“Digital transformations call for a new understanding of the concepts of public health and universal health coverage (UHC), which reflect the extent to which digital technologies are changing notions of health and wellbeing and offering new tools through which public health goals can be achieved.”

–  The Lancet and Financial Times Commission on Governing Health Futures 2030: Growing up In a Digital World

INTRODUCTION

Digital technology has transformed life as we know it – from automating daily tasks, to essentially allowing us to carry around pocket-sized computers. Health systems are also rapidly transforming as new technologies emerge.

Global targets have been set to ensure health for all by 2030. While many countries and regions across the globe have faced challenges in achieving these targets, many low- and middle-income countries (LMICs) lag behind. A joint effort between The Lancet and Financial Times was established to explore how digital transformations could be leveraged in order to support universal health coverage under UN Sustainable Development Goal (SDG) 3. This commission released recommendations for all countries, but has noted that many countries on the African continent are at a crucial junction, being at a critical point of digital transformation and innovation. 

In episode 107 of the Public Health Insight Podcast, the team speaks with Njide Ndili, Country Director for PharmAccess Foundation and member of the joint The Lancet and Financial Times Commission, about leveraging digital transformations to sustainably improve health systems and achieve good health and well-being for all.

Table of Contents

In this blog post, we’ll be exploring:

• Sustainable Developmental Goal 3 and The Lancet and Financial Times commission
• Key findings and action areas recommended by The Commission
• The role and engagement of young people in digital transformation of health

Sustainable Development Goal 3 and The Lancet and Financial Times commission

Adopted in 2015 by all UN member states, the Sustainable Development Goals (SDGs) represented a global effort to improve the lives of all people by 2030. While there has been significant progress in meeting SDG 3: Good Health and Wellbeing, gains have been uneven between and within countries. Many nations are not on track to meet SDG 3 targets. Universal Health Coverage (UHC), or access to required health services without sustaining financial hardship, is considered crucial to achieving SDG 3 (UNDP Oslo Governance Centre, 2022; WHO, 2021b).

In October 2019, The Lancet and Financial Times came together to establish a commission that explored the convergence of digital health, artificial intelligence (AI), and frontier technology to achieve UHC, supporting SDG 3. Called The Lancet and Financial Times commission on governing health futures 2030: growing up in a digital world (The Commission), the group was made up of 19 members from a range of sectors, disciplines, and backgrounds (Growing up 2030 in a Digital World, 2021).

The Commission was tasked with examining existing digital health, AI, and UHC policies around the world then identifying potential avenues to improve health equity – particularly for LMICs. The Committee sought to network across multiple digital initiatives around the world through engaging with key stakeholders including private sector partners, international organizations, and NGOs (Growing up 2030 in a Digital World, 2021). 

Notably, The Commission intentionally gave special consideration to children and young people, consulting youth advocates and organizations. The Commission aimed to include the views of the next generation who will be growing up in our continuously evolving digital world (Growing up 2030 in a Digital World, 2021; Kickbusch et al., 2021). 

Key findings and action areas identified by The Commission

In November 2021, the Commission published its findings and recommendations for governance approaches and initiatives to realize UHC in the increasingly digital world. In reviewing digital health transformation and UHC policies globally, there were some common themes such as those included in Figure 1.

The Commission delivered four key recommendations aimed at ALL countries to best harness the potential of digital transformation to benefit health and achieve UHC by 2030 in support of SDG 3.

1.   Acknowledge and recognize digital technology and transformation as new determinants of health.

Long before the establishment of the Commission and the publication of its report, people around the world were engaging with and looking to technology for health and wellness – whether accessing health information online, connecting with specialists from a distance, or adopting specialized apps for tracking health data. The importance of digital technology and transformations to health is only growing and must be recognized as an additional determinant of health. Connectivity, which is critical to accessing data and technology, should be viewed as a human right. 

Currently, connectivity and access to digital technology is not equitable and often disproportionately controlled by the private sector. The Commission recommends that governments together with private providers and community organizations work to achieve universal, safe, and affordable connectivity to close this digital divide (Kickbusch et al., 2021).

2.     Build-up public trust in digital transformations of health

Working to engender trust in digital health transformation is critical to adopting and accepting digital health technologies as they emerge. Efforts to build trust must target everyone in the health system from decision makers to health professionals to the general public. The Commission’s recommendations include adopting strategies to:

• safeguard health data
• protect young and vulnerable populations from online harms
• promote transparency and accountability for health applications
• regulate businesses and practices that contribute to health misinformation
• integrate digital health literacy into basic education curricula

The public should be actively engaged in developing strategies and policies that govern digital health, encouraging ownership and oversight of health transformations from the bottom up (Kickbusch et al., 2021).

3.     Apply the concept of data solidarity in approaching health data governance

The Committee outlines three components to a data solidarity-based approach to health data governance:

• ensuring individuals have control over their own health data,
• channeling health data for public good, and
• building a culture of data justice and equity –  or fairly treating, counting, and representing populations in regards to their digital data as well as counteracting health data algorithms that have contributed to inequality and oppression (Hummel & Braun, 2020; Kickbusch et al., 2021).

The Committee highlighted the urgent need for globally agreed upon international standards and rules for data sharing, particularly in regard to international health emergencies such as global pandemics. By 2030, The Committee advises that all countries should have institutions in place to break down and utilize health data in a way that maximizes public value while preserving individual rights (Kickbusch et al., 2021).

4.     Invest in the enablers of digital transformation and UHC

Harnessing the potential of digital transformation for health is not possible without the key components of a ‘digital health readiness.’ Does the entire population have consistent access to affordable electricity, connectivity, and data? Are important digital tools such as smartphones accessible and affordable? Is the population literate in basic digital health concepts? These are considered some of the many enablers of digital transformation.

The Committee recommends investment in these enablers of digital transformation, with governments taking a central role particularly regarding oversight and equitable distribution among the population  (Kickbusch et al., 2021).  If the enablers of digital technology are distributed inequitably, the health benefits cannot be equitable.

The role and engagement of young people in digital transformation of health

Involving the innovative and curious voices of children and young people was central to The Committee’s investigations and report. As young people are set to inherit the health systems transformed through digital technology, holistic and meaningful youth engagement was critical to The Committee’s outputs. A Youth Team was established alongside the Committee with this team producing their own Governing Health Futures 2030 Youth Statement and Call for Action (Kickbusch et al., 2021).  

Young people are uniquely positioned to demonstrate the potential of technology as they heavily contribute to the development and content of emerging digital tools. Many young people are growing up immersed in digital transformations. Around the world, children and young people adopt new technology more readily than others in the population, even in areas with lower connectivity (Kickbusch et al., 2021). A survey by the Youth Team found that 88% of young people around the world used some form of health digital technology (The Lancet & Financial Times Commission, 2021).

The experiences of young people and how technology impacts their growth and development is not homogenous, and youth around the world experience digital technology in diverse ways. The digital divide is particularly evident in younger populations, as technology is central to how young people access health information as well as to their growth, development and education (Kickbusch et al., 2021; The Lancet & Financial Times Commission, 2021). 

The intentional emphasis on the experience of young people is part of the reason The Committee has given special attention to the African continent, where the countries with the youngest populations on the planet are found. By 2030, one-third of the earth’s population under age 15 will live in Africa. These countries with the youngest populations often have weak health systems as well as poor connectivity (Holly, Franz, & Smith, 2021). 

Despite challenges, the pace at which African countries have been adopting digital technologies has been rapidly accelerating over the past few decades. While there are wide variations between and within countries, technologies such as mobile phones and smart phones have been readily adopted. The population has shown interest in expanding the role of technology for health, particularly in the wake of COVID-19 (Holly et al., 2021). Indeed, African-developed innovative digital tools, like mobile health wallets in Kenya, have already rapidly contributed to health system improvements (Sturman, 2020).

Key Takeaways

Globally, technology has revolutionized the way people work, interact, and access services – including healthcare. Harnessing the power of digital transformation is crucial to achieving SDG 3 by 2030. The joint The Lancet and Financial Times commission has provided key guidance intended for all countries in order to maximize the public health impact of emerging technology and utilize this to achieve UHC. Special attention must be given to nations with young populations, low connectivity, and struggling health systems – as is the case for many on the African continent.

It is up to each nation together with global partnerships to evaluate and apply the recommendations by The Committee in order to embrace digital transformation and achieve good health and wellbeing for all and sustain health gains into the future. 

Written by: Malissa Underwood, BSN, MPH