Ungoverned digital advances undermine global healthcare gains

The Covid-19 pandemic has highlighted the pervasive role of digital technologies in transforming how we understand and address health and wellbeing. It has influenced health behaviours and heightened pressure to adopt digital solutions for improving individual and population health, alike.

Digital tools have helped people access medical consultations remotely via telemedicine, and eased case identification through online symptom reporting. They have also supported public health surveillance and decision-making — via contact tracing apps, predictive analytics, geospatial modelling of viral spread dynamics, and data sharing.

But digital technologies have also fostered the online diffusion of disinformation and misinformation about the pandemic — for example by contributing to vaccine hesitancy.

In addition, they have provided governments with powerful tools to erode democracy and human rights under the guise of public health interventions.

Several countries have been accused of using contact tracing during the pandemic to analyse location and telecommunications data (often with the assistance of private companies), and there are fears that digital health surveillance could reinforce existing discrimination against minorities and other vulnerable groups, or deter them from seeking medical care.

Vast research gaps still exist in understanding digital technologies’ long-term effects on health and wellbeing, including the prolonged exposure of children and young people to digital devices and products.

Even beyond the pandemic, digital transformations are redefining the future of health in all areas of our lives. The vast inequities that exist in people’s ability to access digital and Big Data-driven tools, and the limited capacity of many groups to protect themselves against potential harms, highlight the importance of governing such transformations using precautionary and value-based approaches.

At the same time, as digital health becomes a growing focus for technology giants, as well as for start-ups and traditional healthcare companies, there is a danger of reinforcing growing power imbalances. Big Tech companies experienced the greatest gains in market capitalisation during the pandemic, while multilateral efforts to regulate and tax the digital economy have been slow and met resistance.

The Lancet & Financial Times Commission on Governing Health Futures 2030, which we co-chair, was launched in 2019 to explore these trends. It seeks to help decision makers improve health while mitigating the risks of deploying digital technologies without respect for key public health values — such as democracy, equity, solidarity, inclusion and human rights.

At the heart of our recommendations is the acknowledgment that digital transformations are an increasingly important determinant of health, both in their own right and as accelerators of other commercial, political and social-environmental factors. We urge a series of co-ordinated and ambitious responses.

First, governments must expand digital access and literacy to fight inequalities within and across countries. The “digital divide” has widened differences in access to health and education. Universal connectivity and the capacity to improve digital competence are essential to ensure no one is left behind in benefiting from the positive effects of digital transformations.

Second, we need to build public trust in digital technologies through stronger protection of rights threatened by extensive data extraction and digital surveillance. That requires greater public participation in decision-making and design, and in the accountability of governments and the private sector. It needs a greater emphasis on public consultations, the systematic adoption of open data strategies, and the development of oversight and redress mechanisms.

Third, we must build a culture of “data solidarity”. We need innovative solutions to empower people to exert greater control on how their health data is used, while facilitating sharing when it is valuable for the public good. For instance, data trusts and co-operatives are being tested to provide independent stewardship of health data. All countries should have such institutions in place to support greater accountability of private companies and increase trust in data sharing.

Fourth, governments should scale up investments in, and build capacity for, digitally-driven transformations of their health systems. This will require greater engagement and control by low- and middle-income countries and ways to ensure that digital health interventions are cost-effective and tailored to the local context.

Finally, it is vital to place the concerns of children and young people at the centre of digital transformation and to involve them in shaping their own health futures. Digital technologies must make health services more responsive to their expectations — which increasingly include concerns around mental health, sexual and reproductive health and general fitness.

This focus will prove a litmus test of the capacity of our governments to ensure that digital transformations benefit everyone, since children and young people are often among the most vulnerable groups in society.

Our report provides a blueprint for stimulating new research, thinking and practices in the interface between digital transformations and health. There is too much at stake for the future of health and wellbeing to leave digital transformations ungoverned.

Ilona Kickbusch and Anurag Agrawal are co-chairs of the Lancet & Financial Times Commission on Governing Health Futures 2030