Matt Hancock and NHS England are not the only eager advocates of digital technologies.

In June this year WHO Director-General Dr. Tedros Adhanom Ghebreyesus argued that “harnessing the power of digital technologies is essential for achieving universal health coverage.”

However a Tek4HealthEquity conference in New York early in November has served to flag up some dangers that the fans of digital solutions are keen to brush aside.

A report from this conference by the Antwerp-based International Health Policies Network (IHP Network) warns that “rampant commercialisation and weak regulation challenge the ideal of digital public goods capable of reducing inequalities.”

The authors point out that enthusiasm for digital health solutions reflects the broader technological optimism that has long characterised the global health field.

But it is “founded in the belief that market-based solutions and innovation-driven development will produce cost-effective solutions to solve the world’s problems.”

Discriminatory

They report that presentations at the conference highlighted “discriminatory design, high costs and weak regulations” as some of the challenges to the idea of digital public goods capable of reducing global and national-level inequities in health.

The conference’s starting point was that digital technology is not neutral, “but is developed and deployed in specific social and political contexts, and is therefore susceptible to built-in biases, which can become embedded in the technology itself.”

“A study recently published in Science revealed that an algorithm used by American hospitals and insurance companies to enable treatment that is more efficient systematically discriminates against black patients.”

And “while commercial actors often reap heavy rewards, the solutions are not necessarily cost-effective for public authorities, nor do they always have proven health benefits.”

Health care is facing a “technological wild west” in which ownership is concentrated among a few, dominant tech companies like Google, Facebook and Amazon combined with non-existing or inadequate legal and regulatory frameworks.

As a result, the authors argue “Before we conclude that digitalization benefits vulnerable individuals and accelerates improvements in global health equity, we need a closer look at which kinds of technologies are developed, for whom and with what purpose.”

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John Lister
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