Digital transformations can improve health for all people around the world. But this is only possible if digital technology is governed in the public interest rather than for private profit, and the health for all values of democracy, equity, solidarity, inclusion, and human rights are put at the core of its design and use, according to a new Lancet and Financial Times Commission on Governing Health Futures 2030: growing up in a digital world.
Digital technologies are transforming all areas of life and health, a trend that has been accelerated by the COVID-19 pandemic, but the benefits of these advances are not reaching everyone equally. In widespread analyses, the Commission highlights how limited governance together with the accumulation of data and power by the world’s big technology companies and governments for surveillance, are exacerbating health inequities, eroding trust, and compromising human rights.
The report warns that following the current path of data-extractive, commercially-driven digital transformations, will fail to deliver health benefits to all. Instead, a radical new approach is needed that redirects digital technologies to advance universal health coverage (ie, all people receiving quality health services without incurring financial hardship), ensures that the gains in digital health are equitable, and puts children and young people, who have been exposed to these technologies their entire lives, front and centre.
With access to quality health information and services increasingly reliant on digital technologies and data, the Commission also calls for digital access and digital literacy to be recognised as a key determinant of health, and to ensure that every person has safe and affordable access to the Internet by 2030.
The Lancet-FT Commission is the result of two years of work from 19 leading experts from 14 countries, with backgrounds in global health, clinical medicine, public health, mental health, digital media, ICT, social science, economics, and politics, as well as global consultations with youth groups.
“Digital technologies offer extraordinary potential to improve the health of all people around the world, reduce health inequities, close gender gaps, and protect the most vulnerable”, says Co-Chair of the Commission, Professor Ilona Kickbusch from the Global Health Centre. “While there is great hype and technology excitement, there has been little focus on broader societal and governance questions. For example, how do we protect data confidentiality while simultaneously ensuring that such data is used effectively to benefit public health? How can we address a lack of trust in technology by involving people and communities more centrally in its design and governance? This report must be a wakeup call for countries to overhaul their approach to digital health, laying out a roadmap that governments and societies can use to put essential regulation and governance in place that will result in a healthier, fairer future for all.”
She continues, “Central to the Commission’s recommendations is that the governance of digital technologies should be grounded in the established public health values of democracy equity, solidarity, inclusion, and human rights. Only then can we reach universal health coverage, improve access to quality health services, and more effectively prevent and manage public health crises.”
Lancet-FT Commission presses for radical rethink on digital health
The Commission emphasises that digital transformations (the integration of technologies into people’s lives) shape our health both directly (via promoting health information or misinformation and the use of digital health and wellbeing tools such as wearables and telemedicine) and indirectly through a wide range of social, economic, commercial, and environmental factors that affect health. For example, social factors such as age and ethnicity, and socio-economic factors such as income and educational levels, influence people’s ability to access health services as well as their exposure to marketing and political messaging.
According to the report, the pandemic has laid bare the extent to which our societies—and their health—depend on digital technologies to function and the power of large providers and platforms. “The health sector has been behind in leveraging digital transformations” says co-author Dr Jeanette Vega Morales from the Chilean National Research and Development Agency. “Only if we use them in the right way will digital technologies allow us to advance towards universal health coverage and more equitable health systems.”
To make real health gains and mitigate potential harms, the Commission advocates widespread reform to increase public trust, rapidly strengthen the governance of digital technologies and health data, and to develop more equitable tools for health care.
Digital technologies—a new determinant of health
The report emphasises the growing role of digital technologies as determinants of health, which can have important implications for those populations and societal groups that are already particularly vulnerable. For example, the report highlights that young people growing up in this digital world experience the extremes of digital access—some digitally consumed and vulnerable to online harm and many digitally excluded, affecting their access to education and employment as well as health information and services.
While network coverage and smartphone ownership are rising globally, over 2 billion people aged 25 years and younger remain unconnected. And the digital divide is exacerbated by the gender gap in internet use, with more men than women using the internet in two out of every three countries.
The authors note that only 38% of young people in low-income countries are using the Internet, affecting their chances of harnessing digital technologies as potential tools against preventable or treatable health problems. The Commission warns that the way that digitalisation is governed and made accessible will either exacerbate these challenges or resolve them, and calls for digital access to be recognised as a key determinant of health (just like income, education, or sex and gender), and for digital connectivity to be recognised as a human right and public good.
Commission co-author Christopher Fabian, co-founder of the Giga initiative, a partnership of UNICEF and the International Communication Union, says, “Connectivity and health access are inextricably linked. Health equity in the digital age is predicated on being digitally connected.”
Putting the concerns and expectations of young people front and centre
The Commission also stresses the importance of building the public’s trust in digital health and empowering patients and vulnerable groups to shape their own health futures, particularly children and young people.
“We will never deliver beyond the hype unless we engage the whole of society, from private companies to clinicians, researchers, and people in low- and middle-income countries who use these technologies”, says Co-Chair of the Commission, Professor Anurag Agrawal from the Institute of Genomics and Integrative Biology in India. “Putting the concerns and expectations of children and young people who are growing up in an increasingly digital world at the heart of efforts to reimagine universal health coverage will be crucial to ensuring that everyone benefits from digital health.”
Extensive youth consultations by the Commission, with over 23,000 children and young people (aged 14-29 years) from 176 countries on digital health, finds that their top concerns include inaccurate health information and digital technologies making them less physically active. The consultations also suggested that young people around the world want to be protected from commercial exploitation and harmful content, to know how their health data are being collected and used, to give informed consent to sharing their data, and to be given the knowledge and skills to identify reliable health information and design their own health futures.
The Commission proposes that all governments should adopt country-wide strategies to safeguard health and digital rights, including regulatory measures to protect children and young people against online harms (eg, gender bias and discrimination, cyberbullying, and the effect of excessive screen time). They must be accompanied by equally ambitious reforms, giving the public the tools they need to play a part in the design and governance of digital health solutions, and large-scale digital health literacy efforts.
Although digital technologies have been promised to improve health in many different ways, from disease outbreak response to the use of mobile phones to support the earlier diagnosis of cancer, the Commission notes that transparent evaluations of their reliability and the implications for privacy and human rights are lagging far behind.
“The Commission's report encapsulates the profound shift needed in how we think about health in the digital age”, says Dykki Settle, Chief Digital Officer of PATH, USA and one of the report’s co-authors. “Its work is already having an impact by encouraging action to address inequities in access to digitally enabled health services, changing how we view data ownership and transforming approaches to governance.”
The Commission highlights the need for innovative forms of stewardship, regulatory frameworks and accountability for digital transformations of health, by equipping civil society, health worker associations, patient networks, and local government to act as stewards and watch dogs.
Data solidarity—pooling resources for the benefit of all
Alongside building public trust, the Commission calls for data solidarity—a radical new approach to the collection and use of health data that protects individual rights, ensures that data is harnessed in the public interest, and builds a culture of data justice and equity. Most importantly, it requires the regulation of health data within the private sector, an agreement of the public health goals achieved through data collection, and transparency on how data sharing and secondary use of data will improve public and individual health.
“The concept of data solidarity is central to the Commission’s recommendations”, says Professor Rohinton Medhora, President of the Centre for International Governance Innovation in Canada and one of the co-authors of the report. “Data increasingly governs the way we live and solidarity in relation to health data recognises that we’re all in it together. The way we govern our health ultimately determines the economic wellbeing and the quality of our whole society.”
A starting point for all countries should be to develop data trusts that can unlock the public value of data while safeguarding the rights of those people to which the data relates. The second focus should be to build trust in the process of data sharing and to strengthen systems of redress to protect digital rights and ensure that data users are held accountable.
The way forward
A Lancet Editorial that accompanies the Commission says that, “No amount of technical innovation or research will bring equitable health benefits from digital technologies without a fundamental redistribution of power and agency, achievable only through appropriate governance. There is a desperate need to reclaim digital technologies for the good of societies. Our future health depends on it.”
Professor Kickbusch warns, “The path that the world chooses today will irreversibly mark our children’s futures. We must listen to the 3 billion young people (almost 40% of the world’s population) who will need universal health coverage to respond to their needs and aspirations by 2030.”
