Invited Keynote to the "Digital Health Promotion Executive Leadership Summit" held at George Washington University on June 5-6, 2018.

1. Public Health & Digital Health:
The Road to Discovery
Bradford W. Hesse
Chief, Health Communication & Informatics Research

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What is the road ahead for
public health in the digital
age?
(with apologies to Bill Gates)

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Public Health

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Source: Colgrove, J. K., Markowitz, G. E., & Rosner, D. (2008). The contested boundaries of American public
health. New Brunswick, N.J.: Rutgers University Press.
The first half of the 20th Century belonged to
public health, with dramatic improvements in
sanitation, infection control, infant mortality,
and life span.

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The second half of the 20th Century belonged to
biomedicine, with the emergence of “wonder
drugs,” advances in biomedical knowledge, and
technology.
Penicillin
Artificial Heart
Source: Colgrove, J. K., Markowitz, G. E., & Rosner, D. (2008). The contested boundaries of American public
health. New Brunswick, N.J.: Rutgers University Press.

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Challenges Confronting the 21st Century
• Global rise in chronic disease
• Aging populations world-wide
• Rising number of co-morbid conditions
• Increasing medical costs for patients
with complex conditions
• Decreasing supply of trained health
professionals to accommodate
projected rise in medical demand
See: Hesse, B. W. (2009). Rebuilding the levees in public health [review of The Contested Boundaries of
American Public Health]. PsycCRITIQUES, 54(2), No Pagination Specified.

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Public Health Biomedicine
Health Promotion
Neither Public Health Practice nor Biomedical
Practice alone will be sufficient. Boundaries
must converge.
See: Hesse, B. W. (2009). Rebuilding the levees in public health [review of The Contested Boundaries of
American Public Health]. PsycCRITIQUES, 54(2), No Pagination Specified.

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NIH Director Testimony to Congress: March 9, 2005
Elias Zerhouni,
NIH Director
2002-2008
Medicine and Public Health must go beyond
their industrial, mass communication roots.

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The Last Mile
Problem

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The Digital World

13. “Augmenting Human Capacity” – December 9, 1968
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14. Connecting Data & People: ARPAnet 1970’s to 1980’s
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Power to the people: Computing goes personal.
Jobs and Wozniak Pioneer
Personal Computing

16. Congress opens up its investments in TCP-IP (Internet
Protocol) to schools, the public, and commercial interests
Senator (later VP)
Al Gore
Representative
Newt Gingrich 16

17. Psychological research provides insight into
sociotechnical influences on behavior
See also: Hesse, B. W., Sproull, L., Kiesler, S. B., & Walsh, J. P. (1993). Returns to science: computer networks in oceanography.
Commun. ACM, 36(8), 90-101.
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• Increase in candor as social cues
become less salient
• Increases in disinhibited speech
(flaming)
• One to many query capabilities: “Does
anyone know?”
• Increased capacity for parallel
processing -- crowdsourcing
• Benefits to temporally or geospatially
displaced individuals

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The Interface Wars: Cognitive principles and human factors
approaches improve intuitiveness & marketability.
See: Hesse, B. W., & Shneiderman, B. (2007). eHealth research from the user's perspective. Am J Prev Med, 32(5 Suppl), S97-103.

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Public Health Surveillance on Communication Environment

20. National Goals: Healthy People 2010 & 2020
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21. The Rise of Mobile to Access Health Information
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Trust vs. Use of Information Sources / Channels
Source: Hesse, B. W., Moser, R. P., & Rutten, L. J. (2010). Surveys of physicians and electronic health
information. N Engl J Med, 362(9), 859-860.

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Trends for Interacting with Healthcare System Online
Source: Hesse, B. W., Greenberg, A. J., & Rutten, L. J. F. (2016). The role of Internet resources in clinical
oncology: promises and challenges. Nat Rev Clin Oncol. doi:10.1038/nrclinonc.2016.78

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We’ve reached a “supernova” of change
fueled by:
• Smartphone technology
• Internet of things, ubiquitous computing
• Parallel processing
• Cloud computing
• Cognitive technologies
• Expansive social media platforms

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Public Health in the Digital
World:
The Road to Discovery

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National Committee on Vital & Health Statistics: Creating a
National Health Information Infrastructure
Published in 2001

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See: Hesse, B. W., Hansen, D., Finholt, T., Munson, S., Kellogg, W., & Thomas, J. C. (2010). Social Participation in Health 2.0. IEEE
Computer, 43(11), 45-52.

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Prelude to Healthcare Reform
Meaningful Use
Safety, Quality
Improvement
Privacy, Security
Patient
Engagement
Continuity of
Care
Population
Health
Management
HITECH Act of 2009: Meaningful Use for Health IT

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21st Century Cures Act: Connecting Systems for
Accelerated Impact
• Trusted Exchange
Network
• API without Special
Effort

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Creating an Ecosystem for Advancing Public Health
through Connected Data Flows
Source: Mandl, K. D., & Kohane, I. S. (2016). Time for a Patient-Driven Health Information Economy? N Engl J Med, 374(3), 205-208.

32. 32Courtesy: Wendy Nilsen, National Science Foundation
Smart and Connected Health Funding Initiative

33. L.A.U.N.C.H.
Linking and Amplifying User-Centered Networks
through Connected Health
FundingFocus on symptom
management: Patrick et al
achieved 50% reduction in
preventable hospitalizations
with this approach

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What if?

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We could link our public health data systems to improve our
support for population health management.
Source: NCI and Department of Energy Collaboration to Improve Cancer Surveillance.

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We could create a life-sensitive support system to optimize
health across the life span?

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We could solve the last mile problem by connecting all of
our communities through telehealth and digital therapies?

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We could apply industry-level engagement techniques to
help individuals and communities improve their health.

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