THE PROMISES AND PERILS
OF DIGITAL STRATEGIES
IN ACHIEVING
HEALTH EQUITY

Workshop Summary

Karen M. Anderson and Steve Olson, Rapporteurs

Roundtable on the Promotion of Health Equity
and the Elimination of Health Disparities

Board on Population Health and Public Health Practice

Health and Medicine Division

THE NATIONAL ACADEMIES PRESS

Washington, DC

www.nap.edu

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by contracts between the National Academy of Sciences and the Aetna Foundation, The Kresge Foundation (245367), Merck & Co., Inc. (APA-2013-1223), the U.S. Department of Health and Human Services [Centers for Disease Control and Prevention] (200-2011-38807, TO#34), and the U.S. Department of Health and Human Services [Health Resources and Services Administration] (HHSH25034010T). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-43891-9
International Standard Book Number-10: 0-309-43891-8
Digit Object Identifier: 10.17226/23439

Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2016 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. The promises and perils of digital strategies in achieving health equity: Workshop summary. Washington, DC: The National Academies Press. doi: 10.17226/23439.

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The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

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PLANNING COMMITTEE ON THE PROMISES AND PERILS OF DIGITAL STRATEGIES IN ACHIEVING HEALTH EQUITY¹

GILLIAN BARCLAY (Co-Chair), Aetna Foundation

ANTONIA M. VILLARRUEL (Co-Chair), University of Pennsylvania

CAROLINE McKAY, U.S. Outcomes Research, Merck

MELISSA SIMON, Northwestern University

ROHIT VARMA, University of Southern California

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

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ROUNDTABLE ON THE PROMOTION OF HEALTH EQUITY AND THE ELIMINATION OF HEALTH DISPARITIES¹

MILDRED THOMPSON (Co-Chair), PolicyLink

ANTONIA M. VILLARRUEL (Co-Chair), University of Pennsylvania

PATRICIA BAKER, Connecticut Health Foundation

GILLIAN BARCLAY, Aetna Foundation

ANNE C. BEAL, Patient-Centered Outcomes Research Institute

NED CALONGE, The Colorado Trust

IRENE DANKWA-MULLAN, National Institutes of Health

JAMILA DAVISON, ACM Medical Transition Care

FRANCISCO GARCIA, Pima County Department of Health

ALLAN GOLDBERG, Merck & Co., Inc.

J. NADINE GRACIA, U.S. Department of Health and Human Services

JEFFREY A. HENDERSON, Black Hills Center for American Indian Health

EVE J. HIGGINBOTHAM, University of Pennsylvania

CARA V. JAMES, Centers for Medicare & Medicaid Services

OCTAVIO MARTINEZ, Hogg Foundation for Mental Health

NEWELL McELWEE, Merck & Co., Inc.

PHYLLIS W. MEADOWS, The Kresge Foundation

AMELIE G. RAMIREZ, University of Texas Health Science Center

MELISSA SIMON, Northwestern University Feinberg School of Medicine

CHRISTINE TORBERT, Health Resources and Services Administration

PATTIE TUCKER, Centers for Disease Control and Prevention

ROHIT VARMA, University of Illinois–Chicago

WINSTON F. WONG, Kaiser Permanente

TERRI D. WRIGHT, American Public Health Association

HMD Staff

KAREN M. ANDERSON, Senior Program Officer

COLIN FINK, Senior Program Assistant

ROSE MARIE MARTINEZ, Senior Board Director

ANNA MARTIN, Senior Program Assistant

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

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Reviewers

This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:

Gillian Christie, The Vitality Institute

Chazeman S. Jackson, U.S. Department of Health and Human Services

Elizabeth Ofili, Morehouse School of Medicine

Pattie Tucker, Centers for Disease Control and Prevention

Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Derek Yach, The Vitality Group. He was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteurs and the institution.

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Contents

ACRONYMS AND ABBREVIATIONS

1 INTRODUCTION OF THE WORKSHOP

Highlights of the Workshop

Organization of the Report

2 TECHNOLOGY AND HEALTH DISPARITIES

Equity at the Henry Ford Health System

The Potential of Technology

The Perils of Technology

Engaging Communities

The Diversity of Hope

Realizing the Promise of Mobile Technologies

Mobile Technologies and Health Disparities

Using Mobile Technologies to Change Behavior

3 ENGAGING PROVIDERS AND RACIAL/ETHNIC MINORITY PATIENTS IN DIGITAL STRATEGIES

Creating a Movement for Change

The Value of Theories

A Health Literacy Perspective on Health Disparities

Designing Systems for Health Literacy and Equity

4 EXAMPLES OF ENGAGING RACIAL/ETHNIC MINORITY COMMUNITIES IN DIGITAL HEALTH STRATEGIES

Reducing Digital and Health Inequities in Latina Immigrant Communities

A Tailored Web-Based Intervention for Young MSM in Southeast Michigan

5 POLICY AND TECHNOLOGY PERSPECTIVES

Top-Down and Bottom-Up Approaches to Policy

The Policy Perspective from an Integrated Health Care Delivery System

Observations from a Technology Developer

6 SYNTHESIS OF WORKSHOP MESSAGES

Generating Evidence of Effectiveness

Privacy and Sustainability

The In-Person Component

Involving Communities

Scalability and Adaptability

Involving Providers

REFERENCES

APPENDIXES

A EXAMPLES OF EHEALTH SOLUTIONS FEATURED AT THE WORKSHOP

B WORKSHOP AGENDA

C SPEAKER BIOGRAPHICAL SKETCHES

Acronyms and Abbreviations