January 10, 2013

1. What do ICTs have to do with Health Equity? The eSAC project January 10, 2013 Andrea A. Cortinois, PhD Alejandro Jadad, MD DPhil FRCPC FCAHS Global Health Division, Dalla Lana School of Public Health, University of Toronto and People, Health Equity and Innovation Research Group (Phi Group) Camilo Erazo, MD, MBA Consultant Pan American Health Organization

2. The eSAC project experience has provided greater understanding about conflicting perspectives in eHealth • There is an intrinsic contradiction between: • A focus on Information and Communication Technologies • An equity oriented goal • We suggest tentative ideas on ways to move beyond this contradiction • It is important to “push the envelope” and look well ahead of the current, exitist discourse on eHealth.

3. eSAC: a regional researchprojecttopromotePubliceHealthinnovation • Aim: improving the health of disadvantaged groups and contributing to the advancement of equity in health in Latin America and the Caribbean (LAC), by nurturing and promoting Public eHealth innovation. • Stimulate researchers, policy makers, practitioners, entrepreneurs, innovators, the media, and the general public to think beyond traditional eHealth solutions with an individual-level focus, by exploring the use of ICTs in public health and to impact the social determinants of health. www.esacprojet.net A hub for professional development activities and knowledge management

4. Several factors prevent a rich dialog on the role of ICTs for improved equity • The essential terms around which such debate should develop are not homogeneously defined and understood by those who should participate in it. • Decision makers and practitioners in the Region lack a supportive environment to learn about the application of ICTs in public health and to share ideas and experiences. • Two separate and non-communicating audiences exist: • eHealth experts usually know little about the concept of health equity. Also, they are used to think of technology exclusively in the health care context. • Equity scholars know little about the potential and flexibility of ICTs, well understanding the danger of an excessive emphasis on technological discovery.

5. eSAC attempts to explore an intersection among (ill defined) concepts HealthEquity PublicHealth Social Epidemiology SDoH ICTs I PubliceHealth Digital Divide PublicHealthInformatics ICT4D Infodemiology

6. PublicHealth PubliceHealth The various applications of ICTs to all sub-fields of public health, as well as to both proximal and distal social determinants of health. ICTs “The systematic application of information and computer science and technology to public health practice, research, and learning.” Public Health Informatics: “The science of distribution and determinants of information in an electronic medium, specifically the Internet, or in a population, with the ultimate aim to inform public health and public policy” (Eysenbach, 2009) Infodemiology: • Organizational, educational, and other types of web sites; • databases, both locally-maintained and online, including disease registries, bibliographic collections, and resource databases; • data sharing networks and health information exchanges linking public health services, clinical services, and community health organizations; • epidemiological surveillance and response detection and monitoring systems; • applications for outreaching and training, such as webinars (web conferencing), online tutorials, and collections of lectures and other resources; Virtual communities of practice • management information systems for the support of complex public health operations, such as the management of natural disasters; • geographic information systems (GIS), computer-aided database management and mapping technology often used in conjunction with remote sensing from earth-observing satellites. ICT-based tools used in the field of public health:

7. Decision makers and practitioners lack a supportive environment to learn about the application of ICTs in Public health • This is in part due to the conceptual shortcomings discussed previously • Consequently, they tend to default to the ‘traditional’ applications of technology, such as • telemedicine, • electronic health records • information systems management • ... finding difficult to envision ICTs untapped potential. Attempt to form a Virtual Community of Practice to provide a platform for learning about Public eHealth

8. eSAC aims to bridge non-communicating audiences • eHealth experts: • Usually know little about “health equity” (or even “public health”!) • Used to think of technology exclusively in the health care context -> “efficiency”, “quality of care”, and “access” for geographically remote population • largely ignoring the dimensions of equity that transcend healthcare (SDoH‘language’) • Equity scholars • Know little about the potential and flexibility of ICTs • Often suspicious of ICTs, well understanding the danger of an excessive emphasis on technological discovery.

9. Early lessons: How to communicate with different audiences • With eHealth experts: • Discuss use of aggregated data from EHRs (personal) to extract system/population level knowledge • Discuss how more, better data could help address the ‘real’ causes of disease • Talk about inequity in access to technology (‘Digital divide’) -> elaborate from there to other sources of inequity to SDoH • With Equity Scholars: • The value of “simple” technology: • the Health Equity PAHO listserv • Technology aiding research and scientific communication; formation of online communities • “ICT4D” provides body of research and experience • OLPC • Flip the discussion of ‘Digital divide’ - provide figures and hard data demonstrating uptake of social media/mobiles in disadvantaged countries/communities

10. Conclusions • Developing a deep understanding of the contribution ICTs can offer to improve equity in health is a complex, challenging and long term endeavour. • Eventually, technology will provide better tools to deepen this understanding: • Addressing complexity • Knowledge management and synthesis • Visualizing the relationships among concepts and ideas • Fostering communities of practice, research and ACTION. • But the full contribution ICTs can offer in the health field should follow a path parallel to the one that the conceptualization of health has followed over the past century or so: moving from a focus on the individual and the biological causes of disease to populations and population health to the social economic and political determinants of health. • eSACrepresents a small, if significant, contribution to this effort and an opportunity to learn early lessons. • Communicating with stakeholders and finding common ground about health equity: THE KEY • The tension between the technological focus of the project and the essentially political nature of health equity deserves more attention.

11. “A technical solution to a political problem fails 99% of the times” Jay Parkinson Medicine 2.0 2011 http://www.flickr.com/photos/kk/2987413084/sizes/m/in/photostream/

12. Thank you! • Dr. Camilo Erazo Leiva • erazoc@paho.org • @CamiloErazoL www.esacproject.net

13. Invitación: • A formar parte de una Comunidad de aprendizaje en la región, dedicada a investigar el uso innovador de las TICs en Salud Pública, inspirando nuevas formas de promover la Equidad en Salud. • esacproject.net

14. Competencia de Innovación http://es.esacproject.net/news/competencia-de-innovación