High seas, ICs and health care

ICTs and Health
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“John Stone, aged 25, private marine; feels pain in the throat… difficulty of swallowing… diluted sulphuric acid used as a gargle”. The British Royal Navy medical officer who wrote that report didn’t say if the patient got better, and presumably the patient never said anything ever again, so we’ll never know if the cure worked. His colleague who treated fever cases with a tepid salt water bath did however note the salutary effects on all his patients, even though, technically speaking, they all died soon afterwards. If you’ve got an hour or two to waste (as I hadn’t when I was supposed to be writing this article) take a look at this collection of reports compiled by Royal Navy Surgeons and Assistant Surgeons from ships, hospitals, naval brigades, shore parties and on emigrant and convict ships in the period 1793 to 1880.

For the casual reader like me, the most interesting aspects are stuff like being attacked by a walrus, stealing a skull, being struck by lightning, or accidentally circumcising yourself when playing a joke on your shipmates (anything for a laugh). For the less frivolous, the records are a mine of information on a whole range of medical topics. Mortality for instance: half the deaths on warships were from disease, ten times the proportion killed in battle. Or medical methods and technologies. Apart from the descriptions of acid gargles or blowing tobacco smoke into a drowned sailor’s lungs to revive him (it worked), the reports list more mundane treatments. “Amputation” appears a lot. In fact, on a quick reading it seems to be the main surgical activity on the ships, and other sources describe how during a naval battles, the surgeon’s assistants (“loblolly men”) could fill tubs with severed limbs.

Many of those who survived the surgery died later from infections, and this was the case for civilian patients operated on shore as well. That would change by the end of the period covered by these reports, with the Victorian “surgical revolution”, brought about by the introduction of anaesthesia in the 1840s, antisepsis in the 1860s and x-rays in the 1890s. We often talk about “medical science”, but what happened over that half century had nothing much to do with science. It was a technological and organisational revolution that would mark medical care well into our times.

In this article, Jim Connor reminds us that knowledge of chemical or physiological principles had little to do with the advent of anaesthesia or explaining how it works. There was little scientific basis for antisepsis when Lister introduced it. And Roentgen was pioneering radiology before any theoretical explanation for x-rays was available. Technology was not the servant of science, or of the market. As Connor argues, there was no call for these innovations from practitioners, and many patients were even reluctant to undergo anaesthesia for fear of what the doctors might do when they were unconscious.

The revolution came from the interactions of science, technology and medicine among each other and with economic and social trends. If the state and business get involved in such a process, the result is what John Pickstone calls “technoscience”, where scientific knowledge and its applications become marketable commodities. The result in the 19th century was to change the position of the surgeon from an independent artisan, owning his own tools and premises and seeking out clients, to essentially an employee of a large organisation that centralised demand and supplied the equipment, bought from an increasingly powerful group of outside suppliers.

This fundamentally changed health care as a calling and as a business. Today, another revolution is underway, driven by ICTs, or what we might call tele-technoscience, and responding to what a new OECD report identifies as “social and demographic changes, the rise in chronic diseases, and the need to improve the efficiency and quality of healthcare delivery”. ICTs and the Health Sector: Towards Smarter Health and Wellness Models looks at how mobile devices, the Internet and ICT in general can be used to support self-management, behavioural modification (not as sinister as it sounds) and “participatory healthcare”, and allow health care systems to learn.

The streams of data flowing from medical devices and research programmes are the raw materials the new systems will be built on. But data as such are of relatively little value if they can’t be processed, turned into useful information and shared. Those old naval records contained masses of data on cases, living conditions, even climate and geography, as well as potentially life-saving information on best (and worst) practices. But this information couldn’t be shared significantly using the technologies available at the time.  The OECD report talks about a similar situation with today’s technology and analytical tools, arguing that they can’t effectively manage or even capture the many data streams available and turn them into useful information.

The Victorian revolution produced the hospital-centred, doctor-oriented system we know today. The ICT revolution could produce a system that is based on the patients, their family and community, with more emphasis on evidence-based approaches and personalised care, and a less prominent role for the clinician’s training and experience in diagnosis and treatment. These will remain important though, as will the practitioners’ attitude to their job. Bruno Pappalardo, the specialist in charge of the Royal navy collection, told The Independent newspaper that despite the harsh environment the naval medical officers worked in, “their compassion shines through – they did their utmost to care for people.”

Useful links

OECD work on health policies and systems

Green and smart: ICT jobs for tomorrow

No job for a lady? Ada, Countess of Lovelace,the world’s first programmer

There used to be adverts on buses and trains saying “If u cn rd this u cd gt a rly gd job”. At the time, I nvr figured out what the jb was, but now I realise it was probably to write software for texting applications. Like everything else, sms had its origins in Victorian love poems (and if you don’t believe me, look at this). However, when clever Charles Bombaugh was writing about loving “U 2 X S,/ U R virtuous and Y’s”, the only programmer in the country had been dead for about 20 years, and the computer she wrote the algorithm for, clever Charles Babbage’s analytical engine, was never built.

The memory of Countess Lovelace (for it was she) lives on in the programming language Ada named in her honour, but today most programmers are men, or boys (they’re getting younger every day). Women account for only 30% of ICT sector employment and 20% of ICT specialist occupations. Both categories are recruiting and resisted the impacts of the crisis more than most, and companies are looking abroad to fill the gaps, either by recruiting immigrant workers or offshoring the tasks.

Companies and governments are also facing a new challenge according to a report prepared by OECD analysts Christian Reimsbach-Kounatze and Cristina Serra Vallejo: developing the competences for a “greener and smarter” economy. The link with “smarter” is obvious, but at first sight, it’s hard to see what’s green about ICT. Electronic waste is one of the fastest growing types and according to the UN, around 40 million tons of waste from electrical and electronic equipment, WEEE, are generated each year from the products we throw away. In 2005, visitors to London could see the Weee man, a 7 metre high giant composed of the estimated electrical and electronic waste one UK citizen will discard in a lifetime.

There’s also what’s sometimes called “digital waste”, the terabytes of forgotten emails, photos, videos and so on kept online. It all has to be physically stored somewhere, along with the files we actually use, and server farms and the data centres that host them have an impact on the environment through the electricity generated to run the equipment and cool the buildings. Google for instance said that its offices and data centres emitted over 1 million tons of carbon in 2010, claiming that the figure would have been twice as high without efforts to reduce its footprint.

Data centres and other ICT infrastructures are increasingly vital for all sectors of the economy, and green growth strategies will require people capable of both greening ICT itself and helping ICT to make other activities greener. ICT skills and employment: New competences and jobs for a greener and smarter economy (the OECD report mentioned above) argues that promoting ICT skills in the green and smart economy pays a double dividend by encouraging job creation and accelerating the transition to green growth.

The jobs wouldn’t just be in the sector itself. Employment in the ICT industry and employment of ICT specialist skills each accounts for up to 5% of total employment in OECD countries, but ICT intensive-users account for more than 20% of all workers in all branches. A car mechanic I know told me that when he started working 30 years ago, the first thing you did when a car came in to the repair shop (apart from telling the client it was a big job and would be ready on Tuesday) was to get your hands dirty poking around the engine or jacking it up, whereas now you start by plugging it in to a computer. And hundreds of other jobs across the whole skills range now need knowledge of ICT as well.

A clear and widely accepted definition of what a green job actually is doesn’t exist yet, therefore the report uses a definition from another OECD study: “…jobs that contribute to protecting the environment and reducing the harmful effects human activity has on it (mitigation), or helping to better cope with current climate conditions (adaptation)”.

On that basis, some of the new jobs will be in the ICT sector, writing software or developing and manufacturing environmentally efficient semiconductors and other products for instance. Other green jobs will be related to greening the economy, for example working on the systems that operate wind farms or installing and maintaining the equipment that smart buildings use to control lighting and temperature.

Given the potential of ICT to boost both green growth and employment, it’s surprising to learn that only a minority of governments are explicitly promoting green ICT-related skills and jobs according to an OECD survey.

Useful links

OECD work on ICT skills and employment

OECD work on green growth

Are boys and girls ready for the digital age? Report from OECD-PISA on how proficient 15-year-olds are in gathering and processing information from printed and digital material:

  • On average, girls outperform boys in digital reading; however, the gender gap is narrower than it is for print.
  • Among boys and girls with similar levels of proficiency in print reading, boys tend to have stronger digital navigation skills and therefore score higher in digital reading.