“We need to stop talking about digital health and need to [start] talking about health in a digital age,” urged Dr. Stefan Germann, chief executive officer of Fondation Botnar, during his address at the sixth annual Global Digital Health Forum, which was held December 9–11, 2019. He encouraged the community to embrace the reality that digital technology is an integral and inseparable part of health and wellness rather than a specialized part of health care delivery.
Throughout the Forum, presentations and discussions focused on realities of the digital age that need to be confronted if digital tools are to reach their promise of improving health care quality and access. Themes included the following:
- Youth as digital natives want to use technology to improve their health; but digital tools for health often are not designed with their input and do not consider their unique needs.
- Technology companies have a gender imbalance and are concentrated in developed countries; this leads to technology that is designed with inherent biases and blind spots.
- Achieving Universal Health Coverage by 2030 depends in part on efficiencies that can be created when people address some of their health care needs through digital tools rather than at in-person consultations. More applications that allow for self-care are needed to empower individuals to take control of their own health.
(Left to right) Dr. Stefan Germann, Fondation Botnar; Erica Troncoso, Jhpiego; and Dr. Henry Mwanyika, PATH, participate in a panel at the 2019 Global Digital Health Forum. Photo: Christopher Neu
Digital tools for health need to be designed with youth and for youth.
On the African continent, young people between ages 15 and 24 are estimated to make up 20 percent of the population. In India, half the population is under 25. At the Forum it was discussed that adolescents have had poor experiences when seeking out health services in traditional settings and want to be able to address some of their health care needs through the digital tools that are already an integral part of their lives. Sylvia Wong, innovation lead at the United Nations Population Fund, discussed a poll they conducted with youth to determine what health resources young people want to see available via mobile phone. Findings show that youth want:
- On-demand sexual and reproductive health information.
- Ways to connect with and ask questions of peers.
- Resources for finding adolescent-friendly health services.
In addition to crowdsourcing information from youth to understand their needs, makers of digital applications for health need to do more to involve youth in the design and testing of tools and establish ways for youth users to provide consistent feedback, such as youth advisory councils.
“Adolescents want to be able to address some of their health care needs through the digital tools that are already an integral part of their lives.”
The lack of diversity among designers and developers leads to technology tools that have fundamental design flaws.
Technology is only as good as those who design it. For instance, a bias was discovered in an artificial intelligence-enabled resume review system, which penalized female-sounding names because the system had been taught using resumes from mostly male candidates. Ashley Bennett, lead governance officer in the Center of Digital and Data Excellence at PATH, in her Lightening Talk titled “Mind the Equity Gap,” explained that issues with technology such as those with the resume system aren’t bugs. “These are the way the technologies are designed. And we need to acknowledge that and work to address it,” she said. To learn from past mistakes, the designers of digital health applications should:
- Ensure that all people, including women and minority populations, are given equal importance in the design and development of digital tools.
- Engage in user-centered design processes when developing new tools to ensure that the needs of a diverse range of potential users are considered.
- Support efforts to diversify the technology workforce.
Digital tools and approaches can support a new era of self-care.
Digital tools can allow people to improve their health by providing them with on-demand health information and applications for self-care. The World Health Organization defines self-care as “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider.” Successful approaches supporting self-care have included text message reminders being sent to patients with conditions such as HIV/AIDs or tuberculosis to help them remember to take medication and visit a facility at the right time. These automatic reminders take this follow-up responsibility away from nurses or community health workers, allowing them to spend their time on other tasks and work with other patients. Today, smartphones allow for more sophisticated self-care tools, such as these presented at the Forum:
- mDoc, which has been rolled out in Nigeria and allows individuals with chronic conditions to track health indicators such as blood sugar levels and connect virtually with nutritionists and health coaches to get health advice.
- Nivi, which uses an artificial-intelligence-enabled chatbot to answer reproductive health questions and make referrals to partner clinics. It has been tested with youth in Kenya and India.
In addition to developing appropriate tools, education and awareness raising are needed to help individuals understand what tools are available and how they can effectively and safely use digital tools to manage their own health. As digital tools for self-care become more accessible, citizens will be increasingly empowered to identify health problems before they escalate and reduce unnecessary visits to health facilities.
Where do we go from here?
There is no question that we exist in a digital age that has fundamentally changed how we get information, communicate with one another, and care for ourselves. Technology can be an enabler of better health and wellness. Now is the time to ensure diverse voices are engaged in defining what digital tools are needed and ensuring that tools are designed to empower a wide range of users to take control of their own health.