Life is in constant change, and health is not the exception.

Nowadays, when we refer to public health we still think of hospitals, health centres, major awareness campaigns, etc. But this way of understanding the functioning and the actions of the public health corresponds to a reality that has changed. In the past, the preeminence of infectious diseases, limited access to information, non-personalized technology, etc., required the construction of major hospitals where people living in a wide geographical domain may attend, the achievement of major awareness campaigns through mass media, etc.

However, the current situation is different and it is necessary for public health to adequate to these changes. These days, the change that has been produced in the life style, the extended life expectancy, the advance of medicine in the prevention and cure of infectious diseases, etc, has led to that 63% of the deaths are from chronic non-communicable diseases diseases (WHO), and it is estimated that by 2030, these causes of deaths will amount to 75%. All these, plus the development of personalized technology and the advent of the knowledge era, are enough reasons to rethink the whole health system.

This impels us to rethink a way to face this new context. The chronic non-communicable diseases require a completely different treatment than the infectious diseases. Contrary to the infectious diseases we were accustom to and that required specialized and well equipped hospitals,with patients that needed hospitalization and medical assistance, etc, we see, at present, an increase of chronic diseases that will increase even more in the future. As its name clearly indicates, chronic diseases are those that will last a lifetime; this is why the patient needs the monitoring of the disease instead of hospitalizations and extremely costly and complex equipments that require the professional’s assistance. Today, the principal causes of death are cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes, all of them requiring continuous monitoring of patients. These days, to control the evolution of their disease, patients must go to the health centre and consult with a medical professional. All these circumstances not only can be prevented, but also must be prevented. It makes no sense that a diseased person has to go to a hospital, loss his/her time and money and also the doctor’s time, generating an expense to the State, when instead the patient can make that medical checkup at home.

Then, why keep insisting on the old system of health. We are dealing with the advance of chronic diseases that require two actions: prevention and monitoring.Prevention may be no massive and personalized, as we are accustomed to, identifying the groups at risk and targeting the information in a personalized way, using tools 2.0 and communication technologies. As regards monitoring, it must also be personalized, granting the access to the equipments necessary to measure the progress of the disease, the knowledge of how to use those equipments, and analyzing its results and granting the platform that would enable distance consultations with the physicians.
Let us think of the principal cause of death which is cardiovascular diseases: how much time does the patient loss by going to the hospital to check, for example, his/her blood pressure, blood cholesterol levels, etc? This is, again, time and money that the State also losses, when instead the patient could check on his/her own, without leaving home. If the diseased person can measure his/her blood pressure, blood cholesterol levels, pulsation, etc, at home, how much money and time do the State and the patient save? If, instead of expending large sums of money building hospitals, the money saved is destined to equip diseased persons with the necessary and personalized equipments and to instruct them to use those equipments, there will be not only a better allocation of resources but also a better quality of life for all of us. Not only does the chronic diseased person attending to a hospital losses time, but also all the other people waiting for medical attention and the personnel of the hospital loss time too.
Si el enfermo puede medir él mismo, en su casa su presión arterial, su colesterol en sangre, sus pulsaciones, etc. ¿Cuánto dinero y tiempo se ahorra?, ¿Cuánto dinero se ahorra el Estado? Si en vez de gastar altas sumas de dinero construyendo hospitales, se destina ese dinero a equipar de aparatología personalizada a los enfermos y de capacitarlos para su uso, no sólo hace una mejor asignación de recursos sino que también mejora la calidad de vida de todos. Cuando un enfermo crónico debe asistir a un hospital, no solo el pierde tiempo sino que también lo pierden todos los que necesitan atenderse en el hospital y también los que trabajan en el mismo. This does not mean that we should stop investing in hospitals, but the new context should be taken into account and we should adapt to it.