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• It works! GeneEQUAL is improving health care for people with intellectual disability
  

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• аIJʹÙÍø medicine graduate awarded NSW Rhodes Scholarship

Neil Martin 00:00
Welcome to аIJʹÙÍø Engineering the Future podcast. Today we're discussing the importance of equitable healthcare and how we can make access to medical services and health professionals fairer for everyone over the next 30 years.

Lauren Kark 00:21
Equitable healthcare means people are flourishing. People are living their best lives, so they're active members of their community, they're going to school, getting an education, they're gainfully employed. And then we're also adding to the diversity, the rich tapestry of our society, which can only make us better if we can learn from one another and bring all that together.

Neil Martin 00:41
That's Associate Professor Lauren Kark, an assistive tech expert from аIJʹÙÍø. On Engineering the Future, we speak to academics and industry leaders who are embracing cutting-edge ideas and pushing the boundaries of what is truly possible. Join us as we discover how world-changing action starts with fearless thinking in engineering the future of equitable healthcare.
Hello and welcome to Engineering the Future of Equitable Health. My name is Neil Martin, and I'm a journalist and STEM communicator working in the Faculty of Engineering at аIJʹÙÍø.
Joining me today to discuss the importance of fair healthcare for all is аIJʹÙÍø Associate Professor Lauren Kark. Lauren is Deputy Head of School, academic in the School of Biomedical Engineering and champions experiential learning with societal impact. Since 2015 her students have repaired 2000 medical devices in rural hospitals across Cambodia, Nepal, Tonga and Uganda, and in 2019 she founded the Assistive Technology Hub at аIJʹÙÍø, where students co-create assistive devices for people with disabilities. Hello Lauren.

Lauren Kark 01:59
Hi Neil, lovely to be here.

Neil Martin 02:00
Also with us is Dr Kathryn Currow, a paediatric doctor, medical educator and leader with broad ranging Australian and international experience. Kathryn is dedicated to furthering improvements in the health and wellbeing of children and young people in Australia and globally, having worked as a GP for more than a decade and in paediatric emergency as a Senior Chief Medical Officer.
She was the Executive Principal and Adjunct Associate Professor of the Sydney Child Health Program for 20 years, and in 2019 founded Taking Paediatrics Abroad, where she is currently the Managing Director. Kathryn is recognised as a global Goodwill Ambassador, is an advisor to Stronger Brains, and is also Visiting Professor at the Mongolian National University of Medical Sciences. Welcome Kathryn.

Kathryn Currow 02:51
Hello, Neil. Lovely to be here. Thank you.

Neil Martin 02:55
So I want to jump straight into this and ask you both what is actually meant by equitable health care. I guess some people might hear that and think it's giving everybody exactly the same attention and treating everybody equally. But is that correct or not?

Kathryn Currow 03:12
I guess the definition I like is that health inequality is an uneven distribution of resources, whereas health inequity adds a layer of unfairness over that. So unavoidable inequalities, the differences can be the status or distribution of resources, and they can be reduced by the right mix of government policies. So they really impact particularly children, because they're so vulnerable. You might like to add to that, Lauren, you had a lovely definition.

Lauren Kark 03:43
When we think of equality, it's equal access. And so if we want to put this into an engineering framework, if we think of equality as the input, whereas hopefully equity is the output. So when we do the same thing to a whole group of people, we're not going to have the same output, but what we would like is instead to have the same output. We want everyone to be able to live the best and healthiest lives that they can. And that means that perhaps we don't have the same inputs, but our goals are certainly the same outputs.

Kathryn Currow 04:13
Beautifully said. And I think the thing is that children are particularly vulnerable, so they need a disproportionate input to help them get the same output and have lives that flourish and enable them to fulfill their best potential.

Neil Martin 04:29
I think some people might be aware of a visual image of this where there's three children trying to watch a sports game, and they're standing on a box and there's a small child that can't see over the fence. We might be able to put that image in the show notes of this episode. But do you think that really does highlight the fact that the small child needs a different assistance, different help to be able to see the game.

Kathryn Currow 04:53

Absolutely and it's just like a child with significant disadvantage. Be it a mother with mental health problems or appalling life circumstances, or a parent whose substance abused, needs additional help to even get them to a level playing field. And I like the word flourish. We want to see them flourish and have a life that's productive and helpful. And that's in everyone's interest in society - it costs us all less if we have those outcomes, really, absolutely.

Lauren Kark 05:25
So coming back to that image, I suppose if we give everyone the same box, which is equal access, we're not going to have the same outcome. Not everyone's going to be able to see that game. But then you think about it, and it's multi-dimensional, right? So maybe the middle person can now see but the middle person has a visual impairment and requires glasses. And so we've got this multi-dimensional play of access, not only in the health space and the technology space, as Kathryn mentioned in the introduction, there are so many factors that go into creating an environment where people can flourish and live their best lives.

Kathryn Currow 05:58
And if we think about the UN rights of the child, it's for the child to have access to the best possible, attainable standard of healthcare. That's what we're really talking about.

Neil Martin 06:08
And I think in that image, there's a number of panels, and the final panel, I think, is labelled justice, and that's removing the fence completely. Yeah. Is that the ultimate aim? Do you think that kind of justice so that the barrier isn't there in the first place?

Lauren Kark 06:22
Yeah, absolutely. I think if we think about it as an output, the output is flourishing. And if we can remove the barriers to do that, who's going to complain about that?

Kathryn Currow 06:32
It's a wonderful ideal, maybe very hard to attain, but it's a really wonderful ideal. It’d be good not to need to have these conversations?

Neil Martin 06:41
Yeah, exactly. And this might sound like an obvious question, but I'll ask it anyway. But why do you think equitable healthcare is important for society?

Lauren Kark 06:50
So I can speak. My area is in Disability and Assistive Technology, and equitable healthcare means people are flourishing. People are living their best lives, so they're active members of their community. They're going to school, getting an education, for example, perhaps they're participating in communities through paid work. They're employed, they're gainfully employed, and then we're also adding to the diversity, the rich tapestry of our society, which can only make us better if we can learn from one another and bring all that together. I think that there's big power in those opportunities.

Kathryn Currow 07:22
I love the idea, building on that, that these people grow up to become adults that then help other children with similar circumstances to develop their best life. So it's a cumulative positive for society as that develops.

Lauren Kark 07:38
Constant investment.

Kathryn Currow 07:39
Yeah.

Neil Martin 07:40
And when we talk about, let's say, the unfairness that currently exists in healthcare, can you give me kind of some of the key groups? I know Kathryn, you obviously concentrate on children and young people being disadvantaged but what other groups do you think are there that are struggling or not having this fair access to healthcare?

Lauren Kark 08:04
I think there are different examples throughout the globe at the moment. I mean, within Australia, even we've got a disparity between our regional and metropolitan, between our Indigenous and non-Indigenous. Globally, we've got countries that are war affected. So those are, I guess, some examples. And then within, I suppose, we talk about pathologies. There's groups like disability, like mental health, and there's many, many other examples that we can think of.

Kathryn Currow 08:30
I absolutely agree. I think of Australian Aboriginal children particularly, I think of refugees here. There's many, many issues in refugee health, of enormous disadvantage, and if we can make a little bit of difference to that person, then it's kind of like they blossom, and they contribute so much to society. The return on investment is huge. I like the Mongolian people, they say investing in children is an investment in the future wealth of our country. It's a lovely way of looking at it.

Neil Martin 08:58
And do you think people might not fully recognise that, as well as the kind of global issue. I think people will understand that, like you said, people in war-torn countries or developing nations maybe don't have that level of access to healthcare. They kind of understand that, but maybe they don't realise those problems are happening on their own doorstep as well.

Kathryn Currow 09:21
So I guess one of the issues is that we're working with colleagues at an Aboriginal Medical Service in New South Wales. There's a 12-month wait for children to get to see a paediatrician. They've got to travel hours. That means they've got to have transport. If they've got no transport, then it's really, really difficult for those children to get access to the care they need.

Neil Martin 09:44
I read a stat the other day that said that the incidence of diabetes is twice the level in Western Sydney as it is compared to the northern and the eastern suburbs. So even in a really rich area like the Sydney city, you have these inequalities and unfairness due to geography or socio-economic issues.

Lauren Kark 10:08
Absolutely, the postcode lottery of life, right, which we wish didn’t exist.

Neil Martin 10:14
Kathryn, your specialty's with children. I believe 5 million children die per year globally of issues that are probably preventable. How big a problem is that? And how would you like to see it addressed, I guess?

Kathryn Currow 10:27
It's a massive problem, and they're the ones we have recorded. So the data in is likely to be far higher than that, and we say that they die from mostly preventable or treatable conditions. So if those children were living in Australia, we would be shocked and horrified, and there'd be news all over the place about the inadequacies of our healthcare systems. And I have to think, what if it’s your child or my child in those circumstances? That’s a very confronting thing, and then we don’t ever measure the children who suffer and the children who are not able to flourish and achieve all they need to achieve in life, to become citizens that improve the world. I mean, that’s the tragedy to me.

Neil Martin 11:16
So the data is predominantly just recording unfortunate infant mortality, yeah, and not things that are preventing other things. What kind of things would they be? Do you think that should be recorded or noted and then hopefully dealt with?

Kathryn Currow 11:29
I think Lauren's example of war comes to mind. So children who have arms and legs missing, children who lose their parents, children who have other horrendous injuries, they haven’t died, but they’ve got lifelong, severe limitations on their abilities as a result of that. And the ones who lose parents. I mean, I worked in Cambodia in 1980 and we had a village that had no children because they'd all died of starvation. And then there was a baby boom, and orphans brought in. And you know, you see those children and what their lives hold for them. It’s really difficult.

Neil Martin 12:04
And do you see the same thing in Australia, Lauren, with the work that you do at аIJʹÙÍø and the research that you’re doing, do you have that kind of data input issue?

Lauren Kark 12:14
I think in Australia, we do record data very, very well. So we do have access, obviously, to mortality and morbidity and affected lives. Where perhaps we could do better is measuring things that go beyond the medical. So, you know, are they healthy? Yes or no. But health is, again, multi-dimensional. It’s not just are they physically well or mentally well. Lots goes into that, not just their health status. So, participation in sport, participation in work, friendship, those sorts of things. I think we can possibly do better in our data collection, but Australia does data collection very, very well.

Neil Martin 12:50
And your work with the Assistive Tech Hub at аIJʹÙÍø, I guess I think you're having these conversations with people who have those limitations, is that where you're getting most of your information from to find out what they actually need?

Lauren Kark 13:05
So just a little introduction to the Assistive Technology Hub. We match our students with people with disability to co-create technology that enables participation, and that could be participation in all sorts of life events. So we’ve had projects where we’ve worked on modifying workshops so people can use a drill press independently, modifying rowing oars so people can row, creating a custom musical instrument so someone can perform. In that particular case, he was a concert violinist before his accident and couldn’t return. So, none of these are medical requirements, but if we’re talking about flourishing, he performed for the first time after six years. And I don’t think there was a dry eye in the room. But again, that wasn’t a medical case—that was enabling flourishment in his life. And so with the Assistive Technology Hub, we're very end-user driven. So what do people want to do? And can technology be that bridge for not being able to do it to then being able to do it—not always, but sometimes.

Neil Martin 14:05
I guess these people are very grateful that you're listening to their problems and that you're trying to help them.

Lauren Kark 14:13
Kathryn's nodding emphatically. I think we're grateful to be able to learn, to be honest. I think it is very eye-opening, especially when our students get involved—that we're not always designing to the average, and we shouldn't be designing to the average or to the norm. We should be designing for everyone, inclusively. And so that is so powerful for our students to be able to learn while they're undergraduates. When they go into society, they're not creating—whether intentionally or unintentionally—systems or technology that is not available to some portion of society. So I think the gratitude lies with us, rather than the end users. But certainly, having access to such a service is pretty unusual, and so there is, I suppose, an element of thanks, but  I think our thanks goes to the people who engage with our students.
Kathryn Currow 15:00
I think that's very humble. I think that there's a lot of reciprocity.

Neil Martin 15:04
And you must see the same with your work, with Taking Paediatrics Abroad, Kathryn? Can you maybe give us some examples of the work that you do and the success stories that you've achieved with that project?

Kathryn Currow 15:18
Okay, so Taking Paediatrics Abroad is a charity that was developed in response to requests, a bit like Lauren saying, it's requests for help. People wanted Australian paediatric sub-specialist expertise. As you know, as in engineering, knowledge is expanding at an incredibly rapid rate, which means that as clinicians, we can't just focus in one area, but that area of focus becomes more and more refined to sub areas. And therefore our patients need us to talk to each other as clinicians so that they can get the best healthcare. If you're in a low resource country, you don't have access to the plethora of subspecialists we have here and we need in everyday practice. So TPA provides the connection between clinicians in low resource countries and paediatric subspecialists, be they doctors, nurses or allied health professionals here in Australia. We're not seeing patients in any of these consultations, we're working only with clinicians. The first week we did this, a baby's life was saved directly as a result of a meeting on Zoom with a specialist paediatric endocrinologist, and that little girl is now almost five. It created a foundation for colleagues to suddenly say: ‘Oh, this can be really helpful. Oh, we're empowered. We're blessed.’ But it also creates the capability for them to treat future children in appropriate ways and save lives into the future. What they didn't tell me till later was every child with this particular condition before this meeting had died. So this was quite transformative to their abilities.

Neil Martin 17:04
In terms of those other groups that we maybe spoke about—that postcode lottery, like you said, Lauren—even within Australia, do you know of any other projects that you've seen or heard about that are kind of doing well in terms of equitable healthcare and specific groups that are being assisted?

Kathryn Currow 17:25
I think there are many, many groups working in this space, and it's very hard to map them all, but there are very large organisations who are doing things at systems level, like UNICEF. There's many other groups involved in supplying medical equipment, in providing surgery for children. The list goes on and on and on, and our little charity is there to contribute where people need us, and it's very much demand driven. So we're there to respond to requests for support and help. We're there to address difficult problems and address the priorities in that country. We're very delighted to work with the School of Biomedical Engineering and to introduce Lauren and her team to our discussions around disabled children in low resource settings because the resources are so limited, and the appreciation for development of new technology that helps them has been extraordinary.

Neil Martin 18:24
You say that about resources—is this the big picture problem? Is this something that just needs more money and more resources? Would that actually solve it? Or—I see you're shaking your head a bit there.

Lauren Kark 18:37
Yeah, I'm shaking my head. I think, you know, money can do a lot, but money can only do a lot when it's doing the right things. And so I think there's more to the solution than throwing money. We've got plenty of examples where money has been thrown and it hasn't worked, or it's been so reliant on that money that when that money has been withdrawn, any initiatives or innovations have ultimately fallen down. So I think it's a feel-good factor to put money to it. But I think because the problems are so complicated, complex, multi-dimensional, ultimately what we'd like to see is—I think it's capacity building, it's knowledge sharing—and I think that's where sustainable change is going to happen, not just throwing money at a problem.

Kathryn Currow 19:17
I totally agree that throwing money, in fact, can be counterproductive, because the money gets siphoned off to other things, and there's big disbursement problems in some low resource countries—how do you spend? And if you don't spend, you have to give it back. So I think giving agency to people in-country, helping them to decide what they need and how to address their priorities and working alongside them with that. I love the example that somebody said to me is: we don't want to be walking out in front of people. We want to be walking with them and helping them in their steps each day and addressing the priorities that they see, because that's what's going to empower and—what’s important.

Neil Martin 20:00
Do you think there is a danger? Maybe this is a historic thing that’s happened where people try to address a problem in the way that they think it should be addressed, and they’re not getting input from the community, and maybe the problem comes back?

Kathryn Currow 20:17
So you’re talking about imposing solutions, as opposed to co-creating solutions, and I'm very into the model of co-creating solutions, because I've seen the impact they have. And in fact, our model of telehealth was co-created. You know, somebody in the Solomons going, it's easy, Prof Kathryn, all you do is set up a schedule and we'll present our cases. And you think it's perfect, because that way we're meeting your needs, we're addressing the priorities of your country, and you're the ones leading this, and you're the ones empowered as clinicians, and we're there to support that process.

Neil Martin 20:50
I think you used the word buy-in. People need to be engaged. They need to have agency of their own issues as well.

Kathryn Currow 20:56
Yeah, absolutely.

Lauren Kark 20:58
I think that's key to sustainability. I just wanted to pick up on a phrase that we've been using, and that was the low resource phrase, which at the moment is sort of seeing, I suppose, an evolution, because there's plenty of countries that are low resource, according to our definition, that have plenty of resources. They've got social resources, they've got environmental resourcing. So when we talk about low resource at the moment, we're talking about financial or access to equipment—stuff, things, tangible things. But I think there are plenty of communities that have plentiful resources and perhaps just haven't had the opportunity to make use of these resources.

Kathryn Currow 21:31
And then the sustainability of those resources. Lauren and I have many conversations about the amount of medical equipment that sits in hospitals that has broken in inverted commas and is therefore never used again. And I'm delighted that there are biomedical engineering students that actually do something about this when they go in-country visits.

Neil Martin 21:55
So would that be an issue whereby a country or a group provides a nice, swanky machine to somebody, but they don't actually maybe teach them how to use it or how to maintain it?

Kathryn Currow 22:07
And the person who they taught may have left as well or maybe moved somewhere else. Or the whole sustainability-continuity-succession is an issue.

Lauren Kark 22:16
And there are variable statistics around this, where, you know, a lot of the equipment arrives already broken. And there’s no judgment there—it may have broken in transport. And so already people can't use it. And then, of course, there is the maintenance of it. I mean, in certain countries, the rubber on a blood pressure cuff, for example, will degrade. That's a very simple exchange, but nobody's shown people how to do that, or perhaps that rubber is not available in that community. So what are the alternatives? And in one study, they showed that within five years, 97% of donated medical equipment was out of service. It's incredible, and so to see an equipment graveyard in a hospital in many, many countries is not unusual.

Kathryn Currow 22:54
And that equipment might extend to laptops and all sorts of other IT equipment, and that's really quite debilitating, because, you know, getting access to good technology to connect with others is incredibly important.

Lauren Kark 23:08
And Kathryn's got lots of examples where people are doing surgery with iPhone lights, and that equipment didn't need to break, but broke because the maintenance requirements were either unreachable or were not communicated.

Neil Martin 23:23
And I guess people wouldn't necessarily think of that immediately. That kind of follow-on, ongoing support is maybe something that people haven't traditionally thought about. Do you feel that it's being noted now?

Lauren Kark 23:37
I’d like to say yes, because it's a comment on my discipline, but yes. I think ultimately, we see the importance of technology in medicine. I personally feel technology is a tool in the ecosystem. So I can't—I wouldn't weight one higher than the other, but the highest to me is that knowledge is power, and that network is even more powerful.

Kathryn Currow 23:54
And sadly, some of that knowledge transfer is via technology. So it sort of becomes a bit of a vicious cycle, doesn’t it?

Lauren Kark 23:59
That's right. I mean, Kathryn's example with Zoom. I mean, who would have thought Zoom could have been used in this way? And that's not a medical technology, but that's a technology that's had huge impact in contributing to reducing inequities.

Kathryn Currow 24:13
People tell me now that COVID was a blessing in disguise, which I find a bit horrifying, really, but that's what I've had said to me in overseas countries.

Neil Martin 24:22
And can you kind of just expand on that? Is that because previously, people were not kind of making big use of that—you know, I think video calling, video conferencing existed, but it probably wasn't being utilized, and then all of a sudden everybody had to use it?

Kathryn Currow 24:38
Absolutely.

Neil Martin 24:39
Is that what kind of happened?

Kathryn Currow 24:40
Yeah, so our charity was set up to organise face-to-face volunteering, and the COVID travel bans came in a week before we were due to go overseas for the first time, and I'd spent 18 months setting up a charity, so I thought this is very depressing, and I have to do something about this. And over the course of a weekend, we invented the ‘telehealth’ project and contacted colleagues, and they said, yes, go. Let's try. And that's what happened. And the first week it happened, a baby's life was saved. So we didn't script that—it just happened.

Lauren Kark 25:10
And how many of these sessions have you run now, Kathryn?

Kathryn Currow 25:13
About 1100 odd. So it's just extraordinary. And the demand grows. Demand grows and grows. Face-to-face is costly. There's risk in travel, and there's carbon footprint that people think about, especially in the South Pacific—that’s a really hot topic. So if you can do things at low risk, low cost, and with much more availability... If you're waiting for a clinician to come once every six months or once a year, then you've got a lot of patients waiting a long time for that expertise. If you can do it through a Zoom meeting, then you've got the answers—at least the start of a journey to those answers—and a plan of how to move forward.

Lauren Kark 25:54
And scalable.

Kathryn Currow 25:56
Yeah, absolutely. So instead of you going right to meet just one person in a city, you're covering the provinces. Now, of course, technology doesn't always reach the most remote places in some areas, as it doesn't in Australia, I have to add, but it's an issue. But we can certainly reach a lot more people with one Zoom meeting.

Neil Martin 26:15
Yeah, and I think that's a really interesting point as well. I was going to say—I saw a definition of healthcare, which is access to medical assistance within a 60-minute journey by car. And 20%, I believe, of the Indigenous population of Australia does not meet that. They are more than 60 minutes’ drive away from a healthcare professional. So that technology, I guess, is helping them as well—or can help them in the future.

Kathryn Currow 26:47
So one of the things we set up during COVID was actually paediatricians doing telemedicine. So this is patient consultation into Aboriginal Medical Service in Moree. They liked it so much, they told their friends in Inverell, so there's now a similar service set up there and in a town nearby. So absolutely, it makes a huge difference, and it's been a model that's been involved in telepsychiatry here for many, many years.

Neil Martin 27:13
If we talk about the future of equitable healthcare, what more do you think needs to be done—either by governments or individual groups or, I guess, also society, in terms of maybe a change of way of thinking. What would you like to see happening?

Lauren Kark 27:30
That's a big question.

Neil Martin 27:33
That's what we're here for.

Kathryn Currow 27:36
I think thinking about it is really important. So one of the things we did when we did a survey of cases of health inequity in Australia was come up with some recommendations for people to actually put this into their medical consultation—asking about social determinants of health, asking about people and their needs, and seeing how they can be addressed. It's not possible for GPs to do all of that work. It needs other systems in our society to be helping them and supporting them. It may be social work, it may be financial, it may be mental health counselling—there's many, many other layers that belong to that. So I think it's a complicated and difficult area to give you a simple answer, but at least thinking about it and being aware and asking the questions is the start of a journey. In our current situation here, with many people focused on cost of living, it's very hard for them to look overseas and to see the incredible challenges. So if we think life is hard here, we take up hurdling. If we look overseas, we have to take up pole vaulting as an example. It's that much order of magnitude different.

Neil Martin 28:43
If I bring it back to Australia—I know we have the National Agreement on Closing the Gap from, I think, July 2020, and there's a couple of elements in that, where they say that everyone should enjoy long and healthy lives, and that children are born healthy and strong. And there also is the National Aboriginal and Torres Strait Islander Health Plan, which runs to 2031, which is aimed to improve health and wellbeing outcomes for Aboriginal and Torres Strait Islander people over the next 10 years. Are you kind of happy to see those things happening in Australia and other similar things happening, I guess, on a global scale?

Kathryn Currow 29:23
The Closing the Gap document is a really important and helpful reference. It's a measure of where we're up to, and sadly, the trajectory for improvement is nowhere near where it needs to be. So it's there as an ideal and as a standard, but we've got a long way to go to make that really as equitable as we would like it to be.

Lauren Kark 29:47
You said it far more eloquently than I was going to, but I agree with your comments. And I think it would be very nice for us to start to see, you know, this knowledge sharing being more effective and efficient—I think between our different stakeholders and our communities—to really work in appropriate and effective and sustainable solutions.

Neil Martin 30:10
I've read a couple of those documents, and they do seem to be quite focused on engagement with the community. So I guess that's positive—that picking up on what you spoke about before, of giving people agency, and not just coming with a set solution that's been decided on their behalf.

Kathryn Currow 30:25
Absolutely. There’ve been many examples of effective solutions involving strong women in communities, for example, that educate and help improve the standards of hygiene in kids, and how that's reduced scabies and how that's reduced rheumatic heart disease. It's a really important thing.

Neil Martin 30:47
Lauren, you mentioned before about technology, and obviously that's predominantly what the Assistive Tech Hub is all about. Do you think it is just about technology, or is there other elements that are going to help us to kind of achieve this fairness in healthcare? Or how do they balance out against each other and work in tandem, I guess?

Lauren Kark 31:08
Yeah, so Steve Jobs said technology alone is never enough, and I subscribe to that comment. As I mentioned before, I think technology is a tool that we use to achieve a common goal. How we weight it? I think it depends on the circumstance. Sometimes technology will be very, very important. Other times it'll take a back seat. And sometimes it may be irrelevant entirely. A conversation between two people may be all that's required, and you don't need to put this layer of technology in. That being said, I think there's incredible opportunities at the moment where we can leverage what's happening in technology—especially in the software space—that can contribute. So use technology where appropriate, and use it wisely.

Neil Martin 31:50
On the tech side—Lauren, are you aware of anything where AI is really being implemented to help with this equitable healthcare issue?

Lauren Kark 31:59
I think in the broader field, yes. AI is being used in many areas, especially in imaging, and Kathryn may like to talk about the clinical side of things. But some examples I've seen are artificial intelligence looking at images from cervical scans to detect the likelihood of cervical cancer; AI used in obstetric management, so in low-cost ultrasounds. And then we've also got the examples of dermatology—AI being used to detect whether a mole is potentially turning cancerous and needs removal. So I think there's plenty of potential there. And then, of course, there's all the health informatics, that of course requires a system that records a lot of data we also need to be able to treat—and there’s some interesting low-cost technology that's around. And then, you know, you could even go pie in the sky with remote surgical robotics. People don't even need to be in country to do the operation. I mean, I don't think we're there yet, but that’s an interesting future—where someone sets up here in Sydney and does an operation overseas. That's pretty incredible.

Neil Martin 33:01
But what would be the issues that we'd need to be thinking about when we implement artificial intelligence?

Lauren Kark 33:06
There's a huge piece on data security. There's also a huge piece on social practice—like, where are the images going? What happens if there's a breach? We see breaches all the time. So are people right to put blind trust into AI? Well, that’s up to them, but that comes down to literacy again, and whether that’s a risk that you're comfortable to take. Alert but not alarmed. I think many systems probably need a little bit more work done to them to make them acceptable clinically.

Neil Martin 33:34
And if that kind of thing was implemented, again, it would have massive implications for those remote Pacific Island, Southeast Asia communities as well—to have that access.

Kathryn Currow 33:45
I think it would. I think it's a little way off, as Lauren said, for many issues—but part of that being infrastructure, locally, unfortunately.

Neil Martin 33:53
And maybe another element that goes not so much to technology, but also the training. As you said, you're training students, Lauren. You're involved in training as well, I presume, Kathryn. How important is that? I guess it comes back to that thing we were talking about before—whereby people need to continue the knowledge and share the knowledge for many, many years into the future. That’s as big a thing as technology, would you think?

Lauren Kark 34:20
I would say probably even more, because that's the key to our sustainability. And so we're training our students, but our students are also training others. So we had an example—and Kathryn participated in this workshop—where our students taught students in the Solomon Islands to adapt toys for kids with disability. So we've got these multi-levels of training. And, you know, our students—I mentioned this the other day—our students are with us for four or five years, but they're in society for 60 years. And so imagine what they can do, having had these experiences and this knowledge while they’re students. And then hopefully they continue that, and that will increase their impact and hopefully increase their desire to want to do these sorts of activities throughout their career.

Neil Martin 35:02
It might lead me on to my final question, which is a big one—and it might not be so easy to answer—but if I gave you a magic wand to make one change with regards to equitable healthcare, looking ahead to 20 or 30 years down the line, what would you choose to do and why?

Kathryn Currow 35:21
First of all, I would be asking our colleagues overseas what they need, and I'd be asking our colleagues in Aboriginal communities what they need and what they think will be most effective. I think you could spend many hours debating whether interventional radiology introduction into a low-resource country is the most effective way of improving overall health of everyone—I'm talking about an extremely high-tech, expensive thing—or whether it's better to ensure every child gets vaccinated and gets adequate nutrition. I think there has to be a multi-pronged approach.

Lauren Kark 35:56
I'm going to say something that maybe doesn't fit in with my profession, but I think education. I think education—access to education—is key. So not only to train doctors, to train engineers, but also these community-based interventions, if you like.

Neil Martin 36:15
And is there also important education to society of the bigger problem and the bigger issues, so that everybody understands, and everybody kind of buys in and knows the reasons why equity is important and why we're trying to achieve that?

Lauren Kark 36:31
Yeah, absolutely. I think there's a piece for the individual, but there's also the piece for the community at the society level—and there's no reason not to do it.

Neil Martin 36:41
Well, let's hope in the next two or three decades, there really is fairer opportunity for all when it comes to health and well-being. It's been so interesting to hear both of your thoughts on this topic. Associate Professor Lauren Kark, many thanks for being here.

Lauren Kark 36:56
Thank you for having me.

Neil Martin 36:57
And also to Dr Kathryn Currow, it's been a pleasure to talk to you.

Kathryn Currow 37:01
Thank you so much, Neil. It's been a joy.

Neil Martin 37:03
Unfortunately, that's all we've got time for. Thank you for listening. I've been Neil Martin, and I hope you'll join me again soon for the next episode in our Engineering the Future series. You've been listening to the аIJʹÙÍø Engineering the Future podcast. Don’t forget to subscribe to our series to stay updated on upcoming episodes. Check out our show notes for details on in-person events, panel discussions, and more fascinating insights into the future of engineering.