A recent Rock Health report highlights $5 billion in digital health investments thus far in 2019 and projects this year will represent the second largest funding year ever. Like previous years, most of these investments will not reach underserved populations. Why does this happen year after year? Most investors first prioritize financial opportunity over building health tools for the poor. But there is another reason.
Many investors and innovators still believe underserved populations lack access to technology and the Internet. This question is posed with shocking frequency–as recently as last week. Underserved populations can adequately access technology and the Internet. Beliefs to the contrary should not be a barrier to innovation for these groups.
As previously described by Pew and Commonwealth Fund supported research, mobile phone access is high among the poor. In addition, a variety of affordable phone service plans are available to underserved communities and are good alternatives to higher cost options. Although lower cost plans may operate on slower networks through devices with less phone memory and can dissuade interest in downloading apps, they facilitate consistent and reliable access to the Internet.
Furthermore, in underserved communities around the world, mobile devices are imperative for millions who rely on them to communicate via text, complete job applications, conduct financial transactions, summon ride share services, browse social media and source information via the Internet. This is true even for many of the homeless. A few days ago, I received a text message from an acquaintance seeking health support for a homeless relative who was only reachable by cell phone. We connected and the homeless man sent me a follow up text with his location. Many homeless people like him own cell phones and the devices are not a luxury but a lifeline.
A growing concern about the innovation disparity created by lopsided health tech investing is its potential to further exacerbate health inequity and disparities. Health disparities are born from unequal access. Daniel Weiss and Ejim Mark are two of many who highlight the potential for uneven access to health tech to disproportionately impact the socially-disadvantaged.
Another common explanation for scarce investment in innovation for the underserved is a perception that the health technologies being developed will eventually “trickle down” to underserved populations. The digital health revolution started over 10 years ago and has yet to trickle down and improve outcomes for the poor. Furthermore, these technologies are being developed without context and language needed to benefit the underserved. Thus, in the event they trickle down, how useful or detrimental might they be? For example, there is growing concern about bias conferred by artificial intelligence (AI) tools. Earlier this year Dhruv Khullar opined about potential for AI to exacerbate disparities and warned that the systemic biases institutionally and culturally embedded in care delivery will become “invisible and automated” as we “begin to accept the wisdom of machines over the wisdom of our own clinical and moral intuition.” His position is bolstered by a recent study by Ziad Obermeyer and others, highlighting racial bias in health algorithms that guide care decisions. Guarding against these adverse outcomes from tech access disparities requires focus, intention and inclusion-inclusion of both patients and experts to help inform methods for discovery, testing and implementation.
The US is challenged by a growing need to confront social inequities and the digital health community can help. Because health tech is a relatively new space, innovators and investors still have opportunity to engage underserved communities in the design and deployment of digital health tools. While the access isn’t perfect and may not achieve every health care goal, it is certainly good enough to ensure the most vulnerable aren’t continually left behind.
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