Longwoods Blog

Equity – a blog
Ontario’s Ministry of Health and Long-Term Care (MOHLTC) has identified equity as a key component of quality care. The Ministry has developed a Health Equity Impact Assessment (HEIA) to support improved health equity, including the reduction of avoidable health disparities between population groups. HEIA also supports improved targeting of healthcare investments—the right care, at the right place, at the right time. And that is what this blog covers. Join us in the conversation.

How will information and communication technologies affect equity in health?

“Words are like children… the more care you lavish on them, the more they demand.”

Attributed to Martin Luther

The first commercial cell phone call was made on October 13, 1983. Less than 30 years later, there are more than 6 billion mobile phone subscribers in the world. In most high-income countries today there are more mobile phones than people. This unprecedented level of technological penetration in human history is bound to lead to more equitable health. Or is it? To answer this question, it is essential to pay heed to Luther’s admonition and yield to the demands for attention from the words “equity” and “health”.

Although both words have a long history, most of the recorded work on their meaning dates back few decades. The main milestone in relation to the meaning of health in the 20th century occurred during the ratification of the World Health Organization (WHO), in 1948, when the term was defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. This definition, which has remained unchanged for six decades, has been criticized for being static and for its lack of operational value. In particular, it has been noted that by demanding complete physical, mental and social well-being, the WHO definition of health would “leave most of us unhealthy most of the time.” In 2008, one of us (ARJ) led an online global conversation about the meaning of health, which motivated the Health Council of the Netherlands (Gezondheidsraad) and the Netherlands Organization for Health Research and Development (ZonMw) to bring together 38 international experts to The Hague, in December of 2009, to work on a reformulation of the WHO definition. Instead, the group re-conceptualized health in more dynamic terms as: “the ability to adapt and to self manage” in response to physical, mental or social challenges.

Similarly, the term “equity in health” has evolved over time, moving away from a medicalized narrow focus to a broader, more dynamic social perspective. In the early 1990s, it was defined as “equal access to available care for equal need, equal utilization for equal need, equal quality of care for all”. From 1995 to 1998, the now defunct WHO initiative on Equity in Health and Health Care attempted to operationalize equity in health as “minimizing avoidable disparities in health and its determinants–including but not limited to healthcare–between groups of people who have different levels of underlying social advantage or privilege, i.e., different levels of power, wealth, or prestige due to their positions in society relative to other groups”.

This approach, once again, was deemed as insufficiently operationalizable. In 2006, Braveman re-conceptualized equity in health by focusing on “a particular type of difference in health or in the most important influences on health that could potentially be shaped by policies; it is a difference in which disadvantaged social groups (such as the poor, racial/ethnic minorities, women, or other groups that have persistently experienced social disadvantage or discrimination) systematically experience worse health or greater health risks than more advantaged groups.” Briefly, she then proposes a definition for health disparities or health inequalities as “potentially avoidable differences in health (or in health risks that policy can influence) between groups of people who are more and less advantaged socially; these differences systematically place socially disadvantaged groups at further disadvantage on health”.

The corollary of these two fresh approaches to the meaning of health and equity in health is that, on the one hand, it is possible to separate health from disease, and on the other, that any successful attempt to level the playing field for disadvantaged groups would require enlightened policies and aggressive political action. How, then, could new information and communication technologies contribute to removing the differences in ability that exist now in every country in the world for individuals and communities to adapt and self manage when faced with physical, mental or social challenges? We hope to engage readers in a collective quest for answers to this question and others that will emerge along the way.

Answering them will require bold and innovative policies and laws, and powerful incentives and accountability frameworks. It will also require an honest, responsible acknowledgment of the reasons why healthcare systems and services around the world have not made the most of the contribution information and communication technologies could have offered over the past one hundred years, while diagnostic and therapeutic technologies were enthusiastically embraced. We have failed to harness the power of telephone lines, since the early years of the 20th century, of electronic mail since the mid 1970s, of fax machines and mobile phones since the 1980s, of the Web since the 1990s, of smartphones in the 2000s and of apps in the 2010s. The problem has not been a lack of technology, but a failure to address economic, political and social issues that protect the status quo and impede change. What will it take to bring communication technologies from the fringe of the health system to its core, while unleashing their potential to level the playing field for us all?

Alejandro R. Jadad, MD DPhil FRCPC FCAHS
Andrea Cortinois, PhD
People, Health equity and Innovation (Phi) Research Group
University of Toronto and University Health Network
Toronto, Canada

About the Authors:

Alejandro (Alex) Jadad is a physician, educator, researcher and public advocate, whose mission is to help improve health and wellness for all, through information and communication technologies.
Dr. Jadad has been called a «human Internet», as his research and innovation work seeks to identify and connect the best minds, the best knowledge and the best tools across traditional boundaries to eliminate unnecessary suffering. Such work focuses on a radical ‘glocal’ innovation model designed to improve the capacity of humans to imagine, create and promote new and better approaches to living, healing, working and learning across the world. Powered by social networks and other leading-edge telecommunication tools, his projects attempt to anticipate and respond to major public health threats (e.g., multiple chronic conditions, pandemics) through strong and sustainable international collaboration, and to enable the public (particularly young people) to shape the health system and society.
Dr. Jadad is currently the Founder and Chief Innovator of the Centre for Global eHealth Innovation, and a Senior Scientist at the Centre for Health, Wellness and Cancer Survivorship at the University of Toronto and University Health Network, where he is a full professor, staff physician and holder of the Canada Research Chair in eHealth Innovation.

Andrea Cortinois
Andrea has worked as a journalist, a researcher, a teacher, and a manager of health-related interventions on four continents, mainly in low-income countries. He has earned a Masters of Public Health, in the UK, and a PhD in the Department of Health Policy, Management, and Evaluation at the University of Toronto. Andrea works at the Centre for Global eHealth Innovation, Toronto General Hospital, where he leads the Multiculturalism and Health research stream within the People, Health Equity and Innovation Research Group (Phi Group). Over the past several years, Andrea has been involved in research projects focusing on the application of new information and communication technologies to reach marginalized population groups. He teaches international health at the University of Toronto.

This entry was posted on Monday, April 23rd, 2012 at 12:34 pm and is filed under Longwoods Online.