Now Go Build with Werner Vogels – S1E6 Rio de Janeiro | Amazon Web Services

Summary

In 'Now Go Build', Werner Vogels explores Brazil's healthcare challenges, where half the population is medically homeless. He meets Marcelo Gomes, who uses modeling to predict disease spread, and Onicio Neto, who leverages crowdsourced data for early disease detection. Dr. Consulta's Thomaz Srougi discusses their tech-driven approach to affordable, preventative healthcare. The episode highlights how technology and data are revolutionizing healthcare, making it more accessible and proactive for millions.

Takeaways

• 🌏 The world is experiencing rapid changes, and technology is playing a crucial role in shaping our future, especially in healthcare.
• 🏥 Half of the world's population lacks access to basic healthcare services, and even where healthcare is available, it doesn't necessarily equate to better health outcomes.
• 🇧🇷 Brazil's government provides free public healthcare, but due to poverty and inefficiencies, the system struggles to meet the demand, leaving 150 million citizens without access to healthcare professionals.
• 🏞 Rio de Janeiro, with its diverse income levels and complex geography, is a microcosm of the broader challenges Brazil faces in public health.
• 🔬 Marcelo Gomes, a public health researcher, uses modeling to track epidemics globally, emphasizing the importance of technology in identifying outbreaks and estimating current situations.
• 📊 'Nowcasting' is a technique used to estimate the current state of an epidemic based on incomplete data, which can significantly improve with platforms for self-reporting and social media information.
• 📲 Epitrack, a digital disease detection platform, uses crowdsourcing to collect real-time symptom data, helping to identify potential outbreaks and inform public health interventions.
• 📈 Dr. Consulta is a network of clinics that uses technology to provide affordable and efficient healthcare to low-income families, moving from a reactive to a proactive healthcare model.
• 💰 Dr. Consulta's model is designed to be cost-effective, with prices significantly lower than traditional healthcare, and emphasizes transparency to empower patients with informed decisions.
• 📈 The use of data in healthcare is pivotal for predicting future health risks and shifting from a reactive to a preventative model, which can lead to better health outcomes and cost savings.
• 🌐 The script highlights the broader challenges in global health, including infectious diseases, noncommunicable diseases, environmental factors, and mental health, and the potential for technology to address these issues.

Q & A

What is the main theme of the video?

The video focuses on how technology and innovative approaches are being used to tackle healthcare challenges in Brazil.

Who is Werner Vogels and what role does he play in the video?

Werner Vogels is the host of the video series 'Now Go Build,' where he travels the globe to talk to start-up founders using technologies to make the world more interesting, accessible, and livable.

What is the current state of healthcare in Brazil as described in the video?

Brazil's government offers free public healthcare, but pervasive poverty and bureaucratic inefficiencies mean that the healthcare system cannot keep up with demand. Out of 200 million citizens, 150 million are considered medically homeless, lacking access to healthcare professionals.

Who is Marcelo Gomes and what does he do?

Marcelo Gomes is a public health researcher with Fiocruz, part of Brazil's Ministry of Health. He works on modeling epidemic spreading, primarily focusing on influenza, Dengue, and Zika.

What is 'Nowcasting' and how is it used in public health?

'Nowcasting' is a technique used to estimate the current situation based on incomplete information. It helps in determining if small fluctuations in case numbers signify an outbreak.

Who is Onicio Neto and what is Epitrack?

Onicio Neto is a social entrepreneur and biomedical scientist with a doctorate in public health. Epitrack is his organization that focuses on digital disease detection through crowdsourcing health data.

How does Epitrack collect health data?

Epitrack deploys mobile apps where people can self-report symptoms. This data is collected in real time to detect potential outbreaks and provide information to decision-makers.

What is dr.consulta and what are its goals?

dr.consulta is a network of clinics in Brazil that aims to provide affordable healthcare. It uses technology to drive down costs and offer preventative care, especially to low-income families.

How does dr.consulta use technology to improve healthcare delivery?

dr.consulta uses technology for efficiency, such as booking appointments through an app, storing medical history digitally, and predicting future health issues to provide proactive care.

What are some of the global health challenges mentioned by Onicio Neto?

The four big global health challenges mentioned are infectious diseases, noncommunicable diseases, environmental changes, and mental health issues.

What impact has Epitrack had on public health?

Epitrack has had a significant impact by allowing faster detection of potential epidemics, which helps in making timely interventions and preventing widespread outbreaks.

How does dr.consulta ensure transparency in healthcare costs?

dr.consulta practices price transparency by allowing patients to see the costs of services ahead of time, helping them make better-informed decisions.

What does Marcelo Gomes mention about the Zika outbreak during the Olympic Games?

Marcelo Gomes explains that despite fears of a pandemic during the Olympic Games, the Zika virus did not spread significantly due to seasonal factors affecting the mosquito population.

How does dr.consulta's approach to healthcare differ from traditional models?

dr.consulta focuses on a proactive, preventative care model rather than a reactive one. They use data to predict and prevent health issues, aiming to keep people away from hospitals.

What are the benefits of the patient-centric model mentioned in the video?

The patient-centric model focuses on long-term health and well-being, prioritizing patients' needs over short-term profits, leading to improved quality of life for millions.

Outlines

00:00

🌏 Global Health Innovations

In this segment, Werner Vogels embarks on a journey to explore how technology is revolutionizing healthcare across the globe. The focus is on Brazil, where half the population lacks access to basic healthcare services due to poverty and inefficient government systems. The country's challenges are highlighted by Marcelo Gomes, a public health researcher, who discusses the importance of technology in disease modeling and outbreak prediction. The concept of 'Nowcasting' is introduced as a method to estimate current disease prevalence using incomplete data, which can significantly improve the response to potential epidemics.

05:02

📲 Crowdsourcing Public Health Data

This paragraph delves into the innovative work of Onicio Leal Neto, a biomedical scientist and social entrepreneur, who has developed Epitrack—a platform for digital disease detection. Epitrack utilizes crowdsourcing through mobile apps where individuals can self-report symptoms, providing real-time data that can indicate the start of an outbreak. The data is used to inform decision-makers and enable timely interventions. The approach is efficient, focusing on a syndromic method that combines symptoms to predict disease risks, and it emphasizes the importance of data collection regarding people, place, and time.

10:03

🏥 Rethinking Healthcare Access in Brazil

Thomaz Srougi, the founder of dr.consulta, shares his vision for a new model of healthcare in Brazil. With 150 million people considered medically homeless, Srougi's clinics aim to provide affordable, preventative healthcare to the masses. The clinics use technology to predict health issues and offer same-day appointments, drastically reducing waiting times compared to the public system. The focus is on efficiency, cost reduction, and price transparency, with the goal of creating a sustainable healthcare model that prioritizes long-term success and patient well-being.

15:05

🛡️ Addressing Global Health Challenges with Technology

The final paragraph discusses the broader implications of the technological advancements in healthcare. It touches on the global health challenges such as infectious diseases, noncommunicable diseases, environmental factors, and mental health. The speaker emphasizes the potential of crowdsourcing and machine learning to detect health threats before they become widespread issues. The segment concludes with a reflection on the importance of implementing patient-centric models for a sustainable and healthier future.

Keywords

💡Healthcare access

Healthcare access refers to the availability of medical services to individuals. In the video, it is highlighted that half the world lacks basic healthcare services, and even where it is available, it often does not lead to better health outcomes. For instance, in Brazil, 150 million citizens are deemed medically homeless, meaning they cannot access healthcare professionals.

💡Public healthcare

Public healthcare is a system in which the government provides medical services to its citizens. The video discusses Brazil's effort to offer free public healthcare, which faces challenges due to poverty and bureaucratic inefficiencies, resulting in an inability to meet the healthcare demands of its population.

💡Nowcasting

Nowcasting is a technique used to estimate the current situation based on incomplete information. Marcelo Gomes explains that this method is crucial for identifying whether small fluctuations in data indicate an outbreak, using platforms like self-reporting and social media to improve estimates significantly.

💡Crowdsourcing for health

Crowdsourcing for health involves collecting health-related data from a large number of people to detect disease trends. Onicio Neto describes how Epitrack uses mobile apps for digital disease detection, allowing individuals to self-report symptoms, which helps identify potential outbreaks and fill gaps in public health information systems.

💡Syndromic approach

A syndromic approach involves collecting data on a combination of symptoms rather than specific diagnoses. Onicio Neto mentions that Epitrack collects data on symptoms and demographics, using the combination of symptoms to generate disease risk assessments, making it an efficient way to monitor public health.

💡Preventative healthcare

Preventative healthcare focuses on preventing illnesses rather than treating them after they occur. Thomaz Srougi of dr.consulta emphasizes moving from a reactive system to a preventative one, using data to predict and mitigate future health risks, such as identifying and addressing potential diabetes in patients.

💡Medically homeless

Medically homeless refers to individuals who do not have access to healthcare services. The video highlights that 150 million people in Brazil are medically homeless, struggling to see doctors due to the inefficiencies in the public healthcare system, leading to a significant portion of the population being underserved.

💡Digital health data

Digital health data encompasses electronic records of patients' medical histories, treatments, and other health-related information. dr.consulta uses digital systems to store patient data, which helps reduce costs and improve efficiency by avoiding redundant tests and enabling proactive healthcare.

💡Epidemiology

Epidemiology is the study of how diseases spread and can be controlled. Marcelo Gomes and Onicio Neto both discuss using epidemiological methods and data, such as monitoring influenza and Dengue, to model and predict disease outbreaks and improve public health interventions.

💡Environmental health challenges

Environmental health challenges refer to health issues arising from environmental changes. The video mentions that climate change is causing new areas to become hospitable to mosquitoes, potentially leading to the spread of diseases like Dengue to new regions, illustrating the complex interplay between environment and health.

Highlights

The rapid change in our planet and civilizations is discussed by Werner Vogels, emphasizing the role of start-ups in shaping the future.

Half of the world's population lacks access to basic healthcare services, and even where healthcare is available, it doesn't guarantee better health.

In Brazil, despite free public healthcare, 150 million citizens are medically homeless due to poverty and bureaucratic inefficiencies.

Rio de Janeiro's challenges in public health, including varying income levels and complex infrastructure, mirror Brazil's national issues.

Marcelo Gomes from Fiocruz discusses his work on modeling epidemic spreading, primarily focusing on influenza, Dengue, and Zika.

Official notification cases are the primary data source for epidemic modeling, but there's a significant gap due to underreporting from private hospitals.

The importance of technology in public health is underscored, with 'Nowcasting' techniques used to estimate current disease situations from incomplete data.

Self-reporting platforms and social media can significantly enhance the ability to estimate disease prevalence in real-time.

Epitrack, founded by Onicio Leal Neto, utilizes crowdsourcing for health through mobile apps, allowing real-time symptom reporting and disease detection.

Epitrack's syndromic approach to data collection involves monitoring symptom combinations to identify potential disease risks efficiently.

The use of digital disease detection aids decision-makers with real-time epidemiological insights, facilitating timely interventions.

Thomaz Srougi of dr.consulta explains how technology is central to providing affordable and excellent healthcare at scale.

dr.consulta's model focuses on efficiency and technology to reduce healthcare costs, offering very low prices and price transparency.

The clinic network has 60 locations in Brazil, with a focus on providing access to low-income families through a preventative healthcare model.

dr.consulta's proactive approach to healthcare involves using data to predict and prevent future health issues for patients.

The potential ripple effect of a healthier Brazil on the quality of life for millions is highlighted, pointing towards a brighter future.

Epitrack's impact on faster disease detection is noted, with aspirations for real-time information to inform interventions.

Global health challenges, including infectious diseases, noncommunicable diseases, environmental factors, and mental health, are discussed as areas for technological intervention.

The transcript concludes with a reflection on the importance of implementing patient-centric models for long-term success in healthcare.

Transcripts

(pensive electronic music)

- [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".

(upbeat music)

(pensive guitar music)

- [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.

(mellow drum and bass music)

- [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.

(pensive electronic music)

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.

(violin music)

- 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.

(smooth electronic music)

- 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.

(pensive violin music)

- [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.

(gentle guitar music)

- [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.

(flute music)