Elon University

Panel Session: The Future of Public Health and the Internet

Smart human networks can help us avoid disasters and become more vibrant

Brief description: Web technology and approaches provide a new set of tools for public health practitioners. The Web offers new capabilities for those committed to protecting and promoting the public’s health, from combining data resources for detecting early outbreaks of infectious diseases and other events to using social networks for data connection. Participants will bridge the nexus from the front lines of public health to research in new methodologies. Session organizer was David Potenziani, senior associate dean, University of North Carolina-Chapel Hill Gillings School of Public Health. The moderator was Charles Coleman, managing director and senior strategist of SAS Institute’s Education and Medical/Healthcare practice. Panelists included Deborah Tate, UNC Health Behavior and Health Education Department, will talk about using the Web and mobile devices for health promotion; Jeff Heard, senior research software developer with RENCI, the Renaissance Computing Institute; Kurt Ribisl, of UNC’s Health Behavior and Health Education Department, will look at a public health approach to regulating dangerous and age-restricted goods sold online.

Details of the session

Moderator Charles Coleman, managing director and senior strategist of SAS Institute’s Education and Medical/Healthcare practice, noted that “Public health is in the process of catching up with other industries.” He introduced a panel of experts who are working to find ways to help better leverage new technology tools to make a significant difference in the future of public health.

Coleman talked about a new program that just came into existence the past couple of months titled “NC Be Prepared.” “It is a theory and a vision for proactive surveillance [of public health] that has three key elements in it,” he said. “First, ‘early cuing,’ which means, ‘ah, I’m starting to see something evolve, second, pattern recognition, meaning ‘I’ve seen this before, it looks like this,’ and third, situational awareness, which is kind of a government term for ‘what is the situation? – I need to be briefed, I need to act, I need to know what to do next.'”

He said “Tomorrow” is a part of this NC Be Prepared vision. It is the predictive and preventative aspect to this program, asking “what could happen?” “what is about to happen?” and “what can I do to prevent what’s about to happen?”

He said this is all an interesting intersection of advance analytics and biosurveillance using some high-end algorithms that allow you to do predictive indicator analysis and some surveillance on the preventative side.

“The idea,” he said, “is to identify a problem earlier, whether it’s an outbreak or a disease, whether it’s sarin gas when it’s terrorism, whether it’s West Nile disease or its H1N1, etc. The whole idea is to get to the point so I can see what is developing and I can act on it.”

He added that tremendous amounts of research are being driven by technology today. “A lot of the health surveillance since 9/11 is being powered by Internet, World Wide Web-based applications, not only at the federal level, but at the state and local level.”

A farmers’ market may not be an entity many think of as having a vast amount of research potential. But Jeff Heard of RENCI, the Renaissance Computing Institute, said tracking census data will bring more opportunities for nutrition from farmers’ markets to lower-income families. He works to link local, sustainable food systems to public health.

Heard asks: “How does eating local impact obesity, the environment and the economy?’

“The aim of our company is to engineer tools around the new, massive amounts of data coming in on the Internet and computing the power of that data… and to embrace the fact that not everyone’s a computer expert,” Heard said.

The overarching goal of his project is to increase the availability of local food to local markets, in a way that gives more people access to the resources.“To increase the variability of local food markets so we can increase access,” he said. “We embrace the fact that not everyone is not a computer expert …and we try to build tools that people in the research community can use.”

One of those tools is a geo-location application that uses open source to acquire data from the US census about farmers’ markets, the Farmers’ Market Geolocator Tool, which “takes a lot of open source tools that are already out there and puts them together in a very unique way,” Heard said.

While such a tool won’t replace the knowledge that the people involved in local farmer co-ops have or tell  exactly where a market might best be built, it does indicate various strengths and weaknesses of a particular area. “No geolocator tool is going to replace the local knowledge that a farmer’s co-op has about their market,” he said, “but the goal is to show the strengths and weaknesses of local sites, based on key economic indicators.”

RENCI uses Huff’s Probability Model to compute with other markets and uncover source population and income. “We make the tool widely available by making it web-based,” Heard said.

Deborah Tate of the UNC School of Public Health is using the Web to advance her work with health behavior. She has been researching obesity and how individuals can manage weight via the Web. She began her work in 1992 when she created a Web engine to look at the walking behavior of people.

“Internet intervention,” as she calls it, allows for a combination of technology with a support system. “Many of the leading causes of death are preventable, such as smoking and obesity,” she said. “The problem is many people don’t know how to implement changes and maintain motivation.”

Tate and her colleagues have developed technological tools to change these detrimental behaviors.

In the case of obesity, on which much of her research focuses, Tate realized the health industry must go beyond traditional means of support in order to reach out to such a large population. The Internet offers an approach with a wide reach and the capability of bringing people together. For instance, the Internet allows those suffering from obesity to access “transforming treatments.”

The methods are evolving over time to include new interactive components, enhanced by technology.

“IHC’s (interdisciplinary health communications) are usually Web-based,” she said. “They are found to have significant positive effects on knowledge, contributing to social support and (favorable) clinical and behavioral outcomes.”

Tate has studied whether or not Web-based interventions are favored over non-Web-based interventions. What she found was that people seem to prefer managing obesity through Web programs, including online diaries, video education sessions and online weight monitoring.

“We’re getting more evidence that these kinds of approaches work,” she said.

Tate stressed though that the online tools are not enough; personal support is still crucial to help individuals with medical obstacles.

“We can’t just link them to cool apps and expect those apps to change their behavior,” Tate said. “They need support along the way. How you use the Internet to change behavior matters.”

Following Tate, Kurt Ribisl discussed the dangers and harsh realities of various shady online vendors. He discussed, for instance, how minors have access to ordering products such as cigarettes, alcohol, marijuana, guns and even prescription medications such as oxycontin on the Web.

“Some are totally illegal…Some are totally tangible,” Ribisl said. “I’ve looked at the regulation of these issues online, and you have a disconnected process between ordering and receiving (products), unlike in the real world. We need to really think about what’s actually being sold and promoted on the internet,” Ribisl said.

He stressed that one of the biggest obstacles is that it is difficult to find out who is behind this content because of the plethora of domain names.

Ribisl conducted a study of the ways in which teenagers buy cigarettes online. The only proof of age required by all of the online vendors he studied was a check-box “verifying” that the person making the request was at least 18 years old. “It was a very flimsy type of age-verification process,” Ribisl said.

He found 76 of 83 purchase attempts were successful, a rate of 92 percent of underage teens who were able to order cigarettes.

In 2005, a landmark agreement was passed ceasing payment processes for Internet cigarette vendors online. The same year, UPS, DHL and Fedex ceased shipment of cigarettes. In 2008, 34 states passed laws regulating Internet cigarette vendors. But illegal underage transactions are still often taking place and people of all ages are often acquiring drugs they should not be using because online vendors are making them easily available.

Ribisl said there are three ways that policy makers have attempted to address the problem, none of which have been completely successful: individual states have sued vendors; state revenue departments have pursued smokers; and some states have tried to cut vendors off from certain business partners.

“There is still some evidence that certain types of policies may eventually have some type of impact on the issue,” Ribisl said.

-Laura Smith, Ashley Dischinger and Janna Anderson, Imagining the Internet

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