Abstract
The United Nations set forward ambitious goals at the beginning of this new millennium to improve life for humankind in eight universally acclaimed objectives to be realized by 2015. The world was perhaps a little too ambitious in starting a new epoch, and the relief of having dodged the cyberbullet of a Y2K computer meltdown had left us all with a little exuberance and perhaps a lot of hubris. Then we had 9/11, the Tsunami, Hurricane Katrina, earthquakes in Pakistan and Haiti, desultory wars without resolution, more terror, the Iceland volcano and daily images of our essential vulnerability to natural disaster, and lack of resolve to adjudicate and resolve those disasters authored by our fellow beings. Maybe we just experienced the dreaded donor exhaust after so much trouble that the prospect of ending poverty and rearing healthy children faded away somehow. Then the financial crisis of 2008 further distracted the world from even the noblest goals of mutual assistance and doing the right thing. At any rate at this interval, full achievement of the Millennium Development Goals by 2010 seems a distant dream.
It was always disappointing that telemedicine and e-health were not included in the specifics of the goals. That always seemed an oversight to the true believers in our community. However, in these last 10 years there have been fabulous advances in our ability to recruit, manage, and distribute information and to make a global community of caregivers through telemedicine and health information technology (HIT). Telemedicine may be considered the clinical application of HIT for all practical purposes. The costs of telecommunications have continued to fall in the last decade and the application of this drop to health is a tempting counterpoise to the continued escalation of healthcare costs and the consequent failure of access when resources are constrained. Perhaps, this is a good time to revisit the noble eight goals and find the application of telemedicine and HIT that might make some of them become reality in the near future if not in time for the target date of 2015. Perhaps, we could provide a half full glass of potable hydration to slake the continuing problem of health inequity and the consequent problem of mothers, children, empowerment, and misery.
Most of you know the goals. A recent meeting to assess progress in the goals noted modest and hard-won progress in many areas as of 2010 (
It is doubtful that telemedicine can eradicate extreme poverty and hunger by cutting in half the number of people living on less than a dollar a day (Goal 1). It is equally uncertain that telemedicine can achieve universal primary education (Goal 2). It is not clear that HIT can achieve environmental sustainability (Goal 7) or create a global partnership for development (Goal 8). However, our community of scholars, practitioners, and policy makers has much to offer to make great progress in these four areas. Goal 6 (HIV, malaria, and other diseases) is tractable with help from HIT and m-health, which possess considerable tools for acquiring, processing, and disseminating the information needed. We can indeed attack this huge disease burden with full epidemiological data and monitored prudent therapy delivered to an enlightened patient population. Goal 4 calls for reduction in child mortality to end the millions of annual infant and child deaths from preventable causes. Information technology, empowerment, and timely, applicable interventions for child health could bring the precious task of raising up our next generation with a global standard of disease management and prevention. Goal 5 calls for improved maternal health. HIT and telemedicine could bring the best of management into the picture as women enter the often perilous but marvelous process of producing the next generation of our species without an undue toll on the health of the mother who must survive pregnancy and childbirth in vigorous health to care for herself and her children in the future. Telemedicine and HIT offer resources in seamless management, early recognition of risk, and empowerment.
Each of these goals if addressed by telemedicine and HIT offers some promise for Goal 3. Empowerment of women, healthy personal engagement for their education, and vigorous pursuit of gender equality could be the outcome if women are not encumbered by devastating health and sick child issues, which otherwise can marginalize them whether intended or not.
The full involvement of the telemedicine and HIT community in a degree of realization of the Millennium Development Goals is not out of reach. Application is not only possible but may be in fact essential to any measure of success. The design and ambitious intent of the goals are irrevocable and right even though our energies may have been diluted and attention distracted. The ambitious objectives strive to eliminate dreadful health and social divides that have assigned such large portions of our population to a fate marked by short, painful, marginalized, and frustrated lives that fail to meet a global expectation of full, enfranchised, and fruitful lives. There is every motive for a continued zeal for the improvement of the status of our fellow humans. Why not make this a task for telemedicine and HIT? These can make an enormous difference for all humankind.