Download pdf - Need new skills and competencies - AAVMC · Need new skills and competencies NAVMEC July 2010July 2010 Las Vegas USA Dr. Theresa Bernardo WHO/PAHO ... ‘One Health’ may provide

Health Wanted:Health Wanted:Need new skills and

competencies

NAVMECJuly 2010July 2010 Las Vegas USA

Dr. Theresa BernardoWHO/PAHO Washington DC Mi hi St t U i itMichigan State University

Skills & Competencies: pEmerging & New

Competency in a much broader spectrum of digital technology: communications, diagnostic & therapeuticKnowledge of eco-issues, climate change, ‘green’Increasing awareness on ethical issues includingIncreasing awareness on ethical issues, including genetic modificationIncreased political engagement & advocacyIncreased political engagement & advocacy‘One Health’ may provide opportunities for new roles, requiring new skills (medical and non-medical)requiring new skills (medical and non-medical)

Skills & Competencies: pEmerging & New

Competency in a much broader spectrum of digital technology: communications, diagnostic & therapeuticKnowledge of eco-issues, climate change, ‘green’Increasing awareness on ethical issues includingIncreasing awareness on ethical issues, including genetic modificationIncreased political engagement & advocacyIncreased political engagement & advocacy‘One Health’ may provide opportunities for new roles, requiring new skills (medical and non-medical)requiring new skills (medical and non-medical)

New Commission on the Skills of the American Workforce 12/06

Leaders from business educationLeaders from business, education and government“the US needs to bring what and howthe US needs to bring what and how it teaches into the 21st Century”The ability to function effectively asThe ability to function effectively as part of a team that crosses disciplinary, cultural, linguistic anddisciplinary, cultural, linguistic and geographic barriers is central to the skill set required for a global economy

New Commission on the Skills of the American Workforce 12/06

Leaders from business educationLeaders from business, education and government“the US needs to bring what and howthe US needs to bring what and how it teaches into the 21st Century”The ability to function effectively asThe ability to function effectively as part of a team that crosses disciplinary, cultural, linguistic anddisciplinary, cultural, linguistic and geographic barriers is central to the skill set required for a global economy

7 July 2005 London England8 50 th h b b l d d8:50 am: three synchronous bombs exploded

9:08 am: First Entries in Wikipedia9:08 am: First Entries in Wikipedia

- geography

The Wisdom of CrowdsThe Wisdom of Crowds

“By the end of the day over 2500By the end of the day, over 2500 users had created a comprehensive 14 page account of the event that was muchpage account of the event that was much more detailed than the information provided by any single news outlet."p y y g

Reference: Tapscott D. & Williams A.D. 2006. Wikinomics: how mass collaboration changes everything. Portfolio (Penguin), New York, 65.

29 Aug 2005 Gulf Coast USAgHurricane Katrina: 1500 dead, a million displacedp

Notices were posted in hundreds of online forums

http://www blogherald com/2005/08/31/hurricane katrina missing persons appeal/http://www.blogherald.com/2005/08/31/hurricane-katrina-missing-persons-appeal/

I’m looking for my daddy, Kenrick Bennett ! Last time seen was Aug 28,2005 please call me anybody. Also Brandon Gilmore and family, Je’von Baker, and her family. My cell is (504)329-1779 my location is Florida. Cell is working please call anybody !!!

LOOKING FOR MY SON DAVID CASLER WIFE MARI AND KIDS …………… OO G O SO C S S ……………PLEASE CALL US AT 850 777-7579 CELL ………..

Please, I am deperate to find out information on Jones County, particularly Laurel. I have parents that I cannot contact. My father is in poor health and needs a power supply toMy father is in poor health and needs a power supply to survive. I fled Hattiesburg yesterday and am now in Jacksonville, FL. Their names are John and Charlotte Mosley. Please, PLEASE contact my at slimshadygrove25@hotmail com with ANY information [email protected] with ANY information. Thank you.

Notices were posted in hundreds of online forums

http://www blogherald com/2005/08/31/hurricane katrina missing persons appeal/http://www.blogherald.com/2005/08/31/hurricane-katrina-missing-persons-appeal/

I’m looking for my daddy, Kenrick Bennett ! Last time seen was Aug 28,2005 please call me anybody. Also Brandon Gilmore and family, Je’von Baker, and her family. My cell is (504)329-1779 my location is Florida. Cell is working please call anybody !!!

LOOKING FOR MY SON DAVID CASLER WIFE MARI AND KIDS …………… OO G O SO C S S ……………PLEASE CALL US AT 850 777-7579 CELL ………..

Please, I am deperate to find out information on Jones County, particularly Laurel. I have parents that I cannot contact. My father is in poor health and needs a power supply toMy father is in poor health and needs a power supply to survive. I fled Hattiesburg yesterday and am now in Jacksonville, FL. Their names are John and Charlotte Mosley. Please, PLEASE contact my at slimshadygrove25@hotmail com with ANY information [email protected] with ANY information. Thank you.

Order Out of ChaosOrder Out of Chaos

Tech savvy volunteers:Tech-savvy volunteers:deployed an automated process to scour the web, extracting essential information for collation in a central databaseauthored an open source standard for missing persons data: “PeopleFinder Interchange Format”set up a wiki to organize who was doing whatset up a wiki to organize who was doing what

Result: a single site searchable by name, zip code or address ( 1 illi h d t d)(> 1 million searches conducted)

Lessons LearnedLessons Learned

“th d f di d l t t f t“thousands of dispersed volunteers can create fast, fluid and innovative projects that outperform those of the largest and best-financed enterprises”g p

appeared to be spontaneous, but instigators had experience in the open source software industry (whereby programmers share and build upon each other’s code)

th i l li d th i kill i th f lthey simply applied their skills, using these powerful tools and practices, to a new situation.

Reference: Tapscott D. & Williams A.D. 2006. Wikinomics: how mass collaboration changes everything. Portfolio (Penguin), New York, 65.

Infectious Disease CorollaryInfectious Disease Corollary

Epidemic CurveEpidemic Curve

Time


Epidemic CurveEpidemic Curverapid response

early detectionprevention responsedetectionprevention

Time




Time

Rapid ResponseRapid Response

R dl f th t f di t ( t lRegardless of the type of disaster (natural, man-made, infectious, environmental), time saves livesCoordination of communication and logistics major limiting factors Use the Internet! Combine collaborative skills with scientific situational expertisesituational expertise

Eg. Use social networking tools to track h t i h i th d dwhat is happening on the ground and

solicit expert opinion

Web 2 0: Social MediaWeb 2.0: Social Media

Web sed to be abo t finding informationWeb used to be about finding informationNow its about interacting with each other!!

Eg. blogs, wikis, Facebook, MySpace, Twitter, texting web enabled cell phones

People on site

texting, web-enabled cell-phones …

pcould update a blog, send a picture and consult anand consult an expert

24 April 2009 Pandemic H1N124 April 2009 Pandemic H1N1

Pan American Health Organization (PAHO)R i l ffi f thRegional office of theWorld Health Organizationhttp://www.paho.org/

Pandemic H1N1 2009

Web conferenceconference

3 languages & Interpretation

All PAHO Country Offices and Centers

Ministers of HealthMinisters of Health

PAHO Regional Office PAHO Regional Office –– Task forceTask force

Monthly Meetings per YearNo. of Virtual Meetings per month

2173

2000

2500

g p

14551319

1579

17971650

13851500

2000

720 690810

12601110

960

12151110

1005855

1319

11321000

57157 112 78 105 80 89 92 113 105 153

85

375

606

0

500

0

Jan

Feb

Mar

ch

April

May

June

July

AugustSep

tem

berOct

oberNov

ember

Decem

ber

2007 2008 2009

Ministry of Health Guyana - webconferencing

• H1N1 meetings with PAHO and dissemination of• H1N1 meetings with PAHO and dissemination of information to public health officials• decreased phone and travel costs

i d i i i i h i l• increased participation in technical events• 2 yr postgraduate surgery program

•MoH, main hospital, CIDA and Canadian pInstitutions (UBC, U of T, McMaster U.)•5 graduates establishing surgery programs in regional hospitals (another 5 grads in Nov 09)regional hospitals (another 5 grads in Nov 09)

12 Jan 2010 Haiti Earthquake7 0 M 230 000 d d 1 illi di l d7.0 Mw: 230,000 dead; 1 million displaced

Matching offers and needsMatching offers and needs

?

DFID

British Red Cross

Matching offers and needsMatching offers and needs

?

DFID

Thunder.clap

British Red Cross

Ushahidi orgUshahidi & Ushahidi.orgHaiti Earthquake Crisis MappingCrisis Mapping

Graphic Facilitation by Peter Durand Alphachimp Studio

Ushahidi orgUshahidi.orgThe Ushahidi Platform was built for information

collection, visualization and interactive mappingmeans “testimony” in Swahili

b b d l f i i ll d l dweb-based platform originally developed to map reports of violence in Kenya after the disputed 2007 election based on collaboration among Kenyan citizen journalistsbased on collaboration among Kenyan citizen journalistssupported by volunteers including human rights workers and software developers primarily in Africa, also EU /US it is a free and opensource, allowing for information collection by text, email and web It serves as an early warning system and helps withIt serves as an early warning system and helps with data visualization for response and recovery

MapsMapsOpenStreetMap

a free editable map (think WikiMap) of the whole world that anyone can view, edit or download

C i i C /C i i CCrisis Commons /Crisis Campsglobal network of volunteers: US/UK/CA/CO/CHgeospatial programmers team leaders linguists etcgeospatial programmers, team leaders, linguists, etc.

Haiti applicationspassable roads “OpenRouteService org”passable roads OpenRouteService.orglocation & operational status of hospitals/health facilitiesthe Haiti Population Calculator . Allows a user to draw t e a t opu at o Ca cu ato o s a use to d aa random polygon around an affected area and retrieve the population and its attributes and land area

People finderPerson Finder: Haiti Earthquake English | Français | Kreyòl | Español

People finder

What is your situation?

I'm looking for I have information

Person Finder: Haiti Earthquake English | Français | Kreyòl | Español

I m looking for someone

I have information about someone

Currently tracking about 55200 records.

PLEASE NOTE: All data entered will be available to the public and viewable and usable by anyone. Google does not review or verify the accuracy of this data.

Embed this tool on your site - Developers - Terms of Service

Common Operating PictureCommon Operating PictureCombine information from all relevant sources

OneResponse (Sharepoint) UNAPAN (all partners access network) US military/civiliansHaiti resilience system

Use a variety of collaborative tools and methods for data visualization analysis and disseminationdata visualization, analysis and dissemination

open maps, open data, open educational resources Modify in response to a variety of situations (naturalModify in response to a variety of situations (natural,

man-made, infectious and environmental) electionselectionshurricanes (Katrina) and earthquakes (Haiti, Chile) wildlife and environmental monitoring (Gulf oil spill)

Wiki iWikinomics

2010 World Economic Forum2010 World Economic Forum Quotes from Don Tapscott at Davos:

panel discussion on The Power of Social Networks“Thanks to the internet, there are now new global networks that are multi stakeholder and that arenetworks that are multi-stakeholder and that are beginning to address global problems in new ways.”“These are networks that involve governments, private g , pcompanies, civil society organizations and a new fourth pillar of society – individuals.” “ pl nked right in the middle of the disc ssion is this“…plunked right in the middle of the discussion is this actual example [Haiti] of this occurring.”

Collaborative ToolsCollaborative Tools



Time




Time




Time

What are we dying from?What are we dying from?

Group I: Infectious, maternal, perinatal andmaternal, perinatal and nutritional conditions

Group II:199055%2020Group II:

Noncommunicablediseases

55%202073%

Group III: Injuries (suicide, war, road trafficaccidents fire violence)accidents, fire, violence)



Developing regionsDeveloping regions

• by 2020 deaths from noncommunicable diseases are expected to reach 70%

• driven by population aging, augmented by the large numbers ofaugmented by the large numbers of people who are now exposed to tobacco

Ten Leading Causes of Death 2006 Lo Middle Income Co ntries2006 Low-Middle Income Countries

World Deaths inmillions

% of deathsmillions deaths

1. Ischemic heart disease 5.7 11.82. Cerebrovascular diseases 4.6 9.53. Lower respiratory infections 3.4 7.04. HIV/AIDS 2.6 5.35. Perinatal conditions 2.5 5.16. COPD 2.4 4.97. Diarrheal disease 1.8 3.78 T b l i 1 6 3 38. Tuberculosis 1.6 3.39. Malaria 1.2 2.510. Road traffic accidents 1.1 2.2

Source: Global Burden of Disease and Risk Factors 2006

Ten Leading Causes of Death 2006 High Income Co ntries2006 High Income Countries


% of deathsmillions deaths

1. Ischemic heart disease 1.4 17.32. Cerebrovascular diseases 0.8 9.93. Trachea bronchus lung cancers 0.5 5.84. Lower respiratory infections 0.3 4.45. COPD 0.3 3.86. Colon and rectal cancers 0.3 3.37. Alzheimers & other dementias 0.2 2.68 Di b t llit 0 2 2 68. Diabetes mellitus 0.2 2.69. Breast cancer 0.2 2.010. Stomach cancer 0.2 1.9

Source: Global Burden of Disease and Risk Factors 2006

Sign UpAnimal Obesity Awareness is on FacebookAnimal Obesity Awareness is on Facebook

InformationCategory:Organizations - GeneralDescription:This is a group created to raise awareness about the obesity epidemic that is sweeping our nation The obesity in our pets is aThis is a group created to raise awareness about the obesity epidemic that is sweeping our nation. The obesity in our pets is a serious issue in today's world and we could be setting up future generations of overweight, unhealthy animals. Some of the more serious issues include heart disease, diabetes, stroke, and saddest of all, low self esteem.

Hill’s Pet Nutrition Survey of EU Veterinarians:2/3 identified pet obesity as the single biggest p y g gghealth issue facing domestic animals, with early death as the most serious consequence

Global challenges?Global challenges?

Population growthPopulation growth • currently 6.8 billion• growth rate peaked at 2.2% in 1963• reach 9 billion in 2040 – 2050?

Resource limitations • clean air, water and soil,• energy (peak oil in 2011)

Climate changeClimate change


water people and petswater people and pets

l tplants

energy

food animals


New models of global problem solvingNew models of global problem solving

Collective human intelligenceCollective human intelligence +

Machine intelligenceMachine intelligence =

I t lli t l ti ?Intelligent solutions?

Thank you!!


Hot flat and crowded (climateHot, flat and crowded (climate change, populationCommon Wealth: economics for a crowded planetpPopulation versus carrying capacitycapacityJust as diseases don’t recognize borders

Peak OilPeak Oil

Point in time when thePoint in time when the maximum rate of global

t l t ti i h dpetroleum extraction is reached, after which the rate of production enters terminal declinedecline

PopulationPopulation

Currently 6 8 BCurrently 6.8 BExpected to reach 9 B between 2040 and 2050Growth rate peaked atGrowth rate peaked at 2.2%/year in 1963, has since declineddeclined

Web 3 0 Semantic webWeb 3.0 Semantic web

Intelligent agentsIntelligent agentsThe semantic web is a vision of information that is understandable by computers, y p ,so computers can perform more of the tedious work involved inof the tedious work involved in finding, combining and acting upon info on the webupon info on the web.Realtime publishing and sharing

Early DetectionEarly DetectionOfficial disease reports (WHO/OIE/FAO)

verified with national government prior to release

1994 ProMED (30,000 subscribers in 150 countries)Captured reports from a wide range of constituents and combinedCaptured reports from a wide range of constituents and combined human/animal/plant health

1999 GPHIN: Global Public Health Intelligence Networkj i t j t f P bli H lth A f C d d WHOjoint project of Public Health Agency of Canada and WHOautomatically scans news feeds (eg. Reuters, AP) and web sites in multiple languages for reports of public health significance“gisted” into English by machine translation, checked by humanscredited with early detection of ~ 40% of WHO verified disease outbreaks (SARS, HPAI); led to changes in reporting obligations (International Health Regulations)

The World Is FlatThe World Is Flat

The World Is FlatThe World Is Flat

“ the creation of a global web enabled playing… the creation of a global, web-enabled playing field that allows for multiple forms of collaboration – the sharing of knowledge andcollaboration the sharing of knowledge and work – in real time”

“… developing new processes and habits for horizontal collaboration … is the most important force shaping global economics and politics in the early 21st century.”

Source: The World is Flat: A Brief History of the 21st Century by Thomas Friedman

Collaborate and Share the WorkCollaborate and Share the WorkTime of unequalled opportunityTime of unequalled opportunity

Complex public health challenges can only be met through collaboration (internal and external)through collaboration (internal and external)public sector (national, regional and international)private sector (foundations, corporations)media (reporters, celebrities)academia (researchers, educators)civil society (NGOs individuals)civil society (NGOs, individuals)

Not just colleagues, but clients!!!

Web Collaboration SoftwareWeb Collaboration Software

What is Health?What is Health?

WHO d fi iti “H lth i t t fWHO definition: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”y

R f P bl t th C tit ti f th W ld H lth O i tiReference: Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Offi i l R d f h W ld H l h O i i 2 100) d(Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

Ten Leading Causes of Death All Co ntries 2004All Countries 2004


% of deaths

Coronary heart disease 7.2 12.2Stroke/cerebrovascular diseases 5.7 9.7Lower respiratory infections 4 2 7 1Lower respiratory infections 4.2 7.1Chronic obstructive pulmonary dis. 3.0 5.1Diarrheal disease 2.2 3.7HIV/AIDS 2.0 3.5Tuberculosis 1.5 2.5Trachea, bronchus, lung cancers 1.3 2.3Trachea, bronchus, lung cancers 1.3 2.3Road traffic accidents 1.3 2.2Prematurity and low birth weight 1.2 2.0

What is eHealth?What is eHealth?

WHO d fi iti "th t ff tiWHO definition: "the cost-effective and secure use of ICTs in support of health and health-related fields, including health-care services, health surveillance, , ,health literature, and health education, knowledge and research "knowledge and research.

Reference: WHO (2005) eHealth. Fifty-Eight World Health Assembly. Ninth Plenary Meeting, May 25. Committee A, seventh report. Geneva: World Health Organization.










Time

Early DetectionEarly DetectionOfficial disease reports (WHO/OIE/FAO)

verified with national government prior to release

1991 HandiSTATUS:Help with world ANimal DIsease STATUS> 100 countries 3 languages maps risk analysis user updates> 100 countries, 3 languages, maps, risk analysis, user updates

1994 ProMED (30,000 subscribers in 150 countries)Captured and distributed reports from a wide range of constituents first use of email (internet) for global health reportingfirst to include human, animal and plant health (One Health)open to reports from all sources (albeit moderated), thus p p ( ),demonstrating the value of INFORMAL REPORTINGwas a form of ATTRIBUTION: recipients could make value judgments about credibility and contributors could build a reputation for reliabilityy p y

Early DetectionEarly Detection1999 GPHIN: Global Public Health Intelligence Network

joint project of Public Health Agency of Canada and WHOautomatically scans news feeds (eg. Reuters, AP) and web sites in multiple languages for reports of public health significance“gisted” into English by machine translation, checked by humanscredited with early detection of ~ 40% of WHO verified disease outbreaks (SARS, HPAI); led to changes in reporting obligations ( ) g p g g(International Health Regulations)

2007 InSTEDD2007 InSTEDDInnovative Support To Emergencies Diseases &

Disasters: open source platform for public healthDesigned to streamline collaboration between humans (obtained through social networking) and machine(obtained through social networking) and machine learning algorithms (Bayesian) for biosurveillance

Major modulesMajor modulesData gathering (SMS, RSS, email, web, EMR, etc.)Automatic feature extraction, classification and tagginggg gHuman input and review (comment, tag, rank, generate and rank hypotheses, model)P di ti d l t t tPredictions and alerts outputField confirmation and feedback: rate reliability of sources

Haiti Epidemic Advisory SystemHaiti Epidemic Advisory SystemOperates as a community reporting system:

provides alternative to formal surveillanceidentify and prioritize infectious diseases that may become a crisis or disaster (potential IMPACT)become a crisis or disaster (potential IMPACT)>180 individuals representing Haitian authorities, various UN agencies (health, water/hygiene/sanitation, g ( , yg ,security…), NGOs, unaffiliated medical personnelproactive behaviour in response to warning information ( i i t k IV fl id t t t di h )(eg. rains coming, stock up on IV fluids to treat diarrhea) unofficial communication ensures rapid net—centric awareness of potentially actionable informationa a e ess o pote t a y act o ab e o at odoesn’t replace official verification and investigation

FrontlineSMSFrontlineSMScommunication for NGOs in developing countriesturns a laptop and mobile phones into a communications hub – does not require an Internet connection!leverages what is most frequently available (computersleverages what is most frequently available (computers and mobile phones) to create instantaneous two-way communication on a large scaleeasy to implement, simple to operate, just normal costs for text messaging current version has on screen support for 15 languagescurrent version has on-screen support for 15 languagesuseful for field work, surveys

FrontlineSMS:medicFrontlineSMS:medic“text messages save lives”communication among community health workersextending to enable better patient management, electronic medical records via cell phone cheap mobile diagnosticsmedical records via cell phone, cheap mobile diagnostics

Applications:Patient compliance (eg. increasing Tx rates for TB/HIV)p ( g g )Patient view: to manage patient information at small health centers, will move on to a robust MRS in the futureWorking with OpenMRS (medical records system) for text message integration with medical recordsRemote diagnostics with CelloPhone (UCLA): cellular-levelRemote diagnostics with CelloPhone (UCLA): cellular-level images of blood taken using the camera sensor of a simple camera phone ($1: CBC, Malaria/TB, T cell counts)

Google orgGoogle.orgGoogle Flu Trends

Analysis of search queries (people searching for flu info) detected influenza 1 – 2 weeks earlier than CDC

$15 Milli f h d t ti th$15 Million for research on detecting new pathogens and conditions necessary for spread

Global Viral Forecasting Initiative collects blood samplesGlobal Viral Forecasting Initiative collects blood samples at the human/animal interface around the world

(eg. animal markets, restaurant workers, hunters)

Improve weather prediction and effects on disease outbreaks

(eg. rains Rift Valley Fever)(eg. rains Rift Valley Fever)

Google AlertsGoogle Alerts



l l d f d ( b b bl d )Also, Blogs and RSS feeds (subscribe to blog updates)

Google Maps – My MapsGoogle Maps – My Maps

HealthMapHealthMap

GoogleGoogleOutbreaks Near Me

iPhone app that allows users to track and report outbreaks of infectious disease in real time Combination of HealthMap and alertsCombination of HealthMap and alerts

Google Docsfree shareable office suitefree shareable office suite

Google Wavestill in betastill in betaonline collaboration (eg. writing proposal) that provides a view of what has changed over time

PreventionPrevention

Knowledge:Knowledge:

discovery of new knowledge through researchdiscovery of new knowledge through research

sharing knowledge through education & communication

consolidating knowledge as standards and best practices

Complex problems Collaboration!!

Historical TrendsHistorical Trendsand

Future Challenges

World Average per Capita IncomeWorld Average per Capita Income

6000

5000

40004000

3000

2000

1000

0500 1000 1500 1800 1900 2000

Year

Source: Data from Maddison (2001); in The End of Poverty by J. Sachs.

Industrial RevolutionIndustrial Revolutionenergy from fossil fuelst t d f tilitractors and fertilizers increase agricultural efficiencyefficiencylabor shift from agriculture to manufacturing & servicesgadvent of public education

championed by industrial magnatesp y gmass production of the “docile worker”rote learning, able to read, follow directions

environmental degradation

Development Trendspdemand for education migration: rural urban (megacities) wealth and consumption of animal protein density and mobility of people, animals, food

Population (billions) versus Days p ( ) y(to circumnavigate the globe)

300350400 88

7 7

66

150200250 55

44

33

050

100 22

11

001850 1875 1900 1925 1950 1975 2000

Days Population

Source: Adapted from Michael Osterholm, University of Minnesota

Emerging Infectious Diseases (70% zoonotic)

1993 – Hanta virus1994 – Plague

1998 – Nipah virus (Malaysia)1999 W t Nil(India)

Ebola virus (Zaire)

1999 – West Nile2000 – Rift Valley Fever

1996 – New Variant of CJD (UK)

Fever2001 – Anthrax2002 – Norwalk-like

1997-H5N1 influenza (Hong Kong)

2002 – Norwalk-like viruses2003 – SARS2009 – H1N1

Double ThreatDouble Threat1) Disease in humans and animals

2) Economic ruin: disruption of livelihoods, trade, tourisme oods, t ade, tou s