Proposing cutting-edged solutions to combat health inequities

The Health Care Challenge is a student competition run by the Health Studies Students’ Association (HSSA) where Health Sciences students – in tandem with students from Psychology, Geography, BMOS and Ivey Business School – present proposals about building a resilient health system in Canada and beyond, to a panel of industry and academic judges.

The competition aims to provide students an opportunity to apply knowledge gained in the classroom towards innovative and interdisciplinary real-world solutions. Each member of the winning team receives a $500 scholarship.

What follows was the winning solution presented by Health Sciences students Erik Elliott, Leah Marsot-Shiffman, Cameron Feil and Dory Abelman.

*   *   *

Infectious disease is seldom thought of as a major health threat by many Canadians. Unfortunately, this is not the case for all Canadians, as some Indigenous populations are significantly affected by infectious diseases. For example, Indigenous rates of tuberculosis are nearly six times that of the general population, and their HIV/AIDS rates are almost three times as high as urban Canadians.

Clearly, the health inequities across rural and Indigenous communities need to be addressed.

The health-care case-competition challenge this year posed the question: How can Canada improve the resilience of the health-care system?

In this context, resilience refers to the systems ability to adapt to new and adverse health issues within the population. Our team decided to focus on the management of infectious disease in rural and Indigenous communities.

The proposed solution combines methods from both the Indian tuberculosis surveillance tool called Nikshay and the Estonian e-health system. In the Nikshay program, patients registers on a database and their cellular devices are promoted with reminders to take their medication. The Estonian system is built using blockchain technology, providing patients, doctors and other health-care professionals access on a need to know basis.

Blockchain has reached mainstream audiences as the software that facilitates bitcoin and other cryptocurrencies, but the potential for health-care applications using blockchain technology has only recently been discovered. There are many reasons health-care professionals are intrigued by the potential of blockchain technology. The first being it offers to store data on a highly secure network, when compared to current systems. In addition, blockchain also has offered higher storage capacity and can be accessed quickly and easily. These features make it ideal for using to track and store medical records for both patients and providers.

The senior Health Sciences team proposed using blockchain in the management of infectious disease across Canada’s Indigenous populations. These populations typically live in remote areas, have poor access to health-care providers and have lower health literacy rates compared to urban places.

Four main areas where this type of a technology could benefit infectious disease management in Indigenous populations persist.

The first is the creation of an electronic medical record database. Blockchain would enable patients to have sovereignty over their information. Patients would have control over who is allowed to access their health records, such as health-care providers, but their information would be kept secure otherwise.

The second benefit would be doctors could maintain contact with patients from long distances. This is particularly important when managing infectious diseases, as prescription adherence and regiment need to be monitored closely.

The third benefit is the ability for physicians to continue the care process. Doctors working in remote regions often fly in and out, working for a few months at a time. This maintenance of contact is very important as it facilitates physician and patient trust.

The final benefit for Indigenous patients is the potential for the system to incorporate data on the social determinants of health, such as socioeconomic and environmental conditions. This would allow for researchers to address health inequalities and problems at their root cause. This information can then be used to create targeted, evidence-based public health interventions to prevent the further spread of the infectious diseases, as well as target failures in infrastructure that perpetuate disease and illness.

One major consideration, though, is the level of Internet access currently available in remote regions, where a majority of the cases are recorded. This may currently be a barrier, but the Canadian government has committed billions to the implementation of Internet services in indigenous populations across the country. Under the Trudeau administration, Internet access has become a right of all citizens. The team hopes policy-makers act on this and push projects like blockchain to the forefront of solutions in healthcare.

The Canadian government has recently set mandates the quality of life and health status across rural and Indigenous communities. The implementation of a blockchain would create a sustainable, cost-effective disease management system. It would reduce disease-related health issues, such as improving treatment efficacy and adherence. Further, it would increase evidence used by researchers to address health inequalities in rural and Indigenous populations. Lastly, it reduces physician scarcity in Canada by allowing providers to contact patients from satellite locations.

It is hoped the proposed benefits of implementing a blockchain system will motivate policy-makers to take action and address health inequalities in rural and Indigenous areas.