frontiers in public health

frontiers in public health

The Impact of Technology on Public Health

1. Introduction

Technology has already had a profound effect on public health. Increases in life expectancy and quality of life throughout the 20th century can largely be attributed to several technological developments in public health, as well as the training of a public health workforce. One of the clearest examples of the successful use of technology was the worldwide eradication of smallpox in 1977. This was accomplished by massive vaccination campaigns, supported by the development of a strong global infrastructure for disease surveillance. The development of the smallpox vaccine, as well as the tools to deliver and track vaccination numbers in the third world, are equally important types of technologies that allowed this to happen. This is just one example of how a targeted technological solution was able to have positive effects on public health.

There is a growing interest in understanding the role of technology in the field of public health. Public health is defined as the science and art of preventing disease, prolonging life, and promoting health through the organized efforts of society. This could include surveillance and control of diseases, environmental health issues, or preventative education. The objective is to investigate and evaluate the potential impact of technology on public health at local, national, and global levels. This can be accomplished by focusing on the ways that technology has been used for specific public health problems, considering different options concerning resource allocation, and discussing how this allocation may change as a result of new technologies. It also involves investigating potential unintended consequences of new technologies on public health and considering how new technologies may alter the training and professional orientation of future public health professionals. This essay will serve to inform the reader about the scope of some of these effects, as well as provide an overview of some of the different technologies and situations that this topic covers.

2. Advancements in Data Collection and Analysis

Some of the most notable recent technological advancements can be seen in data collection and analysis. Establishing cause and effect in the field of public health has always been a challenge, and technology is making it ever easier. Randomized control trials are considered the gold standard in measuring an intervention’s effect on a health outcome. However, these can be very expensive to implement and in some cases it is impossible to randomize an exposure. In these cases, researchers are turning to new observational study designs made possible by new technology. Propensity score matching is a technique that matches people with a certain treatment to those of a similar condition who did not receive the treatment. This method has been greatly simplified by electronic medical records and allows for a more valid comparison of treated and untreated subjects. In some instances, an exposure may take place inside of a very short time period, too short for a researcher to capture using traditional data collection methods. E-health technology has allowed for the creation of a device known as a Personal Digital Assistant, which can be carried by a subject and will prompt them to record information at certain times determined by the researcher. This can be programmed to happen immediately after an exposure takes place, greatly reducing error in the reporting of when the exposure occurred. A trickier situation is when an exposure takes place in a clinical setting, and the patient is unlikely to remember and accurately report this occurrence at a later date. Time-stamped data collection of patient encounters with physicians has made this a more feasible event to capture.

3. Telemedicine and Remote Patient Monitoring

The potential of information technology to create a real-time communication channel between patients who have Internet access and a health concern and a provider who is logged into an electronic health record has intriguing implications for the concept of “virtual visits.” This is not intended or appropriate for all types of clinical encounters. Patients with severe, acute problems need to be seen in person and there is no substitute for the data available from a face-to-face encounter. But for certain types of follow-up visits, such as management of a stable chronic condition or medication check, it may be feasible to conduct a focused visit in a secure chat room, in which patient and provider type messages to each other. This mode of communication presumes that the provider can easily access all information in the patient’s record and might allow more immediate engagement between patient and provider compared with an office visit scheduled several weeks in the future. An even more advanced version of a virtual visit would involve video conferencing, which preserves some of the visual and interpersonal cues of a face-to-face encounter. Although we are unaware of studies examining virtual visits in a mainstream US practice, this method has been shown to be feasible and cost-effective in several European healthcare systems.

The usage of various forms of communication technology not just to inform patients about the appropriate sites of care for specific clinical presentations, but also to expedite the care process has widespread implications for the healthcare system. One well-established method in which communication technology can improve patients’ access to care by their regular providers is through online communication about a specific health concern. If email has become an expected form of communication in the business world, then it is not a far stretch to anticipate that patients and providers will use this method to communicate about health-related issues. Patients who can reach their own providers quickly when they have questions or concerns about a recent diagnosis or exacerbation of a chronic condition might avoid more costly and inconvenient office visits. Also, email can be a much better tool than phone calls for relaying information about nonurgent issues when patient and provider cannot find a time to talk synchronously.

4. Health Promotion through Digital Platforms

The massive proliferation of digital platforms has changed the role of health promotion in public health. In the past, health promotion was incorporated into the life of individuals and communities by the institutions serving those communities. It was implemented within the sectors of public, private, and voluntary and involved different strategies depending on the needs of the population targeted. Most health promotion was designed to be delivered face-to-face and was local and specific to the community. In more recent years, health promotion has lost its dependence on what can be described as the traditional health sectors and has expanded into a much wider field. Health promotion has been adopted by many other sectors as a major function, such as the education and employment sector. There has also been a major shift in health promotion being implemented into policy as can be seen by the incorporation of social marketing and more recently the health tax. With regard to promoting healthy lifestyles, there is a common understanding now that health status is not only influenced by the actions of individuals and their support networks but is significantly affected by the broader determinants of health. This shift has led to more health promotion aimed at broader community-wide changes. These changes in the nature of health promotion provide a clear link to the utilization of digital media as a promotional tool.

5. Ethical Considerations in the Digital Age

Types of predictive models used in this study can help aid doctors and patients in making hard joint decisions to improve the patient’s chance of survival. For example, with the patient’s best interests in mind, a doctor will use a surrogate to estimate the patient’s forecast while taking into account all benefits and risks of treatment. This can help prevent wasting resources and time on treatments with little chance of success or treatments which may negatively affect the patient. This can all go towards providing the best decision for the patient. However, there are potential hidden dangers in predictive models which need to be properly addressed to ensure no unethical activity. This kind of judgment, at many times, could cross the line between beneficence and maleficence by taking action intended to be beneficial but may inflict harm. An example of this could be when a patient’s survival chance is so low that it would be harmful to still try and cure them. Predictive model tools designed to estimate a patient’s life expectancy can auto-generate a message at treatment selection prompt which was not originally desired by the patient. This could potentially cause great distress to a patient when they receive a suggestion to stop treatment. In extreme cases, a poor prediction could cause a doctor to give a recommendation on treatment selection to a patient without consulting the model. These tools can lead to further justice issues as improper selection of participants, taking into account data selection bias, can lead to unfair predictions for certain communities. This could potentially mirror the injustices of The Tuskegee Syphilis Study, with a vulnerable community receiving harmful riskier treatments. A statement by J.D Knapton et al suggests that more applied effort should be placed into ethics in the design, development, and implementation of medical simulation software. Simulation models aim to replicate real-life medical systems to aid public health policy and decision making. This is highly useful for testing various systems to foresee the outcome it may have on population health. Due to advancements in technology, there are no strict guidelines on ethical considerations for this sort of research. With the side effects of simulation often leading to change, it is hard to assure no harm to ‘patients’, and while there may be no change to human experimentation, it is still hard to guarantee the best interest as per the Detroit area systematic drug strategy changes simulation.

Ethical considerations in health research are not a new issue. Many influential historical cases have taken place to cause disruption in this topic of conversation. For example, the Belmont Report, which came about by The Tuskegee Syphilis Study, had three main goals. First, to ensure that a patient’s autonomy and dignity is respected. This relates to our module highly because it is necessary to assure that data collected on individuals is done with good conscience and with the individual agreeing to this use. Failure in this can cause serious privacy breach and loss of an individual’s respect and dignity. The second goal is to ensure that individuals are not subject to harm in their participation. The third goal is to focus on justice, with it stating “the selection of research participants needs to be scrutinized”. Failure in the aforementioned points within the Belmont report could come under the category of unethical or illegal activity due to negligence.