Four questions for mHealth analyst Jody Ranck

By Brian Dolan
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This week GigaOM Pro posted a report penned by longtime global health analyst Jody Ranck -- who recently joined the mHealth Alliance's executive board -- on the rising trend of mobile health applications. Ranck's paper serves as a well-crafted, high level overview of activity in the global mobile health field. While it's 25 pages long, the report moves swiftly from one topic to the next and is a good primer for both mHealth newbies and incumbents. This week MobiHealthNews asked Ranck about his report on mHealth.

MobiHealthNews: Early on in the report you pointed to McKinsey's estimate of $60 billion as the global market opportunity for mHealth. There are a number of market estimates out there -- and I think we all struggle with this -- but I was just curious why you chose this one?

Jody Ranck: To be totally honest with you, I was part of the Rockefeller Foundation when they put together their eHealth conference and we had BCG put together a market analysis of the broader eHealth market. These estimates are often a shot in the dark. It's a very inaccurate science to figure out the global market for eHealth or mHealth. The controversy surrounding the discussion of determining a market size for eHealth in the developing market has been a big issue for some time. No matter what number you first come up with, I find there is a great deal of debate and discussion around the accuracy of these numbers. I am accustomed to the debate over what these numbers actually mean in real terms.

I think that is the biggest one out there though, right? $60 billion?

Yes, it is one of the largest I've seen.

I liked your explanation for the definition of "mHealth." You provided the UN Foundation's definition but ended up explaining that for the purposes of the report the definition of mHealth would remain "flexible." Why?

I have found that there is pressure from some quarters to come up with a precise definition for mHealth. Intuitively I resist that, though. Look at the word "mobile" and the trajectory of technology and innovation: There are always things that pop up that we don't see. (So, as background, I am by training a hybrid health policy person and anthropologist.) We are constantly hit by things out of the blue that totally change the way we think about certain concepts, mobility or mobile devices are both good examples. In order to have an eye on where things might go and in order to have some ability to anticipate or analyze the unexpected, resisting a precise definition for mHealth, in my mind, is a good thing.

Also, a lot of folks just want to talk about the mobile phone [as being mHealth.] As you know there are a lot of things we can connect to mobile phones. Most of my work is in developing markets -- in fact, I just joined the executive team of the mHealth Alliance -- and in that context we see people have mHealth interventions who don't even own mobile phones. They use a memory stick, laptop and cloud computing when they get in-range of the Internet... A very narrow definition can blind us. In global health you can feel the impact of a lot of linear thinkers and it can be a constraint on innovation. I like to avoid that. Sometimes people need a precise definition to do their market research study -- I understand. I think there are costs involved in putting too great a limitation on it, though. As a result creative responses to certain problem sets might get overlooked or not even thought about.

You also mentioned a lack of Spanish speaking mobile health applications for the US market. I've seen the Pew data and given the Latino community's sometimes greater uptake of mobile devices, that fact that there is a lack of Spanish speaking applications struck me as important. Hadn't heard that before. Is there a specific need and lack of supply for Spanish speaking apps?

The example I use in the report -- and as a disclaimer I am on the board of this group because I believe in the cause -- but the Open Hands Foundation from TuDiabetes, is an online forum for the Latino community. In this community you have a very high disease burden especially in second generation Latinos where a combination of lifestyle and diet change has led to the incidence of diabetes going up. If you look at the Indian population in India a confluence of genetics and lifestyle has created a diabetic epidemic there. So, it's not only Spanish that's important but other languages as well. As we build services for non-English speaking communities though we may also need to consider other things: trackers, incentives, utilization of the healthcare system. Different cohorts of folks have different patterns. We shouldn't think about this as a need for strict one-to-one translation. There are other things we need to do on top of that to improve health outcomes using the mobiles in different linguistic populations.

Every time I talk about mHealth to the public health community in the US, they all say that the community doesn't use these things. 'You are just a white guy from Silicon Valley!' There is a complete denial about how mobile computing changes the demographics over who is doing what. The poverty here is also sometimes a poverty of imagination within the public health community for not looking at the demographic data and making assumptions about who these folks are that aren't necessarily true. This makes the discussion intellectually sloppy at times. I'm so happy that folks at Pew and company are so focused on getting the numbers on this because that can change the perception that low income or non-English speaking folks aren't using technology. When in fact, in many cases they are the lead users of technologies and we could learn a lot from them.

Where are the gaps in the discussion of mobile health? What's not being talk about that should be?

There are two things. For the global setting, there are no evaluations [of mHealth programs] being done. Funders aren't funding evaluations but they say: 'We need an evaluation to fund it more!' They want to get the numbers behind it. There is a market failure there. At the mHealth Alliance we launched a new hub site, called HealthUnbound and one piece of that is an evaluation commons. We also have to understand how things work as we scale them up. We can get a lot more in understanding how things scale. We could learn a lot more about how to scale mHealth.

The other thing that needs more discussion is business models. A lot of people are thinking about their company's business model for mHealth, but this is not a situation where one company can do it on their own in isolation. To me, the way forward is to follow Clayton Christensen's idea of a network facilitation model. We need an ecosystem. We need a more collaborative business model for this emerging field. That will get things to scale and make mHealth more sustainable. I like that idea of collaborative business models. Look at the way Amazon and eBay started out originally. Their success was partially because of Commerce.net launching an ecosystem. We need cooperation not just competition. Payers aren't going to be the main player initially. They will sit on the fence for a long while. Can we get employers, retailers and a whole ecosystem to use mobile as a platform? This is what we are leaning towards for maternal health in the developing world. mHealth needs a cooperative ecosystem.

For more from Ranck, read more about the report over at GigaOM Pro

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