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Archive for 30 diciembre 2020

El año pasado empecé mi felicitación de Año Nuevo con “2020 tiene un sonido mágico, suena bien”. Y continué con un post que hablaba de sociedades resilientes. Probablemente todos hubiéramos deseado un “sonido” más agradable, pero a pesar de todo la sociedad ha demostrado ser resiliente. Trabajemos hacia un futuro mejor, hacia un nuevo Felices Veinte, lo mismo que nuestros abuelos fueron capaces de sacar lo mejor después de una devastadora guerra hace cien años.

Las sociedades han demostrado ser resilientes. La historia habla de “Guerras Mundiales”, pero el número de países afectados por ellas no tiene comparación con el de afectados por el Covid-19 que sí que ha afectado a todos los países del mundo. Sin embargo, el número de muertos causado por el Covid-19 es muy inferior, felizmente, al causado por cualquiera de las dos guerras mundiales.

Oímos hablar de la “Nueva Normalidad”. No sé quién ha inventado tan estúpida expresión y su concepto. Creo que debemos aprender de las sociedades de posguerra: reinventarse. Los “Felices Veinte” de después de la Primera Guerra Mundial o los “Trente Glorieuses”, como lo llaman en Francia, después de la Segunda Guerra Mundial no tienen nada que ver con “Nueva Normalidad”. Supusieron una completa revolución en la sociedad, tanto desde el punto de vista sociológico como económico.

Es este tipo de revolución el que estoy esperando ahora. Un movimiento violento hacia un mundo mejor; más humanizado y al mismo tiempo mejor sostenido por la tecnología. Con la tecnología trabajando para la persona, al igual que en los “Trente Glorieuses” una revolución invisible (J. Fourastié, la Révolution invisible) transformó Europa, combinando un aumento de la productividad con mejores sueldos y, sobre todo, un nivel de beneficios sociales sin precedente en la historia de la humanidad.

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Last year I started my New Year’s greetings with “2020 has a nice ring to it, a magic kind of sound.” And I continued with a post talking about resilient societies. Probably all of us would have liked a “nicer ring”, but society has proved to be resilient. Let us work towards a brighter future and work towards a New Happy Twenties, the same way that our grandparents were able to make the best after a devastating war 100 hundred years ago.

Societies have proved to be resilient. History talks about “World Wars”, but the number of countries affected hardly compares to those affected by Covid-19. Covid-19 truly affects the whole world. Happily, its effect on society has nothing to do with the number of casualties caused by either of the two world wars.

We now hear about the “new normality”. I don’t know who invented such a stupid word or imagined the concept behind it. I think we should learn from what society did after the two world wars: reinvent themselves. Be it the Happy Twenties -after WWI- or the Trente Glorieuses as the French called it -after WWII- it had nothing to do with “new normality”. There was a complete overhaul of how society behaved, sociologically and economically.

It is this kind of overhaul that I am looking forward to this time. A push for a better world; more humane and at the same time more technologically based. With technology working for the person, the same way that during the “Trente Glorieuses” an invisible revolution (J. Fourastié, la Révolution invisible) transformed Europe, combining high productivity, higher wages and, above all, a level of social benefits unprecedented in the history of humankind.

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The Riyadh Declaration on Digital Health articulated seven priorities and nine recommendations to be adopted by the health community. Even though Covid-19 has been an accelerator of the adoption of ICT tools applied to the health sector, a deficit in the widespread adoption of digital tools to foster a better healthcare persists.

Of course, out of the 7+9 we could choose many culprits for the situation. But to me there are two recommendations that are the core of the problem:

Number 6: Cultivate a health and care workforce with the knowledge, skills, and training in data and digital technologies required to address current and future public health challenges

Number 8: Develop digital personal tools and services to support comprehensive health programmes (in disease prevention, testing, management, and vaccination) globally

Both recommendations focus on people; one on the healthcare professional, the other on the citizen. Both groups are eHealth users, and both groups are normally forgotten by the developer. The basic problem is the existence of a generation gap. Most ICT developers are millennials, the kind of person who, like somebody I was with yesterday, thinks that a 40-year-old person is “old”. They are not willing to pay attention to the reality of demographics. If they invested some minutes to the study of today’s demographics, they would discover that one third of healthcare workers are over 50, and that one fifth of the EU-27 population is over 65 (see Training for ICTs).

The point is that developers should have users in mind. I know that, at least in EU funded projects, it is a requirement to take end-users into the equation. And I know that efforts are made by the developing consortia to involve them. But the problem exists, and it exists because the process of getting an ICT application into the market starts with the ICT developer dreaming of a solution to a problem that the developer has identified, and then looking for an end user that fits the dream.

The correct process should have been, and very seldom is, for the end user to dream about solving his or her problem, and then identify the ICT developer that fulfils the dream. As you can see, the end user should be the driver of the process, not the back-seat passenger in the development vehicle. Acting this way will make it easier for ICT to reach its true potential.

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Rehabilitation is mostly understood as a side order of a full-blown treatment of an illness. Should it be so? The first casualty of that point of view is rehabilitation itself. Rehabilitation is “a set of interventions needed when a person is experiencing limitations in everyday physical, mental, and social functioning due to ageing or a health condition, including chronic diseases or disorders, injuries, or trauma”[i] The definition does not imply that rehabilitation should be linked to the treatment of an illness. My point is that rehabilitation should be linked to maintaining one’s physical or mental health: a prevention tool more than a cure.

If we take that approach, rehabilitation would become part of primary care as against being a by-product of specialist care. Primary care is the point to which a person will turn when feeling something is wrong with his/her health. That does not mean necessarily that the person is ill; that the person is a “patient”. I resent very much that word. The label “patient” is diminishing any way you look at it. Does it mean you must be tolerant with the health professional who is treating you? Or is it that you must endure your suffering? The use of the word “patient” limits also the scope that rehabilitation should have since it links rehabilitation to illness.

Rehabilitation should take a bigger role in humans’ wellbeing. A recent paper[ii] points out that almost one in three people on the planet needs some kind of rehabilitation. If we narrow the focus, 1.71 billion people have musculoskeletal conditions that could benefit from rehabilitation. Narrowing even more, around 30% of the population in the European Region has musculoskeletal problems.

With an ageing society, that percentage is only going to increase and the health system, or primary care for that matter, is not and will not be able to cope with the problem. A different approach must be taken to devise a system that relies more on prevention and less on after- the fact- cure. The situation represents a unique opportunity for developing easy to use ICT tools that help primary care professionals address the growing demand for preventive and curative rehabilitation therapies.


[i] Cieza A. Rehabilitation the health strategy of the 21st century, really? Arch Phys Med Rehabil 2019; 100: 2212–14. Cited by Cieza A. et al Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. thelancet.com on December 4, 2020

[ii] Cieza A. et al Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. thelancet.com on December 4, 2020. https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2932340-0 Accessed 08.12.20

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