“People underestimate the amount of innovation going on,” said Bill Gates at the mHealth Summit in Washington, D.C. today. “They assume tech remains the same.” Given the thousands of attendees walking around the floor to see the mobile technology on display, there will be more awareness of what’s happening by the end of the day. Those listening to Gates in person or online could take away a few more lessons as well.

First of all, the key applications in the mobile health world are those that are tied to better outcomes, said Gates. Metrics like the number of children dying is one such metric, he said, and could be mitigated by mobile apps that register every birth on a cellphone to track vaccine coverage. Tracking supply chain for medical supplies and online medical records also can lower key metrics like child mortality, said Gates. Highlights from Bill Gate’s keynote conversation with Dr. Kristin Tolle are embedded below:

“In general, the world underfunds research because the person who takes the risk doesn’t capture the full benefit,” said Gates. “Government comes in for things the market doesn’t work well on.” Some research and development simply won’t get funded otherwise, in the absence of a strong profit motive. That’s likely one reason the Gates Foundation has focused on malaria, a disease that big pharmaceutical companies haven’t put significant resources behind.

“As the world goes from 6 billion to 9 billion, all of that population growth is in urban slums,” said Gates. That context provides a target for innovation in mobile healthcare technology, particularly given the increasing penetration of cellphones. Improving mortality rates is also relevant to that burgeoning population, he reflected. “Within a decade of having better health outcomes, people decide to have less children,” said Gates. citing the research of Han Rosling. Rosling’s TED Talk is below:

http://video.ted.com/assets/player/swf/EmbedPlayer.swf

What’s the medical challenge for the aid community to target? “Funding vaccines is so clear,” said Gates. Polio may not get eradicated because of a  lack of funding, he said, reflecting on “going begging” around the world to try to get the last $800 million dollars for vaccine.

What’s next? Where will innovation be happening and change how societies work? “Now the idea is to do digital transactions where you don’t use currency at all,” said Gates, pointing to M-PESA in Africa and the huge growth in mcommerce.

Those changes may not be proportional to the greatest needs, however, nor grounded in the traditional frame of ‘first world vs developing world.’ According to Gates, “middle income countries are where the most innovation in healthcare is going to happen.” The poorest countries need to address the true basic for survival before mhealth can make progress.

In richer countries, meaningful change is already happening because of mobile apps. Some of those innovations are just beginning to filter in. “What percentage of people have to be put in longterm care, versus have someone stop by?” asked Gates. Cellphones already enable new monitoring capabilities for seniors, children and caregivers; he anticipates better sensors and connectivity to change how we communicate and watch one another even further in the decades to come.

In a bid for the hearts and minds (and perhaps wallets) of the entrepreneurs present, Gates observed that conditions like obesity, diabetes and smoking cessation are good candidates for mobile health technology to address in rich countries.

He also appealed to officials making decisions on government policy and funding decisions.  “The degree that health and education go together – I don’t think that’s surprising,” he said. “We should invest in both.”

Asked to reflect upon where to invest next, Gates was clear: “If you just pick one thing, it’s got to be robots,” citing improvements in robotic mobility, dexterity, productivity and the growing needs of both an aging population and childcare.

He also reflected upon the future hinted at by the increasing use of big data tools to deliver insight. “Our ability to discover drugs using computation – that is changing,” he said. “In a ten to fifteen year period, it will be utterly different.”