In his opening remarks, University of Miami President Julio Frenk, M.D., a noted scholar in global health, said, “Since joining the university 22 months ago, one of my priorities has been building intellectual, cultural and geographic bridges. This Latin American forum has been very successful in bringing together our colleagues in different schools, and reaching out to our partners from throughout the hemisphere.”
More than 120 physicians, administrators, students and policy makers attended the LIFE2017 event, which was sponsored by Boston Scientific, under the guidance of Mauricio Ortiz, president Latin America.
Steven G. Ullmann, chair and professor of Health Sector Management and Policy, and director of the School’s Center for Health Sector Management and Policy, was co-program director with Felicia Marie Knaul, a professor of public health services at the university’s Leonard M. Miller School of Medicine, and director of the Institute for Advanced Study of the Americas.
Addressing the Challenges
From a global perspective, Latin America has led the way in innovative approaches to provide high quality, affordable insurance to everyone, said Frenk. “But there are still huge challenges, such as highly-segmented health systems serving different population groups, resulting in huge inequalities in the delivery of care.”
While Latin American nations have generally dealt effectively with communicable diseases, they now must address non-communicable health issues like cancer, stroke and Alzheimer’s disease. That requires a change in mindset to focus on prevention, broadly based population health initiatives, greater sharing of knowledge and more transparency and accountability, Frenk said. “Universities will play a major role in helping Latin America make these changes,” he added. “We educate business and health care professionals, adding to health systems human resources, and through research we generate knowledge for health progress.”
Preventing cardiovascular disease
Latin American providers should increase their focus on preventing cardiovascular disease, according to Ralph L. Sacco, M.D., chairman and professor in the University of Miami’s Department of Neurology; executive director, Evelyn F McKnight Brain Institute; Miller Professor of Epidemiology, Public Health Sciences, Human Genetics, and Neurosurgery; Olemberg Family Chair in Neurological Disorders; president, American Academy of Neurology; and former president, America Heart Association.
In his keynote talk, “Access to Health Care: Hypertension, Heart and Brain Health,“ Sacco said hypertension (high blood pressure), smoking, and high levels of blood sugar and cholesterol, are the leading risk factors for death and disability related to cardiovascular disease.
“Lifestyle modifications, such as restricting salt consumption, losing weight and eating more fruits and vegetables, are critical for addressing hypertension,” Sacco said. “We need to build awareness, improve screening and surveillance in order to reach public health goals.”
Sacco also moderated a morning panel discussion on hypertension, heart and brain health with Claudio Luiz Lottenberg, M.D., CEO of United Healthcare Brazil and former president at Albert Einstein Israelita Hospital; Enrique Ruelas, M.D., a former vice minister of health for Mexico; and Edward Martinez, a senior vice president and chief information officer, Miami Children’s Health System.
“We found a higher incidence of stroke in the periphery of Sao Paulo, indicating that neighborhoods suffering socially are more affected by cardiovascular disease,” said Lottenberg. “We need to look for improvements at the community level, develop workforce strategies and engage students as leaders in this transformation.”
Ruelas called for a shift in thinking from treating individual patients to focusing on population health. But he added a note of caution. “Patients need access to good health care regardless of income,” he said. “Accessibility without quality is simply irresponsible.”
Martinez emphasized the power of health informatics, using data to empower patients as well as physicians. “Mobile devices and applications help us make health decisions on our own,” he said. “In the next decade, machine learning and artificial intelligence (AI) will help us make decisions that enhance our lifestyles.”
Applying Artificial Intelligence
In her keynote address, the “Role of IBM Watson and Intersection of Data and Technology," Tina Moen, deputy chief officer for IBM Watson Health, also emphasized the growing importance of big data, predictive analytics and AI. “We are now entering the cognitive computing era, which will help accelerate development timelines, and deliver more personalized healthcare, so that people are healthier and happier and lead longer, more productive lives.”
Moen said IBM Watson Health wants to improve health across populations, pulling in the information so providers can make better recommendations. Today, it takes 17 years to translate scientific discoveries into practice, and about 45 percent of medicine is still not based on evidence, she said.
Cognitive computing can also help patients make good choices for themselves, Moen added, noting that about 40 percent of an individual’s health is related to behaviors such as smoking, eating, and exercise, 30 percent is environmental, 20 percent is genetic and only 10 percent is related to care. “Both patients and physicians are fearful about robots taking over, but we see AI as new tool, like a stethoscope, to help in the prevention, diagnosis and treatment of disease.”
Closing the Cancer Divide
Before lunch, Knaul presented a keynote session on "Closing the Cancer Divide: Challenges and Opportunities for Women's Health and Health Systems in Latin America." She described her personal experience with breast cancer while living in Mexico, and its impact on her husband Julio Frenk and their two children.
“Today, Mexico guarantees treatment for every woman diagnosed with cervical or breast cancer, regardless of income, through its Seguro Popular coverage,” she said. “But women’s cancer care must be a global health imperative.”
Knaul called for a “diagonal approach” that focuses on interventions for prevention and treatment of different diseases across population groups. “For example, how can we integrate the delivery of cancer care into other programs seeking to reduce poverty?” she said.
Knaul also moderated a panel on “Women’s Access to Health Care: Cancer Prevention and Treatment” with Argentine oncologist Eduardo Cazap, M.D., the president of SLACOM (Sociedad Latinoamericana y del Caribe de Oncología Médica);
Alvaro Soto, president of Roche Latin America Sub Region; and Gilberto Lopes, M.D., the medical director international programs at Sylvester Comprehensive Cancer Center of the University of Miami Miller School of Medicine.
“The death rate from cancer in Latin America is twice as high as in the United States,” said Lopes. “One reason is inadequate funding. We spend hundreds of dollars per cancer diagnosis here compared with only $8 in Latin America.”
However, U.S. institutions can learn lessons about the delivery of care from Latin American providers, Cazap said. “In the 1980s, chemotherapy was an inpatient treatment, even though it increased the side effects,” he said. “We didn’t have enough hospital beds in Argentina, so we pioneered the outpatient approach, which is now a common practice around the world.”
Soto called for increased public-private collaboration and greater transparency in order to improve health outcomes across the region. “We need to bring in different stakeholders in order to get the right treatments to patients,” he said. “Sessions like this play a vital role in expanding our knowledge and giving us an opportunity to learn from other professionals.”
The conference concluded with experts from Latin America brainstorming and reporting out policies which would enable enhanced education, prevention, access and treatment of disease processes.
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