The Picture Of Health - What Happens Next? podcast on digital health

Dr Susan Carland (SC): Hi, I'm Dr. Susan Carland and welcome to What Happens Next. In this episode, we've gathered all the practical tips from our experts about taking advantage of this acceleration in digital healthcare and how we can make it work for all of us.

Maithri Goonetilleke is an Associate Professor in Global Health in the Faculty of Medicine, Health and Nursing at Monash University. For the past 15 years, Maithri has worked as a clinician and public health worker in both Australia and Eswatini in Sub-Saharan Africa. Let's hear from Maithri Goonetilleke.

Maithri Goonetilleke (MG): Hi, my name's Maithri Goonetilleke, I'm a GP and I'm an Associate Professor in Global Health at Monash University.

SC Dr. Maithri, thank you so much for joining us. What would be your advice to anyone who might want to understand planetary health better? Where do they start?

MG: Well, look, I mean, I work at Monash so I would say the School of Public Health and the MSDI, which is the Monash Sustainable Development Institute, they've got some fantastic resources on their websites. There's a brilliant sort of document that came out called Our Future on Earth, if you just Google that you can ... it's really accessible, it's easy, it's got lots of pictures, which I like, and it's got really easy-to-understand explanations of things around planetary health. There's a planetary health alliance.

But I think, really, what we can do, what everyone can do to address planetary health is to understand that health is not limited to a hospital or a clinic, that health is the domain of all of us, because it is this environmental disruption, it is this social disorder which is actually creating and exacerbating the health issues that we're seeing. And so, if all of us take responsibility for that, for not just advocating or for being a part of that, but understanding that every time that you work towards creating social justice, every time that you work towards improving climate change and improving environmental sustainability, you're actually improving health outcomes for your country and your world. That's how we begin.

SC: Maithri, this was so interesting- Thank you so much for your time.

MG: My pleasure, Susan. All the best.

SC: Dr. Selina Lo, a Senior Research Fellow at the Monash Sustainable Development Institute has been responsible for global and planetary health commissions and has worked for Doctors Without Borders across the world. Let's hear from Selina Lo.

Selina Lo (SL): I'm Selina Lo, I'm a Senior Research Fellow at the Monash Sustainable Development Institute and my other life, I'm a consulting editor to The Lancet Medical Journal, based out of London, and there I commission work on planetary and global health.

SC: What would your advice be to anyone who wants to better understand what planetary health is? Where could they start?

SL: Yeah. I get asked that question a lot because planetary health as a concept has been around for years, back to the 1940s you can actually find literature that uses this terminology, but it was in more recent times, in public health at least, in global health, birthed, so to speak, in a Rockefeller Foundation-funded Lancet commission report, led by Andy Haines of the London School in 2015 and it brought together a number of scholars from very different disciplines to look at the challenge of human health and the natural world on which humans depend on.

The definition of planetary health is quite specific and I think it's sometimes misunderstood, not so much the definition, but we forget it as we go along, but the original definition of the commission is "the health of human civilisation and the natural world on which it depends." So, it's actually more than health and even health determinants, but it's civilisation, human civilisation, so the way we organise ourselves, the kind of cultural and systems inputs that we put into human civilization. And the tenets of planetary health are intergenerational equity, so the report ... the original report argued and showed that we have really done well on many indicators, child survival, maternal mortality and even infectious diseases over the last 50 to 100 years, but we've kind of mortgaged off the future of our children and grandchildren's health because our activity, human activity on the planet is hurting these so-called planetary boundaries in which human health and survival is best able to exist.

And the other important principle of planetary health is relying very much on trans-disciplinary research, training, but also transformation. And trans-disciplinary by nature, as you know, is about transformation, it's not just about bringing different inter-disciplines together to address a problem, but it's in that process to transform both our understanding and our approach. So, it's really seen as transformative and there is kind of a time urgency limit on it because, even going beyond the sustainable development goals, which is until 2030, planetary health is talking about inter-generations.

And then the last principle I'd probably want to emphasise, but people can ... I think readers can certainly investigate themselves - is on the notion and the definition of civilisation. We don't really link too much to these words anymore in health, except maybe through some of our political and social determinants, but there is a lot of scope for defining this. And I would say right now, in the context of where we are in Covid, we've actually been asked by civil society to define our legacy for civilisation or health. And that would be, very local examples, defunding of arts and humanities education and the sector. We need the arts for our wellbeing and thriving. WHO only last year published an excellent review, citing over 900 publications, showing the benefit of arts on health and wellbeing, but I mean, people ... I don't have to argue to people from the arts and humanities, but it's also important for societal wellbeing, as well.

But also with the Black Lives Matter movements all across the world, civil society is asking us to look at racism and disparities and institutional racism once and for all, please. And not to address this is ... it's ... I mean, I won't go so far to say is that it's ignorant, because it certainly is, but it's also losing opportunity to really co-create a present and future that is not only going to determine societal wellbeing, but will really, as we've known for years, speak to the core of all these determinants of health that we've been struggling with for so many decades.

So, in terms of where you could go for understanding, there's the work of The Lancet, the journal that launched Planetary Health, there is a new journal now called Lancet Planetary Health that for ... all inter-disciplinary research is interested in this because they apply not just to health but all of the SDGs, Sustainable Development Goals, so everything from gender to energy use and land use to human rights is covered there, but the journal will take submissions from across the board. But also there are networks now in the world looking at planetary health. There's a network ... it's mainly North American and Europe coming out of Harvard called the Planetary Health Alliance, based out of Harvard University. There are also discussions here at Monash, actually, to build different alliances and I'm involved with discussions in Asia with MSDI on various centres that will be promoting planetary health, from Hong Kong to Korea to Singapore, Indonesia and in the Pacific, as well. There is a lot of work that is labelling themselves in this kind of terminology, so it's quite good at the moment. The challenge is to implement things fast enough that we can be useful.

SC: Selina Lo, lots to think about there. Thank you so much for your time today.

SL: No worries, thank you so much, Susan. That was a pleasure.

SC: Chris Bain is a Professor of Practise in Digital Health in the Monash Faculty of Information Technology, the first to ever hold this role. He leads the University's efforts in digital health, working with faculties and institutes across the University, as well as with a range of health industry partners. With more than 30 years' experience in the health industry, including 12 in clinical medicine, Chris sees incredible potential for innovation and change for the better in healthcare delivery.

Chris Bain (CB): So, hi, my name's Chris Bain, I'm the Professor of Practise in Digital Health at Monash University. It's the first job of its kind in the University, so I lead efforts around digital health research and to some extent work with others around education around digital health. And my background's heavily actually been out in healthcare for about 27 years in Victoria and then in the University for the last three years.

SC: For people out there who are listening, who are perhaps interested in any aspect of digital health, Telehealth but beyond, but maybe are a little uncertain about it or wondering how could they make better use of it, either as patient or as practitioner, what's some simple advice you could give to them?

CB: Yeah so certainly for the community, I think especially at the minute it's really important people listen to the advice of their healthcare professionals, both the ones they know personally, but even the advice coming out of health departments, including around digital health and things like Telehealth. There are a few players who come into the marketplace who are spruiking services who think ... understandably are using this as an opportunity to get people to try new things. I'd be a little wary about not ... for consumers, in particular, and patients, making sure those sort of things are either auspiced by their treating GP or their specialist, don't necessarily go themselves to something that looks attractive, especially at the minute, it's a slightly different conversation afterwards. There are places in Australia, so there's the Australian ... Australasian Institute of Digital Health that I'm affiliated with and many of us in this area are. I'm sure they're happy to take questions and queries from people, even from the public about digital health in Australia and what it represents.

In terms of healthcare professionals, I think ... I mean, they're doing their job and they're doing a really good job under tough conditions and where things like digital health and Telehealth have been made available to them, they have the means to engage with those things. I guess I'd encourage them to reflect, more than anything. So as, hopefully, Victoria catches up to the rest of Australia and some relative normality comes back is, think about what that's been like, think about the good and the bad of that, think about things you would have done differently, think about opportunities that were missed, so that when we have that collective conversation afterwards we're in a really good place to contemplate the future of healthcare in Australia and the future of digital health.

SC: They were really good tips! Thank you so much for your time.

CB: No worries, Susan, my pleasure.

SC: Cathie Reid is the co-founder of Australia's Epic Group, including Epic Pharmacy and Epic Good Foundation, and the co-founder of Icon Group and she's passionate about new health solutions. She's also a Monash alumni from the Faculty of Pharmacy and Pharmaceutical Sciences. Let's hear from Cathie Reid.

Cathie Reid (CR): Hi, my name's Cathie Reid, I'm the co-founder of Australia's Epic Pharmacy Group and also co-founder of Icon Group, which includes Icon cancer centres and Slade Health chemotherapy compounding. And with it I've had a long interest and passion, I guess, for the role that digital health and digital technology can play in the delivery of health services.

SC: What are your tips for people about how they can take advantage of these changes, either as patients or maybe the health practitioners we have listening, how can we take advantage of the changes that we're seeing swirling around in this time of Covid? And how can they better embrace the opportunities that might be presented to them?

CR: Look, I think from a consumer perspective, it's to make sure that your healthcare practitioners know how ... whether you enjoyed the experience, whether it was better for you? Did it actually make your life easier, not having to come into the surgery all the time? Can you reach a compromise, essentially, with your doctor? If the doctor's preference is that you return to face-to-face, can you actually say, "Well, it was easier for me to be at home and I actually felt safer because I wasn't exposed to potentially other patients with other potentially infectious conditions in waiting rooms. I actually like seeing you by Telehealth, could we please continue that?" So I think the patients actually have ... making the ask and making sure that their doctors knew whether they did or didn't enjoy it and what they would like to do, going forward.

I think equally for doctors asking ... having those same conversations back with their patients and asking them what they thought of the experience, were they ... if they were using any tech to help them monitor their condition, whether it was blood pressure monitoring or diabetes monitoring or some of the cardiac monitoring or some of the billion different apps that you can use to help assess your mood and your sleep and all of those other pieces, what they've ... having those conversations to say, "Was this helpful? Was the way that we were actually interacting with sharing that information and me giving you feedback and designing what your care plan was based around that, is that something that we can continue with, going forward, or are you more comfortable going back to where we were?" But I think that's where ... I think the biggest thing is just to be having those conversations and neither party to be making assumptions about what it has to look like going forward.

SC: Right. And I think maybe also, often as patients I think perhaps we're reluctant or don't even feel that we can make those sort of requests, we just sort of, I don't know, pliably go along with whatever instruction is given and don't realise we can actually say to the doctor, "Can we try this a different way?" I've got a family member who has cancer and her oncologist is a two-hour drive away from her. She needs to see her oncologist relatively recently just to talk about her latest test results, but during lockdown she did do that by Telehealth because she doesn't need to see the oncologist in person, he doesn't examine her, he just looks at the test results, which get sent to his office anyway. And it saved her a four-hour round trip!

CR: Exactly. And I think that's the thing for ... patients really need to be ... like you say, feel confident enough to be able to put that forward as a request. Ideally, their healthcare practitioner should be having the conversation and asking them if they want that, but if they're not being offered it they should feel comfortable and confident enough to put their hand up and go, "You know what? We did this because of the COVID restrictions, but it actually really worked for me and I'd really like to continue that. Can we please do that, going forward, because I really feel it was beneficial to my health."

SC: Yep, great advice. Cathie Reid, thank you so much, you've given us some really useful things to think about.

CR: You're welcome! Thanks, Susan.

SC: That is it for this episode and for this topic! As always, more information on what we talked about today can be found in the show notes. I'll see you next time on What Happens Next?