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Panelists of Improving Equity through Health IT in the US and Internationally and GHDonline staff

You may use this brief for informational, non-commercial purposes with credit attribution: The Global Health Delivery Project, GHDonline.org, Jul 09, 2014. Please see our Terms of Use for more information.

Improving Equity through Health IT in the US and Internationally

Added on 09 Jul 2014

Authors: By Joaquin Blaya, Edited by Marie Connelly and Isabelle Celentano

The issue of rising income inequity is one of global concern. Health researchers have shown low-income countries contribute 56% of global disease burden, but account for only 2% of global expenditure on health (Mathers, 2006). In addition, there is great inequity within most countries. Among adults in the US with chronic conditions, 45% of those with below-average incomes reported going without needed care because of costs, compared with just 4% in the Netherlands (Davis, 2010). Economist Joseph Stiglitz argues, “We are paying a price in terms of our politics and society—inequity is undermining our basic values.” Many policymakers seek to understand how to bridge this gap.

This panel looked at how health IT ameliorates or deepens these health inequalities both in the US and low and middle-income countries (LMICs), and what can be done to decrease these inequalities.

Key Points:

  • The terms “health equity” and “health care equity” are not interchangeable
    • Equity is the result of the action of a large number of social determinants of health (SDOH), one of which is a high quality, universally accessible health care system
    • Other factors such as access to safe water and sanitation, adequate food, and education have a more significant impact on health outcomes than the health care system
    • Since equity is a political issue, not a technical one, information technologies will usually only support equity-oriented policies and interventions, not directly increase equity
  • For health care to become more equitable, patients and providers must be able to communicate and have a continuum of on-going care—IT has the potential to facilitate this
    • In remote communities, the on-going challenge of obtaining and maintaining trained providers causes many patients to be sent out of the area to receive the required treatment, often with little continued communication between those who performed the service and the caretakers in the home community
    • Emerging social media can alter how people participate in their health management and the ability of patients and health care providers to collaborate more effectively
  • Health IT presents an interesting avenue in improving access to health services amongst all groups, especially those who have been traditionally excluded from access like women and girls in LMICs
    • Women experience an unequal distribution of SDOH, including poverty and lower technological literacy
    • Initiatives leveraging information and communication technologies (ICTs) to generate income amongst women while improving healthcare access both at the field and policy level are needed
  • IT alone cannot reduce these inequalities and the panel suggested a three-pronged approach, targeting:
    1. Recruitment, education and retention of clinicians in limited resource settings. IT initiatives are useful when they better facilitate communication between the isolated community and healthcare personnel. The penetration of mobile phones presents numerous opportunities for this.
    2. Development of educational content, technologies and tools that are culturally sensitive and operational in resource-limited settings
    3. Adoption of health IT that not only drives operational workflow, but also enables clinicians to have access to external resources for additional information, education, and external consultations
  • Another method involves building tools to help trigger proactive care and outreach. Iora Health gives as much actionable data as possible to care teams so they can reach out to a patient when the need arises, without waiting for the patient to schedule an appointment or relying on face-to-face visits
  • In some cases, the use of technology may actually create a larger gap in access to care both in developed and developing countries
    • Web-based portals and patient health records (PHR) are playing an increasingly important role in access to quality health care, yet internet-connectivity in the home is optimal for their effective use. Internet access is limited in homes of people of color and Limited English Proficiency (LEP) individuals in the US, putting these already-marginalized groups at a further disadvantage
  • It is important not to abandon more “analog” methods of health care delivery and to make sure that all methods are accurate and equal, so as not to exclude those with less reliable access to newer technologies

Initiatives:

  • Iora Health, which has established a number of primary care practices across the United States: Culinary Extra Clinics, Freelancers Medical Insurance Company, Turntable Health, Carpenters Care (See “Care Coordination and the Iora Health Model” for further discussion of Iora Health’s approach.)
  • Whānau Ora, an initiative to address the New Zealand health care system’s lack of cultural sensitivity and to coordinate treatment and services from all the agencies involved in the health and social well being of the patient
  • Andean Health & Development, a non-profit committed to building hospitals, as well as training and employing local Ecuadorians to provide great care
  • Project OSITA provides services for women in Colombia displaced due to the internal armed conflict
  • Text4Baby, a program in the US designed to support mothers in caring for themselves during pregnancy and their newborns for one year after birth
  • Únete Latina, a text-based support program for Latina women living in Fresno County with information on local resources, an initiative of Youth Tech Health
  • The central focus of the eSAC projec is the link between IT and equity (beyond clinical care and, possibly, beyond the health care system)
  • The Get the Message campaign from the Healthy Caribbean Coalition, a mobile phone text-based advocacy campaign to tackle non communicable diseases as a regional priority
  • The Youth Net Project, a program that gives young people in Brazil an opportunity to use GPS enabled mobile phones to map environmental risks in their communities. This information is then aggregated and displayed in a manner that engages stakeholders and decision makers.
    • A similar use was recently applied in Haiti, where teenagers attempted to identify and document barriers to access to preventive services for HIV, using mobile phones. This example yields very concrete results, related to public health, equity (through the participation of vulnerable populations), social and environmental determinants of health, and ICTs.

Key References:

Download: Health_IT_and_Equity_Discussion_Brief.pdf (161.3 KB)