Mobile Global Health

Key Takeaways

• Public health services and epidemiology research can reach larger audiences if accessible via mobile technology, from cell phones to smartphones to tablet devices.
• Harnessing the power of mobile devices can improve public health worldwide in the fields of both chronic and infectious diseases, with mobile apps for public health of key importance.
• The Global Health Network Supercourse plans to expand its capabilities to facilitate the development of mobile apps for public health, starting with physical activity, which is easy to monitor using mobile devices.

In the past 15 years, researchers at the University of Pittsburgh Department of Epidemiology (part of the Graduate School of Public Health) and a global network of 50,000 researchers and teachers have devoted time to developing the Supercourse, which has collected a library of more than 4,700 online lectures targeting public health and prevention. Supercourse lectures have traditionally used online PowerPoint slides with notes, but over the past few months Supercourse approaches to mobile global health have taken off.

A Google search on mobile global health finds 77 million sites. Supercourse has a website on mobile global health issues — the beta version of the Mobile Global Health Supercourse site — where we present 10 outstanding lectures on the mobile revolution, as well as 20 YouTube educational videos showing people how to use mobiles and apps. This site also features links to apps for exercise, science, and health.

While originally designed for Internet use, Supercourse lectures look acceptable on mobile devices, as shown in Figure 1.

Figure 1. Supercourse Global Health Lecture on a Mobile Device

Mobile Apps

Since the Supercourse began 15 years ago we have noticed striking changes in the way people receive and share information — from computers and laptops to smaller devices such as Android devices and iPhones and iPads — and over the past 15 years the number of mobile phone users worldwide has increased tremendously. Mobile apps,¹ which run on hand-held devices, are increasingly popular among smartphone users especially. Consequently, we believe mobile technology represents the future of global health and prevention, or m-health.

The most widely cited definition of m-health is by Robert Istepanian, who first defined it in the late 1990s as "emerging mobile communications and network technologies for healthcare."² The Supercourse has a somewhat different focus on mobile technology, targeting prevention. During the past 50 years humans have seen an increase in life expectancy of 30 or more years, almost all due to prevention, yet most prevention consists merely of communication, education, and dissemination of public health knowledge. For the first time in the existence of humankind we can reach almost everyone in the world through mobile phones, dramatically improving the opportunities for prevention of health problems around the world.

Supercourse Mobile Network now encompasses 50,000 global health experts supporting the content offered and more than 300 individuals interested in mobile technology and health. Global health and prevention specialists have limited knowledge of technology, so we are trying to build a dialogue between the experts in mobile technology and the experts in global health.

"App-idemiology" and Mobile Technology

An interesting conceptual shift in the field of public health is to consider the future one not of epidemiology but of app-idemiology — the application of apps on mobile devices to epidemiology and global health issues. Global research might become much easier with mobile technology, for example, with surveys reaching around the world in seconds. Research studies conceivably could have a sample size of 6.2 billion, and health education could be available to almost everyone.

Previous research found that even among homeless people in the Philadelphia area, almost half (44 percent) of the sample had a mobile phone.³ Not everyone in the world has access to smartphones, however. We would appreciate the thoughts of the global community about using simple and inexpensive cell phones because the more advanced the mobile technology, the fewer the people who use it. Mobile global health efforts must therefore work at all levels of mobile connectivity.

Although the benefits associated with mobile technology offer great potential in the healthcare sector, widespread adoption has lagged.⁴ Despite some use of cell phones for public health surveillance, mobile technology could monitor potentially large numbers of diseases, including chronic and infectious ones. Cell technology can also be used effectively during disasters, not only to monitor the epidemiology of the disasters but also for long-term mitigation to reduce the epidemiology of fear and for triage. Deploying remote radiation and chemical sensors would markedly increase the density and thus effectiveness of environmental monitoring, helping government and international public health entities anticipate — or, better, prevent — public health disasters. We can think of health education not just for hundreds of people, but for billions.

Apps have been explored in the context of clinical areas. Pervasive healthcare support through mobile information technology solutions plays an increasing role in the attempt to improve healthcare and reduce costs.⁵ Even in poor regions of Honduras, most chronically ill patients have access to mobile technology, and most are willing to participate in automated telephone disease-management support.⁶ Migration in Haiti was evaluated through the GPS systems of cell phones, which provides a nice early example of public health surveillance. Accelerometers in cell phones could monitor physical activity and falls in the elderly. The many existing weight-loss apps become increasingly important with the growing obesity epidemic. While more than 100 exercise apps are available, most of them do not deal with health and prevention but with building muscle. There are many opportunities to develop more health and disease prevention apps.

New Challenges, New Solutions

One of the biggest challenges that Supercourse faces as it transitions to support mobile global health requirements is how to embrace the wide variety of content formats and slide decks that health professionals want to contribute while also delivering these disparate content collections to different mobile devices. Further complicating the challenge are user expectations. Mobile apps must be simple, efficient, and extremely easy to use.

Today, a Supercourse "experience" is typically represented as a PowerPoint slide deck downloaded or viewed on a laptop or desktop PC. Some smartphones and tablets such as Apple's iPad include apps that can view PowerPoint slides. The ability to view these slides across all mobile operating systems is not guaranteed, however, because of software incompatibilities. Additional risks associated with an information strategy based on a single file format include competitive pressures between mobile operating system manufacturers. Google's Android mobile OS competes directly with Microsoft's Windows Phone 7, and each company has drawn rigid competitive battle lines over office documents and cloud services. Apple's iOS may not be licensed on third-party hardware, only on Apple devices. These incompatibilities complicate moving Supercourse content to mobile formats.

While PowerPoint has served Supercourse well, educational and mobile expectations with digital material have expanded significantly in the past five years. Studies have shown that educators and students benefit greatly from presentations that employ dynamic and rich media. As a means for organizing and distributing a comprehensive mobile educational experience, PowerPoint falls short.

According to Bill French, a mobile information design consultant, Supercourse could benefit greatly by providing a mobile publishing framework that bundles rich media artifacts in a common configuration and delivers them as a single mobile app experience. As Bill points out:

"This approach has two key benefits — (i) it makes it possible to avoid creating multiple mobile apps for every educational experience desired, and (ii) it provides a method for creating and distributing simple or complex collections of digital materials such as slides, video, audio, and supporting documents. We must make it possible for potentially thousands of 'mobile educational experiences' to emerge easily and be distributed across all mobile devices without friction. The Supercourse publishing framework must embrace the likelihood that health educators will create a wide variety of information types that must be assembled as a cohesive experience that can be consumed instantly.

"Imagine an app — a mobile global health app — that knows how to retrieve a basket of health content goods and present each document in a way that is easy to access and seamless to view, share, and replay — all from a mobile device. This is what the future Mobile Global Health Supercourse must provide."

We also need to explore which population groups and age groups are most interested in this technology. Because mobile applications are relevant only to smartphones, tablet computers, and other devices with more advanced operating systems, it is imperative that we explore ways in which individuals possessing basic mobile phones can access Supercourse information. Whether we offer subscribed text messages or weekly voice recordings, we must develop materials specific to the populations we want to reach and for those who most need this information. Imagine, for example, an epidemiology professor presenting a Supercourse lecture on infectious diseases from a classroom in Pittsburgh, while a Peace Corps volunteer teaches the same information on a smartphone in a rural Ecuadorian village.

As mentioned, using cell technology in times of disaster may prove extremely useful. Having the ability to capture images using basic cell phones may play a role in structural triage after an earthquake, for example, such as recently occurred off the coast of Japan, followed by a destructive tsunami. After a disaster leaves many buildings in ruins, photo evidence of a questionable structure could be sent via text message to structural experts, who could then offer opinions as to whether the structure is safe for occupation. Not only does this speed up the process of recovery, it contributes to "reducing the epidemiology of fear." We anticipate that contributions from multiple disciplines will assist in the development of these capabilities.

We believe that in the future mobile devices will play a critical role in improving people's health, especially in the developing world, through prevention. One of the important applications of mobile technology is prevention of diabetes, which is a growing problem around the world. We hope that mobile technology and apps will increase our research capabilities and help researchers collect information much faster. While most of us have cell phones these days, we do not use their full potential to improve health. The development of more disease prevention apps should encourage more frequent use of mobile devices by the general population. We welcome everybody's thoughts about the development of global mobile apps for health. Please contact us at [email protected].

The direction in which education starts a man will determine his future life.
— Plato (427BC–347BC), The Republic

1. Apps can be defined as application software running on a computer, a mobile device (iPhone, Android phone, personal digital assistant), or other platform (Facebook, Twitter) to help people perform an activity.
2. See the Wikipedia entry on mHealth and Nick Booth's report of Professor Robert Istepanian's work on m-health in the research feature "Blackberries are not the only fruit…" Istepanian is on the faculty of the Computing, Information Systems, and Mathematics department at Kingston University London.
3. Karin M. Eyrich-Garg, "Mobile Phone Technology: A New Paradigm for the Prevention, Treatment, and Research of the Non-Sheltered 'Street' Homeless?" Journal of Urban Health, vol. 87, no. 3 (May 2010), pp. 365–380.
4. Susan Standing and Craig Standing, "Mobile Technology and Healthcare: The Adoption Issues and Systemic Problems," International Journal of Electronic Healthcare, vol. 4, no. 3/4 (2008), pp. 221–235.
5. Huiying Zhang, Mihail Cocosila, and Norm Archer, "Factors of Adoption of Mobile Information Technology by Homecare Nurses: A Technology Acceptance Model 2 Approach," Computers, Informatics, Nursing, vol. 28, no. 1 (January/February 2010), pp. 49-56.
6. J. D. Pietteet et al., "Access to Mobile Communication Technology and Willingness to Participate in Automated Telemedicine Calls Among Chronically Ill Patients in Honduras," Telemedecine Journal and E-Health, vol. 16, no. 10 (December 2010), pp. 1030–41.

© Faina Linkov, Eric Marler, Bill French, Meredith Hennon, Kyle Freese, Francois Sauer, Ronald LaPorte, and Evgeniy Shubnikov. The text of this EQ article is licensed under the Creative Commons Attribution 3.0 license.