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000
The Ugly
Maurice Mars
Dept of TeleHealth
University of KwaZulu-
Natal, South Africa
International Society for
Telemedicine
and eHealth
Reasonable Expectations
What is the Global Health Problem ?
Money
The Developed World - The Problems
The Global Health Problem : Money
• Developed world – rising health costs,
ageing population, chronic disease. • Developing world – poverty and low
health budgets, burden of disease
The Developing World ?
Developed World
~ 1 Billion
Emerging and
Developing
Nations
~ 5 Billion
The Bottom Billion
World 2010
Population Distribution (% Total Pop)
World 2010 Europe 2010 Africa 2010
Population Distribution %
Median Age By Region
Population Growth
1950 2010 2050
World 2,529 6,829 9,150
Africa 227 1,010 1,998
Asia 1,403 4,121 5,231
Europe 547 732 691
Latin America / Caribbean 167 582 729
Northern America 172 348 448
Oceania 13 35 51
Source: United Nations Population Division, World Population Prospects
2008 Revision (Medium variant)
Population Data (Millions)
Telemedicine in the Developing World
The Problem
Can one justify
spending money
on ICT solutions ?
Population Living on <US$1 /Day (PPP)
African region 42.6%
South-East Asia region 38.4
Global Average 22.7
Western Pacific region 16.0
Eastern Mediterranean 11.0
Region of the Americas 4.8
European region -
WHO World Health Stats 2012
The Global Problem
Per Capita Government Health Spend US$
South-East Asia region 19
African region 41
Eastern Mediterranean 96
Western Pacific region 361
Global Average 549
Region of the Americas 1,566
European region 1,677
WHO World Health Stats 2012
The Most Bang For Your Buck
The Problem
The Global Situation
Doctors per 100,000 people
African region 22
South-East Asia region 56
Eastern Mediterranean 109
Global Average 142
Western Pacific region 148
Region of the Americas 200
European region 332
WHO World Health Stats 2012
Country Rank Telephone Mobile
Cellular
Fixed
Broadband
Niger 165 41.3% 73.4% 210.5%
Malawi 164 18.2 91.0 2,408.0
S Africa 99 5.2 4.8 5.7
USA 12 0.3 0.8 0.5
Monaco 1 0.1 0.3 0.3
ICT Cost
Cost of a bundle of telephone, mobile phone,
broadband as a percentage of GNI per month
International Telecommunications Union 2011
Darkest Africa
Digital Divide
0
10
20
30
40
50
60
70
80
90
100
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011*
Per
100 i
nh
ab
itan
ts
Mobile-cellular telephone subscriptions
Internet users
Fixed telephone lines
Active mobile-broadband subscriptions
Fixed (wired)-broadband subscriptions
Source: ITU World Telecommunication /ICT Indicators database
Global ICT Developments, 2001 - 2011
39,1
28,5 26,3
16,6 13,0
9,7
1,4
0
5
10
15
20
25
30
35
40
45
Europe The Americas
CIS** World Asia & Pacific
Arab States
Africa
Source: ITU World Telecommunication /ICT Indicators database
Fixed Phone Lines /100 People 2011
0
10
20
30
40
50
60
70
80
90
100
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011*
Per
100 i
nh
ab
itan
ts
Developed
World
Developing
Source: ITU World Telecommunication /ICT Indicators database
Internet Users / 100 People, 2001-2011*
0
10
20
30
40
50
60
70
80
90
100
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011*
%
Developed
World
Developing
Source: ITU World Telecommunication /ICT Indicators database
Proportion of Households With Internet
Access 2002 - 2011
0
5
10
15
20
25
30
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011*
Pe
r 1
00
in
ha
bit
an
ts
Developed
World
Developing
Source: ITU World Telecommunication /ICT Indicators database
Fixed Broadband Subscriptions / 100
People, 2001 - 2011
0
10
20
30
40
50
60
2007 2008 2009 2010 2011*
Pe
r 1
00
in
ha
bit
an
ts
Developed
World
Developing
Source: ITU World Telecommunication /ICT Indicators database
Active mobile-broadband subscriptions /
100 People, 2007 - 2011
Digital Divide and the Health Divide
The digital divide is widening
Why is this?
Is this increasing the health divide ?
If so what do we need to do?
Population Living on <US$1 /Day (PPP)
African region 42.6%
South-East Asia region 38.4
Western Pacific region 16.0
Eastern Mediterranean 11.0
Global Average 22.7
Region of the Americas 4.8
European region -
WHO World Health Stats 2012
Rethinking the Problem
Understand the problem
Prioritise young vs old?
Reduce digital divide
Reduce communication costs
Reverse the brain drain
New funding paradigm – eAid
Think Developing World in all that you do
Take Home Messages
The developing world is different
Expectations must be relevant
ICT solutions must be appropriate
National budgets are low – sustainability
Get the most bang for the buck
Is eHealth for ageing a priority ?
The Ugly
The developing World
continues to be left behind
It
Needs
YOU