If the country is serious about reforming the healthcare system, then it needs to look beyond just improving access to medical care. Reforms must acknowledge and address the underlying causes of poor health, many of which cannot be adequately treated by healthcare professionals alone. Indeed, for some 50 million low-income Americans, the barriers to getting healthy represent unmet legal needs better remedied by a lawyer than a healthcare professional.
Unenforced sanitary codes leave families living in unsafe housing where children are made sick by mold, or made sicker by the fact that utilities in their homes have been wrongly shut off. Health system complexities and inefficiencies prevent seniors from benefitting from the insurance and long-term care coverage to which they are entitled, and keep wounded veterans from accessing durable medical equipment such as a wheelchair or other crucial supports. In each of these cases, traditional healthcare services – no matter how expertly administered, and no matter how capable and compassionate the clinician – will not improve individuals’ health. Rather, legal assistance is crucial to negotiate with landlords and utility companies, appeal denied insurance claims and expedite access to veteran benefits and services.
The use of cell phones by community health workers and other medical practitioners in low-income countries has been promoted as a potential revolution for health systems development. This “mHealth” revolution has been seen as an opportunity to develop diagnostic, treatment and surveillance networks wirelessly, to build mobile apps allowing remote nurses and doctors to provide higher-quality care to rural patients even in places without a hospital or well-functioning health clinic. Several foundations are now offering grants to build and distribute phone applications that will offer everything from prescription drug advice to epidemic surveillance tools. But is mHealth really going to improve health outcomes? Or is it just another technological bomb thrown at poverty and poor infrastructure?
Globally, about 3.1 billion people used mobile phones in 2007; that’s nearly half the planet. The greatest growth during the last decade has occurred in Asia, the Middle East, and Africa. In many of these continents, mobile phone subscribers outnumber fixed-line telephone subscribers, particularly as countries leap-frog over the traditional development step of planting land-lines and rely instead on building wireless communication towers and Internet-based businesses.