Anna Alex – PHAA intern
The world is witnessing an era of accelerated and interlinked environmental, technological, economic and societal transformation, brought on by the impacts of the COVID-19 pandemic and climate change. In such a scenario, health futures unfold increasingly linked to these changes.
The past two years have significantly altered the functioning of health care systems worldwide and in turn our understanding of them. The pandemic resulted in the development and dissemination of information about the virus, diagnostics and vaccines globally at record times and increased the uptake of digital health worldwide. One might even argue that the pandemic provided the much-needed thrust to propel the utilization of telehealth services that had so far instigated a scarce market and significant pushback from both professionals and consumers of the healthcare system.
It is expected that over the coming years, most governments will invest in and aim to integrate healthcare with digital health. In essence, the current trajectory of developmental transformation across all sectors portrays a largely digital future, wherein digital technologies influence and integrate into all aspects of human life. The health sector takes on a vital position in this transformation owing to the growing value of health data and the need for innovative digital health solutions.
Digital transformation in the health sector, however, can result in both positive and negative consequences. These consequences may either be a result of direct effects of digital technologies on health service delivery, self-monitoring of health status and behaviours; or through indirect effects on the social determinants of health through environmental, social and commercial influence of digital technologies.
Expected benefits of digital transformation include closing the gap of services for remote geographic locations, aid self-monitoring of health status and behaviour by users, promote routine use of monitoring devices for vital signs and symptoms and assist targeted communication of health information for vulnerable communities.
On the other hand, digital transformation may result in inequitable access to digital technology and digital literacy, human rights infringements due to privacy concerns about the use of health data, targeted advertising of unhealthy food, wide-spread generation and dissemination of misinformation and social isolation/alienation.
Increasingly, it is also being recognised that access to digital technology and literacy can influence health outcomes due to the varying levels of digitalization across all aspects of human experience (such as social and community networks and the socioeconomic, political and environmental spheres of life). The digital environment is thus positioned as an important determinant of health in itself. This is especially true for children and young people, who have the highest exposure to digital technologies and largely represent the first digital generation.
Impacts of the use of technology on human health in research normally focus on social interaction and mental health consequences. However, it is also important to consider the growing disadvantage caused as a result of inequitable digital access and literacy. For example, lack of digital and connectivity access was identified as a major barrier to education, telehealth services, and dissemination of important health information during the COVID-19 pandemic. The interconnectedness of digital transformation with social determinants of health threaten to further increase pre-existing inequities if not managed carefully. In a fast- transforming world, children and young people living in digital disadvantage risk missing out on crucial life opportunities, information and a sense of identity and belonging in a digital age.
Digital transformation of health and health services thus present enormous challenges and opportunities. Associated with clear social and political costs, moving forward it is pertinent to implement safeguards that adequately address the concerns raised as per above. These safeguards must provide for a public purpose in implementing new technologies over short-term economic gains. As suggested by the Lancet and Financial Times Commission on governing health futures 2030, the following suggestions can provide a starting point to tackle some of the forecasted issues of digital transformation of the health sector.
Firstly, public health and Universal Health Cover (UHC) needs to be reimagined to reflect the reality of a digital world. This entails expanding the breadth of services covered by UHC and working towards an equitable distribution of digital health technologies that are economically feasible and ensure decentralized and democratic control of data systems.
Moreover, it would be worthwhile to place children, their needs and priorities at the forefront of the discussion on digital futures. Shifting focus towards children’s needs and priorities will address the role of digital technologies as determinants of health in early childhood, crucial for reducing the social and economic burdens of disease later in life. The subsequent health and wellbeing outcomes of children and young people will reflect on the capacity of society to harness digital transformations in support of UHC for all people.
Secondly, a greater recognition of digital technologies as determinants of health is required by policy makers, medical professionals and academics. In response, a governance structure promoting “health for all” should be developed to safeguard the rights of individuals, regulate powerful stakeholders, promote accountability and enhance trust in digital health.
Thirdly, health data collection and utilization should align with the aim of promoting the public good and building a culture of data justice and equity. Lastly, the materialisation of an equitable digital healthcare sector will require further investment in the enablers of digitally transformed health systems and objective with clear roadmaps on how to achieve them.
Digital transformation in the health sector is inevitable and may soon become the norm. If planned properly, it will result in a plethora of positive, life altering benefits as has been witnessed with technological advancements in medicine throughout history. Digital health technologies will aid in the prevention of disease, help reduce healthcare costs and enhance patient participation in their health through self-monitoring practices. To ensure these benefits are enjoyed by all in an equitable manner, it is necessary to have a future focus, remove barriers that unjustly disadvantage certain communities and safeguard the rights of the population.