenya, backed by the UK development group, DFID, and Gates himself. The system achieved “critical mass” by ensuring that users could easily put money in and take money out, thereby establishing trust.

Digital Transactions & Future Prospects:

Gates discusses the next steps for M-Pesa: a full transition to digital transactions without the need for physical currency. This foundational work by M-Pesa sets the stage for more complex financial ecosystems.

Bootstrap Problems in Health:

Moving on to mHealth, Gates points out similar “bootstrap” challenges that need to be overcome, like establishing a reliable birth registry to assist vaccinators. Such foundational elements require initial investment but are critical for large-scale health interventions.

Country-Specific Implementation:

Gates says that once these health applications reach a certain stage of development, efforts will be made to implement them in specific countries. He mentions that a few areas, such as parts of Kenya and India, have already shown promise due to government investment and motivated local leaders.

Adoption Complexity:

He concludes by noting that some health applications can be adopted on a patient-by-patient basis, like a TB reminder system. However, for the most impactful solutions, system-wide adoption is essential, making it a complex but worthwhile endeavor.

Problem of Scaling in Different Contexts:

Bill Gates discusses the difficulty of scaling mobile health (mHealth) solutions. Solutions that work in one setting often fail in another, whether the variation is geographical or disease-specific. Gates attributes this inconsistency to a multitude of factors, including local infrastructure, personnel quality, and contextual complexities.

Critical View of Success:

He emphasizes the need for a stringent criterion for determining a project’s success. Sometimes a program might seem effective due to unique conditions like dedicated personnel or uninterrupted electricity, which may not be replicable elsewhere.

Targeting Broad Issues:

Gates identifies several major health issues, such as tuberculosis and vaccination coverage, that could significantly benefit from well-designed mHealth solutions. These are problems with enormous scale, affecting hundreds of thousands and deserving of focused effort.

Different Tiers of Healthcare Innovation:

He suggests that healthcare system innovations are most likely to occur in middle-income countries like China, Brazil, and Mexico. These countries have the potential for rapid adoption of mHealth solutions, in contrast to high-income countries, which often have conservative, heavily regulated healthcare systems.

Funding and Incentives:

Gates acknowledges that most funding goes toward high-end applications aimed at wealthy populations. He mentions that middle and low-income countries can be more receptive to innovative healthcare solutions and should not be overlooked by researchers and developers.

Focus on Impactful Problems:

In addressing poverty and healthcare in the U.S., Gates points out that the problems may be different than in other parts of the world, but they are equally worthy of exploration. He also notes that mHealth has the potential to help with a range of issues, from obesity to elder care, and should be tried in various contexts.

Narrow Focus Risks:

Gates warns against targeting too narrow an audience or problem, as this can make it difficult to scale the solution up again. The key is to find broad applications that can have a wide impact.

By examining the difficulties and strategies in scaling mHealth solutions, Bill Gates offers a nuanced perspective on the promise and limitations of using technology to address healthcare challenges.

Role of Rational Health Systems:

Bill Gates emphasizes that rational health systems, like Health Maintenance Organizations (HMOs) in the U.S. or country-wide systems like the NHS in Europe, can play a crucial role in the sustainability of mobile health solutions. In such systems, if a mobile application provides preventative care benefits, there is a clear financial incentive for the HMO or health system to invest in that technology.

Incentive Alignment:

Properly aligning incentives is vital for the adoption of mobile health technologies. Gates argues that if a health application can demonstrate a net benefit in preventative care, it should find buyers among the numerous healthcare organizations in the U.S. and Europe. If an application fails to gain traction in these settings, it’s a sign that the developers should be concerned.

Exemplary Success Cases:

According to Gates, every field needs a few success stories to pave the way for broader acceptance and investment. He notes the absence of such exemplary cases in mobile health but recognizes the role companies like Google and Microsoft are playing in making healthcare records more accessible.

Philanthropy and Aid:

Gates suggests that philanthropic efforts can give initial momentum but are not a long-term solution for sustainability. He states that the proportion of aid given has changed over time. It’s becoming a shrinking percentage of the total health spend, emphasizing the need for sustainable, capitalistic models in mobile health.

Complex Privacy Issues:

In rich countries, privacy becomes a considerable concern, especially regarding healthcare records. Gates asserts that while privacy issues are complex, they should not stand in the way of progress and are solvable.

End Users and Providers as Payers:

Ultimately, Gates believes that either end-users will pay for mobile health solutions because they find value in them, or healthcare providers will fund these technologies because they result in overall healthcare benefits. Both avenues contribute to making these solutions more sustainable and scalable in the long term.

Long-term Benefits:

Bill Gates discusses the notion that both health and education require investment in the present for benefits that will manifest in the future. For example, dropping out of high school can close doors to well-paying jobs later in life, just as neglecting health can lead to problems down the line.

Time Horizon and Human Behavior:

He elaborates on the challenges of changing behavior when the risks or benefits are not immediate. His example was an AIDS awareness campaign in South Africa. Despite successfully educating people on how AIDS is contracted and prevented, there was no significant change in behavior. He attributes this to the latency of the disease; since the consequences aren’t immediate, people underestimate the risk.

Latency and Discontinuity:

Gates emphasizes that discontinuities or latencies in seeing results are a significant hurdle in both education and healthcare. If people could see immediate rewards or consequences, behavioral change would be easier to achieve.

Correlation Between Education and Health:

He agrees that education and health are correlated, but argues that data suggests the causative relationship runs from health to education. When a family’s health is secure, and they don’t have to have many children for support, women are more likely to be educated and contribute to their communities.

Role of Foundations and Local Efforts:

In South Africa, Gates’ foundation initially aimed to raise AIDS awareness. Despite achieving high awareness levels, this did not result in behavioral change. The experience emphasized the complexities of human behavior and the limitations of awareness campaigns, highlighting the need for more direct and effective interventions.

Education, Literacy, and Women:

Gates finds that there’s a strong correlation among women, literacy, and health. Improving healthcare in families often leads to more opportunities for women, which in turn contributes to better education and societal outcomes.

In summary, the talk underscores the importance of long-term planning in both education and health, the challenges posed by human behavior and latency, and the interconnectedness of education and health, particularly in relation to women’s roles in society.

Robotic Revolution:

Bill Gates identifies robots as a technology with transformative potential for global public health. He notes how robots could revolutionize maternal care by performing C-sections in sterile environments, overcoming barriers of expertise and availability. Robots are also seen as valuable for elderly care, capable of operating round-the-clock once trained.

Evolution of Computers:

Gates discusses the transformative changes in computer technology, mentioning how they are becoming more interactive and capable. From simply being devices for typing and displaying information, computers are now learning to see, speak, listen, understand handwriting, and even move around.

Challenges in Robotics:

He acknowledges the complexity of certain tasks that robots are still struggling to accomplish. For example, lifting an elderly person from a bed is a task that involves intricate balance and feedback, something humans excel at. While it’s a difficult problem for robots now, Gates is optimistic that they’ll eventually be able to manage such tasks effectively and inexpensively.

Advances in Biological Knowledge:

Gates emphasizes that even though robots have significant potential, advances in biological knowledge trump everything else. He refers to the development of rational drug design and functional genetic therapies as vital for the future. He also mentions that our understanding of ‘shape space’ in biology is still limited but predicts that significant leaps will be made in the next 10-15 years.

Drug Discovery:

Despite the low rate of drug discovery over the last decade, Gates believes innovation in biological knowledge will accelerate the process. He mentions that computation will aid in more efficient drug discovery, replacing current hit-and-miss methods.

Equity in Innovation:

Lastly, Gates insists that if managed wisely, these technological advancements could benefit not just the affluent but also the impoverished.

In summary, Gates predicts that robotics and advances in biological understanding will have a significant impact on global public health. He notes the challenges in both fields but remains optimistic about the transformative power of technology, provided it is applied equitably.