Evidence of meeting #84 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was technology.
A recording is available from Parliament.
NDP
Libby Davies NDP Vancouver East, BC
Is that changing among physicians, this idea that there's a barrier between what they know and what the patient knows?
Chair, Rural Medicine, Gateway Rural Health Research Institute
There are two big movements going on. One is patient-centred medicine, but that's about 10 or 15 years old.
The new momentum is something called shared decision-making. I don't make the decision for you about whether or not to get a CAT scan. We talk about the risks and benefits of getting a CAT scan. You may have a bad intracranial bleed, but, you know, that CAT scan has a lot of radiation and it may lead to a brain tumour. Which is worse? I'm there to help you make the decision, but it's shared decision-making so that you ultimately make the decision based on the information I can provide to you.
Chief Executive Officer, Beagle Productions
I also think we need to get people before they get to the hospital, and that's where a lot of the knowledge comes in. It has to be about learning how to make healthy decisions. That's purely education.
How do we get that to people? That's hard, because—
NDP
Libby Davies NDP Vancouver East, BC
How do you think we do that? I'm asking you how we get that to people.
Chief Executive Officer, Beagle Productions
Well, I've seen a few things that work.
One obviously is youth. We have them in our grasp at school, so that's the one place where we can get them and teach them. Mandating the use of that so it could be part of their lifestyle could potentially happen through school.
We do most of our work south of the border. The affordable care act is coming through in January, which means that companies will have to provide wellness opportunities for their employees. It is something that is being mandated and there's money being set aside for that for companies. They're actually mandating that you have to give wellness options for your employees.
There could be something that is driven through the workforce from that standpoint. That's another place where we have people.
The reality is that it needs to get to the parents too. If we can reach people in the workforce and reach kids in school, then maybe that will meet at home. We need to have the parents. Until we have the parents, who sometimes are working two jobs and getting some kind of TV dinner that has a terrible amount of calories, actually making the right choices for their kids, we—
Conservative
The Chair Conservative Joy Smith
Thank you. We're just about at the end.
Thank you so much.
We'll go to Mr. Lizon.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
Thank you very much, Madam Chair.
Thank you to all the witnesses for coming. Each of the presentations was very interesting.
I would like to start with a very general question.
We live in very interesting times. We are in a kind of transition. I use smart devices, but I grew up without them; therefore, for me to get by without them would be fine. There's the generation of my children who are quite attached to these devices, and then my grandchildren, who do not remember life without them.
I remember a funny situation when my daughter's friend was holding her device and she said, “What? Is it raining? My app says it's supposed to be sunny.”
How do we apply all these new technologies, everything we have, and yet not lose our common sense? That's a general question.
Anybody can elaborate on this.
Principal, CENSE Research + Design , Adjunct Professor, Dalla Lana School of Public Health, University of Toronto, As an Individual
I think one of the answers is to use the concept of health literacy. I think we need to build the literacy and the critical thinking capacity around the technologies as they apply to regular life. I think there has been a tendency towards leading with the tools, that toolset instead of the mindset. We need to think about what it means to have a network and what network thinking implies, that you're actually getting information from multiple different sources simultaneously.
We saw a good example of this in the news with some of the recent events in the United States. People were reporting all sorts of stuff. If you're thinking like a network, and very rapidly, you will ask questions about the data you're getting in a different way than if you're just thinking of it as the device. The device is faulty.
I would suggest that one of the investments might be on expanding our health literacy and focusing less on the technology, although that's obviously important. We also need to think about it from a literacy standpoint. What are the fundamental skills around the foundations, around how we learn from tools? The tools will change and it's going to be something else; it will be whatever it is—wearable or anything like that. If you're able to build that robustness in a literacy, that will maintain itself beyond the technology.
Conservative
Chair, Rural Pharmacy, Gateway Rural Health Research Institute
I want to connect on that point and tie in with Ken's earlier point about shared decision-making.
We tell the health care providers that it is their responsibility to be the resource person and to be the guide in a lot of these cases, but the reality is a lot of health care professionals are not comfortable with technology. They're in the learning phase, depending on what stage they're at themselves. For example, in Europe they publish a European directory of health apps, I believe on an annual basis. It outlines what apps there are for which conditions. Depending on what profession you're in, if you're a pharmacist or a physician, in hospital versus the community, it tells you what kind of apps you can take advantage of. I think those kinds of supports also will be important.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
Mr. Friesen, your presentation on interactive health tools is very impressive and interesting, but how do you actually get a person to follow what he or she should be doing? You go through all the assessments and the person says, “I'm overweight, so what do I do?” You tell them that they have to diet and exercise. You tell them what is the cause of their condition in the first place. How do you reverse it so that people don't get to that condition where sometimes there is no escape and it becomes a chronic condition?
Chief Executive Officer, Beagle Productions
Unfortunately, a lot of times it does depend on the person. There are incentives that you can provide. Some people, employers, spouses, friends, provide incentives. Incentives help motivate people to start, but again, it really comes down to the literacy. You have to learn what you need to do. Behavioural change comes with finding out why you're in that spot in the first place. You really need to find out what happened to get you there. That's why diets usually don't work, because you're not dealing with the problem; you're just dealing with the outside part of it.
There also is a level of accountability and personalized guidance that comes from a specialist, whether it's a health coach, a doctor, or a nutritionist. It depends on the type of person you are. Some people can handle self-guidance. Some people need more personalized guidance. Some people need an accountability partner, a doctor, or a coach to help them.
Incentives have been found in the corporate world to help get people down the path. After that, they need the proper motivation and accountability to keep them going.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
Dr. Milne, with all the technology and apps available, how would you see your role as a doctor? Is it changing? Would you see it as an educator, a preventer of disease, rather than a person who treats a patient?
How would the changing technology allow a person to still make a decision on his or her own instead of depending on what the app is telling them. It might tell them to buy something. When I go to the grocery store, I don't think I know 10% of the choices that are available. Therefore, if you go with your app, what do you choose? How do you decide? Do you depend on the device? We should still, as human beings, be able to make our own choices.
Conservative
The Chair Conservative Joy Smith
Time is up, Mr. Lizon.
I don't know if you have a quick answer, anyone, to that.
Dr. Milne.
Chair, Rural Medicine, Gateway Rural Health Research Institute
It should be shared decision-making with the physician helping the patient, but it's patient centred. The technology allows you to customize that for each and every individual patient. The answer won't be the same. It will be unique for every patient encountered.
Conservative
The Chair Conservative Joy Smith
Thank you.
You got your answer, Mr. Lizon, a pretty good one.
We'll go to Dr. Fry.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
Thank you very much, Madam Chair.
To the witnesses, you're a very interesting panel, and I like what you're saying, but let me throw a little skeptical wrench into this thing.
I understand the issue. Mary was one of our great health ministers—Mary, I need to say that—but there's one thing we need to talk about here. I can understand the validation of the apps, the evaluation component of it, etc., and I do agree with Mary that there is a role for the federal government to be kind of the clearing house—as Feng said, Europe is doing this—checking out the apps, making sure they are valid and giving the proper information. You're looking at outcomes on them. I understand that. I get that.
I think Libby brought up an issue of access. That issue is a bit of a concern for me. We're talking about young people who have easy access to smart phones and know how to use them. We're talking about seniors being the largest growing group of people who use this kind of technology. However, there's a whole lot of people who cannot: the low-income groups, the working poor, the ones on the streets, the chronically ill who are isolated and who aren't motivated. For me, the issue is how we give access to those people.
Before we even talk about that, we have to ask, and I think this is what Libby was basically asking, who gives that access? Does the province supply everybody with a smart phone so that they are able to have access? Who does that?
Before you even give access, you have to have motivation. I mean, come on; we know how long it took, in spite of the horrendous pictures on cigarette packages, to get people to stop smoking. We know how difficult it is to get people to even pay attention to the fact that as they watch their girth increasing, their risks, as everybody knows—you'd have to be living on Mars not to know—of getting type 2 diabetes are high, or that obesity is a problem.
The people you're talking about who will use these apps are the motivated people. They are people who want to take charge of their health. They are people who want to take charge of the chronic problems they're having, or prevent them from occurring.
My question is kind of similar to asking who will bell the cat. For the people who are continuing to get chronic diseases, such as type 2 diabetes, obesity, etc., while eating tons of salt, how do we get them motivated?
I understand from what Ken said that if you already are a person with a chronic disease, your physician can introduce you to the apps and say that you should get one and use it to help check yourself. I can see that, but what about the preventative piece? That's the one I'm concerned about. How we do get people to be motivated? I'm not talking about all of us, about the 25% or 30% or whatever the number is, who are motivated to use their smart phones for something like this.
How do you get workplaces to take this on? You can't mandate a private sector workplace to demand that every one of their workers does this and that they supply all their workers with it.
This is the big issue for me. How do you get that motivation going in terms of prevention? How do you give access to the people who cannot afford it? For them, it isn't on their agenda at all, because they're busy trying to make ends meet, or they're on the street, or they're couch surfing, as many homeless people are. How do you get a lot of those people, or even the youth, who think this is all about Bieber and downloading the newest music, etc., to be interested and motivated to use this?
If we can do that, I can see this being a wonderful thing, but how do we do it?
Conservative
The Chair Conservative Joy Smith
You have three minutes to solve this problem.
I shall begin with you, Dr. Norman.
Principal, CENSE Research + Design , Adjunct Professor, Dalla Lana School of Public Health, University of Toronto, As an Individual
That's a complex question. Usually, complex questions deserve complex answers, but because we only have three minutes, I'll give you a simple one.
Liberal
Hedy Fry Liberal Vancouver Centre, BC
I think Mary wants to answer, so you don't have three minutes.
Principal, CENSE Research + Design , Adjunct Professor, Dalla Lana School of Public Health, University of Toronto, As an Individual
All right: one minute.
I would say that one of the key things is to really engender within the whole health system a creativity about how these tools can be used. In North America we have a tendency to have one phone, one person. That's not the way it's used in a lot of other parts of the world, where the idea is that we have the one device.
There are ways that you can empower people—teachers, physicians, educators, policy people. You can even do things in the mall using all kinds of different media. You can do it through education and through all kinds of different things that we have the technology for.
I think what happens is that we get trapped in the idea, or the thinking, but if people don't have the phone, they can't access it. It doesn't mean that a physician, a teacher, or someone else can't use the phone to demonstrate something. It's a fantastic teaching tool.
Chair, Chronic Disease Prevention Alliance of Canada
I may be a little heretical, but quite honestly I don't think this is the answer to everything. I still think we have to have a whole variety of strategies. Certainly at the BC Healthy Living Alliance we've done all these programs with low-income groups and have had a lot of experience on how to motivate people, particularly around the food side and physical activity. It's really hard work.
A lot of it is about connecting people and having a sense of belonging so they want to be part of a group that maybe is.... With low-income groups, we did food skills for families. You take them shopping. You help them have healthy food. It's a variety of things. I wouldn't put all my money just into apps, quite honestly.
I still think there's all the personal stuff, the community groups and community organizations that we have to count on to help people, certainly for the next decade.