The document discusses the global digital and health divides between developed and developing nations. It notes that developing regions have significantly lower rates of access to technologies like phones, internet, and broadband as well as lower health spending and doctor availability per capita. This widening digital divide risks increasing inequality in health outcomes. To address this, the document argues for rethinking solutions to prioritize the developing world context, reduce communication costs, and find sustainable funding models in order to maximize the benefits of technologies for improving health.

1. The Ugly
000 Maurice Mars
Dept of TeleHealth
University of KwaZulu-
Natal, South Africa
International Society for
Telemedicine
and eHealth

2. Reasonable Expectations

3. What is the Global Health Problem ?
Money

4. The Developed World - The Problems

5. The Global Health Problem : Money
• Developed world – rising health costs,
ageing population, chronic disease.
• Developing world – poverty and low
health budgets, burden of disease

6. The Developing World ?
Developed World
~ 1 Billion
Emerging and
Developing
Nations
~ 5 Billion
The Bottom Billion

7. Population Distribution (% Total Pop)
World 2010

8. Population Distribution %
Africa 2010 World 2010
Europe 2010

9. Median Age By Region

10. Population Growth

11. Population Data (Millions)
1950 2010 2050
World 2,529 6,829 9,150
Africa 227 1,010 1,998
Asia 1,403 4,121 5,231
Europe 547 732 691
Latin America / Caribbean 167 582 729
Northern America 172 348 448
Oceania 13 35 51
Source: United Nations Population Division, World Population Prospects
2008 Revision (Medium variant)

12. Telemedicine in the Developing World

13. The Problem
Can one justify
spending money
on ICT solutions ?

14. Population Living on <US$1 /Day (PPP)
African region 42.6%
South-East Asia region 38.4
Global Average 22.7
Western Pacific region 16.0
Eastern Mediterranean 11.0
Region of the Americas 4.8
European region -
WHO World Health Stats 2012

15. The Global Problem
Per Capita Government Health Spend US$
South-East Asia region 19
African region 41
Eastern Mediterranean 96
Western Pacific region 361
Global Average 549
Region of the Americas 1,566
European region 1,677
WHO World Health Stats 2012

16. The Most Bang For Your Buck

17. The Problem

18. The Global Situation
Doctors per 100,000 people
African region 22
South-East Asia region 56
Eastern Mediterranean 109
Global Average 142
Western Pacific region 148
Region of the Americas 200
European region 332
WHO World Health Stats 2012

19. ICT Cost
Cost of a bundle of telephone, mobile phone,
broadband as a percentage of GNI per month
Country Rank Telephone Mobile Fixed
Cellular Broadband
Niger 165 41.3% 73.4% 210.5%
Malawi 164 18.2 91.0 2,408.0
S Africa 99 5.2 4.8 5.7
USA 12 0.3 0.8 0.5
Monaco 1 0.1 0.3 0.3
International Telecommunications Union 2011

20. Darkest Africa

21. Digital Divide

22. Global ICT Developments, 2001 - 2011
100
Mobile-cellular telephone subscriptions
90 Internet users
80 Fixed telephone lines
Per 100 inhabitants
70 Active mobile-broadband subscriptions
60 Fixed (wired)-broadband subscriptions
50
40
30
20
10
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011*
Source: ITU World Telecommunication /ICT Indicators database

23. Fixed Phone Lines /100 People 2011
45
40
39,1
35
30 28,5
26,3
25
20 16,6
15 13,0
9,7
10
5 1,4
0
Europe The CIS** World Asia & Arab Africa
Americas Pacific States
Source: ITU World Telecommunication /ICT Indicators database

24. Internet Users / 100 People, 2001-2011*
100
Developed
90
80 World
Per 100 inhabitants
70 Developing
60
50
40
30
20
10
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011*
Source: ITU World Telecommunication /ICT Indicators database

25. Proportion of Households With Internet
Access 2002 - 2011
100
90 Developed
80
World
70
60 Developing
%
50
40
30
20
10
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011*
Source: ITU World Telecommunication /ICT Indicators database

26. Fixed Broadband Subscriptions / 100
People, 2001 - 2011
30
Developed
25
World
Per 100 inhabitants
20
Developing
15
10
5
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011*
Source: ITU World Telecommunication /ICT Indicators database

27. Active mobile-broadband subscriptions /
100 People, 2007 - 2011
60
Developed
50
World
Per 100 inhabitants
40
Developing
30
20
10
0
2007 2008 2009 2010 2011*
Source: ITU World Telecommunication /ICT Indicators database

28. Digital Divide and the Health Divide
The digital divide is widening
Why is this?
Is this increasing the health divide ?
If so what do we need to do?

29. Population Living on <US$1 /Day (PPP)
African region 42.6%
South-East Asia region 38.4
Western Pacific region 16.0
Eastern Mediterranean 11.0
Global Average 22.7
Region of the Americas 4.8
European region -
WHO World Health Stats 2012

30. Rethinking the Problem
Understand the problem
Prioritise young vs old?
Reduce digital divide
Reduce communication costs
Reverse the brain drain
New funding paradigm – eAid
Think Developing World in all that you do

31. Take Home Messages
The developing world is different
Expectations must be relevant
ICT solutions must be appropriate
National budgets are low – sustainability
Get the most bang for the buck
Is eHealth for ageing a priority ?

32. The Ugly
The developing World
continues to be left behind
It
Needs
YOU