Social Entrepreneurship Challenge on eHealth
June 13 - 16
Setting the scene: eHealth, Air Quality & Non-Communicable Disease
During the past two decades, the global disease burden has been shifting from infectious to non-communicable diseases (NCDs). The World Health Organization estimates that 40.5 million global deaths in 2016 were attributable to NCDs.
The term NCDs incorporates a range of illness, including diabetes, cardiovascular disease and cancer, amongst many others. Risk factors for NCDs are classified into “modifiable behavioral risk factors” which include physical inactivity, unhealthy dietary habits, exposure to tobacco smoke, harmful use of alcohol and “metabolic risk factors” which include raised blood pressure, overweight/obesity, hyperglycemia and hyperlipidemia. While NCD risk is frequently attributed to such individual behaviours, the international health community views the broader social determinants of health as highly significant to development of NCDs:
“The social determinants of health (SDH) are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.”
What this means is that a myriad of physiological, environmental, genetic and behavioural factors contribute to the incidence of NCDs. Often referred to as chronic diseases, these diseases affect people of all ages, irrespective of country or ethnic origin. Although the geriatric population is most commonly affected by NCDs, growing evidence points to NCD-attributable deaths in the middle-aged population, as well as the risk posed to children’s short and long term health outcomes. Importantly, around 80% of these premature deaths occur in low and middle-income countries. This diversity of diseases, causes and those affected means it is almost impossible to adopt a one-size-fits-all approach to developing interventions and practices that deal with the global burden of NCDs.
Many current public health solutions to combat NCDs focus on targeting modifiable behavioral risk factors, such as encouraging healthier food choices, reducing smoking rates and increasing participation in physical activity. Yet these do not address the underlying and systemic factors which strongly influence NCD risk, and which are inextricably linked to health inequalities. Interventions are therefore needed to address issues such as rapid urbanization, poor air quality and access to nutritious food.
Considering the magnitude of the threat posed by NCDs, we at Young Leaders for Health are on a quest for novel approaches to implement the principles of eHealth, creating sustainable solutions that tackle this global disease burden.
The term ‘eHealth’ has no universally accepted definition. It broadly incorporates the use of information and communications technology, or ICT, for health. The development of such sophisticated ways of communicating and storing large amounts of information has led policymakers to ask how these technologies could be used to make healthcare, disease prevention, diagnosis, treatment, monitoring, conducting research and management more effective and efficient.
In practice, this might mean that patients' health records are stored digitally, enabling them to be shared more easily, or that they could be asked to fill in digital surveys that yield large volumes of useful and accessible health data. In the European Union, for example, EU citizens have the right to work and travel in different member states. If they need medical care in a member state different from the one in which they usually reside, then it is useful for their medical records to be accessible across borders. To this end, the EU has set up an eHealth network, which brings together the Ministries of Health from all EU member states to develop common goals for eHealth.
However, eHealth is not simply about individual healthcare provision. The proliferation of wearable devices, apps and consumer health products to measure health-related information shows how much the private sector has attempted to move into this market in recent years.
Regardless of their potential to improve health, such eHealth interventions could potentially widen existing health gaps both within populations that frequently use information and communications technologies (ICT) as well as between those who do not. A wearable fitness band isn’t much use if you are homeless, healthy eating apps aren’t all that practical if you are struggling to buy groceries.
This is why we believe there is a need to look beyond market-focused approaches to eHealth and consider how it can be harnessed for the sake of public policies in the fields of disease prevention, urban planning and health literacy. The technologies that make eHealth more efficient can also be used to drive forward health improvement at the population level, including through improvement of air quality.
The term ‘air quality’ refers to the condition of the air we breathe, both ambient (outdoor) and household (indoor), with good air quality broadly pertaining to the degree which this air is free of pollutants. Poor air quality, due to the presence of pollutants such as smoke, smog and soot, has been implicated in causing or worsening a range of health conditions. According to the World Health Organisation, air pollution is the leading environmental health risk humans face. It is also a health inequality issue, with the most vulnerable and those from the most deprived areas disproportionately affected.
What is air pollution?
Air pollution is the presence of chemicals and compounds in air that are either toxic or at toxic levels, thereby posing a threat to health. There numerous pollutants present in our air, the most common and/or dangerous being Carbon Monoxide Nitrous Oxides, Sulphur Oxides, Ozone and Particulate Matter.
How does air quality impact people’s health?
Air pollution affects health throughout the life course. There is evidence that exposure to air pollution during pregnancy can impact fetal development, with associations made between air pollution and low birth weight, brain development and worse postnatal health outcomes. Globally, 543 000 children under 5 years die every year from respiratory disease linked to air pollution, while up to 14% of children aged 5-18 years have asthma relating to factors including air pollution. It has also been implicated in the incidence of several childhood cancers.
For adults, there is robust evidence that air pollution is closely associated with cardiovascular and respiratory disease. Worldwide, almost a third of the cardiovascular disease burden is attributable to indoor and outdoor air pollution (17% and 13% respectively), as well as 29% of chronic obstructive pulmonary disease (COPD) deaths being attributable to indoor air pollution and a further 8% to outdoor air pollution. The mechanism behind this is thought to be due to chronic exposure to pollutants triggering inflammation and oxidative stress in these organ systems, leading to disease. In the acute setting, several urban centres have also seen a spike in incidence and severity of exacerbations of asthma and other respiratory conditions, correlating to spikes in atmospheric pollutant levels.
Beyond physical health impacts, there is emerging evidence that air pollution is implicated in poorer mental health outcomes - for both adults and children. Studies have shown an association between higher concentrations of air pollutants and psychiatric medication usage, presentations of psychosis and symptoms of anxiety. Recent longitudinal research has found that exposure to pollutants, such as nitrogen oxide and particulate matter, at age 12 increases the chance of experiencing depression at age 18. The pathologic process of air pollution leading to mental illnesses has been poorly researched, however hypotheses detail neuroinflammatory and gene-environment interaction pathways.
In the elderly population, who are already more vulnerable to the effects of air pollution, there has been a small amount of evidence that air pollution exposure contributes to a person’s risk of developing dementia.
What will happen if we don’t act on air quality?
The Organisation for Economic Cooperation and Development estimates that, unless action is taken, air pollution will cause between 6 and 9 million premature deaths a year - or one every 4-5 seconds - by 2060. The biggest rises in mortality rates from air pollution are forecast in India, China, Korea and Central Asian countries like Uzbekistan, where rising populations and congested cities mean more people are exposed to power plant emissions and traffic exhaust.
Not only is it a direct threat to people’s health, it poses a great burden to health systems. In the 15 countries that emit the most greenhouse gas emissions, the health impacts of air pollution are estimated to cost more than 4% of their GDP, as a result of medical costs and sick days.
There is also evidence on the impact of air pollution on areas including educational outcomes, sustainable development and food security. As these are all wider determinants of health, any detrimental impact from poor air quality could have far reaching consequences. For example, a potential reduction in crop yields as a result of pollutants could have serious health implications, particularly in countries with a high malnutrition burden.
How can we improve air quality?
Some cities and countries have taken steps to address their air quality, many of which have also had co-benefits for health and development. This is underpinned by various international treaties, however these are only legally binding if a country has ratified it - a long process which doesn’t always happen.
On a national level, governments are encouraged to have robust enforcement of international standards for industry and agriculture, as well as developing and utilising technologies to mitigate pollutant emission. Incentives for behaviour change, such as financial support for purchasing low or no emission vehicles, can support local and personal interventions.
Locally, cities and communities can address their contribution to pollution through measures such as establishing low emission zones and improved provision of sustainable modes of travel. Development of new infrastructure should ensure clean air by design, allowing for environmentally friendly architecture and supporting green infrastructure.
Behaviour change on an individual level can contribute to the global movement to improve air quality. People are encouraged to address how they travel, participate in effective waste management and eat a climate friendly diet. There are also global movements to improve heating and cooking systems, to reduce them as a source of pollutant emission.
Air quality and Non-Communicable Diseases: an opportunity for eHealth
The development of ehealth tools in the scope of air quality control has enhancing health promotion, and, according to the WHO, has had an important impact to prevent, monitor, and increase the quality of care in NDCs.
On an organizational level, and besides the industrial adoption of new technology to reduce air pollution, evidence shows the pertinence of creating educational programs and Human Computer Interaction strategies so workers can use, and want to use, technology which cuts pollution.
Applications for air quality monitoring are also perceived as fundamental to develop environmental policies. Current solutions allow access to air pollution warning patterns, sending real-time information from a host of monitoring stations in cities to smartphones. These databases have been extremely useful to create new assessment risk tools, and to increase the individual awareness about this topic.
With virtual platforms, sensors and other Internet of Things devices it is currently possible to calculate the personal exposure to a specific environment. Sharing the sensed air quality measures with institutions increases the opportunities of promoting new prevention programs.
Air quality assessment has also been used as an indicator to predict the onset of type 2 diabetes or asthma, based on models that cross this information with other data, such as hours of physical activity, smoking habits, weight, or height. Other innovations have explored the association between air quality and chronic obstructive pulmonary disease (COPD), suggesting the implementation of mobile applications to help patients identify and control their exacerbations.
eHealth is creating a paradigm shift in healthcare, and evidence-based ICT solutions support the individual in their responsibility for their own health. In this particular topic of air quality, it is also important to use technology as means of empowerment, raising awareness about it as a public health concern.
World Health Organization, ‘How air pollution is destroying our health’:
Organization for Economic Cooperation and Development, The Economic Consequences of Outdoor Air Pollution:
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Roberts S., Arseneault L., Barratt B. et al. Exploration of NO2 and PM2.5 air pollution and mental health problems using high-resolution data in London-based children from a UK longitudinal cohort study. Psychiatry Research:
Linking e-health records, patient-reported symptoms and environmental exposure data to characterise and model COPD exacerbations: protocol for the COPE study. BMJ Journal:
ICT Sustainability: Assessment and strategies for a low carbon future. Retrieved from
ICT Methodologies and Spatial Data Infrastructure for Air Quality Information Management. IEEE Journal of Selected Topics in Applied Earth Observations and Remote Sensing:
Effects of an air pollution personal alert system on health service usage in a high-risk general population: a quasi-experimental study using linked data. J Epidemiol Community Health:
Air pollution and public health: emerging hazards and improved understanding of risk. Environ Geochem Health:
On The Correlation Between Geo-Referenced Clinical Data And Remotely Sensed Air Pollution Maps. Stud Health Technol Inform:
PULSE: Using Artificial Intelligence and Big Data to predict the onset of diabetes and asthma.