health

Set It and Forget It: How Default Settings Rule the World

Curated on July 27, 2016October 10, 2018 by Stefaan Verhulst

Lena Groeger at ProPublica: “We’ve seen how design can keep us away from harm and save our lives. But there is a more subtle way that design influences our daily decisions and behavior – whether we know it or not. It’s not sexy or trendy or flashy in any way. I’m talking about defaults.

Defaults are the settings that come out of the box, the selections you make on your computer by hitting enter, the assumptions that people make unless you object, the options easily available to you because you haven’t changed them.

They might not seem like much, but defaults (and their designers) hold immense power – they make decisions for us that we’re not even aware of making. Consider the fact that most people never change the factory settings on their computer, the default ringtone on their phones, or the default temperature in their fridge. Someone, somewhere, decided what those defaults should be – and it probably wasn’t you.

Another example: In the U.S. when you register for your driver’s license, you’re asked whether or not you’d like to be an organ donor. We operate on an opt-in basis: that is, the default is that you are not an organ donor. If you want to donate your organs, you need to actively check a box on the DMV questionnaire. Only about 40 percent of the population is signed up to be an organ donor.

In other countries such as Spain, Portugal and Austria, the default is that you’re an organ donor unless you explicitly choose not to be. And in many of those countries over 99 percent of the population is registered. A recent study found that countries with opt-out or “presumed consent” policies don’t just have more people who sign up to be donors, they also have consistently higher numbers of transplants.

Of course, there are plenty of other factors that influence the success of organ donation systems, but the opt-in versus opt-out choice seems to have a real effect on our collective behavior. An effect that could potentially make the difference between someone getting a life-saving transplant or not.

Behavioral economist Richard Thaler and legal scholar Cass Sunstein pretty much wrote the book on the implications of defaults on human behavior. Nudge: Improving Decisions About Health, Wealth, and Happiness is full of ways in which default options can steer human choices, even if we have no idea it’s happening. Besides organ donation, the list of potential “nudges” include everything from changing the order of menu itemsto encourage people to pick certain dishes to changing the default temperature of office thermostats to save on energy.

But my favorite has to do with getting kids to eat their vegetables.

What if I told you there was one simple change you could make in a school cafeteria to get children to eat more salad? It doesn’t cost anything, force anyone to eat anything they don’t want, and it takes only a few minutes to fix. And it happened in real life: a middle school in New York moved their salad bar away from its default location against a walland put it smack in the middle of the room (and prominently in front of the two cash registers, as seen in the diagram below). Salad sales more than tripled….(More)”

Big data for government good: using analytics for policymaking

Curated on July 26, 2016August 3, 2018 by Stefaan Verhulst

Kent Smetters in The Hill: ” Big Data and analytics are driving advancements that touch nearly every part of our lives. From improving disaster relief efforts following a storm, to enhancing patient response to specific medications to criminal justice reform and real-time traffic reporting, Big Data is saving lives, reducing costs and improving productivity across the private and the public sector.Yet when our elected officials draft policy they lack access to advanced data and analytics that would help them understand the economic implications of proposed legislation. Instead of using Big Data to inform and shape vital policy questions, Members of Congress typically don’t receive a detailed analysis of a bill until after it has been written, and after they have sought support for it. That’s when a policy typically undergoes a detailed budgetary analysis. And even then, these assessments often ignore the broader impact on jobs and the economy.

Yet when our elected officials draft policy they lack access to advanced data and analytics that would help them understand the economic implications of proposed legislation. Instead of using Big Data to inform and shape vital policy questions, Members of Congress typically don’t receive a detailed analysis of a bill until after it has been written, and after they have sought support for it. That’s when a policy typically undergoes a detailed budgetary analysis. And even then, these assessments often ignore the broader impact on jobs and the economy.

We must do better. Just as modern marketing firms use deep analytical tools to make smart business decisions, policymakers in Washington should similarly have access to modern tools for analyzing important policy questions.
Will Social Security be solvent for our grandchildren? How will changes to immigration policy influence the number of jobs and the GDP? How will tax reform impact the budget, economic growth and the income distribution? What is the impact of new investments in health care, education and roads? These are big questions that must be answered with reliable data and analysis while legislation is being written, not afterwards. The absence leaves us with ideology-driven partisanship.

Simply put, Washington needs better tools to evaluate these complex factors. Imagine the productive conversations we could have if we applied the kinds of tools that are commonplace in the business world to help Washington make more informed choices.

For example, with the help of a nonpartisan budget model from the Wharton School of the University of Pennsylvania, policymakers and the public can uncover some valuable—and even surprising—information about our choices surrounding Social Security, immigration and other issues.

By analyzing more than 4,000 different Social Security policy options, for example, the model projects that the Social Security Trust Fund will be depleted three years earlier than the Social Security Administration’s projections, barring any changes in current law. The tool’s projected shortfalls are larger than the SSA’s, in fact—because it takes into account how changes over time will affect the outcome. We also learn that many standard policy options fail to significantly move the Trust Fund exhaustion date, as these policies phase in too slowly or are too small. Securing Social Security, we now know, requires a range of policy combinations and potentially larger changes than we may have been considering.

Immigration policy, too, is an area where we could all benefit from greater understanding. The political left argues that legalizing undocumented workers will have a positive impact on jobs and the economy. The political right argues for just the opposite—deportation of undocumented workers—for many of the same reasons. But, it turns out, the numbers don’t offer much support to either side.

On one hand, legalization actually slightly reduces the number of jobs. The reason is simple: legal immigrants have better access to school and college, and they can spend more time looking for the best job match. However, because legal immigrants can gain more skills, the actual impact on GDP from legalization alone is basically a wash.

The other option being discussed, deportation, also reduces jobs, in this case because the number of native-born workers can’t rise enough to absorb the job losses caused by deportation. GDP also declines. Calculations based on 125 different immigration policy combinations show that increasing the total amount of legal immigrants—especially those with higher skills—is the most effective policy for increasing employment rates and GDP….(More)”

How Snapchat Is Recruiting Bone Marrow Donors

Curated on July 25, 2016October 23, 2018 by Stefaan Verhulst

PSFK: “Every ten minutes, blood cancer takes a life away. One of the ways to treat this disease is through stem cell transplants that create healthy blood cells. Since 70% of patients who need a transplant cannot find a match in their family, they need to turn to outside donors. In an effort to increase the number of bone marrow donors in the registry, Be The Match turned to Snapchat to find male donors from the ages of 18 to 24.

The aim of the campaign “Be the Guy” is to release short videos on Snapchat of regular guys acting silly. This emphasizes the idea that literally anyone can save a life, no matter who—or how quirky—you are. With a swipe up, any Snapchat user will be directed to a form that makes it easy to sign up to be a donor. To complete the registration, all it takes is to receive a kit in the mail and mail back a swap from your cheek….(More)”

Against Elections The Case for Democracy

Curated on July 23, 2016August 3, 2018 by Stefaan Verhulst

Book by David Van Reybrouck: “Democracy is in bad health. Against Elections offers a new diagnosis – and an ancient remedy. Fear-mongering populists, distrust in the establishment, personality contests instead of reasoned debate: these are the results of the latest elections.

In fact, as this ingenious book shows, the original purpose of elections was to exclude the people from power by appointing an elite to govern over them.

Yet for most of its 3000-year history, democracy did not involve elections at all: members of the public were appointed to positions in government through a combination of volunteering and lottery.

Based on studies and trials from around the globe, this hugely influential manifesto presents the practical case for a true democracy – one that actually works.

Urgent, heretical and completely convincing, Against Elections leaves only one question to be answered: what are we waiting for?…(More)”

Fine-grained dengue forecasting using telephone triage services

Curated on July 21, 2016August 3, 2018 by Stefaan Verhulst

Nabeel Abdur Rehman et al at Science Advances: “Thousands of lives are lost every year in developing countries for failing to detect epidemics early because of the lack of real-time disease surveillance data. We present results from a large-scale deployment of a telephone triage service as a basis for dengue forecasting in Pakistan. Our system uses statistical analysis of dengue-related phone calls to accurately forecast suspected dengue cases 2 to 3 weeks ahead of time at a subcity level (correlation of up to 0.93). Our system has been operational at scale in Pakistan for the past 3 years and has received more than 300,000 phone calls. The predictions from our system are widely disseminated to public health officials and form a critical part of active government strategies for dengue containment. Our work is the first to demonstrate, with significant empirical evidence, that an accurate, location-specific disease forecasting system can be built using analysis of call volume data from a public health hotline….(More)”

Use of big data risks making some people uninsurable

Curated on July 21, 2016August 3, 2018 by Stefaan Verhulst

Oliver Ralph at the Financial Times: “More sophisticated use of data could create an “underclass” of people who cannot afford insurance. According to a new report from the Chartered Institute of Insurance, consumers could miss out on some types of cover altogether if insurers deem them too risky.

Big data are one of the insurance industry’s great hopes for the future. Established insurers and a host of start-ups are investing millions in new systems to better understand the information they hold about customers, and to collect more data. They hope that by better analysing the risks that each policyholder faces, they can not only price their products more accurately but also advise customers on how to avoid problems.

However, the CII paper warns that using data in this way threatens the concept of pooling risk on which the industry was founded.

“Data is a double-edged sword,” said David Thomson, director of policy and public affairs at the CII. “The insurance sector needs to be careful about moving away from pooled risk into individual pricing. They need to think about the broader public interest.”

The report says that the concept of pooling risk “underpins the effectiveness of insurance cover”.

It adds: “Some people may be identified as such high risk to insurers that they are priced out of insurance altogether. Big data could, in effect, create groups of ‘uninsurable’ people. While in some cases this may be to do with modifiable behaviour, like driving style, it could easily be due to factors that people can’t control, such as where they live, age, genetic conditions or health problems.”

The issue of genetic data is a particularly contentious one.

In theory, genetic data could be useful to insurers when deciding how to price life or health insurance. Because of the ethical questions this poses, an agreement signed in 2000 between the government and the Association of British Insurers stops the industry from using predictive genetic test results. The agreement runs until 2019, although a review is due this year.

“You could price people out of the market for health products. There’s a danger insurers will not offer health cover to some people. The government would intervene if people are doing social sorting,” said Mr Thomson.

Better use of data in other areas has already forced the government to act. Improved mapping and data analysis have allowed insurers to more accurately assess which homes and businesses run a high risk of flooding. Many people complained that the resulting prices made cover unaffordable for people living in areas at risk….(More)”.

Is internet freedom a tool for democracy or authoritarianism?

Curated on July 20, 2016May 29, 2019 by Stefaan Verhulst

Elizabeth Stoycheff and Erik C. Nisbet in the Conversation: “The irony of internet freedom was on full display shortly after midnight July 16 in Turkey when President Erdogan used FaceTime and independent TV news to call for public resistance against the military coup that aimed to depose him.

In response, thousands of citizens took to the streets and aided the government in beating back the coup. The military plotters had taken over state TV. In this digital age they apparently didn’t realize television was no longer sufficient to ensure control over the message.

This story may appear like a triumphant example of the internet promoting democracy over authoritarianism.

Not so fast….This duality of the internet, as a tool to promote democracy or authoritarianism, or simultaneously both, is a complex puzzle.

The U.S. has made increasing internet access around the world a foreign policy priority. This policy was supported by both Secretaries of State John Kerry and Hillary Clinton.

The U.S. State Department has allocated tens of millions of dollars to promote internet freedom, primarily in the area of censorship circumvention. And just this month, the United Nations Human Rights Council passed a resolution declaring internet freedom a fundamental human right. The resolution condemns internet shutdowns by national governments, an act that has become increasingly common in variety of countries across the globe, including Turkey, Brazil, India and Uganda.

On the surface, this policy makes sense. The internet is an intuitive boon for democracy. It provides citizens around the world with greater freedom of expression, opportunities for civil society, education and political participation. And previous research, including our own, has been optimistic about the internet’s democratic potential.

However, this optimism is based on the assumption that citizens who gain internet access use it to expose themselves to new information, engage in political discussions, join social media groups that advocate for worthy causes and read news stories that change their outlook on the world.

And some do.

But others watch Netflix. They use the internet to post selfies to an intimate group of friends. They gain access to an infinite stream of music, movies and television shows. They spend hours playing video games.

However, our recent research shows that tuning out from politics and immersing oneself in online spectacle has political consequences for the health of democracy….Political use of the internet ranks very low globally, compared to other uses. Research has found that just 9 percent of internet users posted links to political news and only 10 percent posted their own thoughts about political or social issues. In contrast, almost three-quarters (72 percent) say they post about movies and music, and over half (54 percent) also say they post about sports online.

This inspired our study, which sought to show how the internet does not necessarily serve as democracy’s magical solution. Instead, its democratic potential is highly dependent on how citizens choose to use it….

Ensuring citizens have access to the internet is not sufficient to ensure democracy and human rights. In fact, internet access may negatively impact democracy if exploited for authoritarian gain.

The U.S. government, NGOs and other democracy advocates have invested a great deal of time and resources toward promoting internet access, fighting overt online censorship and creating circumvention technologies. Yet their success, at best, has been limited.

The reason is twofold. First, authoritarian governments have adapted their own strategies in response. Second, the “if we build it, they will come” philosophy underlying a great deal of internet freedom promotion doesn’t take into account basic human psychology in which entertainment choices are preferred over news and attitudes toward the internet determine its use, not the technology itself.

Allies in the internet freedom fight should realize that the locus of the fight has shifted. Greater efforts must be put toward tearing down “psychological firewalls,” building demand for internet freedom and influencing citizens to employ the internet’s democratic potential.

Doing so ensures that the democratic online toolkit is a match for the authoritarian one….(More)”

Big health data: the need to earn public trust

Curated on July 19, 2016August 3, 2018 by Stefaan Verhulst

Tjeerd-Pieter van Staa et al in the BMJ: “Better use of large scale health data has the potential to benefit patient care, public health, and research. The handling of such data, however, raises concerns about patient privacy, even when the risks of disclosure are extremely small.

The problems are illustrated by recent English initiatives trying to aggregate and improve the accessibility of routinely collected healthcare and related records, sometimes loosely referred to as “big data.” One such initiative, care.data, was set to link and provide access to health and social care information from different settings, including primary care, to facilitate the planning and provision of healthcare and to advance health science.1 Data were to be extracted from all primary care practices in England. A related initiative, the Clinical Practice Research Datalink (CPRD), evolved from the General Practice Research Database (GPRD). CPRD was intended to build on GPRD by linking patients’ primary care records to hospital data, around 50 disease registries and clinical audits, genetic information from UK Biobank, and even the loyalty cards of a large supermarket chain, creating an integrated data repository and linked services for all of England that could be sold to universities, drug companies, and non-healthcare industries. Care.data has now been abandoned and CPRD has stalled. The flawed implementation of care.data plus earlier examples of data mismanagement have made privacy issues a mainstream public concern. We look at what went wrong and how future initiatives might gain public support….(More)”

The big health data sale

Curated on July 15, 2016August 15, 2018 by Stefaan Verhulst

Philip Hunter at the EMBO Journal: “Personal health and medical data are a valuable commodity for a number of sectors from public health agencies to academic researchers to pharmaceutical companies. Moreover, “big data” companies are increasingly interested in tapping into this resource. One such firm is Google, whose subsidiary Deep Mind was granted access to medical records on 1.6 million patients who had been treated at some time by three major hospitals in London, UK, in order to develop a diagnostic app. The public discussion it raised was just another sign of the long‐going tensions between drug companies, privacy advocates, regulators, legislators, insurers and patients about privacy, consent, rights of access and ownership of medical data that is generated in pharmacies, hospitals and doctors’ surgeries. In addition, the rapid growth of eHealth will add a boon of even more health data from mobile phones, portable diagnostic devices and other sources.

These developments are driving efforts to create a legal framework for protecting confidentiality, controlling communication and governing access rights to data. Existing data protection and human rights laws are being modified to account for personal medical and health data in parallel to the campaign for greater transparency and access to clinical trial data. Healthcare agencies in particular will have to revise their procedures for handling medical or research data that is associated with patients.

Google’s foray into medical data demonstrates the key role of health agencies, in this case the Royal Free NHS Trust, which operates the three London hospitals that granted Deep Mind access to patient data. Royal Free approached Deep Mind with a request to develop an app for detecting acute kidney injury, which, according to the Trust, affects more than one in six inpatients….(More)”