A simple glance at James McGinnis's famous pie chart shows that behavior has dramatically more impact on health (measured by premature death) than does the quality of one's health care.
|McGinnis et al. Health Aff (Millwood) 2002;21(2):78-93|
Yet, our nation's health expenditures continue to be directed disproportionately at the 10% slice. The simple reason for this is that we have tangible tools to deal with this fraction; we build facilities and fill them with personnel equipped to diagnose and treat this 10%, and we use medical schools to train physicians to run these facilities. We might do the same for the 40%, but we lack the tangible tools to do so (illustrated by the question mark below).
|With effective behavior modification tools,|
we could train for both the 10% and 40%.
What if mobile health apps are the tools to affect health behavior patterns? If so, we could begin to marshall the engines of health care against a much bigger piece of the pie.
|Are apps the behavior modification tools we're looking for?|
Since apps and other digital technologies have had such dramatic impact on other behaviors (witness all those hunched over their phones in elevators, streets, and dinner tables), it's certainly worth a try to apply them towards health behavior.
What about the role of medical school?
SUNY Upstate's teaching hospital is proudly constructing a new cancer center (illustrated in the graphics above), which is a welcome development for many in Upstate New York. It is inconceivable that a medical student will develop a new chemotherapy treatment or diagnostic modality, although they most certainly may help such developments in the lab.
Yet, it is entirely conceivable that a med student might develop an effective smoking cessation app, thereby preventing a number of cases of cancer. And we don't even have to build new facilities to achieve these results. This is even more impressive when we consider that the cancer center can only help those patients who can get themselves there, while the smoking cessation app can be accessed anywhere in the globe at almost no extra cost.
How? Please allow the obligatory reference to The Medium is the Message.
This crazy phrase means that if we teach medical students with books and lectures, they will treat their patients by reading books and lecturing them. This method has a poor track record; content in print is old, and patients don't remember lectures. If instead, students are taught with apps and other digitized tools, they will use apps and digital tools to treat their patients.
Medical schools need to put app development in the hands of medical students, point them at the 40%, and press play.