F119 How are technologies improving global public health (Dr. Padmini Murthy)

No doubt, mobile technology has brought massive improvements to public health. One of the challenges we still need to overcome though is gender stereotyping. Women also often suffer from inequity in healthcare because they are for many reasons at the bottom of the ladder in their access to even using technology, says Dr. Padmini (Mini) Murthy.

Dr. Murthy is Professor and Global Health Director at New York Medical College School of Health Sciences and Practice. She is a physician and an activist who trained in Obstetrics and Gynecology. She has practiced medicine and public health for the past 28 years in various countries. She worked as a consultant for United Nations Population Fund, she is the Secretary-General of the Medical Women’s International Association (MWIA) and its NGO representative to the United Nations (UN). She is the global health lead for the American Medical Women’s Association (AMWA). Her latest book titled Technology and Global Public Health is a great read if you wish to get a perspective about health and technology, women, and technology in countries like Ethiopia, Nigeria, Ghana, Japan, Georgia, Saudi Arabia, Bangladesh, and more.

Public health is focused on making sure that the public has access to the health care and health services they need. Sometimes this can be a lot faster using low-cost technology. If the COVID pandemic has thought us something, we’ve learned that technological solutions always need to be local with the local culture and mindset in mind. The colossal failure of contact-tracing apps in the West was a clear example of policymakers and technologists being too optimistic about what technology can do. It is useless if people reject it. As a comment to this problem, Dr. Murthy said it is critical for the technologists and policymakers to work together and continuously reassess what works and what doesn’t.

No doubt, mobile technology has brought massive improvements to public health. In Ghana, the initiative, called Mobile Doctors Network (MDN), started in 2008 to facilitate communication among doctors. Over 95% of doctors in Ghana have registered to the MDNet program, where they can communicate with other registered doctors at no cost, write Dr. Padmini Murthy and Mahtab Naji in the book.

As mentioned in the book by Dr. Padmini Murthy and Mahtab Naji,

According to a 2019 survey conducted by the Pew Research Center to assess the availability and accessibility of mobile phones in 11 different emerging market economies, the majority of people in these countries have access to mobile phones and more than 53% of them have access to a smartphone. This survey was conducted in middle-income countries as defined by the World Bank, including Mexico, Venezuela, and Colombia; South Africa and Kenya; India, Vietnam, and the Philippines; and Tunisia, Jordan, and Lebanon.

Based on the same survey, most people found mobile phones to be a useful tool for education, understanding the economy, and connecting people.

While progress is visible, Dr. Murthy warns about the problem of in-equity of women. To clarify: equity refers to the quality of being fair and impartial, whereas equality is the state of being equal. “In healthcare equity means that the person with lesser gets more access. Women often suffer from inequity in healthcare because they are for many reasons at the bottom of the ladder in their access to even using technology.”

Women in-equity and inequality

As mentioned in the book, the interplay between cultural norms, lack of Internet access, and low health literacy creates barriers to eHealth service access, especially in developing countries.

The most severely affected groups are often women and children, mentions Irene M. Wohlman in the Chapter about The Worldwide Digital Divide and Access to Healthcare Technology:

Dr. Murthy moderating a high level panel on HIV/ AIDS on World AIDS Day at the UN.

In some countries, women may face sociocultural norms that discourage independence and prevent them from making financial decisions, including purchasing and using a cell phone or computer. According to a 2014 Telecom Regulatory Authority of India report, out of 900 million-plus cell phone subscribers, only 30% were female. Fears of mobile phone use leading to adultery and distraction from studies led to a ban on cell phone use in villages in three Indian states, while in Morocco a woman was stoned to death for owning a cell phone. In sub-Saharan Africa, women are 43% less likely to be online. /.../

While in the developing world 25% fewer women than men can access the Internet, in regions like sub-Saharan Africa the gender gap approaches 45%. In contrast, Internet use by all is highly encouraged in some Asian countries, such as South Korea, where it is viewed as an educational tool with the potential to improve one’s status or future. /.../

According to June 2019 statistics, about 39.8% of the African population has Internet access. The challenge in Africa is the vast expanse of rural areas that can comprise anything from impenetrable jungles to endless deserts. In these regions, the growth of broadband Internet is not the only problem; many homes throughout Africa are not even connected to the electric grid.

Reflecting on her 30-years long career Dr. Murthy observes an improvement in decreasing the taboo of women’s health. Debates about menopause, for example, are not taboo anymore. One of the challenges we still need to overcome though is gender stereotyping. “If you are a woman in menopause, it's fine, you can talk about it. You don’t have to cast away a woman just because she's had menopause. It’s just a physiological process. The other issue we have is there is not enough support for women. Even now, so many women are dying in childbirth, which should not be the case,” said dr. Murthy in the podcast interview.

Tune in for the full discussion:

Some questions addressed:

You worked for United Nations Population Fund and received several awards for these efforts. In your thirty-year history, what were the main progress made in the field of women’s health? Perhaps you can start by talking and elaborating a bit further about the issues around these topics, especially in the developing countries?

Your specialty is public health and you spent a large portion of your medical career as a women’s health specialist. What was the trigger for you to take upon a project of global health and technology book?

The focus of the book is on exploring universal health coverage in different countries around the world and the impact of technology on healthcare. The goal of achieving UHC was adopted by the world’s leaders at the United Nations (UN) General Assembly in 2015 under the framework of the Sustainable Development Goals (SDGs), which all countries of the world commit- ted to achieve by the year 2030. In this exploration, where do you see the role of technology in this goal? Is it even related since the key thing to achieve universal coverage is the policy?

Several authors from different countries contributed to the report. The book starts with a chapter about UHC in Japan, health knowledge empowerment in Africa, the role of technology in Georgia, Saudi Arabia, etc. Given that you’ve been in the global public healthy space for years, what were to you the key surprising findings?
Why does the global perspective matter to you when healthcare is always local, dependant of the national culture and history the healthcare systems are based on?