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a social determinant of health that can exacerbate all the others

As we race into the era of connected care, we must make one principle sacrosanct: The digital revolution cannot simply make only the wealthy healthier. Like climate change, healthcare inequities represent a worldwide existential crisis and will require multiple stakeholders both within and outside the traditional healthcare system to work together to see the promise of healthcare at any address.

All of this came into the spotlight during the COVID-19 lockdowns. Telehealth became the primary mode for supporting patients at home, and for many provided huge benefits. But we also saw again what we’ve long known—while most Americans have a smartphone, many don’t have access to a data plan able to support both connected care and virtual education. The ability to connect to the internet has now become a true social determinant of health. 

The digital revolution is here. But it’s our responsibility to do it right and quite simply, healthcare providers cannot do this alone. We need a new coalition of technology, government, education and business. Universal connectivity is the first step.

It’s time to see broadband access as a utility, like electricity and plumbing. If the U.S. could extend electricity to every household in America, it can do the same for data. The longer our connectivity disparity continues, the more we will leave people behind. Most critically, lack of connectivity makes worse every other social determinant of health. Consider:

Cost of care. To reduce the growing cost of healthcare, we must help the 5{f771d91d784324d4be731abc64bffe0d1fd8f26504ceb311bcfd8e5b001778f4} of people who account for 50{f771d91d784324d4be731abc64bffe0d1fd8f26504ceb311bcfd8e5b001778f4} of the cost. Many suffer from comorbidities with underlying mental health issues, especially depression and addiction. The ultimate promise of connected care is to create a feedback loop to provide complex care—something our siloed industry does poorly. 

Education. Perhaps the most fundamental way to ward off health disparities and poverty, education has been devastated by the lockdowns. For many children, 2020 is a lost year. When there are wide gaps in connectivity, online education only deepens education inequity.

Jobs. Building a career today often requires new skills, which now include digital readiness. The retraining industry is now online. Indeed, even the interview process demands connectivity. We are walling off the poor from those jobs.

Small business. Digital readiness is now the gateway to building a business, no matter how small. Even taquerias must go touchless to succeed. 

Creating wellness. Everyone who is homebound due to disability, illness and caretaking needs to connect virtually as an alternative to traveling for care. From “hospitals at home,” to emergency guidance, to support for a chronic illness, we need healthcare at any address.

As online meets offline, we must remember the human in the middle. Ethics is not a list of rules, it just means asking the big questions first. For digital products, ethics needs to be injected early in the design stage. Don’t wait and ask the marketing department to make it trustworthy. Issues around privacy, genomics, equity, sustainability, and racial and gender biases need to be recognized and overcome. Trust will be as important as the technology. 

The human in the middle is not just a patient. We must begin to train health professionals to understand and explain the changing roles of humans and robots/technology. Indeed, people need to understand their roles as digital citizens.

Every social revolution has yielded great benefit and great cost. As the digital revolution speeds up, we are virtually walling off communities that cannot access the digital world. Health systems cannot fix this alone. Instead, we need a new coalition that puts “health assurance” into all social policy. We need industry transformation, new business models based on health and sustainability, and a refocus on ethics in the digital economy. We need an alliance that can bridge the bodega-to-Whole Foods gap. 

As we enter 2021, it is time for everyone to step up and address the public health consequences of the digital revolution at hand.


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