Preventive Technology and Gerontechnology in Public Health Engineering
CONTENTS:
Adapted from: Biomedical Technology. Public Health
Engineering (BMT-PHE): a new BMT differentiation of EUT and UM. (1998). BMGT report
98.132. Eindhoven, Eindhoven University of Technology.
J. Rietsema, Eindhoven, 22 March, 2000.
Two large scale developments will be central to the field of public health in industrialised countries in the first few decades of the 21st century. One concerns a new demographic composition of society with the resulting changes in needs, ambitions, and also morbidity, of its members. The other is the increasingly dominant role of technology, especially Information and Communication Technology (ICT).
The major demographic change in the industrialised world of the 20th and 21st century is the aging of the population. As early as 2010, 60+ citizens will constitute roughly 25% of the population, and the proportion will increase at least through the middle of the 21st century. Women are dominant in this group: in the 75+ age groups roughly twice as many women will occur as men. The far majority of the elderly will be living an independent life as individual citizens. Only about 7 % will reside in institutional care. As was stated in the 2nd national health survey of 1997 in the Netherlands (Ruwaard & Kramers, 1997), good health is a very important issue for all elderly and increasingly so with progressing age. And it is not just age itself, but also the process of ageing as part of lifelong development, that commands our attention.
Technological development has been a leading factor in society for the last centuries, and the pace has recently increased due to the massive spread of ICT. This is changing society profoundly both in professional and private spheres. As a commodity, computers are just 30 years old, home computers and satellite navigation 15 years, global mobile telephony and Internet including e-mail, only 5-10 years. The extensive infrastructures of glass fibre and satellite communication, high capacity servers, networks, and the software control that comes with such complex systems have grown similarly fast.
All this exerts an extensive and penetrating influence in the whole of industrialised society that is generally urbanised. Its dynamics will be with us for a long time to come. A recent EU report (ETAN, 1998) mentions three broad areas of technical innovation opportunity:
- the extension of working life among older people,
- enhanced activity, mobility and quality of life, and
- health, well-being, and support.
Most of these belong to the domain of health, in its WHO definition1. Clearly, the field of public health will also be developing fast with technology and in particular with ICT. To ensure that the population will benefit ultimately from such developments, we propose a specially trained engineer: knowledgeable in the field of technology as well as public health.
Public Health Engineering (PHE) can be found in the engineering literature from about 1880. Originally, PHE was devoted to prevention of infectious diseases that raged through the population, killing scores of people, especially children. Nowadays, Public Health is a multidisciplinary field, extending across natural sciences, social sciences and medical sciences and, as we shall discuss, also engineering. Its main concerns are prevention of disease, and health promotions2. Public health is to be distinguished from institutional or hospital medicine, be it that the boundaries need not always be sharp. Public Health undergoes strong influences from the demographic change and ICT developments. It is now broadening in scope to include early detection of risks and intervention as to a variety of chronic conditions and lifestyle choices. If we take health care management, disease control and quality of life as three main concerns of present public health, public health engineering addresses the latter two, i.e. disease control and quality of life. The revolutionary changes in technology through networks, miniaturisation, adaptability, etc., will increase the versatility of public health interventions. Such prevention through intervention includes: improved housing and domotics, better mobility systems, easy communication provisions, individualised information and education systems, lifelong-learning facilities, training on demand, less strenuous work by training simulators and self management, social participation through ICT, systems for safety and security, adaptive services, age-neutral products, ergonomics, navigation, assistive technology, and many others. These will contribute positively to the independence of elderly citizens and to their participation in relevant aspects of society.
As to risks on the workplace, legislature pertaining to health quality of the working environment has shifted from safety regulations for preventing accidents to a complete care system for the quality of working life. Stimulation of healthy working conduct forms an important part of those systems that have to be effective within the economic possibilities of the organisations concerned (EU-COM, 1997). Behavioural technology may be constructed such that it adapts largely automatically to wishes and needs of the individual user, who will remain in control, but is strongly and repeatedly advised to adhere to healthy schemes and to refrain from risky actions. In this way smart technology and smart interfaces open new horizons for health education, not just in the job situation but for the public at large. Monitoring and feedback systems of many types may simultaneously ensure optimum values for a great many health parameters, thus securing optimum (collective) prevention.
However, so far developments in demography and in technology seem independent, and no profession is dedicated to explore and develop the potential of new technology for health in the changing composition of society. In fact, in the Netherlands, the commission Lemstra, advising on collective prevention, observed in 1996 that integration of public health with other community services (such as housing) is lacking, leading towards increased health risks for society.
Already in 1981, the WHO endorsed 'Health Care 2000', because some negative trends in health care showed up after World War II. The general health status was still improving and life expectancy at birth increasing. But a decrease in the growth of improvements and an increase in the demand for care had become apparent in spite of higher investments in health care (law of diminishing returns). For the Netherlands it was calculated in VTV2 of 1997 (Ruwaard & Kramers, 1997) that, without extra interventions, care demand will increase yearly by 2.1 % with only 1.3 % considered economically feasible.
It is for these reasons that we stimulate education in 'Preventive Technology and Gerontechnology in Public Health Engineering'. PHE will constitute the professional education needed to provide public health with the benefits from the myriad of new technological options particularly those stemming from ICT developments.
Profile and career possibilities of the Public Health Engineer would include:
- scientific research in the interdisciplinary field of preventive technology and gerontechnology (informatics, telematics, domotics);
- participation in construction, design, and evaluation of products, processes, services and of the corresponding infrastructure, with a strong emphasis on user interfaces and man-system interaction (engineering advisory groups, architect groups);
- design and evaluation of working environments and working processes for primary and secondary prevention;
- physical, physiological and behavioural monitoring of persons and environments at risk;
- advising public health and home care organisations;
- integrating health, technology, environmental and economic aspects as policy consultant.
The Dutch Minister of Health, dr. E. Borst-Eilers, in her policy document on collective prevention of 1997, stresses the responsibility of individual municipalities and their Local Public Health Organisations (GGD's) to develop and implement a customised and integral health program incorporating prevention, housing, mobility, work, safety of drinking water, garbage collection, assistive technology and social integration, among others. A new type of a technically educated professional is needed and the Health Minister asked the Netherlands School of Public Health (NSPH) to develop courses to this end. We expect employment of the public health engineer by municipalities and Local Public Health Organisations, in addition to firms designing and developing products, processes and services.
The new Public Health Engineer has a much wider scope than traditional Public Health Engineer known from about 1880 that was devoted almost exclusively to preventing infectious diseases through better housing and work technologies. The new PHE is well versed in mathematics, computing, engineering, human biology, biostatistics, and epidemiology. He/she is able to complete an experimental design for a model of a biological system and user interface, and is capable of formulating problem definitions, carrying out research and writing scientific reports. The new PHE has mastered the mathematical basis of concepts and experimental methods in public health technology; and is trained to design and implement preventive technology (hardware and software) aimed at the (self)management of health problems in the working and living environment to be faced in the period beyond 2000. The principles of design in gerontechnology, man-system interaction, domotics and other ICT's can be applied, and human-factors knowledge is present that is necessary for design of customised products, systems, and services (mass- individualisation) in the field of health promotion. The MEPH has also obtained a comprehensive knowledge of topics relevant to public health technology to enable him or her to analyse expected future health problems, and design effective interventions taking into consideration demographic challenges and technological trends. Handling paradoxes between personal health and global environmental measures forms another capacity of the new PHE.
Reference can be made to the 5th Framework program of the European Union (EU) and the criteria defined for future R&D on social objectives and to economic development and scientific and technological prospects. Subjects include environmental factors, the information society, fighting age-related health problems, competitive and sustainable growth, and supporting the development of health, science and technology policies in Europe. Special European attention is given to the 'city of tomorrow', focusing, among others, on town planning and architecture, social integration, safety, energy efficiency and energy savings, and information networks , such as in the concept of 'digital cities'. As to the information society, Europe wants advanced interfaces for elderly and tele-systems to integrate the elderly as well as the disabled into society. Natural language technologies should be developed and integrated in new user interfaces, which help information and communication systems becoming more user-friendly. For the aging population the 5th Framework program stresses the fight against age-related illnesses and health problems, improvement of the quality of life and better functioning of elderly and disabled in society.
The recent ETAN report (1998), mentioned before, identifies a number of priority areas for Research, Technology, Development and Innovation, including new workplace technologies, new life-long learning systems for adaptation to new technological demands at work, enhanced age-friendly mobility and transport systems, housing, high-grade communication systems, and 'seamless' care systems for promoting well-being.
Within the European Union (EU) harmonisation of legislature pertaining to public health and public health engineering is expected to be completed within a decade or so. This will expand the career perspectives of the PHE, who has the whole of Europe as his/her occupational domain.
- Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realise aspirations, to satisfy needs, and to change or cope with the environment (Ottawa Charter for Health Promotion, 1986).
ETAN Expert Working Group (1998) Ageing Population and Technology: Challenges and opportunities. Directorate-General for Science, Research and Development. CG-NA-18-218-EN-C.
EU-COM (1997). The Social and labour market dimensions of the information society: people first-next steps. European Commision.
Ruwaard D. & Kramers, P.G.N. (1997). Volksgezondheid toekomst verkenning 1997 : de som der delen. Amsterdam: Elsevier/De Tijdstroom. ISBN 90-352-1867-1.
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ŠJan Rietsema,
last modified 22 March 2000