An introduction to key challenges and concepts important to understanding the current status and determinants of global health.
Interview with Dr Gary Bennett
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From the course by Duke University
The Challenges of Global Health
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From the lesson
Actors & Action: Finding Global Health Solutions
This module explores the main global health actors, how they work, and what strategies they use to improve global health outcomes and to solve global health problems.
Meet the Instructors
Dr. David BoydHymowitz Family Professor of the Practice of Global Health
Duke Global Health Institute
Hi, class I hope you're doing well today.
It is my great pleasure to have my colleague and friend Dr.
Gary Bennett in my office today Gary, thank you for coming.
>> My pleasure.
>> Dr Bennett is a unique individual to say the least.
>> Hm. >> Unique because his worked falls at
the intersection of so many areas.
Doctor Bennet is a Professor of Psychology, Neuroscience, and
Global Health.
>> Mm-hm.
>> And he works at the intersection of three areas that
we have talked about a lot in our class non-communicable diseases,.
>> Yep. >> In particular.
>> Behavioral change.
>> Mm-hm. >> Always a tough thing.
>> Exact, exactly. >> And also the way that we.
Can use appropriately new technology right and
new types of intervention to achieve, our public health goals.
>> Yeah. >> Through the US and
abroad that a pretty good summary?
>> That is a wonderful summary.
>> Fantastic. >> Better than the one I do.
[LAUGH].
>> So what I thought that we would do today is.
We're going to talk to Dr. Bill about each of these issues to get his perspective on
them, their importance and also to have him talk about some of
the work that he's doing in these different areas.
So let's rock n roll.
>> All right.
>> Yeah.
>> So I tell the students in class and
we're talking about non-communicative diseases we have some public enemies.
>> Mm-hm. >> Public enemy number one, smoking.
>> Yep.
>> Public enemy number two, saying broader, it's going to
pull together a constellation of things, metabolic syndrome.
In particular, diabetes and as we know one of the underlying issues is obesity and
now I'm adding actually air pollution.
>> Oh, that's good.
>> I didn't add that a while ago.
>> Yeah. Hm-hm.
>> Now, but now I do.
And we've talked a lot about, about obesity, and about diabetes in class but
as someone who really works and
does research in this area, I wanted to get your perspective.
On the challenge that say obesity in particular is creating in global health.
>> Yeah.
So, I think so it's a huge challenge There are several billion overweight and
obese people in the United States.
>> Mm-hm.
There, I mean in the world, there just proportionately in the United States but
increasingly in places like Asia, South Africa, the Middle East.
And so obesity's a really big problem no, no pun intended.
>> [LAUGH] If it was that would've been horrible right?
>> Yeah, yeah.
But I, you know, I think the challenge with the, the challenge with obesity is,
is sort of very, it's very widespread.
So, obesity's a really potent driver of cardiovascular disease,
increasingly of cancers, particularly of cancers in populations where smoking is on
the decline certainly, as you mentioned, of diabetes but the problem is that
the relation between obesity and those NCD's is not uniform in each population.
So for example obesity as a predictor, as a risk factor for diabetes, is
a much bigger problem for folks in South east Asia than it is in the United States.
People experienced diabetes at much lower rates of
obesity there than they do here in the US.
People in South Africa, as one example, are protected against the impact of
obesity and diabetes, but they have very high rates of hyper tension and
cardiovascular disease and stroke there.
And so obesity's a big problem, but for lots of different reasons and
it causes lots of different health concerns all, all over the world.
But socially the problem I would say with obesity is that
people don't generally recognize it as a health problem.
>> We are now sort of an artifact of the last five or ten years of.
A lot of activity marketing and social marketing.
>> Mm-hm. >> And, and public and
global health activity about the ills of obesity have raised awareness but you know
in a lot of societies obesity, obesity for a long time was correlated with wealth.
You know you could if you could afford to eat well and
you could afford to gain well that mean that you were doing pretty well.
>> Oh yeah. >> People weren't exactly excited to
be skinny because it was generally viewed as an indicator.
>> Yeah right.
>> Of your socioeconomic level.
and, so, we're in,
we're still experiencing that in lots of parts of the world.
In China, as one example, you know, there are long-standing cultural traditions that
have sort of prized a little bit of heavier body weight.
>> Sure. >> And, now, with,
with one child policy, lots of families are really showering their kids with all
kinds of wonderful things, including food.
And, so, we have the Chinese, Chinese, childhood obesity epidemic in
China that is, is not recognized necessarily as a health problem.
>> Uh-huh. >> Today.
So so obesity's a big challenge but as you mentioned, the reason I love it
is because you have to think about things like health outcomes and social issues and
political issues.
>> Right. >> And cultural issues to
really appreciate its its burden and the challenge of, of, of ending.
>> And I would say something, just along those lines we
talked a lot in class about how we were discussing any global health issue or
any public health issue [COUGH] you must also be able to disaggregate data.
>> Yeah. >> Down to the appropriate level which
you're working so you just made this great point that not only do
you find differences around the world but
within populations within different regions you find differences.
>> Yes. Absolutely.
>> So in the US for example is there any correlation of obesity
with socioeconomic status, education, race, ethnicity.
>> Yeah.
>> Rural, urban what's, what's going on here?
>> So that's what, I'm really glad you mentioned this kind of,
this aggregation thing because it's a really, there's a really good example in,
obesity in the US presents a really good example of this.
>> Mm-hm. >> So we've had an obesity epidemic in
the US over the last 25, 30 years.
>> Mm-hm.
But that obesity epidemic really started in black women after World War two
>> After world war two.
and, at that point we started seeing rising rates of obesity among white women,
and that was trailed by-
I mean black women, I'm sorry, and
that was trailed by rising rates in white women.
And men were somewhat protected against these rates until probably
the last thirty years.
>> Uh-huh. >> And
then you started to see a bit of a divergence blacks, and
black women, in particular, having the highest rates.
>> Mm-hm.
>> Latinas having some, somewhat in the middle.
>> Mm-hm. >> White women having lowest rates and
then all men.
>> So in the last ten years, though, what you hear a lot about in public
discourse about obesity is that we've had a plateau in the rates of, of obesity.
>> Mm-hm. >> And in fact, we have but
only if you look at the general population.
>> If disaggregate by gender, what you see.
Is that men, in the last ten years,
have actually had increasing rates of obesity for the first time in history,.
>> Interesting.
Mm-hm. >> Men are really beginning to
catch up with women.
And that's led by higher rates of obesity among black men in the US.
>> Mm-hm. >> Black men have traditionally had
the lowest rates of obesity black women,
Latinas are twice as likely as white women-
>> Mm-hm. Yeah. >> To have, to be obese but
it really gets interesting when you think about poverty.
Obesity is not associated with poverty in Blacks at all.
>> Huh. >> In fact, the,
in women there's some studies that show that the rates are reverse.
So that higher educated,
higher income Black women, some have somewhat higher levels of obesity.
But, in-,income and poverty are associated with obesity among Whites.
>> And to some set, some extent among Latinos so,
you know, a lot of us belief that obesity to be a condition of poverty.
And at least for our most effected groups it's probably not.
>> Probably not.
>> It's the case that the entire population of those groups are effected.
And so poverty doesn't play as large of a role as it does for some other groups.
>> Fascinating.
So we can't make simple assumptions and simplify the whole notion.
Determinance.
>> No, by no means.
>> Because when you start disaggregating data and
looking at populations in individual groups, the,
what might be seen as general determinance really doesn't hold any water.
>> Absolutely. >> So
we've gotta mash our determinant analysis and our, indeterminant detectives with
a level of with the level at which we are researching at the moment.
>> Absolutely.
And this has real life consequences.
So, if you think about that, you know, we've put lots of policy attention and
lots of resources that have been tied to policies into the challenge of say, for
one example, changing food deserts.
>> Right.
>> In the United States.
>> Mm-hm.
Mm-hm. >> Right.
We all know what food deserts are.
We believe the food deserts are potent predictors of obesity and
a lot of us believe that obesity is correlated with poverty inversely and so,
we should put money into poor communities to try to eradicate food deserts.
To try to improve access-
>> Mm -hm. >> To healthful foods.
I'm for all of that.
>> Sure. >> But the data isn't really supportive of
that, necessarily.
>> Fascinating.
>> Right, so obesity is probably not a problem exclusively in poverty.
>> Mm -hm.
>> And there's not a lot of data that food deserts are associated with
obesity in a causal way and its got a lot of evidence that eradicating those food
deserts will lead to reductions in obesity in among individuals who are impoverished.
And, you know, these things sometimes sound very simple but the devil are in
the details and understanding the complexity of these kind of things is
very important when thinking about how to invest limited prevention resources.
For instance.
>> Absolutely. Instead of just assuming because you
observe it seems that your relationship is not necessarily the cause.
>> Absolutely.
>> You know, you get through, that through the heads of most public health and
global health surgeons around the world because you might have something better.
>> Couldn't agree more.
>> That, better lives.
You know, you were saying that I thought of
I thought of something sort of analogous without sort of applying solutions.
Are trying to create solutions that are basically gun shot what's it called?
Gun, ,.
>> Scatter shot?
>> Scatter shot, thank you, sir.
>> Is that right?
>> Scatter.
>> Shotgun.
>> Shotgun, baby.
Okay.
>> Shot.
>> Shot gun.
Okay.
>> Oh, we're shot.
[LAUGH] We.
We miss a lot of things.
>> Yeah.
>> And I was thinking about drugs.
I honestly, because of the way that drugs are designed, the ones that get the ones
that make it to market for the most part, because of the way they're tested.
I think we can honestly say that most pharmaceuticals are made for white men.
>> Oh yeah. >> With a lot of other people taking 'em.
>> Oh yeah. Yeah.
>> White adult men.
Exactly exactly.
With just this assumption that its going to work in everyone.
And now I even recently saw some work saying that, you know, differences between
men and women biologically, that basically every cell is gender.
Yeah, but you know.
>> Yeah. >> And it has huge impact.
>> This is why the NIH is now.
>> Yeah. >> Requiring investigators,
basic scientists to use female rats in bench science.
>> Uh-huh.
>> In bench lab work, because we recognize even at that level, a lot of
even very cellular, cellular mechanisms, basic biological mechanisms are gendered.
Or maybe in ways that we can't fully appreciate because we lost all of that in
the science aspects.
>> Oh, yeah. Oh, yeah, yeah.
And I think the food desserts was a, was a great example because something like
getting your food desserts is an attempt to.
It's an intervention that's,
that's intended to nudge people towards also behavioral changes as well.
>> Mm-hm. >> And
this is something that students ask me about a lot and
we talk learned that in global health interventions.
And that is, how do you go about, promoting good health and
changing behaviors among populations because none of us likes to change.
>> Yeah. Yeah.
Well, if I had a good answer to that,
I promise you I would be, on an island somewhere.
[LAUGH] [LAUGH] I'd have all of you over at my house in Hawaii.
>> Fly us over.
>> Totally.
Exactly.
Fly or beam you over.
[CROSSTALK] [LAUGH] But I guess I can maybe I
can start by saying what doesn't work.
>> Okay. >> So what doesn't work is education.
>> We've really good evidence that just providing people with
education is not a sufficient way to get them to change their behavior in fact,
you can look at examples like smoking.
Smoking is one of the best examples of this we all know smoking is bad.
You go out on the street and you ask ten, out of ten people whether or
not smoking is bad, all of them will tell you that it's bad.
The problem is we still have a 25-35% rate of smoking in [INAUDIBLE].
>> Right. >> So what causes that well,
education is not sufficient.
People in fact, knew that smoking is bad in the U.S. for 30 or 40 years.
>> Right. >> But the smoking rate didn't dip.
>> Sure. >> Until we started to
make policy changes.
>> You can look at Southeast Asia where we're starting to see increases in.
Smoking rate in fact, the smoking, big tobacco firms are moving there in droves.
Everyone there knows smoking is bad it's not, so
education is not, is not sufficient.
Really what a lot of us do in, in the areas of behavior change is to try to.
Help to motivate people to make small changes, help to validate
those small changes, tie them to bigger changes that are important to them and
then to continue to validate, to reinforce, to give skills, validate,
reinforce and give skills in order for people to more forward.
In the area of obesity I, I, I, we use a model that, that we call like,
the four S's and so the first S is skills strength.
So you, even though education itself doesn't matter,
it doesn't, isn't that important,
you do need to give people behavioral skills to help them to make changes.
>> Sure. So
for example, in the area of obesity at least domestically anyway,.
A good way to figure out how many calories you're taking in is to look at
the back of, of, of, you know, food boxes and read calorie labels.
>> Yep. Yep.
Yep. >> You actually have to be
taught to do that.
>> Sure.
>> You have to be taught to do that you have to be taught how to interpret it.
Sort of what your told calorie intake should be each day and
people have difficulty with math and
so you have to teach people tricks about how to do that you have to teach people.
How to manage situations when they're maybe traveling for work, or
they're eating out, or
they're eating fast food you know, how do you handle situations like that?
How do you avoid stress-related eating those things.
>> Sure. >> So
skills are important self-monitoring is really critical.
Self-monitoring is sort of taking,
keeping track of how you're doing in your behavior change.
>> Mm-hm. >> Mm-hm.
>> So if it's obesity you may be
monitoring diet and physical activity.
>> Mm-hm. >> If it's smoking you
may be monitoring the number of
cigarettes that you're taking.
>> Sure. >> If it's physical activity you may be
monitoring your actual steps. And the life of stress management, you
may be monitoring how you feel everyday. But self monitoring is really critical and
across the spectrum of behavior change we find that self monitoring is
usually the most important predictor of how well people do, so if you can get
people tracking something even at a very simple level then they can make change and
the reason is we get clued into the associations between how we're changing,
how we're feeling, what we're doing-
>> Mm-hm. >> Whether it's working and
psychologists call this self-regulation.
The idea that-
>> Mm-hm.
>> If I look at, I track my weight every day.
I can, over time, I'll start to notice, you know, like,
when I'm eating a little bit more my weight trends up, when I
eat a little bit less my weight trends down; you start to get validated for
how that feels and then you start to make those changes on your own.
So monitoring is really, is really critical.
Support is, is also is that sort of third asset, that's really important too and
usually what that means is support by some type of trained provider, so
a clinician of some sort, we can develop technologies that do some work, so
having somebody to say, do more of this and
less of that, you are doing a great job, good job, we need to work on this issue.
Is really critical in the behavior change process.
>> Sure.
>> People need external support to help to validate their behavior changes you,
you put all these things together and the fourth S is science.
So you really need scientifically rounded approaches.
In my area of obesity, there's probably no better other, better example of a place
where ascientific or non scientific approaches just are rampant, right?
I mean, we can all, like, you know, load up our web pages and say what works for
obesity and the first 20 things are going to full of nonsense.
>> Right. >> So, you,
you combine good scientific based approaches, support, self-monitoring and
schools training and in, for most behaviors you can make a dent.
>> right.
That's interesting, that's fascinating, in fact, because it, it indicates to me that.
That behavioral change in health promotion it's, it's,
it's effective and lasting when it happens in small steps.
>> Yep. >> It's not all or
nothing, moving forward,
creating a huge complex intervention that most people can't follow, as well.
>> Yep, yeah. >> It's building skills.
>> Absolutely.
>> And self regulating.
You know it's interesting when I think about that, because I was thinking you
know, we talk a lot people talk a lot all over the world about individual behavior.
>> Mm-hm. >> Individual responsibility but
I was, you know, watching a great student in class the other day brought in.
It's like, they were eating all sorts of nasty stuff for breakfast.
>> Hm-hm, they do that.
>> And that, [LAUGH] yes.
He kept offering to all the other students in, in this team, and
eventually, everyone took it and I said to someone, why did you take that?
>> Hm. >> And he said, well,
I felt bad my whole team was doing it.
>> Yeah. >> So, any kind of individual change takes
place within the context that might.
Be affirming, or it actually might be a context that's
constantly working against what that individual wants to do.
>> Correct. >> So, it's so complex.
>> It really is.
You know, the work that we do, just as one example.
In China in, in obesity treatment, you know, we frequently hear stories that
are actually not dissimilar from the kinds of stories that we hear in the US.
>> Right.
>> Where people will say, you know, I went home and I told my, my family that I
was trying to lose weight and that I was going to eat less of this oily food.
And they said well why are you trying to lose weight you look pretty good.
>> Right. >> You know, like, why, why even bother?
It's, it's ridiculous.
And it sort of didn't matter to the family at that level that, you know,
that this individual person wanted to lose weight or kind of, its just motivated by
health reason but, you know, sort of it became even more difficult.
You know, this woman could listen to all the stuff that we had to provide but
she was trying to make changes in a context that wasn't supported.
And frankly we hear that in the US all the time.
>> Sure. >> So behavior change is really tough.
>> Mm-hm.
>> I think people, people think you can get it done with an app or
with a nudge or, you know.
>> Mm-hm. >> And you may be
able to make small changes that are not particularly durable, but
if we're talking about making behavior changes that are important for,
making changes in health and reducing the risk of chronic disease.
You know, this, this is tough stuff.
>> Right.
You just mentioned apps.
>> Hm. >> So I want to, I want to switch a little
bit to technology I know now in, in global health and even in, in medicine as well.
That now there's talk a lot about things like in health.
>> Mm-hm.
>> Digital technology and a variety of other things that people.
Talk about as if is a these magic bullets for everything.
So I guess I since you are actually are in the process of developing your center.
Right, on looking at the genealogy and
relationship of health I was wondering if when you might explain to the students.
What these digital technologies and
what all these things are, what they are attempting to do,
and how they can be used successfully >> Mm.
>> In, in health interventions and what they can't.
>> Yeah.
Well I think fundamentally.
>> Unlike Fox you are a fair and balanced man, so.
>> I, I am, I will try to pretend to be, at least.
>> Whoops. Oops, I did an anti-Fox comment in there.
>> [LAUGH] That's horrible.
Horrible of you.
>> That's okay.
Yeah yeah yeah. >> My course.
[LAUGH].
>> [LAUGH] I'm stealing that.
Well I, so let me, let me say.
>> [CROSSTALK].
>> I'm kind of a strange person to do this kind of work, right?
>> Yeah.
>> So I, I've been programming for a longtime.
>> Right. >> I've been playing with computers for
more than 30 years I was on the internet, you know, I'm embarrassed to tell you,
I think you know when I started getting on the internet but
I didn't, I haven't become really bullish around this area.
>> Mm-hm.
Mm-hm. >> Until really the last
five or ten years.
And the reason for that is that, that I like bright shiny new things.
>> Right.
>> And I'm an early adopter I,
you know, I buy everything I was in line for the iPhone, all the iPhones really.
>> Yeah. >> [LAUGH].
>> Til this last one.
I, I, you know, got too old for that at some level, but you know, even I.
Didn't see the connection between these tools and their utility and
improvement to health of low income populations, not particularly.
>> And the reason for that was like, people really weren't all that connected.
>> Sure. >> And I
wasn't convinced that the technologies could do a really good job of rep,
replicating the complexity of, of behavior changes for one example.
>> Sure.
>> A lot of that's change though in the last couple of years.
>> Mm-hm, mm-hm. >> So.
We're certainly now to the point where I see utility in digital health approaches
in extending the reach of efficacious behavior change as one example approaches.
>> Into populations that we've had difficulty reaching.
>> I see.
>> So I'm, I'm not, you know, I'm not, I don't hold hope for
you know my fitness pal or lose it or any of those weight loss apps helping people
to lose weight in you know in flug parts of the world.
I think there's kind of consumer apps that a lot of us interact with that
are very exciting, that are really useful for middle and upper income populations.
But the kind of digital health work that we're beginning to think about.
>> Hm-mm. >> Now is sort of how we take what we know
works.
>> Hm-mm. >> That's been tested in know local,
in a local level maybe using a technology or not using a technology.
And then how do we use technology platforms to take what we know works, but
is really difficult to scale.
>> [INAUDIBLE] >> How do we scale it and spread it.
>> Hm-mm. >> Disseminated it at very low expense.
>> Hm-mm. >> To really large populations.
>> Again that we've had difficulty reaching.
>> Sure.
And what's changed a lot has been as technology has penetrated in
the last ten years, this is really, it's fully become possible to reach people.
You know, like there are more smartphones in the world than there are toilets.
If you look at what's, there's a bit of a,
of a space race of sorts to wire sub-Sahara Africa right now.
>> Sure.
>> Facebook and, and Google and SpaceX and, you know, Elon Musk and Tesla.
Are all talking about satellites and big balloons and, and
really just putting up the wireless network in Sub-Saharan Africa.
>> Mm-hm.
>> Because we recognize that there is a lot of demand there.
>> Absolutely. >> As well as in one level and, and for
people to get on, on board and they are such heavy users of the existing.
>> True. >> Sort of
fledgling wireless infrastructure there.
You know, when Facebook acquired the company WhatsApp for $19 billion dollars
earlier this year, everybody went what's WhatsApp, whose ever heard of that.
But, if you travel anywhere in the world, especially here in Africa and
Asia, you'll know what's WhatsApp is right it's a fundamental technology.
And, so, what we're seeing now is this convergence of
technology penetration people are being wired and, and connected-
>> Mm-hm. >> Via wireless networks in
far-flung parts of the world.
We're seeing a lot of interest among people who can provide resources-
>> Mm-hm. >> For these kinds of
technologies we have a scientific evidence base that's grown up and
that sort of understands to some degree what digital health can do.
And now we're just waiting for
people to put it all together and create these, these interventions that will help.
so, so, you know, in other parts, like,
if you look at other parts of the world like Asia.
They've always used technology more quickly mobile phone technology more than
we have and they text a lot more than we do, like, by an order of magnitude more.
So, it's not just that we can reach people there but
I think that we can reach them more effectively there.
>> Right. >> You look at
the United States right now.
Ten years ago we used to talk about the digital revive and
that was sort of the idea that.
Blacks, Latinos were not connected to the Internet.
>> Hm-hm.
>> And they're still not connected to the Internet in large numbers through
broadband connections, or using desktop computers, or notebooks.
But, Blacks and, and Latinos are disproportionately more likely to
own smart phones than to use those smart phones for sending email, and
text messages, and playing games, and doing videos.
>> Hm-hm, hm-hm.
So that not this just that you can reach these populations this way,
but probably a better way to reach those populations that way.
>> Hm-hm. >> So I think, I am,
I'm pretty bullish of this, but there's a lot of things apps can't do.
>> Mm -hm.
>> It's a good questions and, and one of the things that apps can't do is they
can't replicate what happens in a clinical account there.
>> Sure. Yeah.
>> I'm a clinician you're a clinician.
You know, you have a sense of what you do and, and the kind of impact and
the therapeutic alliance that you forge at the patient.
>> [INAUDIBLE] Yes.
>> As much as I love these technologies, I, I know you can't replicate that.
And I'm not sure you should.
>> Mm-hm.
>> But they can be really great ancillary tools.
>> Sure.
>> That help to empower patients and engage patients.
>> Mm-hm.
>> And make them more prepared to engage in a [CROSSTALK] clinical encounter.
And then I think a lot of us who do clinical work as a lot of realize we
don't need to be involved in everything.
>> It's true. >> We don't want to be
involved everything we're not being reimbursed for
being involved in everything and so there's a lot of things like weight loss,
smoking cessation, you know physical activity promotion, you know?
Sort of getting a preventative screenings, and shots and
you can add up education, a lot of those things can be delivered-
>> Sure. Right. >> More effectively, and more efficiently through technology.
And so, so I think we're, we're starting to get this more.
>> Right. >> But
there's still very few groups nationally or
internationally that are focusing on how to use these technologies for
lower income populations and I think we're fortunate at Duke to have a,
a good number of folks who are interested in that question.
>> Right. And it's going to be fascinating in
the next few years to see how you said you developed I like that you,
really, you really make the point that give you technologies.
They're not a substitution, they're an extension of our toolbox.
>> Right, absolutely.
>> You know, now, once again it's just finding out-
Like every other tool, we have the most appropriate use,
I was also just thinking on a personal level how much my life has changed and
how much my intern has said that her life has changed since the, the group that
I use, the internist checks her email three times a day and basically.
She is now with her, it's a very small patient population but
it's probably cut down the need to go in by 20, 30, 40% and then when
you do need to go in, people go in and see her, she has seen more interesting cases,.
>> Yeah, yeah yeah. >> She has
seen things that need to be seen.
She is not going in and saying great, another score throw us.
You know?
So it's actually made her work more efficient.
>> Right. >> And she's now able to see more people
who really need it.
>> Yeah.
>> And that's just email so I can't even imagine all of the possibilities.
>> Yeah.
You know?
Yeah-
>> You look at things like we've been able to
manage people's antihypertensive medications-
>> Mm-hm. >> Remotely for more than 15 years.
>> Right. >> We've known that like,
we've known that you don't need to come in and see your docs-
>> Sure. >> To have that
managed same thing with diabetes medications.
>> Mm-hm.
>> Same thing with a wide range of medications that patients take either to
prevent chronic disease or to manage chronic diseases.
>> Mm-hm. >> But of course,
if you look at what most patients come to the doctor for,
it's those kinds of things they're coming for basic kind of-
>> Sure. >> Self management.
Issues that can be better managed outside of the care setting.
And I think it would be it's better,
it would, a better healthcare system would be one in which-
>> Mm-hm. >> You do more of
the management at home you do more-
>> Sure. >> More self management-
>> Right. >> At home.
You kind of have contacts like you know,
I go in to get like, go in to get see my doc to get my order of Flonase for.
>> Right. >> You know for
hayfever there is absolutely no need for me to go in-
>> Sure, right. >> And
have the expense of that kind of thing, to get that kind of prescription, and
so I think where we're going with this is that,
at least domestically, we'll start to see more of us use-
>> Mm-hm. >> Technologies to ease the burden on
the healthcare system, lower the cost, make doc's lives more interesting.
>> Sure.
>> You know, unburden us.
But it's really exciting to think about this in places, in parts of world where
we're seeing the transition to, to NCDs and where, where their health systems
have not are not designed in such a way to accommodate those NCD stress gaps.
>> Sure. >> And so that gives us and
opportunity now to come in and design it right the first time and, you know,
sort of use these technologies to help patients to better manage their health and
I think that's really exciting.
>> That's, that's a real honor I'm here to see [LAUGH].
Greg, thank you so much.
>> My pleasure. >> As always.
>> Dr..
Gary Bennett and Dr. Beez signing off
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