The question any member of The Medical Futurist team faces most often is this. Will digital health tools help solve the health inequity issues? If you are not into long articles, here is the short answer: they might, but not right now and not obviously.
Based on the ever-growing amount of quality data on the subject, two trends are present. In some cases, in some countries, in some, traditionally underrepresented groups of developed societies, digital health tools are indeed closing some gaps by providing opportunities for leapfrogging. One great example is how Ghana has overcome lacking infrastructure by using drones for various tasks, like delivering vaccines or blood. Another one is how women of colour in the US show a consistently growing adoption rate of digital health tools. Researchers believe this might be a response to worse than average health outcomes they experience in the traditional healthcare system.
Despite these examples, most of the data paints a grim picture. Figures indicate that underrepresented and/or disadvantaged (poor, rural, minority, women, LGBTQ, etc) groups have significantly less access to all the cutting-edge solutions digital health offers. Thus the gap is not only not closing, but it’s rather further widening right now.
Digital health literacy? What is that?
The three definitions below are vital to understanding what digital health can and can’t do.
Health literacy. The individuals’ ability to find, understand and use information and services to make informed health-related decisions and actions for themselves and others.
Digital health literacy. It is pretty much the same, but with the use of online tools and sources. Officially: “the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem”.
Health equity. Health equity is achieved when everyone can attain their full potential for health and well-being.
Why is that important? Well, for many reasons. If a person experiences worrying new symptoms, their (digital) health literacy skills will be a major factor in determining how they will proceed, and ultimately, when and what kind of treatment they seek. It will determine how efficiently they will find relevant information, and how well they can differentiate between reliable and sub-par sources suggesting different treatment options.
The same skills are required to understand the importance of health management, the use and benefits of wearables and the data they provide, how telehealth apps can support managing chronic conditions and so on. Of course, at the end of the day, it all boils down to structural inequities. If I’m lacking basic literacy and money, I will certainly not be a target customer for an intricate and expensive smartwatch offering complex health data collection and bespoke monthly subscriptions with access to first-tier specialists analysing my data.
I’m sure you get the point. A digital health tool is just a digital health tool. On its own, it does nothing. The theoretical possibility of advanced arrhythmia screening will only result in tangible health benefits if people will have access to the tool and have an understanding of its use and the benefits it can provide.
No arms, no chocolate
As in the incredibly absurd classic French joke, digital health tools of today albeit having the potential to bring care to those without access – are in practice delivering the most for those who need it least. Urbanite, wealthy, well-educated patients, who can afford to buy the gadgets and the accompanying services, who can do their research and so on. According to surveys, digital health currently helps those who have the best access to healthcare in all other channels as well.
In order to reach the full potential of digital health tools, the most important factor (by far!) is to help people using them. This can be done by dedicated healthcare professionals, and centralised initiatives aiming to train members of communities who can mentor their peers.
Train the patients, train the trainers
For healthcare professionals dedicated enough to care the first important factor is to identify patients with low digital health literacy. Experts suggest a list of useful questions to do that. Knowing if a patient is available via e-mail, if they have broadband internet access, if they know how to download an app and so on.
Patients who get “flagged” – not using e-mail is a sign that they might need more-than-average support – can best benefit from very specific, hands-on advice from their practitioners. Instead of suggesting they use this or that app, showing how to download and how to use the specific app will result in a much larger engagement and adherence.
Instead of mentioning the possibility to schedule visits online, walking them through the process will be a more efficient form of help. Instead of suggesting to read more about the benefits of their special diets, suggesting specific information sources they can trust will be significantly more helpful.
Of course, we can’t allocate a full-time professional health mentor to everyone. This is where the ‘train the trainers’ models can shine.
We can train members of communities, who will be able (and willing) to pass over the knowledge to their peers. If I have learned how to use the online scheduling system, I will be able to show it to my husband. If I know that there is an app for managing diabetes and know how to use it, I can explain it to my neighbour who has the condition. If I was educated about how smartwatches can be used to monitor cardiac parameters, I can teach my coworker with blood pressure problems why he might want to buy one and what to look for when using it.
There are some interesting initiatives along these lines. NHS launched a program to train digital health mentors, although this aims at healthcare professionals at the moment. This study shows real-world positive results of peer-to-peer mentoring for diabetes patients.
Disruptive technologies have a tendency to widen gaps – before closing them
It is hard to predict the rate at which digital health becomes reality for everyone. But thinking back to what we know about former examples of how disruptive – not that anyone called them that then – technologies spread, we see a tendency that they tend to widen the gap at first but close them later.
From electricity to washing machines, from polio vaccines to mobile phones – there was a period for each when the benefits were only available for a small group of people, but eventually they became the norm.
The post Will Digital Health Widen Or Close The Health Inequity Gap? appeared first on The Medical Futurist.