In less than a year, the internet has become the main highway for healthcare access, but who has access to this highway? Are we all driving on paved roads? Is everyone able to navigate the signage?
The WHO defines health as a resource for everyday life, and digital health has promised to supercharge this resource with more tools (wearables, trackers, monitors) and information (nutrition insights, biometrics, health education) - but is this resulting in wellness for everyone? Who is being left out?
The digital divide refers to the gap between those able to benefit from the digital age and those who are not.
The promise of digital health being a gateway to more accessible, equitable health has been made for the last decade. Beyond the buzzwords, what will it take for innovations to really support healthier people and safer societies?
Dr. Nitin Mohan is a physician epidemiologist who joins our futures community to help us unpack these promises from a public health perspective. Dr. Mohan completed a Masters in Public Health after his MD, specializing in infectious disease surveillance and preventative medicine, giving him a unique perspective for this conversation. As a partner at ETIO Public Health based in Toronto, Canada he also routinely works with cross-sector stakeholders navigating a changing health system.
In the clips below, Dr. Mohan helps us understand how equity needs to be baked into our design processes so we bring everyone into this emerging digital health system. As we learned from experts over the last year of conversations on the future of healthcare, the potential of technology is only realized when we understand the patients it’s designed to serve.
What does equity by design look like in healthcare?
One of the most basic building blocks of equitable digital health is access to reliable high speed internet. According to Microsoft, approximately half of the US population, mostly living in rural areas, have slow or unreliable internet connections. While the United Nations has labelled internet access as a basic human right, governments around the world are struggling to invest in infrastructure and this issue remains at the core of equitable digital health. For instance, Chawathil First Nation lies just 600 metres north of the Trans-Canada Highway in southwestern British Columbia but feels much more remote when you are trying to get online. Residents shared that it takes nearly two minutes for a webpage to load, and once it does, the download speed is an agonizingly slow one megabit per second (Mbps).
Even with an internet connection, the access challenges are complex. A recent research study compared the demographics of patients who completed telemedicine visits against those who missed or cancelled appointments. Of the 1000 visits that were tracked, and over half (54%) were cancelled. These no-show appointments belonged to predominantly uninsured patients who were also more likely to be from minority groups. These patients were 3x less likely to be able to connect with their doctor for a virtual video visit, and this jumped to 5x less likely if they did not speak English.
In the face of this digital divide, how can we build a digital health ecosystem that serves these groups? In our first clip, Dr. Mohan shares the steps we can take to “build for everyone” in healthcare.
Slower, scalable solutions may not make headlines, but they bring everyone along the innovation journey. The Silicon Valley adage “Move fast, break things” won’t work in healthcare, we can’t break a system that people rely on, and we can’t move faster than the patients we are designing for.
Meeting overwhelm with education and anticipating reactions of fear, distrust, and confusion are part is the only way forward. This is especially important among older, less digitally savvy populations, but also applies to younger consumers who are increasingly concerned about data privacy, surveillance ethics, and cybersecurity.
A timely example of this breakdown in public health education can be seen in the roll-out of Canada’s COVID-19 tracing app. Dr. Mohan shares his reflections on why the app failed in Canada and how public health innovators can learn from this experience.
How do we build a more equitable future?
"Science and technology revolutionize our lives, but memory, tradition and myth frame our response." -- Arthur M. Schlesinger
As we begin a long post-pandemic recovery, we’ve seen the critical role public health plays in our society. The ways we share information, make sense of the news, and connect with each other have been evolving over the last 10+ years, but our governments have not kept up - so, what does an integrated approach to public health look like in the future?
Public health can help innovators take a systems approach to their work, by understanding the intersecting social forces impacting patients. These perspectives can support more inclusive design features and foresee consumer pain-points, leading to more equitable solutions.
In our last clip, Dr. Mohan shares why public health should have a seat at the table whenever a population-based intervention or product is being considered.