BY SOPHIE MARSDEN, HEALTH SYSTEMS PROGRAMME OFFICER, INSTITUTE OF DEVELOPMENT STUDIES
In the immediate future of 20 years, all dots in healthcare systems and service delivery mechanisms will become linked via wireless and mobile infrastructure.
- Workshop delegate
Is the quote above an overly optimistic and indulgent love note to modern technology, or is it an informed, almost prophetic, statement that captures the numerous possibilities to transform healthcare through technological advancement? Whichever interpretation you side with, it does force you to consider the effect that the development of technology — and specifically information and communication technologies (ICTs) such as smartphones, the Internet and diagnostic technologies — will have on our current healthcare systems and how this could transform the way we manage health at both an individual and public level.
At the beginning of June, the Institute of Development Studies convened a three-day workshop titled ‘Exploring the social, ethical and legal implications of new information and diagnostic technologies for the self-management of illness’. The workshop focused on how people living with chronic communicable and non-communicable diseases in low-income countries (LICs) were beginning to actively engage in health seeking behaviour and were using ICTs to manage their conditions. The event was hosted and part-funded by the Brocher Institute, a Swiss foundation based in Geneva. A small group of healthcare practitioners and experts in health policy, law and ethics based in Uganda, South Africa, Cambodia, the Philippines, Bangladesh and the UK were brought together to share their wealth of experience, knowledge and insight into healthcare provision in low-income countries.
There is now an unmediated access to diagnostic technologies, various markets for treatments and healthcare advice, and numerous professional and non-professional providers. In essence, medical pluralism is challenging the traditional bio-medical model within global healthcare. Many of the technological innovations in healthcare flourish in countries with highly organised and established health systems. Patients are able to apply an expert lens when digesting the new information that this technology provides and they continue to comply with the established protocols and rational prescribing within the health system. However, as outlined in a presentation on patient empowerment by Dr Josephine Van Olmen from the Institute of Tropical Medicine in Antwerp, the necessity of managing chronic illness does not necessarily lead to empowered patients. Instead, patients in low-income countries may suffer from a lack of access to a good quality and trusted health system due to the associated cost, a lack of resources or there simply not being the infrastructure in place within their country.
On the second day delegates shared fascinating examples of how patients in LICs with chronic conditions were accessing information from a number of different sources such as community healthcare workers, non- government organisations and peer networks, alongside traditional state services. Dr Mohammad Iqbal from icddr,b described how Diabetes and Hypertension health clubs had been established in Chakaria, Bangladesh to support people in making informed decisions about selecting healthcare from the growing market of informal providers. Maurits Van Pelt also talked about some of his experiences and the challenges he faced in setting up the MoPoTsyo patient information centre in Cambodia, which aims to support patients living with diabetes in poor communities by making them more informed and active in managing their disease.
Telecommunication networks and the ever-expanding reach of the internet means that health information is more widely available than ever before. Combined with innovations in diagnostic and treatment technology, this has led to a proliferation of new healthcare products. Smartphones with health apps and mobile diagnostic technologies provide the ability to manage aspects of chronic illness while Internet provides patients access peer support groups and consultation services to seek out advice and information. As a result, commercial markets for new healthcare-related products, traditionally driven by pharmaceutical companies but increasingly by other businesses, are already well established and continue to expand.
This creates a new power relationship between knowledge intermediaries and patients with chronic illnesses operating as consumers of healthcare. Dr Paula Boddington from Oxford University led a discussion on the ethical implications of the emergence of these new knowledge intermediaries. In a profit driven market there exists clear opportunities for lay actors -- this could be a business selling diagnostic technology or an individual selling alternative medicine -- to exploit of a lack of knowledge and awareness and to manipulate consumers into buying health products and services. As noted by the group, the lack of regulation of healthcare products means the quality and safety of these products can be highly questionable. There was consensus among the group that regulations and guidelines need to be in place to manage the quality, safety and use of ICTs and knowledge intermediaries.
A number of interesting questions were raised during the workshop and many issues demand further exploration and thought. As a result, this is the first post of a six-week blog series written by workshop partipants that draws out some of the key issues. We hope you're looking as forward to the following as we are. Future posts include:
- Slim Slama – “Using an ecological approach to tackle the growing burden of chronic non-communicable diseases”
- Henry Lucas- “Innovation in healthcare; Using ICTs to self-manage illness in lower income countries”
- Raoul Bermejo- “Chronic non-communicable diseases; from Global policies to local implementation”
- Annie Wilkinson-“What are the ethical implications of using diagnostic technologies?”
- Paula Boddington-“Addressing the ethical issues raised by the emergence of new knowledge intermediaries in the public health sphere”