Posted On May 07, 2021

The Great Divide – Can Digital Health fix the US Health Care Inequality?

Understanding the Problem

Access to health care is not the same for each and every one around you. Many ethnic and economic groups in the US are chronically less healthy than others. This is what is termed as health care inequality. Studies show that the poorest families are in the poorest health as well, underserved by lack of the best hospitals, clinics and medical technology. With the cost of health care rising at an alarming rate, low-income families are being pushed into poverty and many are not even covered under Medicaid.

Moreover, African Americans and Hispanic groups suffer from both systemic and unintended biases in their access to health care services. In 2017, Around 10% of African Americans and 16% of Hispanics were uninsured compared to only around 6% of the white population.Moreover, African Americans and Hispanic groups suffer from both systemic and unintended biases in their access to health care services. In 2017, Around 10% of African Americans and 16% of Hispanics were uninsured compared to only around 6% of the white population.

It’s imperative for each of us to care about this, as health care inequality affects all of us, not just the disadvantaged communities among us. This is because the additional cost incurred by hospitals to treat the ER visits of uninsured patients is passed to our tax bill. It raises the cost of health care as a whole.

The Modern Solution?

“Let’s bring the care right to the patient”. This is the promise on which Digital Health was born. Leveraging technology to provide patients and caregivers to connect with each other, surpassing limitations of distance, time zones and cost, Digital Health comprises of a slew of both existing and cutting-edge technologies devised to shepherd our conventional health systems into the era of next-gen, consumer-focused care. Today, Digital Health industry is valued at over $100 Bn, with $21 Bn invested in 2020 alone.

Telehealth, Artificial Intelligence, Remote Patient Monitoring and other modern innovations claim to reduce the chronic health care inequalities as well. But is technological innovation alone enough?

A 2020 State of Telemedicine report surveyed 2000 American adults and found glaring technological disparities between whites and Blacks & Hispanics. The most alarming disparity was owning a desktop or laptop computer, where 82% of white people had one, compared to only 58% and 57% of Black and Hispanic people.

Solutions need to represent the community

When there exists an underlying digital divide between the very people that Digital tools aim to serve, simply investing billions into building an ecosystem will keep on widening the disparity. The technological innovations need to take into account the demographic and technological realities, so companies can build inclusive products from the ground up. Entrepreneurs need to be cognizant of the role of communities in shaping digital solutions, as they are the ones who’ll actually use those solutions. That’s where Community Based Participatory Research (CBPR) comes into the picture, incorporating inputs of community members at each stage of the research phase.

Let’s look at some real world use cases where digital products were created to address fundamental issues in the community and in doing so, managed to effect tangible improvements in the inequalities faced by the population:

FAITH!- Fostering African-American Improvement in Total Health

The FAITH! Intervention was the result of a desire to improve the cardiovascular health of the African American community in Minnesota. African Americans face nearly double the mortality rates from cardiovascular disease (CVD) than whites.

The FAITH! App was an mHealth intervention, which digitalized the face-to-face, church-based health education program, replete with culturally-resonant biblical messages and spiritual messaging, incorporated as a result of the community-led research model. Recruitment and retention rates were a phenomenal 100% and 98% respectively. The academic community even secured federal funding to expand the reach of the app.

PeerTECH- Peer- and Technology-Supported Self-Management Training

Focusing on premature mortality in seniors with a serious mental illness (SMI) like bipolar disorder, major depressive disorder and schizophrenia, PeerTECH started as an academic and community effort to manage both the mental and chronic health of patients aged 60 and older.

PeerTECH was developed in partnership between patients, scientists and certified peer specialists- individuals with personal history of mental health conditions, trained to provide peer support to patients suffering from the same life experiences. Instead of targeting only psychiatric symptoms, the app focuses on a biopsychosocial approach and targets multiple dimensions of health, like social support, loneliness and self-advocacy.

PCCI’s Preterm Birth Prevention Program

Women of color and low-income environments are at a higher risk of preterm birth in the US, facing thousands of dollars in medical bills and potentially fatal conditions for the newborn. Parkland Center for Clinical Innovation (PCCI) in Dallas aimed to address this disparity with its Preterm Birth Prevention Program, through patient-focused prenatal checkups accounting for critical environmental and social factors, a crucial puzzle piece that doctors usually overlook.

PCCI uses data-driven risk prediction, provider notification, customized patient education, and workflow redesign. Risk prediction also includes geographic information, demographics, age, and other contributing factors. The program also includes risk-stratified text alerts to improve patients’ access to prenatal care.

The model has proven to be three to four times more accurate than clinical standards for identifying pregnant women at risk for preterm birth. It also reduced early preterm births by 27% and reduced first-year maternal costs by 54%.

Conclusion

Digital tools are increasingly being adopted both by caregivers and patients to enable outreach, monitoring, intelligent diagnosis and reminders. But diverse populations call for diverse strategies. The inequalities rooted into the health care system need not just innovative but demographically-informed and customized solutions to be developed. Fixing the digital divide and the racial and ethnic disparity present in the population will need effective, well-researched and sustained efforts from policymakers, entrepreneurs and our communities.

Article by Isaac Mwendwa, Founder Ponapal Inc