Lecture 1: Overview: Chung Tin, PH.D

BME3104 Health Maintenance and Wellness Technology 1
Lecture 1: Overview
Chung Tin, Ph.D.
Email: chungtin@cityu.edu.hk
Office: P6416
What is Health technology?

From Wikipedia:
• Health technology is
application of organized knowledge and skills in the form of devices, medicines, vaccines,
procedures and systems developed to solve a health problem and improve quality of lives. This
includes the pharmaceuticals, devices, procedures and organizational systems used in
health care.
• is used to diagnose, monitor or treat diseases or medical conditions affecting humans. Such
technologies (applications of medical science) are intended to improve the quality of healthcare delivered
through earlier diagnosis, less invasive treatment options and reductions in hospital stays
and rehabilitation times. Recent advances in medical technology have also focused on cost
reduction. Medical technology may broadly include medical devices, information
technology, biotech, and healthcare services.
• The impacts of medical technology may involve social and ethical issues. For example, physicians may
seek objective information from technology rather than listening to subjective patient reports.
Course Information
• Lecture: 12:00 noon – 1:50 pm on Friday
• Tutorial: 2:00 pm – 2:50 pm on Friday
• Lab: Starting from Week 4 (Dr. Kannie Chan)
Lecturer
Dr. Chung Tin
• Office: YEUNG P6416
• Email: chungtin@cityu.edu.hk
• Tel: 3442 5145
Dr. Kannie W.Y. Chan

• Office: YEUNG P7723
• Email: KannieW.Y.C@cityu.edu.hk
• Tel: 3442 9141
Course Information
Assessment
• Mid-term: 15%
• Tutorial: 10%
• Lab Report: 10%
• Final Exam: 40%
• Group project: 25%
Tutorial
• Two students as a group is required to provide a critique
for one healthcare product/technology preferably related
to COVID-19.
• In-class presentation (6min + Q&A)
• ~1000 words summary (due in one week after presentation)
• Points to be included
• Describe the healthcare problem addressed by the
product/technology
• Describe the limitation of previous solutions
• Explain the technical details behind the new products/technology
• Discuss the advantages and disadvantages
• Discuss the regulatory requirement / approval obtained
• The first presentation will start from week 4
• Schedule will be released later
Group Project
• The term project provides an opportunity for students to explore a healthcare
problem impacting the world and to propose a solution to address the problem
• The project should cover the following tasks:

1. Identify the healthcare problem of your interest.
2. Evaluate existing technology being used for it.
3. Identify the potential market size and profitability.
4. Propose and evaluate your new solution
5. Develop a simple prototype for demonstration at your presentation
Questions for Healthcare Technology

• What are the problems in healthcare today?
• Who pays to solve problems in healthcare?
• How can we use science and technology to solve healthcare problems?
• Once developed, how do new healthcare technologies move from lab to

bedside?
Global Health Questions to Ask

1. What are the leading causes of death in the developed world? In
the developing world?
2. What is the life expectancy at birth for someone born in the US?
Japan? Mali? South Africa? India?
3. What diseases or health conditions impose the biggest burden in
the developed world? In low-income countries?
4. What are the biggest health risks for people in different places?
What is your chance of dying in childbirth in Boston? In Burundi? In
Austria?
5. How much money flows per year to developing countries as direct
assistance for health?
6. How many doctors per 1000 people are there in Massachusetts? In
Malawi?
7. How does Malawi’s gross national income per capita compare with
US health spending per capita?
8. How much does McKinsey take in for its global health consulting?
9. etc…....
http://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends/en/
Perspectives
• A few major trends in healthcare status consistent with increasing need of
personal healthcare
• Increased life expectancy
• Increased cost in healthcare
• More access to healthcare information
• Change in lifestyle
• Global healthcare is getting more expensive

• Healthcare service is extending from hospital to personal/private environment
• For managing risk factor (primary prevention)
• For managing chronical conditions (secondary prevention)
• Individuals will take increasing responsibility for managing their own health
status
Health expenditure per capita (in US$)
https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD
Health expenditure per capita (in US$)
https://data.oecd.org/healthres/health-spending.htm
65. By the year 2000, those ratios had increased is projected to b
to 1 in every 10 aged 60 years or older and 1 in projected to be o
every 14 aged 65 or older. By the year 2050,
more than 1 in every 5 persons throughout the High proportion
Trends in Global Healthcare world is projected to be aged 60 or over, while

nearly 1 in every 6 is projected to be at least 65
years old.
proportions in A
Europe is c
with the highest
Aging Population Figure 10. Proportion of population
is projected to r
years. About
aged 60 or over: world and development
population is pro
• Average age of population is regions, 1950-2050
up from 20 per c
increasing significantly over the 40
is projected to b
in 2000. In co
world 35
World
More developed regions population of Af
2050, up from 5
• Better working conditions. 30
Less developed regions
65 or over is pro
2000 to 7 per cen
• Better nutrition.
Percentage
25
• Better health care delivery for a 20

More than two i
in some countrie
broad population.
15
• Behavioral/lifestyle changes (e.g. People aged
from one fifth
reduction in smoking). 10
population of A
• Decrease in birth rate (especially 5 Italy, Japan, Slo
than two in ever
Europe and Japan) 0 at least 60 years
1950 1975 2000 2025 2050
Except for the C
• One-child policy in China every three peop
United Nations,
MoreReport on world population
developed regions aging
have1950-2050, ch2,high
relatively 11 to be aged 65 o
(United Nations, New York, 2002). these countries,
proportions of older persons
ngolia 146 958 6 23 10 15 .. 49/29 83 55 17 4 .. 15/17 Marshall Islands .. .. .. .. .. .. 74/51 B .. .. .. .. .. 55/55 ..
public of Korea 5 532 17 095 12 33 9 27 87/37 A 45/24 73 41 9 2 60/606 17/22 Micronesia (Federated States of) .. .. .. .. .. .. 71/37 B .. .. .. .. .. 60/60 ..

Nauru .. .. .. .. .. .. 67/50 C .. .. .. .. .. .. ..
uth-central Asia 110 117 473 646 7 19 8 14 78/43 58/19 91 80 13 5 - 16/18 New Caledonia 19 90 9 23 10 20 66/39 A .. 95 65 12 4 .. 18/21
hanistan 1 100 5 586 5 8 4 7 83/37 C 67/26 98 90 19 13 60/55 13/14 New Zealand 607 1 299 16 29 18 29 69/45 A 15/7 82 52 6 3 65/65 20/24
ngladesh 7 210 42 547 5 16 7 10 95/43 B 70/42 99 96 19 6 .. 15/16 Niue .. .. .. .. .. .. .. .. .. .. .. .. .. ..
utan 144 678 7 12 8 11 .. 73/31 89 76 12 8 .. 17/18 Northern Mariana Islands .. .. .. .. .. .. .. .. .. .. .. .. 65/6520 ..
a 81 089 324 316 8 21 8 15 75/42 B 59/18 91 81 12 4 55/55 16/18 Palau .. .. .. .. .. .. .. .. .. .. .. .. 60/60 ..
n (Islamic Republic of) 3 922 26 359 5 22 7 12 89/66 B 60/13 94 83 18 4 60/55 17/18 Papua New Guinea 212 1 331 4 12 5 10 75/51 C 54/39 99 98 23 8 55/55 13/15
zakhstan 1 772 3 893 11 25 9 17 80/37 A 16/7 59 26 9 4 60.5/55.5 14/19 Pitcairn .. .. .. .. .. .. .. .. .. .. .. .. .. ..
gyzstan 442 1 680 9 22 10 16 82/40 A 15/6 67 33 10 4 60/55 16/20 Samoa 11 33 7 15 10 10 81/46 C .. 78 54 12 7 .. 15/20
dives 16 105 5 12 8 11 67/42 A 50/43 113 82 15 8 .. 17/17 Solomon Islands 20 158 4 11 6 11 74/51 B 70/55 107 117 20 9 40/40 15/17
pal 1 438 6 516 6 12 7 10 79/49 B 70/38 96 83 15 8 60/55 15/16 Tokelau .. .. .. .. .. .. .. .. .. .. .. .. .. ..
Trends in Global Healthcare

istan 8 611 42 840 6 12 8 12 79/50 A 59/18 100 110 15 8 60/55 16/17 Tonga .. .. .. .. .. .. 78/55 A .. .. .. .. .. .. ..
Lanka 1 857 6 370 10 28 9 20 81/51 C 36/7 102 94 11 3 55/50 17/20 Tuvalu .. .. .. .. .. .. .. .. .. .. .. .. .. ..
kistan 414 2 051 7 21 11 15 84/38 B 19/7 79 43 12 5 .. 18/21 Vanuatu 10 64 5 14 11 13 77/57 B .. 108 104 17 7 55/55 15/19
kmenistan 312 1 674 6 20 10 16 78/36 B 24/8 72 38 13 5 62/57 16/19 Wallis and Futuna Islands .. .. .. .. .. .. .. .. .. .. .. .. .. ..
bekistan 1 790 9 030 7 22 10 16 83/38 B 18/6 75 39 12 4 60/55 17/21
uth-eastern Asia 39 482 175 761 7 22 8 16 82/42 57/32 84 70 13 4 - 17/18
nei Darussalam 19 134 5 24 9 23 83/50 B 50/0 104 88 19 4 .. 19/22
mbodia 613 3 502 4 12 7 10 83/43 A 50/37 57 61 19 9 .. 15/17 Notes
t Timor
onesia
39
17 169
254
69 534
5
8
18
22
4
7
8
15
..
84/36 B
65/42
59/32
98
84
74
70
20
13
6
4
..
55/55
14/15
16/18
The designations employed and the presentation of the material Percentage of total population aged 60 years or older
in the present publication do not imply the expression of any
o People’s Democratic Republic 304 1 525 5 13 8 10 .. 63/34 86 81 15 8 .. 15/16 opinion whatsoever on the part of the Secretariat of the United 2002
aysia 1 561 7 874 7 21 9 18 84/44 B 46/21 90 75 14 4 55/55 17/19 Nations concerning the legal status of any country, territory, city or
Aging Population
anmar 3 389 14 793 7 22 10 15 71/39 C 72/42 87 76 14 4 .. 16/17 area or of its authorities, or concerning the delimitation of its
ippines 4 513 25 051 6 20 8 14 82/52 A 65/34 84 61 16 5 60/60 17/18 frontiers or boundaries. The designations “more developed
gapore 463 1 619 11 35 13 36 83/49 A 26/6 87 63 9 2 55/55 20/23 regions” and “less developed regions” are intended for statistical
ailand 5 441 22 337 8 27 8 20 83/49 A 48/26 83 65 12 3 55/55 17/20 convenience and do not necessarily express a judgement about
the state reached by a particular country or area in the
Nam 5 971 29 140 7 24 12 17 84/45 B 50/31 88 75 12 4 60/55 18/20 development process. The term “country” as used in the text of
this publication also refers, as appropriate, to territories or areas.
• Challenges:
stern Asia 14 069 66 146 7 16 9 15 86/50 44/17 87 62 12 6 - 17/20
menia 498 1 243 13 39 7 19 87/44 B 25/9 73 46 7 2 62/57 16/20 The figures cited for 2050 are from the medium-fertility variant of
erbaijan 856 2 858 11 32 10 22 87/46 A 28/10 71 32 9 3 61/56 18/22 the United Nations population estimates and projections as
hrain 33 251 5 25 7 23 87/42 B 41/0 120 98 22 3 60/55 18/20 revised in 2000.
Two dots ( .. ) indicate that data are not readily available.
prus 129 272 16 30 17 25 84/55 B 36/12 82 69 6 3 65/65 20/23 A hyphen ( - ) indicates that the item is not applicable.
orgia 984 1 153 19 36 12 23 85/39 B 23/0 67 35 5 2 65/60 18/22
• The proportion of older persons is

q 1 139 8 077 5 15 8 13 89/50 B 47/5 91 81 19 6 60/55 17/19 More developed regions comprise all regions of Europe and
ael 823 2 500 13 25 17 23 84/49 C 29/10 75 58 6 3 65/60 20/24 Northern America, Australia/New Zealand and Japan.
dan 245 1 821 5 16 8 14 92/46 B 46/5 104 86 20 6 60/55 17/19 Less developed regions comprise all regions of Africa, Asia
wait 105 1 027 5 26 4 14 92/41 B 45/6 212 68 27 4 50/507 19/22 (excluding Japan) and Latin America and the Caribbean and the
projected to more than double

banon 308 1 276 9 25 9 18 .. 40/4 83 71 10 3 64/64 18/19 regions of Melanesia, Micronesia and Polynesia.
cupied Palestinian Territory 162 1 175 5 10 11 12 .. .. 74 73 15 10 .. 17/19 Least developed countries as defined by the United Nations
an 119 916 4 10 7 11 82/33 B 42/4 109 85 21 10 60/55 17/19 General Assembly, as of 2001, include 49 countries, of which
34 are in Africa, 9 are in Asia, 1 is in Latin America and 5 are in
ar 21 172 4 21 2 22 89/36 B 62/0 265 165 41 4 .. 15/15 Oceania. They are included in the less developed regions.
worldwide over the next half century.

udi Arabia 1 083 7 698 5 13 7 12 .. 51/4 119 83 18 8 60/60 17/19
a Hong Kong Special Administrative Region of China.
an Arab Republic 801 6 550 5 18 8 12 89/50 C 47/11 89 83 18 5 60/60 17/19
b Macao Special Administrative Region of China.
key 5 894 22 741 9 23 8 16 86/53 B 48/28 86 67 11 3 55/50 17/20
c Referring to the Vatican City State. Percentage
ted Arab Emirates 160 989 6 27 7 24 82/29 C 52/3 287 127 23 3 .. 21/23
d The former Yugoslav Republic of Macedonia. aged 60 or older
men 709 5 426 4 5 7 10 87/47 B 57/12 76 72 21 17 60/55 15/17
2002
In 2050, up to 33% of the population

1 Letter indicates reference year: A: 1995 or later; B: 1985-1994; C: 1984 or earlier.
•
Figures for the world, more and less developed regions, least developed
ope 148 319 221 079 20 37 15 27 79/42 16/7 68 41 4 2 - 17/22 countries, regions and subregions are weighted averages. Currently married 0- 9
tern Europe 55 820 81 956 19 37 11 20 82/38 19/9 58 32 5 2 - 15/19 includes, where possible, those in consensual unions.
arus 1 889 2 972 19 36 11 20 81/39 A 20/8 54 27 5 2 60/55 14/19 2 Ratio of population aged 15 to 64 years to the population aged 65 years or 10-19
garia 1 693 1 748 22 39 11 19 80/53 B 16/5 75 57 4 2 60/55 15/19
will be 60+ in developed countries.

older.
20-24
ech Republic 1 931 3 383 19 40 14 24 79/40 A 17/8 68 42 5 2 61/55-598 17/22 3 Aged 55 years or older.
ngary 1 978 2 710 20 36 13 21 75/36 A 2/1 62 43 5 2 61/609 16/20 4 For professional women; age 55 for non-professional salaried women and age
No data
and 6 401 11 874 17 36 13 21 74/46 A 31/19 66 43 6 2 65/60 17/21 50 for other women.
public of Moldova 580 1 163 14 33 9 16 81/40 B 13/4 63 42 7 3 60/55 14/17 5 Referring to national pension programme only; pensionable age under
mania 4 211 6 200 19 34 10 18 88/50 A 10/6 75 54 5 2 60/55 16/19 employees' pension insurance is 60 years.
Population aging is unprecedented in

The boundaries shown on these maps do not imply official endorsement or acceptance by the United Nations.
•
ssian Federation 26 207 38 773 18 37 11 20 84/34 B 20/9 53 25 5 2 60/55 14/19 6 To be increased to age 65 by 2033.
vakia 844 1 721 16 37 13 20 79/39 B 28/8 65 50 6 2 60/53-5710 16/21 7 Gradually increasing to age 55 by the year 2020.
aine 10 085 11 412 21 38 11 20 84/35 B 16/6 56 30 5 2 60/55 14/19 8 Gradually increasing to age 62 (men) and ages 57 to 61 (women) by the year
2007; for women, retirement age depends on number of children raised. Percentage of total population aged 60 years or older
history
thern Europe 19 660 31 461 21 34 20 31 73/43 20/8 75 47 4 2 - 19/23
annel Islands 29 42 20 36 17 34 .. .. 80 48 5 2 .. 19/23
9 Gradually increasing to age 62 by the year 2009 for both men and women.
10 Depending on number of children raised.
2050
nmark 1 093 1 617 20 32 20 30 70/43 A 19/8 79 50 4 2 67/67 19/22 11 To be increased six months per year, until it reaches age 63 for men and
onia 278 270 20 36 13 20 77/33 B 32/19 55 29 5 2 63/5911 15/21 women.
roe Islands .. .. .. .. .. .. .. .. .. .. .. .. .. .. 12 To be phased in gradually for women.
Population aging is enduring. We will

and 1 056 1 614 20 34 18 31 70/41 A 10/5 70 37 4 2 65/65 19/24
•
13 Gradually increasing to age 65 for women during the period 2010-2020.
and 43 98 15 29 19 27 70/49 A 50/30 85 63 6 3 67/67 21/24
14 Gradually increasing to age 60 for women by the year 2007.
and 594 1 481 15 28 18 22 63/40 A 27/5 81 52 6 3 66/66 18/22
15 Age 57 for new entrants into the labour force as of 1996.
of Man .. .. .. .. .. .. .. .. .. .. .. .. .. ..
via 512 654 21 37 13 22 77/33 B 32/17 51 18 4 2 60/6012 15/21 16 Gradually increasing to age 65 for women by the year 2009.
not return to the young populations

huania 704 1 116 19 37 13 25 81/38 B 21/11 58 38 5 2 62/60 17/22 17 With 38.5 years of coverage for full pension; gradually increasing to 40 years by
the year 2003.
way 886 1 576 20 32 24 32 71/44 A 23/14 76 50 4 2 67/67 20/24
eden 2 029 2 933 23 38 23 32 71/44 A 20/13 79 54 4 2 65/65 21/25 18 Gradually changing to age 64 for men and women.
ted Kingdom 12 411 20 015 21 34 20 32 74/44 B 19/7 77 48 4 2 65/6013 19/23 19 Gradually increasing to age 64 for women by the year 2005.
that our ancestors knew.

20 Gradually increasing to age 67 during the period 2000-2027.
uthern Europe 32 225 46 832 22 40 16 30 80/47 17/6 75 51 4 2 - 19/24 21 For urban employees; for rural employees, age 60 (men) and age 55 (women).
ania 299 961 9 25 8 19 87/50 B 48/8 88 39 11 3 60/55 17/21 22 To increase to age 62 (men) and age 57 (women) in 2014.
dorra .. .. .. .. .. .. .. .. .. .. .. .. 65/65 .. 23 Gradually increasing to age 60 for women by the year 2003.
snia and Herzegovina 631 1 304 15 38 8 24 .. 27/8 75 45 7 2 .. 17/20 24 Gradually increasing to age 65 for women by the year 2013.
Population aging is pervasive; it is a

atia 966 1 286 21 31 12 25 82/41 B 18/9 68 38 5 2 60/5514 17/21
raltar
ece
y Seec
..
2 539
..
..
3 652
..
..
24
..
..
41
..
16•
..
..
..
29
..
..
85/51 B
..
..
18/7
..
..
82
..
..
67
..
..
4
..
..
2
..
..
65/60
..
..
20/24
..
Sources
World Population Prospects: The 2000 Revision, vol. I:
Comprehensive Tables (United Nations publication, Sales No.
problem of all world countries,

y 14 095 18 178 25 42 17 33 81/47 A 14/4 74 48 4 1 65/6015 20/24 Percentage
ta 69 134 17 34 15 27 66/37 B 15/3 75 50 5 2 61/60 19/23 E.01.XIII.8); vol. II: Sex and Age (United Nations publication, Sales No. aged 60 or older
tugal 2 120 3 217 21 36 15 26 81/49 B 26/11 72 50 4 2 65/65 18/23 E.01.XIII.9); United Nations, Demographic Yearbook (various issues); 2050
n Marino .. .. .. .. .. .. 69/53 B .. .. .. .. .. 60/60 .. national statistics; United States Bureau of the Census, International
Programs Center, International Data Base;
developed as well as non-developed.

venia 392 648 20 42 12 28 80/47 A 16/7 67 34 5 2 63/58 17/23 0- 9
ain 8 842 13 782 22 44 18 30 80/49 B 13/4 75 51 4 1 65/65 20/25 Estimates and Projections of the Economically Active Population,
YR Macedoniad 303 640 15 34 9 20 82/60 B 25/12 82 63 7 2 .. 17/20 1950-2010, 4th ed. (Geneva, International Labour Office, 1996); 10-19
oslavia 1 938 2 931 18 32 9 20 79/51 B 30/18 78 65 5 2 60/55 17/20 Social Security Programs Throughout the World—1999 20-24
(Washington, D.C., United States Social Security Administration). 25-29
30+
Enquiries and comments should be addressed to
Mr. Joseph Chamie, Director, Population Division of the United No data
Nations, New York, New York 10017, United States of America.
The boundaries shown on these maps do not imply official endorsement or acceptance by the United Nations. 25
Population aged 60 years or older

2002
http://www.un.org/esa/population/publications/ageing/Graph.pdf

Growth of Chronic diseases
• Chronic disease is the major cost
drivers in current healthcare system
• A chronic condition is defined as a
health problem that lasts for a year
or longer, limits what one can do
and may require ongoing care.
• Reasons:
• Aging population
• Limitations to fundamentally/completely
http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf
cure degenerative disease but turn them
into manageable conditions

Most prevalent chronic diseases in the US

http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf

• In 2000, more than 125 million
Americans have at least one chronic
condition and 60 million people have
multiple conditions.
à account for 40% employees
• In 2020, >25% of the American
population will be living with multiple
chronic conditions, and costs for
managing these conditions are http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf
estimated to reach $1.07 trillion


Inappropriate lifestyle
Physical Inactivity
• Lack of regular exercise
• Annual estimated cost for diseases associated with physical
inactivity in the US in 2000 was $76 billion
• ~40% in US under physical inactivity in 2000
• Risk factor for cardiovascular disease
Nutrition
• high level of cholesterol associated with obesity and
cardiovascular diseases
• Bad if Total > 200mg/dL, HDL < 40mg/dL, LDL > 160mg/dL

Inappropriate lifestyle
Stress
• Relationship between cardiovascular disease and stress
• ~$300 billion, or $7,500 per employee, is spent annually in the U.S. on
stress related compensation claims, reduced productivity,
absenteeism, health insurance costs, direct medical expenses (nearly
50% higher for workers who report stress), and employee turnover.
Smoking
• Major risk factor cardiovascular diseases and cancer
• ~20% in US, ~30% in Europe
• In 2013, the daily cigarette smoking prevalence of Hong Kong (age 15 or
above) was 10.7% which equivalent to around 645,000 daily cigarette
smokers and is the lowest rate recorded since 1982.
Relevant Diseases/Health problems

Obesity
• Overweight and obesity are defined as abnormal or excessive fat
accumulation that may impair health.
!"#$%& (($)
• Body mass index (BMI) is defined as 𝐵𝑀𝐼 =
*"#$%& + !
• The WHO definition is:
• overweight : BMI >= 25
• obesity : BMI >= 30
• BMI is just a rough guide for obesity
• Overall, about 13% of the world’s adult population (11% of men and
15% of women) were obese in 2014.
• In 2014, 39% of adults aged 18 years and over (38% of men and 40%
of women) were overweight.
• The worldwide prevalence of obesity more than doubled between
1980 and 2014.

Diabetes
• Diabetes mellitus is a chronic disease caused by inherited and/or
acquired deficiency in production of insulin by the pancreas, or by the
ineffectiveness of the insulin produced.
à increased concentrations of glucose in the blood
à damages e.g. blood vessels and nerves
• Obesity is a risk factor
• >194million people have diabetes worldwide
• In 2002, direct+indirect cost of diabetes in US was $132 billion
• Most important needs of diabetes:
• Painless glucose monitoring
• Decision support
• Lifestyle support

Hypertension
• Systolic BP > 130mmHg or diastolic BP > 80mmHg
• For adults 40-69yr old, each 20mmHg increase in systolic BP
or 10mmgHg increase in diastolic BP doubles risk of death
from coronary heart disease
• ~1/3 adults in US has hypertension
• Cost in 2005 ~ $59.7 billion
Asthma
• ~235million people worldwide has asthma
• The strongest risk factors for developing asthma are inhaled
substances and particles that may provoke allergic reactions or
irritate the airways.
• Many of the deaths are preventable, since they often result
from suboptimal long-term medical care and delay in obtaining
help during the final attack.

Sleep disorders
• Conditions including
• Difficulty falling or staying asleep.
• Falling asleep at inappropriate times.
• Excessive total sleep time or abnormal behaviors associated with
sleep.
• Sleep apnea, narcolepsy, parasomnia (e.g. sleepwalking, bad
dreams)
Cancer
• Lung, liver, breast, colon
Cardiovascular disease
• Coronary heart disease, congestive heart failure, stroke

Depression
• common mental disorder that comes with depressed
mood, loss of interest or pleasure, feelings of guilt or low
self-esteem, disturbed sleep or appetite, low energy, and
poor concentration.
• ~121 million people suffer from depression
• can be reliably diagnosed in primary care.
• <25% affected receive appropriate treatment
Assessing Health
• Individual Health vs. Population Health
• Pooled figures such as:
• Infant mortality rates
• Numbers of deaths and causes
• Immunization rates
Example of Health Data

World Health Organization

• Established by charter of the UN after World War II
• The directing and coordinating authority on international health within
the United Nations’ system
• Headquartered in Geneva
• Mission:
• “Attainment by all peoples of the highest possible level of health”
• Website:
• http://www.who.int/en/
Headquarter of WHO (copyright: WHO/P. Virot)

Functions of the WHO

• providing leadership on matters critical to health and
engaging in partnerships where joint action is needed;
• shaping the research agenda and stimulating the
generation, translation and dissemination of valuable
knowledge;
• setting norms and standards and promoting and
monitoring their implementation;
• articulating ethical and evidence-based policy options;
• providing technical support, catalysing change, and
building sustainable institutional capacity; and
• monitoring the health situation and assessing health
trends.
6 Priorities of the WHO

• Advancing universal health coverage
• Achieving health related MDG (Millennium Development
Goals)
• Addressing NCD (non-communicable disease) and
mental health
• Implementing international health regulations
• Increase access to essential, high quality and affordable
medical products
• Reducing health inequities
Uses for health measures

• Identify emerging problems (early warning)
• Rubella (German measles) during pregnancy
• Thalidomide during pregnancy
• AIDS à Kaposi’s sarcoma, PCP
• SARS, MERS, Zika, COVID-19
• Help determine public policy
• Estimate impact of health problems
• # people affected, ages, locations
• Set funding priorities– Millennium Development Goals
• Educate legislators
• Monitor progress toward goals

Types of health data

• Data on the population
• # of people
• Age, sex, ethnic origin, urbanization
• Vital statistics
• Live births
• Deaths (including infant deaths) by sex, age, cause
• Health statistics
• Morbidity by type, severity and outcome
• Data on reportable diseases
• Tumor registries
• Statistics about health services
• # and type of facilities
• # and qualifications of health personnel
• Services and utilization rates
• Costs and payment mechanisms
Quantitative measures of health

• Incidence
• Number of new cases of a disease in a population over
a period of time
• Annual incidence rate
𝐴𝑛𝑛𝑢𝑎𝑙 𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑅𝑎𝑡𝑒
# 𝑛𝑒𝑤 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑎 𝑑𝑒𝑓𝑖𝑛𝑒𝑑 𝑐𝑜𝑛𝑑𝑖𝑡𝑖𝑜𝑛 𝑖𝑛 𝑎 𝑑𝑒𝑓𝑖𝑛𝑒𝑑 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑖𝑛 1 𝑦𝑒𝑎𝑟

=
# 𝑖𝑛 𝑡ℎ𝑎𝑡 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑡 𝑚𝑖𝑑 − 𝑦𝑒𝑎𝑟 𝑜𝑓 𝑡ℎ𝑎𝑡 𝑠𝑎𝑚𝑒 𝑦𝑒𝑎𝑟

• Prevalence
• Number of existing cases of a disease in a given
population at a specific time
• Point prevalence
𝑃𝑜𝑖𝑛𝑡 𝑃𝑟𝑒𝑣𝑎𝑙𝑒𝑛𝑐𝑒
# 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑎 𝑑𝑒𝑓𝑖𝑛𝑒𝑑 𝑐𝑜𝑛𝑑𝑖𝑡𝑖𝑜𝑛 𝑖𝑛 𝑎 𝑑𝑒𝑓𝑖𝑛𝑒𝑑 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑡 𝑎 𝑝𝑜𝑖𝑛𝑡 𝑖𝑛 𝑡𝑖𝑚𝑒

=
# 𝑖𝑛 𝑡ℎ𝑎𝑡 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑡 𝑠𝑎𝑚𝑒 𝑝𝑜𝑖𝑛𝑡 𝑖𝑛 𝑡𝑖𝑚𝑒

• Mortality rate
• Mortality = Death
• Crude death rate, Infant, Neonatal, Post-neonatal, Maternal
• Mortality Rate
𝑀𝑜𝑟𝑡𝑎𝑙𝑖𝑡𝑦 𝑅𝑎𝑡𝑒
# 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑖𝑛 𝑎 𝑑𝑒𝑓𝑖𝑛𝑒𝑑 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑖𝑛 1 𝑦𝑒𝑎𝑟
=
# 𝑖𝑛 𝑡ℎ𝑎𝑡 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑡 𝑚𝑖𝑑 − 𝑦𝑒𝑎𝑟 𝑜𝑓 𝑡ℎ𝑎𝑡 𝑠𝑎𝑚𝑒 𝑦𝑒𝑎𝑟
• Infant mortality rate

𝐼𝑛𝑓𝑎𝑛𝑡 𝑀𝑜𝑟𝑡𝑎𝑙𝑖𝑡𝑦 𝑅𝑎𝑡𝑒
# 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑢𝑛𝑑𝑒𝑟 1𝑦𝑟 𝑜𝑓 𝑎𝑔𝑒 𝑖𝑛 𝑎 𝑑𝑒𝑓𝑖𝑛𝑒𝑑 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑖𝑛 1 𝑦𝑒𝑎𝑟
=
# 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠 𝑖𝑛 𝑡ℎ𝑎𝑡 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑖𝑛 𝑠𝑎𝑚𝑒 𝑦𝑒𝑎𝑟

Example
• If, over the course of one year, 5 women are diagnosed
with breast cancer, out of a total female study population
of 200 (who do not have breast cancer at the beginning of
the study period), then we would say the incidence of
breast cancer in this population was 0.025. (or 2,500 per
100,000 women-years of study)
• If a measurement of cancer is taken in a population of
40,000 people and 1,200 were recently diagnosed with
cancer and 3,500 are living with cancer, then the
prevalence of cancer is 0.118. (or 11,750 per 100,000
people)

Example
• If there are 25 lung cancer deaths in one year in a
population of 30,000, then the mortality rate for that
population is 83 per 100,000.
Burden of disease
• Quality adjusted life year (QALY)
• Measure of quality adjusted life years gained by an
intervention
• Disability adjusted life year (DALY)
• Years of “healthy” life lost
• Years lived with disability + Years of life lost (due to
early death)
• Combines several elements
• Levels of mortality by age
• Levels of morbidity by age
• Value of a year of life at specific ages
Burden of disease
DALY
• A key summary measure of population health for global burden of
disease (GBD)
• Measures the difference between a current situation and an ideal
situation where everyone lives up to the age of the standard life
expectancy, and in perfect health.
• WHO now regularly develops GBD estimates at regional and global
level for a set of more than 135 causes of disease and injury
• Calculating DALY
𝐷𝐴𝐿𝑌 = 𝑌𝐿𝐷 + 𝑌𝐿𝐿
• YLD: years lived with disability
• YLL: years of life lost due to premature mortality
Burden of disease
YLL
𝑌𝐿𝐿 = 𝑁×𝐿
• N: number of deaths
• L: life expectancy at the age of deaths
• For example, a female patient develops severe alcohol use

disorder at age 40 and consequently dies at age 60.
• Assume that life expectancy of 60-year-old females are 25
years in the Life Table.
• Dying at the age of 60 will thus cause a loss of 25 full life years
potentially lived in optimal health
• For this patient alone,
𝑌𝐿𝐿 = 1×25 = 25
Burden of disease
YLD
𝑌𝐿𝐷 = 𝐼×𝐷𝑊×𝐿
• I: number of incident cases
• DW: disability weight (0 - 1)
• L: average duration of disability
• DW = 0 à perfect health
• DW = 1 à worst possible health
• Quantify societal preferences for health states
Burden of disease
YLD
• Example: society judges a year with blindness (DW=0.43)
to be “preferable” to a year with paraplegia (DW=0.57),
and a year with paraplegia to be “preferable” to a year
with unremitting unipolar major depression (DW=0.76).
• Society would also “prefer” a person to live three years
with paraplegia followed by death (3 years x 0.57 = 1.7
lost “healthy” years), than have only one year of good
health followed by death (2 lost years of good health).
standard health state description based on eight core domains of health (mobility, self care,
pain and discomfort,
BME3104 cognition, interpersonal
Health Maintenance activities,
and Wellness vision, sleep and energy,42
Technology affect).
As part of the World Health Survey being conducted by WHO (WHO, 2003), revised
disability weights will be developed during 2003 that are based on health state valuations
from large representative population samples in over 70 countries.
Burden of disease Table 3.1 Examples of disability weightsa
• Examples of DWs Disease or sequelae Mean disability

weight (untreated
Mean disability
weight (treated
form) form)
AIDS 0.50 0.50
Infertility 0.18 0.18
Diarrhoea disease, episodes 0.11 0.11
Measles episode 0.15 0.15
Tuberculosis 0.27 0.27
Malaria, episodes 0.20 0.20
Trachoma, blindness 0.60 0.49
Trachoma, low vision 0.24 0.24
Lower respiratory tract infection, episodes 0.28 0.28
Lower respiratory tract infection, chronic 0.01 0.01
sequelae
Cancers, terminal stage 0.81 0.81
Diabetes mellitus cases (uncomplicated) 0.01 0.03
Unipolar major depression, episodes 0.60 0.30
Alcohol dependence syndrome 0.18 0.18
Parkinson disease cases 0.39 0.32
Alzheimer disease cases 0.64 0.64
Post-traumatic stress disorder 0.11 0.11
Angina pectoris 0.23 0.10
Congestive heart failure 0.32 0.17
Chronic obstructive lung disease, 0.43 0.39
symptomatic cases
Asthma, cases 0.10 0.06
Deafness 0.22 0.17
Benign prostatic hypertrophy 0.04 0.04
Osteoarthritis, symptomatic hip or knee 0.16 0.11
Brain injury, long-term sequelae 0.41 0.35
Spinal cord injury 0.73 0.73
Sprains 0.06 0.06
Burns (>60%) – long term 0.25 0.25
a
Adapted from Murray & Lopez (1996).
Burden of disease
YLD
• Back to alcohol abuse patient, the corresponding
DW=0.55 (i.e. a loss of 55 % of the potential healthy life
years lived during the 20 years of suffering from this
condition)
• For this patient,
𝑌𝐿𝐷 = 1×0.55× 60 − 40 = 11
• Hence, 𝐷𝐴𝐿𝑌 = 𝑌𝐿𝐷 + 𝑌𝐿𝐿 = 36

Burden of disease
Social weighting for DALY
• not all life years lost will be valued equally
• Age weighting
• e.g. A higher weight
Calculating is given to the
disability-adjusted life healthy
years life years lived in the (assumed)
socially more important life span between 9 and 56
• Time discounting
Table 2 Years lived with disability (YLDs), years of life lost (YLLs) ZAþLn
and year
• A healthy disability-adjusted
NOW is more life important
years (DALYs)
thanforin the
thealcohol
FUTURE use dis-
YLL ¼ M % KCxe!bx e!r
order example under different social value choices
A
Scenario [K; r] Age Discount YLD YLL DALY
weighting rate (%)
DALY [0; 0] No 0 11.0 25.0 36.0 where N equals the number

DALY [1; 0] Yes 0 12.3 16.7 29.1 deaths, and DW the disability
DALY [0; 0.03] No 3 8.3 9.7 17.9 factor equalling one if age w
DALY [1; 0.03] Yes 3 9.5 6.7 16.2 otherwise; A and L represent, r
and the duration (Eq. 6), or t
expectancy
“Calculating disability-adjusted life years to quantify burden of disease”, Devleesschauwer, et. al., 2014 at the age of death
Leading causes of Morbidity and Mortality in DALY

20 Leading Causes of DALY
Global
2012 2000
Rank Cause DALYs % DALYs DALYs per Rank Cause DALYs % DALYs DALYs per
(000s) 100,000 (000s) 100,000
population population
0 All Causes 2,743,857 100.0 38780 0 All Causes 2,872,910 100.0 46913
1 Ischaemic heart disease 165,717 6.0 2342 1 Lower respiratory infections 208,336 7.3 3402
2 Lower respiratory infections 146,864 5.4 2076 2 Diarrhoeal diseases 160,723 5.6 2625
3 Stroke 141,348 5.2 1998 3 Ischaemic heart disease 142,226 5.0 2322
4 Preterm birth complications 107,210 3.9 1515 4 Stroke 125,127 4.4 2043
3.6 1409 123,449 4.3 2016
5 Diarrhoeal diseases 99,728 5 Preterm birth complications
3.4 1306 102,031 3.6 1666
6 Chronic obstructive pulmonary disease 92,377 6 Birth asphyxia and birth trauma
3.4 1299 101,643 3.5 1660
7 HIV/AIDS 91,907 7 HIV/AIDS
2.9 1113 3.1 1460
8 Road injury 78,724 8 Chronic obstructive pulmonary disease 89,423
2.8 1081 2.7 1278
9 Unipolar depressive disorders 76,500 9 Malaria 78,246
2.7 1054 2.4 1129
10 Birth asphyxia and birth trauma 74,600 10 Road injury 69,139
2.2 838 2.2 1050
11 Diabetes mellitus 59,258 11 Unipolar depressive disorders 64,300
2.0 779 2.1 985
12 Malaria 55,111 12 Tuberculosis 60,339
2.0 762 1.9 903
13 Back and neck pain 53,920 13 Congenital anomalies 55,308
1.9 742 1.9 902
14 Congenital anomalies 52,532 14 Measles 55,249
1.7 673 1.7 818
15 Iron-deficiency anaemia 47,627 15 Neonatal sepsis and infections 50,067
1.6 617 1.6 763
16 Tuberculosis 43,650 16 Iron-deficiency anaemia 46,725
1.6 600 1.6 729
17 Falls 42,466 17 Self-harm 44,667
1.4 560 1.5 721
18 Neonatal sepsis and infections 39,646 18 Back and neck pain 44,169
1.4 556 1.5 719
19 Self-harm 39,358 19 Diabetes mellitus 44,060
1.4 545 1.5 681
20 Trachea, bronchus, lung cancers 38,535 20 Meningitis 41,725
http://www.who.int/healthinfo/global_burden_disease/estimates/en/index2.html
Developed vs. Developing countries

Leading Causes of Death
Ages 0-4: Ages 15-44: Ages 45-59:

Perinatal conditions HIV/AIDS Cardiovascular diseases
Developing Lower respiratory infections Unintentional injuries Cancers
Countries Diarrheal diseases Cardiovascular diseases Unintentional injuries
Malaria Tuberculosis HIV/AIDS
Perinatal conditions Unintentional injuries Cardiovascular diseases

Developed Congenital anomalies Cardiovascular disease Cancer
Lower respiratory infections Cancer Unintentional injuries
Countries Self-Inflicted Injuries Digestive Diseases
Unintentional injuries
Questions for Healthcare Technology

• What are the problems in healthcare today?
• Who pays to solve problems in healthcare?
• How can we use science and technology to solve healthcare problems?
• Once developed, how do new healthcare technologies move from lab to

bedside?
Rough flow through the healthcare system

Primary prevention
• preventive measures are taken prior to a first acute event and the actual
outbreak of a disease.
Treatment
Rehabilitation & Restoration
Secondary prevention
• After a first health-related event (e.g. a heart attack or a stroke), special
measures have to be taken, in addition to fighting the root causes, in order to
avoid reoccurrence.
Innovation in Healthcare Technology

• Organ-on-a-chip
Lung-on-a-chip, Harvard University
• Wearable Technology
Google glass on Surgeon

iWatch health monitoring

• 3D Printed Biological Materials
• Robotic Surgery 3D Printed organs
da Vinci robotic surgery system


• Cloud-based/AI healthcare system
• Prosthetic and Rehabilitation
• And a lot more …..

Management system for MD

Three complementary systems function together to ensure appropriate
introduction and use of health technology
• Health Technology Assessment (HTA)
• Systematic evaluation of properties, effects and/or impacts of health technology
• Inform policy-making in health care
• Improve cost effectiveness of new technologies
• Health Technology Regulation (HTR)

• Concerned with safety and efficacy
• Assessment of all significant intended and unintended consequences of technology used
• Health Technology Management (HTM)

• Concerned with procurement and maintenance of the technology during its life-cycle
Life Cycle of Medical Devices (MD)

• Community Health Issue
• Need for new clinical process or medical device
• R&D
• Design & Prototype, Product Development
• Manufacture and compliance to design standards
• Clinical Trial or Performance testing
• Regulatory Approval
• Market Acceptance and adoption
• Safety, Efficacy, Quality and Cost
• Application, use and maintenance, safety information
• Production/Device/Equipment condemnation or disposal
General Medical Device Control System

• Technology Assessment
• Clinical trial and biocompatibility
• MD Regulatory Registration Control
• MD design and manufacturing controls (ISO 9001/13485)
• Needs assessment
• Procurement, tendering and project implementation
• Acceptance testing (technical & clinical)
• Asset Control, Maintenance Controls, Configuration management and Preventive
maintenance
• Replacement Planning
• Training and Capacity Building
• Safety Management
• Commendation and Disposal
Life Cycle Management for Medical Device

National and International Standards
• ISO 13485:2003 (Quality Management System (QMS))
• ISO 14971 (Risk Management (RM))
• ISO 9001:2008 (Continuous Improvement)
• IEC 60601-1 (Electrical Safety)
• IEC 61010-1 (Lab Equipment electrical safety)
• IEC 61326-1:2012 (electromagnetic compatibility (EMC))
• IEC 62304 (SW) (Software as Medical Device (SaMD))

Lecture 1: Overview: Chung Tin, PH.D

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BME3104 Health Maintenance and Wellness Technology 1

What is Health technology?

Dr. Kannie W.Y. Chan

• The project should cover the following tasks:

Questions for Healthcare Technology

• Who pays to solve problems in healthcare?

• How can we use science and technology to solve healthcare problems?

• Once developed, how do new healthcare technologies move from lab to

Global Health Questions to Ask

• Global healthcare is getting more expensive

Health expenditure per capita (in US$)

Health expenditure per capita (in US$)

Trends in Global Healthcare world is projected to be aged 60 or over, while

• Better health care delivery for a 20

BME3104 Health Maintenance and Wellness Technology 14

Trends in Global Healthcare

• The proportion of older persons is

projected to more than double

worldwide over the next half century.

In 2050, up to 33% of the population

will be 60+ in developed countries.

Population aging is unprecedented in

Population aging is enduring. We will

not return to the young populations

that our ancestors knew.

Population aging is pervasive; it is a

problem of all world countries,

developed as well as non-developed.

Population aged 60 years or older

Trends in Global Healthcare

Trends in Global Healthcare

Most prevalent chronic diseases in the US

Trends in Global Healthcare

estimated to reach $1.07 trillion

Trends in Global Healthcare

Trends in Global Healthcare

Relevant Diseases/Health problems

Relevant Diseases/Health problems

Relevant Diseases/Health problems

Relevant Diseases/Health problems

Relevant Diseases/Health problems

Example of Health Data

World Health Organization

Headquarter of WHO (copyright: WHO/P. Virot)

Functions of the WHO

6 Priorities of the WHO

Uses for health measures

• Monitor progress toward goals

Types of health data

Quantitative measures of health

𝐴𝑛𝑛𝑢𝑎𝑙 𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒 𝑅𝑎𝑡𝑒

# 𝑛𝑒𝑤 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑎 𝑑𝑒𝑓𝑖𝑛𝑒𝑑 𝑐𝑜𝑛𝑑𝑖𝑡𝑖𝑜𝑛 𝑖𝑛 𝑎 𝑑𝑒𝑓𝑖𝑛𝑒𝑑 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑖𝑛 1 𝑦𝑒𝑎𝑟

Quantitative measures of health

# 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑎 𝑑𝑒𝑓𝑖𝑛𝑒𝑑 𝑐𝑜𝑛𝑑𝑖𝑡𝑖𝑜𝑛 𝑖𝑛 𝑎 𝑑𝑒𝑓𝑖𝑛𝑒𝑑 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑡 𝑎 𝑝𝑜𝑖𝑛𝑡 𝑖𝑛 𝑡𝑖𝑚𝑒

Quantitative measures of health

• Infant mortality rate

Quantitative measures of health

Quantitative measures of health

• For example, a female patient develops severe alcohol use

Burden of disease Table 3.1 Examples of disability weightsa

• Examples of DWs Disease or sequelae Mean disability

• Hence, 𝐷𝐴𝐿𝑌 = 𝑌𝐿𝐷 + 𝑌𝐿𝐿 = 36

DALY [0; 0] No 0 11.0 25.0 36.0 where N equals the number