LAC is one of the most unequal regions in the world. It has sharp income disparities, and gender, race, and ethnicity are strong determinants of who accesses healthcare, education, and employment in the region.1 Under these circumstances, there is a highly relevant debate on whether growing use of technology can reduce inequality and close social gaps or instead exacerbate and deepen them.
How can we encourage the former and avoid the latter?
It is first necessary to understand the two major areas of the equity agenda as it relates to DT in the region. On the one hand, countries must address the severe digital divide, which includes lack of access to digital tools (like internet connections or smart phones) and lack of knowledge or skills needed to use those tools. This issue is also related to structural aspects of the health system. For example, in fragmented systems, the system subcomponents with more resources will be the first to be transformed, widening existing quality gaps.
On the other hand, countries need to make sure they develop and use data-based technology in a way that promotes inclusion and respects the population’s diversity in terms of gender, age, race, nationality, ethnicity, sexual orientation, disability, and socioeconomic level. This requires eradicating data poverty,2 which limits the ability of people, groups, or populations to benefit from a discovery or innovation because of a lack of fully representative data. Additionally, when this data is fed into algorithmic decision-making systems and artificial intelligence systems, the resulting actions can be exclusive, inefficient, or even damaging to certain people and groups
“Every system is perfectly designed to get the results it gets.”
- Dr. Paul Batalden -
How can a tablet support health monitoring in remote areas?
The digital divide in LAC
While LAC’s digital ecosystem (infrastructure, technology use, and public policies) enjoys an intermediate level of development,350% of the population (300 million people) does not have a computer at home or a fixed broadband connection, and only 9.9% of households have a high-quality fiber-optic connection.4 Meanwhile, only 4 out of every 10 rural Latin Americans has internet access options, compared to 71% of the urban population.5
As for technological skills, an estimated 30% of people do not regularly use the internet; a large percentage of the adult population has little to no experience with computers (ranging from 25.2% in Chile to 43.6% in Peru); 6 and only 1/3 of workers use computers, smart phones, or other ICT tools in their job once a week or more.7 These challenges are compounded by the fact that certain groups are severely excluded from accessing and using technology. Examples include Women, people with disabilities, or older people. Other factors that fuel inequality, like limited schooling, poverty, ethnic origin, and race, further aggravate this exclusion.
Learn how cloud-based technology is reducing inequalities un Latin America.
The digital divide and data poverty impact all levels of the health sector. They limit people’s access to tools and services for preventing diseases and providing care. They restrict healthcare providers’ ability to efficiently offer services to the entire population. They also hamper equitable participation in the workforce, as well as fair and informed decision-making and resource allocation that benefits everyone. These inequalities are also perpetuated by a growing reliance on algorithms for decision-making that can be based on biased data, or data with limited or biased information on certain population groups.8 Unless digital technologies are intentionally deployed in an equitable and inclusive way, these imbalances will only grow.
What does artificial intelligence mean for the health sector?
"Knowing the origin of the data used is crucial in order not to increase health disparities"
Initiatives like fAIr LAC have already made important progress on identifying how to address these challenges and on developing tools to make the most of artificial intelligence, while avoiding negative equity impacts.
Promises and Chalenges
The potential of DT
Well-designed DT change systems because they affect key processesthat are flawed. They can prompt new behavior in patients and providers to enhance self-care and the quality of care. They can facilitate tasks shifting, helping medical workers with limited training to make decisions and adapt procedures at the point of care by relying on digital tools. They can improve the flow of information and promote more access to data, increase its transparency, and improve feedback for data. Most importantly, when DT of health care are coupled with an equity and inclusion agenda, they can reconfigure the system’s objectives to tackle inequality at its core and extend benefits to the entire population.
In addition to simultaneously driving an expansion of infrastructure, enabling regulations, and ICT skills, DT processes can help maximize the use of healthcare systems’ existing digital resources and skills. For example, while over 84% of people in LAC have a smart phone with internet access, only 69% use them.9 DT tools and processes can enhance the efficiency of SMS as a way of getting the right healthcare information to the right person at the right time.
The digital component also allows systems to provide more and better service to people unfamiliar with ICT by using, for example, an intermediary (like a social worker) who can use telehealth and telemedicine to connect a doctor or specialist in the city with a patient in a remote area.
It is imperative to design and implement long-term digital transformations of healthcare that involve intentional and profound steps in the areas of people (including education and training), processes (including governance and regulations), and technology (infrastructure and infostructure) to address the current situation of inequality and exclusion.
Countries’ role
Promoting digital equality and inclusion in health requires public and private stakeholders, academia, civil society, and multilateral organizations to take a collective and collaborative approach that prioritizes the necessary commitment and investment, knowledge exchange, and, whenever possible, shared objectives and standards for their activities.
The solutions will vary from country to country based on the needs, resources, and healthcare system, but all countries should address the core issues outlined in the call to inclusive digital health. Inclusivity is one of the PAHO’s 8 guiding principles of the digital transformation of the health sector, and this principle includes a call to seven key actions:
- Include gender criteria, the intercultural perspective, and theprinciples of equity and solidarity in actions related to the digital health inclusivity agenda.
- Use reference data as a starting point to formulate and evaluate interventions, determining which people and groups have some degree of vulnerability and their relationship with the virtual world.
- Take multisectoral action to formulate and implement digital inclusion policies and strategies, such as awareness campaigns and training programs (authorities, providers, and the general population).
- Empower individuals and their communities (children, youth, seniors, women, people with disabilities, and indigenous peoples) through initiatives that promote digital health.
- Analyze beliefs, concerns, and motivations regarding health decisionmaking that may affect the achievement of digital health for all, taking into account the most vulnerable people.
- Promote the inclusion of people-centered digital health, ensuring that the population knows their rights and responsibilities regarding the security, privacy, and reliability of health data.
- Enable a virtual resilience system so that health systems continue to offer coverage if physical care is impossible, with special attention to the most vulnerable populations.
“Leaving no one behind” is a mantra in DT, especially in the area of health, but LAC’s reality demands much more than this. Countries need to capitalize on this unique opportunity to redesign health systems in a way that empowers those most affected by its implementation and puts those who need it the most first.
References:
1 Matías Busso y Julián Messina, ed., The inequality crisis: Latin America and the Caribbean at the Crossroads, (Washington D. C.: BID, 2020), https://publications.iadb.org/publications/english/document/The-Inequality-Crisis-Latin-America-and-the-Caribbean-at-the-Crossroads.pdf
2 Hussein Ibrahim et al., “Health data poverty: an assailable barrier to equitable digital health care”, Lancet Digit Health 3, no. 4, (March 2021)https://pubmed.ncbi.nlm.nih.gov/33678589/.
3 TELECOM ADVISORY SERVICES LLC et al., El estado de la digitalización de América Latina frente a la pandemia del COVID-19, (Caracas: CAF, 2020) https://scioteca.caf.com/bitstream/handle/123456789/1540/El_estado_de_la_digitalizacion_de_America_Latina_frente_a_la_pandemia_del_COVID-19.pdf?sequence=1&isAllowed=y
4 OCDE/BID, Políticas de banda ancha para América Latina y el Caribe: Un manual para la economía digital, (Paris: OECD Publishing, 2016),https://www.oecd-ilibrary.org/science-and-technology/politicas-de-banda-ancha-para-america-latina-y-el-caribe_9789264259027-es.
5 BID et al. Conectividad rural en América Latina y el Caribe. Un puente al desarrollo sostenible en tiempos de pandemia, (Costa Rica: IICA, 2020)https://repositorio.iica.int/handle/11324/12896?locale-attribute=es
6 ECLAC, Universalizar el acceso a las tecnologías digitales para enfrentar los efectos del COVID-19, (Santiago: UN ECLAC, 2020)https://www.cepal.org/es/publicaciones/45938-universalizar-acceso-tecnologias-digitales-enfrentar-efectos-covid-19
7 International Labour Organization (ILO), El teletrabajo durante la pandemia de COVID-19 y después de ella, (Geneva: ILO 2020)https://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---travail/documents/publication/wcms_758007.pdf
8 See Felipe González, et al., (2020) for an overview of the causes and consequences of this type of biases https://publications.iadb.org/publications/english/document/Responsible-use-of-AI-for-public-policy-Data-science-toolkit.pdf
9 Luis Felipe López-Calva, “Estás en Mute: Porque el acceso a Internet no es suficiente para la digitalización inclusiva de América Latina y el Caribe”, Blog del Director, UNDP, March 18, 2021
(PDF LINK DOESNT WORK)https://www.latinamerica.undp.org/content/rblac/es/home/presscenter/director-s-graph-for-thought/_you-are-on-mute--because-internet-access-is-not-enough-for-the-.html
(retrieved August 8, 2021).