Health care is in the midst of a dramatic transformation in the United States. Spurred by technological advances, economic imperatives, and governmental policies, information technologies are rapidly being applied to health care in an effort to improve access, enhance quality, and decrease costs. At the same time, the use of technologies by the consumers of health care is changing how people interact with the health care system and with health information.
These changes in health care have the potential both to exacerbate and to diminish the stark disparities in health and well-being that exist among population groups in the United States. If the benefits of technology flow disproportionately to those who already enjoy better coverage, use, and outcomes than disadvantaged groups, health disparities could increase. But if technologies can be developed and implemented in such a way as to improve access and enhance quality for the members of all groups, the ongoing transformation of health care could reduce the gaps among groups while improving health care for all. As a recent report from the Institute of Medicine (IOM) stated, “Facilitating patient and population contribution to, and control of, their health information has the potential to provide fur-
1 The planning committee’s role was limited to planning the workshop, and the workshop summary has been prepared by the rapporteurs as a factual account of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of the individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. They should not be construed as reflecting any group consensus.
ther insights into, and opportunities to address, disparities in underserved populations” (IOM, 2011, p. 38).
To explore this potential, the National Academies of Sciences, Engineering, and Medicine’s Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities held a workshop at Wayne State University on October 2, 2014. The focus of the workshop was on (1) how communities are using digital health technologies2 to improve health outcomes for racial and ethnic minority populations, (2) how community engagement can improve access to high-quality health information for members of these groups, and (3) models of successful technology-based strategies to reduce health disparities. Box 1-1 lists the goals of the workshop.
The workshop was held in Detroit, Michigan, on the campus of Wayne State University, to emphasize both the promises and the perils cited in the workshop’s title. Detroit has some of the worst health disparities in the nation, yet it is also at the center of work on reducing these disparities, noted M. Roy Wilson, the president of Wayne State University and a former official at the National Institutes of Health (NIH) in charge of the NIH health disparities research agenda. Wayne State University has the only NIH perinatal research branch outside of the NIH campus in Bethesda, Maryland, partly because of the high infant mortality rate in the city (discussed in more detail in Chapter 2). Wayne State also has been a leader in other areas related to health disparities. The Barbara Ann Karmanos Cancer Institute has been looking at the determinants of health among survivors of cancer who have access to the Internet and those who do not. A research project in the medical school is looking at the effect of text message reminders about adherence to blood pressure medication. An interdisciplinary team has developed a sensor that includes a heart monitor and a Bluetooth connection to a smartphone to identify potentially dangerous heart rate increases. “We are very proud of everything that is going on here,” said Wilson.
This report provides a summary of the presentations at the workshop and the discussions that occurred among workshop participants. (Comments made by presenters during the discussion sessions generally are included in the summaries of their talks.) The observations made in the report are of the workshop as a whole and should not be seen as the conclusions of the workshop participants, the Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities, or the Academies. However, they provide many valuable insights into future steps that could be taken to reduce health disparities in the United States.
2 For the purposes of this workshop, “digital health technologies” encompasses all types of personal technology. However, the majority of the technologies described in this summary are cell phone based or interactive websites.
In the final session of the workshop, Gillian Barclay, vice president of the Aetna Foundation, summarized some of the main messages that she heard during the presentations and discussions. The following draws on Barclay’s remarks and on comments made over the course of the day to identify the major ideas that arose during the workshop:
- The main point gleaned from the workshop, said Barclay, is that technology “is really all about people.” Addressing racial and ethnic health disparities and increasing health equity in the United States “goes back to the foundation of placing people first and not technology first,” she said.
- Community engagement is essential in designing, evaluating, and adapting technology-based interventions aimed at improving health in racial and ethnic minority groups.
- Reducing health disparities requires going beyond both the use of technology and health care in general to a “health-in-all-policies” approach. Education, transportation, and other sectors can all contribute to the reduction of disparities.
- Systems and patterns are major determinants of health disparities. Looking at the potential of technology to reduce health disparities requires consideration of these systems and patterns, not just particular events.
Following this introduction to the report, Chapter 2 summarizes the remarks of the two keynote presenters at the workshop, both of whom provided overarching views of health disparities and technology issues on local, regional, and national levels.
Chapter 3 examines a wide range of issues associated with the use of technology to reduce health disparities, including health literacy, community engagement, and the role of theory in program development. Chapter 4 looks in greater detail at two specific programs as a way of exploring how these issues play out in practice.
Chapter 5 considers the broader policy and technology issues that shape health equity initiatives. In Chapter 6, two respondents identified the key messages emerging from the presentations and discussions at the workshop.
Appendix A provides descriptions of nine programs that workshop participants learned about during a “virtual poster session” at lunch. Appendix B contains the workshop agenda and Appendix C gives biographies of the speakers at the workshop.