Going Digital: Who’s Getting Left Behind as Healthcare Innovates?

By Elena David
Social Connectedness Fellow 2017

We live in a digital age, with technology integrated into nearly every aspect of our lives. We have apps that tell us when our train arrives, we can have our groceries shipped to our front door with the click of a button, and we can make video calls to anyone, anywhere, at any time. The medical world has followed this trend, and new advances in digital health are rapidly breaking their way into traditional medical practices.

“Digital Health” is the incorporation of digitized technology into healthcare practices. The possibilities are endless, with technologies ranging from sensors that continually monitor the vitals of newborns in the NICU, to apps that assess health risks using online surveys completed by home elder-care staff, to Reddit support groups for people with mental illness.

The field is booming: across North American cities, digital health start-ups are popping up and funding for medical I.T. is abundant. While the future looks promising for the digital health world, the important question is this: will the needs of the most vulnerable populations be addressed or forgotten?

A handful of cities are charging the frontlines of the digital healthcare market. Last year San Francisco, a faithful hub of new technology, saw $1.6 billion invested across 116 digital health companies. Boston, a city known for advancements in both tech and medicine, came in a close second with $966 million of venture capital funding directed towards these projects.[i] The city of Boston also allocated $250,000 of public funding towards two digital health innovation labs, as well as a 33-person Digital Healthcare Council.

The market is estimated to be worth $32 billion within the next decade, and investors are looking to get a piece of the pie.[ii] With so much at stake, however, the companies currently getting the most funding and support are those that are profit-driven and looking to get the best return. While the field holds promise and hope for the future, the concern of vulnerable populations being excluded from participating in these innovations is very real.

We can look to a phenomenon called the “Digital Divide” to explain why many vulnerable populations are excluded from the digital marketplace. The Digital Divide shows the discrepancy of Internet use across demographic lines, the most significant being income, age, race and geography. Of individuals living on less than $25,000 a year, only 57% have access to broadband Internet. Seniors are among those least likely to be Internet users — for example, only 49% in the US — often due to lack of financial or physical ability and technological illiteracy.[iii] Black and Hispanic populations have 16% and 11% lower Internet usage than white households in the US, respectively;[iv] and in rural populations, there is 6-9% lower Internet access as compared to urban households.[v]

It is these same populations that are disproportionately afflicted with chronic disease. Low income, minority and elderly groups are significantly more likely to suffer from physical and mental illness, and comorbidities are far more common in these groups. Health burdens are closely tied to economic and social obstacles, and may even exacerbate them due to the high cost of medical treatment and medication.[vi] Because of this, these underserved populations are great candidates for digital healthcare tools, but only if developers make them accessible for everyone.

Some of the most significant problems that need to be addressed are lack of Internet access, inability to purchase a home computer or other expensive technology, lack of technological or medical literacy, and language barriers.[vii] A Fitbit, for example, might be a great tool for a diabetic looking to track their fitness and nutrition performance, but someone struggling to afford rent is a highly unlikely consumer of this product. Similarly, a Spanish speaker will have little use for an informative online health guide that is only published in English. Thus, it is crucial that these limitations are taken into consideration as the world of digital medicine expands.

A number of projects are paving the way for inclusive and accessible health technology. For example, a company called Text4Baby sends expecting mothers customized text messages that address maternal health in English or Spanish. While not everyone has access to a computer or Internet, the prevalence of mobile phones in low-income communities is rapidly rising. More than 8 in 10 low income adults both have a mobile phone and use it for texting,[viii] so a service like Text4Baby can reach a wide range of mothers.

Another inclusive project called Polyglot Systems aims to improve medical literacy. The website has educational and informative programs that break down medical terminology, diagnoses, and medicine use in a clear and concise way. Polyglot is available in 18 languages and includes image guides for visual learners and those with low literacy levels. Digital healthcare for underserved communities exists, and these platforms can and should be used as a model for the future of the field.

Digital health holds an immense potential moving forward. It can revolutionize the healthcare industry, especially in a time when the future of healthcare in America is unclear. It is important, however, that this emerging industry does not act to widen the gap of health disparities for vulnerable populations. The people who are currently underserved cannot afford to fall behind further as the rest of the population benefits from innovative health resources. As developers and investors look to capitalize on a hopeful market, it is crucial that inclusivity and accessibility are placed at the forefront.

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[i] Mack, Heather. “StartUp Health: Digital Health Funding Reached $8B in 2016.” MobiHealthNews. 03 Jan. 2017. http://www.mobihealthnews.com/content/startup-health-digital-health-funding-reached-8b-2016

[ii] Ibid.

[iii] Caumont, Andrea. “Who’s Not Online? 5 Factors Tied to the Digital Divide.” Pew Research Center. 08 Nov. 2013. http://www.pewresearch.org/fact-tank/2013/11/08/whos-not-online-5-factors-tied-to-the-digital-divide/

[iv] “Mapping the Digital Divide.”  Council of Economic Advisers Issue Brief (2015). https://obamawhitehouse.archives.gov/sites/default/files/wh_digital_divide_issue_brief.pdf

[v] Carlson, Edward, and Justin Goss. “State of the Urban/Rural Digital Divide.” National Telecommunications & Information Administration (2016). US Department of Commerce. https://www.ntia.doc.gov/blog/2016/state-urbanrural-digital-divide

[vi] “Vulnerable Populations: Who Are They?” The American Journal of Managed Care 12.13 (2006). http://www.ajmc.com/journals/supplement/2006/2006-11-vol12-n13suppl/nov06-2390ps348-s352/P-1

[vii] Sarasohn-Kahn, Jane. “Digitizing the Safety Net: Health Tech Opportunities for the Underserved.” California Healthcare Foundation (2016). http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20D/PDF%20DigitizingSafetyNet.pdf

[viii] Ibid.