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- [Werner Vogels] Our planet and our civilizations
are changing faster than ever before.
Join me as I travel the globe
talking to start-up founders
using technologies to make our world
more interesting, accessible, and livable.
These are the entrepreneurs
that are creating the future we will live in.
This is "Now Go Build".
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- [Werner Vogels] Half the world lacks access
to even the most basic healthcare services.
And while the other half may technically have healthcare
it doesn't mean they are healthier.
Take Brazil for example.
Brazil's government has taken on the monumental task
of offering free public healthcare.
However pervasive poverty
combined with bureaucratic inefficiencies
means that the government's healthcare system
is unable to keep up with demand.
Out of 200 million citizens
150 million are deemed medically homeless.
Meaning that they do not have access
to a healthcare professional.
For technologists,
Rio de Janeiro is the perfect place
to take on the problem of public health.
With its wildly different income levels,
complex geography,
and a complicated infrastructure
Rio is representative of the challenges
that Brazil has to deal with on a national level.
In order to learn more about
the healthcare challenges facing Brazil
I reached out to Marcelo Gomes,
a public health researcher with Fiocruz
of Brazil's Ministry of Health.
Marcelo!
- Hello. - Pleasure.
Thanks for taking your time.
Tell me a bit about what you do.
- [Marcelo Gomes] I've been working with modeling
epidemic spreading around the globe.
Mostly influenza, a little bit of Dengue and Zika.
- Okay so and the data that you work on,
where does it come from?
- So we are mostly working
with official notification cases.
Of course mainly the public health units
do notify those cases.
Private hospitals, usually they don't.
So we miss a lot.
- What's the role of technology in all of this?
- So it's, it's paramount.
Are we just seeing these small fluctuations?
A small number of cases popping here and there.
Or are we already facing an outbreak?
And this is where what we call "Nowcasting"
comes into play.
So it's this technique to estimate
what is the current situation.
- Based on incomplete information --
- Exactly, exactly.
We have shown that if we have
platforms of self-reporting
or social media information
our ability to offer estimates increases significantly.
- So you have the official dataset
which is managed by the government.
And so you augment that dataset
or you sort of start estimating
what it is in reality
based on sort of all sort of additional data streams.
- Yeah, yeah, absolutely.
And in fact we analyzed from previous seasons
what could have been a potential outcome
of actually taking action,
taking measures to mitigate,
and we can see that we could in fact
prevent thousands of cases.
- Okay. - Okay?
And then of course this also represents deaths averted.
We have economic burden being reduced.
So this is something that can lead to
great impact to the population.
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- [Werner Vogels] In order to learn more about
where Marcelo was obtaining
this additional vital information
I met up with Onicio Neto,
a social entrepreneur and biomedical scientist
with a doctorate in public health.
Hey Onicio, how you doing man?
Good to see you.
So tell us a bit about what Epitrack actually does.
- [Onicio Leal Neto] Yeah, we do digital disease detection.
Which is a kind of crowdsourcing for health.
So we deploy mobile apps where people can download that,
make a self-report of symptoms.
- Okay.
- And we collect this data in real time.
If we get a bunch of people with the same symptoms
at the same space in time
maybe this can be a beginning of an outbreak.
- Okay.
- And we put this information in dashboards
that can help decision makers to understand
in real time the epidemiological situation
and can make an intervention
before this disease can spread out.
And since we use this kind of crowdsourcing approach
we are filling existing gaps
in public health information systems.
- So tell me a bit,
what is the actual data that you are collecting?
- In general, symptoms.
- Okay.
- And demographics.
- Okay.
- So, and this is important,
our approach is a syndromic approach,
which means we have this kind of
combination between some symptoms.
And this combination can generate
the risks of some diseases.
This is a very efficient way to collect data.
We don't need to collect long forms of data.
We just collect ten or twelve symptoms
and the combination between them
can generate these outcomes for us.
Our approach is different because
we are using the epidemiology pillars to understand that.
So we use people, place, and time.
Always of this triangulation of this information.
- [Werner Vogels] Yeah, okay.
So proximity is of course,
doing this for that becomes important as well.
- Yeah.
And time is important as well because
of the seasons of some epidemics because --
- Oh really?
- Yeah because like Brazil,
we have seasonal indicators
and it's important to deal with this season
because sometimes we can evaluate
if the season is changing.
And how can we deal with these changes.
- Okay.
So on one hand,
the output is real time in detection of potential epidemics.
And on the other hand it's sort of
reporting about larger prevalence that you find.
- Yeah and trends, of cause, and things like that.
- But what does it mean for the individuals?
What does it mean for the people themselves?
- It means the people can actually know
how healthy is the community where they live.
For private sector,
we can improve doctors with this knowledge,
with these insights.
And the doctors will take care better of their patients.
- [Werner Vogels] To see how the medical centers
are managing this,
I looked into another approach
tackling this healthcare challenge.
dr.consulta is a network of clinics
that reinvented healthcare using technology.
Hey Thomaz, good to see you.
- Good to see you too. - Thanks for taking the time.
Tell me a bit, what is it you guys do?
- [Thomaz Srougi] So we're providing access for the masses
In Brazil there's 200 million people,
and there's about
150 million people medically homeless.
- Oh!
- Meaning they try to see a doctor
but they don't get access to.
When we figured that out we had to
we thought we had to reinvent healthcare.
So we began from scratch creating the model with people.
We redesigned care.
And we came to the conclusion that
if we wanted to change the game,
if we wanted to provide access for low-income families,
which is 75% of Brazil,
we had to provide very affordable care.
Moving from a reactive system,
to a proactive or preventative system.
But if you want to do prevention
you've got to know what you're preventing against.
So you have to predict the future.
And the only way to do that is to use data.
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We said let's go to
the lowest-income place possible in Brazil,
the largest slum area.
- [Werner Vogels] Okay.
- [Thomaz Srougi] And try to recreate a care model.
Because if we succeed there,
we're gonna succeed all over Brazil.
So we started the first clinic
inside the largest favela,
or slum area of Brazil.
Just fine-tuning the model for efficiency
and for an amazing experience.
And driving down costs everywhere we could.
So it took us two and a half years
to validate that clinic.
- [Werner Vogels] Yeah yeah.
- [Thomaz Srougi] And then we began scaling up the model.
- So technology plays a crucial role in all of this.
- Technology is central for providing
affordable and excellent healthcare at scale.
There's no other way to get there without technology.
- [Werner Vogels] So how many of these clinics do you have?
- We have 60 clinics in Brazil, five in Rio.
- Okay, and the others are in?
- São Paulo and Belo Horizonte.
- Okay.
So all of this is really about efficiency.
I mean you're providing the lowest cost healthcare possible.
So tell me a bit about how those all work.
- Yeah I mean we have to be extremely efficient
and use the best technology.
And we have to try to liberate people
for higher value-added work - Okay.
with technology.
Our cost reduces and I reduce my prices.
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- These are pretty low prices, is it, for healthcare?
- [Thomaz Srougi] It's very, very low-price.
It's about ten times less than traditional market prices.
- [Werner Vogels] Okay.
- [Thomaz Srougi] But we also want to practice price transparency.
There's no other place here in Brazil
where you can see how much you're gonna pay ahead of time.
- Okay.
- So that people can make better informed decisions
because they are paying direct out of pocket.
- What's a common waiting time that,
say a time you want to book a cardio exam how...
I mean waiting times in public healthcare
are notoriously long.
- Right, so the average waiting time for
to see a doctor in Brazil is three months.
- Really?
- Through the public system.
- Yeah.
- And sometimes people are waiting more than a year.
So with us you can use the app
and you can book for the same day.
- Okay.
- To come the same day to see your cardiologist.
- So it makes sense for your customers
to continue to come back
given that their medical history is stored
in your digital systems
and thus it's kept more efficient.
- Right, so when all the systems are
or all the exams are in the system --
- Yeah.
- A patient don't need to redo the exams, right?
And they spend less.
But then we begin using the data
to start predicting what's gonna happen
with a patient in the future.
So once we have two data points in time
we can then figure out
"Oh, that person may become diabetic in five years.
So what can we do today to neutralize that future risk?"
That's how we leave our reactive model.
That is today,
healthcare all over the world.
You feel bad?
You search for a hospital emergency unit.
To a proactive model,
a preventative model,
where you use a lot of clinics
you're not using the hospital.
The name of the game is
how to keep people away from hospitals.
- Okay, yeah.
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- The current healthcare system is broken.
We had to make things different.
Even if that meant that we were gonna make less money.
And that's not a problem.
- So it's really looking at the long-term.
Long-term success instead of short-term gains.
- Right and it's really hard
because people are anxious to make money.
- Yeah.
- We're not.
We wanna build the the business that's gonna last forever
and the only way to do that
is to prioritize people's needs.
And the most important stakeholders in the equation
are doctors and patients.
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- [Werner Vogels] You mentioned to Zika
and I remember reading about
that thing before the Olympic Games?
There was a sort of a scare.
- Yeah, yeah, absolutely.
So there was this great debate around that.
Would the Olympic Games in Rio,
due to the Zika outbreak that was going on,
lead to a potential pandemic, okay?
And the thing is it have a great seasonal effect
due to the climate
because of the mosquito
and how it interacts when the weather changes, okay?
And we know, looking into Dengue,
which shares the same factor,
that during the winter time here in Rio
we almost do not see Dengue cases.
So we would expect that,
well for Zika we will have the same thing.
So it shouldn't be something to worry about.
And in fact that was exactly what happened.
During the summer we had a strong number of cases,
of Zika cases,
but during the Olympic Games --
- Nothing happened. - Almost none, none.
- So you were right.
- Yeah, thankfully, thankfully, yeah, yeah.
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- [Werner Vogels] Epitrack has already
significant impact, yeah?
Because you can actually detect things much faster
than you could in the past.
So where do you think this is going?
- I think that the dream is to have
a kind of real-time information
to make these interventions.
But maybe we are, you know, far off that.
And actually this gets on
the really important thing which is,
in terms of global health,
we have these four big challenges right now.
We have the infectious disease,
of curing it every time.
So we got a Zika outbreak in 2015.
We got Ebola's outbreak in Africa.
We got Measles in Europe.
Infectious diseases already happen.
So this is one of the big problems
that we have in global health.
The second one is noncommunicable diseases.
Diabetes, hypertension, things like that.
And this is tough
because even being noncommunicable diseases
they actually are "communicable"
because the behavior can be contagious.
And if I have kind of risk behavior with,
for hypertension for example,
maybe I can "infect" my kids.
I can "infect" my friends with this kind of --
- Bad behavior.
- Yeah.
The third thing is environmental.
I mean climate changes.
We are facing a lot of place
that doesn't have mosquitoes for example,
and now they have.
And how we are dealing with that.
Maybe in ten years Dengue can
achieve some parts of the U.S. for example.
- Okay.
- And the fourth is mental health.
Burnout syndrome and depression,
those things are real challenges in public health.
So how can we deal with those
four big challenges in global health?
My perception is using those technologies,
basing them on crowdsourcing,
basing them on machine learning.
Everything that we can use to give us this visibility
to improve the way to detect these health threats
before they happen.
(soft music)
- Data science is often about finding
more efficient ways to solve age-old problems.
But it is what we do with these new efficiencies
that shape the kind of change we will see in the world.
By implementing patient-centric models
instead of payer-centric models
these visionaries are finding sustainability
within a model based not only on profits
but on the health and well-being
of an entire population.
Who knows what ripple effect a healthier Brazil may have?
But improved quality of life for millions of people
certainly points Brazil towards
a brighter and healthier future.
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