CHAPTER ONE
INTRODUCTION
1.1  Background of the Study  Health and well-being are complex matters. At the individual level, health care serÂÂÂvices, wellness, and behavior all impact health and well-being, but at the population level so too do social and economic policies and politics. The link between “economic well-being†and “health/well-being†is accepted. Countries differ substantially in their levels of health and well-being, but in general terms those countries with higher well-being are those that are more economically developed with higher personal income leading to better health. Increasingly, the link between use of information and communications technolÂÂÂogy (ICT) and the future of health and health care is acknowledged, if not broadly accepted or integrated. Use of ICT in health is termed e-health (WHO, 2014). The first significant and systematic use of e-health was primarily for military and space applications, but its use has steadily broadened. Bringing any innovation to maturity is a challenge, yet this seems inexplicably so for e-health, particularly telehealth, which, in various guises, has been “in development†for well over 100 years, (Shabde, 2016). Indeed, the first use of “ICT for health†may have been in the 1860s when telegraph messages were sent to seek help for treating wounded soldiers during the American Civil War – nearly 155 years ago (Bashshur, 2011). Arguably e-health comprises four main elements: • e-commerce (the business side) • e-learning (the training – awareness, teaching, instruction, and education – side) • Health informatics (the data gathering, storage, analysis, and distribution side) • Telehealth (the interactive – real-time or store-and-forward – side). Investment in innovative e-health research, followed by adoption and integration of proven e-health solutions, is becoming a key aspect of sustainable economic development and health system restructuring, particularly for the develÂÂÂoping world.4 Yet a primary issue remains – what e-health solutions should be invested in? The focus of this paper is on one element of e-health – telehealth. However, any technologically appropriate and culturally sensitive solution based on health “need†may, in fact, require different proportions of all four elements. In general, speaking of “e-health†solutions is more appropriate than speaking of telehealth, health informatics, e-learning, or e-commerce as individual solutions. e-Health is often used in this paper as the overarching term, with specific reference to individual elements (especially telehealth, and m-health) as and when more focus is necessary. Definitions – and misuse of terms – abound (Fatehi, 2012). A generic definition for the element of telehealth is used here. Telehealth is the use of ICTs to exchange health information and provide health care services across geographic, time, social, cultural, and political barriers. Telehealth encompasses activities often termed telemediÂÂÂcine, telecare, or telehomecare, among others. Regardless of the term used, it is important to understand the breadth of technology, application, and role of telehealth. For example, telehealth: a. uses any form of ICT device (from a desktop PC, through laptops and i-pads, to smart devices and sensors); b. covers preventative, promotive, and curative aspects of health; c. uses simple or complex multimedia to videoconferencing to virtual reality; d. can be interactive (synchronous – “real-time†person-to-person or person-to-software engagement; or asynchronous – delayed messaging such as e-mail); e. engages and links all types of users (from highly trained clinicians to minimally trained community health care workers (CHWs), to patients, to the general population); and f. can be used as an alternate or complementary approach for almost any health issue imaginable.