New Delhi: India’s healthcare industry has a long way to go before Big Data—or the capture, storage and analysis of vast amounts of information—can make its mark, experts on a panel at the Mint Healthcare Conclave said. The panel members were discussing the role of Big Data in emergency healthcare and the challenges for stakeholders before it achieves its potential in the country.
“It is important to make the data available for people to use, so that there is transparency. Unless there is transparency, it won’t drive demand. A rights-based approach will help bring equity quality to the data produced,” said Paul Francis, technical officer (maternal and child health) at the World Health Organization. Francis said the challenge was not just the volumes of data, but also its complexity and diversity, which have to be brought together.
“It’s one thing to get data and it’s another thing for it to be meaningful; it’s quite another thing for the data to be meaningful and useful to draw insights from,” said Adheet Gogate, India head (healthcare transformation services) at Philips India. “And it is a difficult problem to use those insights to make business or clinical decisions, to actually change the quality of life and healthcare.”
Kanav Kahol, team leader (affordable health technologies) at Public Health Foundation of India (PHFI), said, “I think there is huge scope. The idea of access, along with affordable access, is central to this.” The search for data, he added, should be extended to more unconventional means. “Why do we look for healthcare data only from healthcare organizations? Why are we not looking at interactive data coming from Facebook and Twitter? You give messages (on social media) to people that are actually nice and happy, and suddenly you start sending messages that are not so. That also is Big Data. We, in fact, have a video game on Facebook which can pre-screen people to find if they have stress-related issues,” he said.
According to Samiran Nundy, chief adviser at RAXA, a health information company, the problem is elsewhere. “It’s not like we have no Big Data; we have no data. What we really need is to start collecting data and then get patterns of disease to monitor treatments, to monitor results. I think it’s a good start to do it through the electronic medium.”
He added: “This is the way to go. Get the patients, give them information and you empower them. And improve the quality of care and you also reduce corruption in healthcare.”
According to Varun Sood, chief information officer at Fortis Healthcare, Big Data is more than just studying clinical records and mining them; it’s also about linking up multiple sets of data to find trends. The country, he said, lacked basic health infrastructure, which needed to be functional, before getting into Big Data analytics.
Many experts agreed that Big Data was at a very nascent stage in India and there were various other aspects of healthcare that needed more attention.
“In Indian healthcare industry, data capturing started just three or four years ago. We have started pushing for electronic data only recently. We haven’t reached a point where we can get into Big Data in a big way,” said Sood. “That said, one area where there is a lot of potential is the diagnostics space. Various activities are happening and a lot of data is already available. People are reporting things.”
If taken forward with the right approach, Big Data can be a part of the quest for universal health coverage in India, according to Gogate of Philips.
“Getting Big Data to the bottom of the pyramid is not a business model; it’s a business essential. For any private company, ultimately, patients, governments and people will not pay for devices until they can partner with them and improve clinical quality,” he said. “The proliferation of technology at low price points is what needs to be concentrated on, and is necessary in the move towards universal health insurance.”
Speaking on the issues of patient confidentiality, Kahol of PHFI said: “I think confidentiality is a pride possession which people choose to give based on what you give them back. Today your phone knows a lot about you. It knows where you live, where you work, where you actually eat your lunches and your dinners. It actually knows a lot and you are willing to give the information because you are getting something back in return.”
He added: “In the healthcare sector, there are issues around confidentiality and there cannot be any compromise there…there are ways in which you don’t sell personal data, but you can look at public and population data, and actually commercialize it.”
Mint Conclave session 2:
Employees should exercise, eat well to keep stress at bay
Regular exercise and a healthy diet will improve employees’ capacity to manage stress at the workplace, a panel of experts at the Mint Healthcare Conclave agreed.
“To begin with, just one thing is enough—exercise,” said Anoop Mishra, director and head (department of diabetes and metabolic diseases) at Fortis hospitals. “One should exercise at least 45 minutes a day or 200 minutes a week. That is enough to not only managing stress, but also in building the capacity to handle stress.” He was speaking at a panel discussion on Corporate healthcare: Is stress leading to lifestyle disorder?
Besides Mishra, the panel moderated by Mint’s Neha Sethi included Ambrish Mithal, endocrinologist at Medanta Medicity; Shikha Sharma, preventive health and wellness consultant; Vikram Patel, director (Centre for Mental Health) at Public Health Foundation of India (PHFI).
The members discussed the effects of work-related stress on physical and mental health, and the resulting fall in productivity.
Why should corporates care about employees’ stress levels? “They have to be concerned about the bottom line and stress directly impacts the bottom line. A stressed workforce is not a productive one,” explained Patel.
In many cases, an employee will attend office despite elevated stress, but his productivity levels will be low. “In India, we don’t say no,” Mithal said. “An employer has to have realistic expectations and employees have to learn to say no. A happy worker is a productive one.”
Poor work cycles where employees start and finish work late, without discipline in eating and sleeping add to stress. “Sleep is very important and food makes a very big difference. An employer can play a huge role in these things,” Mithal added.
Sharma agreed on the effect of diet on stress. A bad diet does not start the cycle; but stressed employees tend to make bad choices in eating habits, which leads to other lifestyle disorders. “Companies do not know what to expect and people are always trying to unsuccessfully fix other people, in the end stressing both sides,” she said.
Stress sometimes leads to high blood pressure and diabetes, Mishra of Fortis said. Employees go on leave to get well, and return to work that has piled up during their absence, leading to even more stress. “It is a vicious circle,” he said. “Stressed employees are less disciplined and follow bad timings, triggering metabolic aberrations. They start neglecting themselves, avoid exercise, and often take refuge in smoking and drugs.”
Stressed workers often do not follow doctor’s advice, and let their cholesterol levels rise. Some develop problems with joints at the knees and back, cervical issues and carpal tunnel syndrome, Mithal of Medanta said. “Research shows that a person sitting for eight hours a day has a 15% more chance of dying in the next three years,” he said, adding it was imperative for employees to get up and move around. Stress is the biggest cause of obesity in the world.
When an employee performs badly, managers tend to make the work environment more stressful for them.
“Depression is a major hidden consequence of stress, leading to anxiety, lack of sleep and loss of appetite,” said Patel of PHFI. Substance abuse includes sleep medication, the most common psychotropic medication available in India which is legal as well.
Patel said employees should not take work home or sacrifice physical health. “The stigma attached to mental health problems needs to be removed and employees encouraged to talk about it. There should be no shame in it,” he said.
Exercise is recommended as the best way to tackle stress. Mithal gave the example of Japan, where employees regularly do some amount of stretching in the middle of the workday, a reason often mentioned for the country’s lowest death rates. Mithal added that stress is both good and bad, as it is required to attain certain goals. But it is a problem when it begins to have an adverse effect on a person.
Sharma said a company can only do so much to tackle stress in a workplace and it should be up to individuals to take care of themselves. One way to start is by regularly practising yoga and eating healthy, on time. Junk food, she added, should be avoided, despite easy availability and low cost.
Counselling can help, said Mithal, but an employee should first do four things: eat right and on time, sleep around seven hours a day, exercise regularly, and enjoy the process. The participants agreed that most people forget to enjoy the journey to their goals and focus only on the goal, thereby increasing stress.
Mint Conclave session 3:
India needs to make healthcare affordable and accessible
India needs to make its healthcare affordable and accessible if it wants to compete with big economies such as China, experts on a panel at the Mint Healthcare Conclave said.
The panel was discussing improving access to affordable healthcare, and included prominent healthcare experts such as Ramanan Laxminarayan, vice-president (research and policy) at Public Health Foundation of India (PHFI); Amit Sengupta, associate coordinator at People’s Health Movement; Rajesh Narwal, technical officer (health systems, stewardship and regulations) at World Health Organization (WHO); Krishna Kumar Ananthasubramanian, managing director of Philips India Ltd; A.K. Dewan, medical director at Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), and Udayan Dravid, regional director at Fortis Healthcare.
If India wants to alleviate poverty, it needs to address the country’s healthcare problems, Dravid said. “Given the expensive set-up of private healthcare in the country due to high real estate costs, imported equipment, etc., an average Indian is unable to avail facilities at such centres,” he added.
One way forward is to make health insurance compulsory.
“Considering the size of the Indian population, there is no reason that the premiums cannot be brought down,” Dravid said. “If we need to participate globally to compete against the likes of China, healthcare is very important.”
Ananthasubramanian of Philips India said the high pricing is leading to a “woeful” shortage of supply. The number of beds in India stands at 1.3 per 1,000 people, he said. In such a situation, the country needs to think ahead of the problem rather than chasing it.
Narwal of WHO said there are two dimensions where India needs to pay attention: “These are the quality and the affordability of healthcare.” According to him, the country spends just 4% of its gross domestic product on healthcare, with 1.2% coming from public sources and the remaining from private spends or insurance. Globally, private spends are just 20% of overall healthcare spends, but in India this figure stands at around 60%. “We have a neglected social sector with very little finances. Therefore, universal health coverage and not universal insurance must be the focus. The end-user must get affordable and quality healthcare,” he added.
Dewan of RGCIRC emphasized on taking healthcare closer to the people in rural India. “Around three-fifth of the people (in rural India) have to travel beyond 5km to access healthcare. Around 50-70% of the time doctors are not available in public healthcare centres,” he said. “Availability refers not just to infrastructure, but also the manpower in far-flung areas.”
Laxminarayan of PHFI blamed the unhealthy lifestyle of Indians for health-related problems. “We need to look at how we can intervene early enough to avert the need for unnecessary healthcare. If you look at NHS (National Health Service in the UK) or Medicare (in the US), they primarily talk about risk protection and not about improving health rather than flush down more finances down the toilet,” he said.
Sengupta of People’s Health Movement blamed the healthcare system of the country: “We have among the poorest performing healthcare systems. We have some of the best hospitals, technology, but these are not dispersed facilities. The healthcare system should be integrated, networked, based on the principles of primary healthcare. Healthcare should be addressed at the primary level. The tertiary level will always be overcrowded if primary healthcare does not work.”