During my research for my blog content concerning public health in the digital era, I came across with Angus Deaton’s book[1]. The Great Escape: Health, wealth and the origin of inequality is originally the title of a film about people fleeing from a war camp during World War II. The Nobel Prize-winning writer and economist uses this in the context of how humanity “escapes” from, among other things, poverty and premature death, and how it creates prosperity for itself.
At the same time, he demonstrates that progress necessarily goes hand in hand with inequalities, but there is also the danger that the lucky ones will pull up the ladder, making it harder for the less fortunate to catch up. I believe this describes well the field of development today and presents my questions related to socio-economic and cultural barriers for access to healthcare, disease burdens and the impact of digital technologies on these factors.
According to Deaton, well-being is a complex concept: we include income, the number of years lived, health, education, but also the opportunity to control our destiny. These are all important, but because our resources are scarce at any given moment, we have to decide from time to time who we give more to, necessarily to the detriment of others. This is decided by the electorates in the framework of a democratic debate, for which they need information and knowledge. This brings the social determinants of health into the equation. Income inequality, medical technology, education, ethnic diversity, structural racism, gender as well as the important role of information and communication technologies (ICTs) and public healthcare expenditure all determine health outcomes[2].
In terms of healthcare, the increasing level of quality, easier and faster access to medicines, vaccines and vitamins makes humanity now less afraid from the horror of several diseases, as it did a hundred years earlier, for example to the average Western citizen. However, there are differences between the Global South and the Global North. Deaton argues that low-income countries cannot hope for lasting change in this area simply by making significant health investments or benefiting from the results of current state-of-the-art medical procedures. “Poverty-related diseases” specific to poor countries can only be truly eradicated if insecurity in that country is eliminated, leading to not only health but also general social security.
While there is an increasing number of humanitarian organizations and projects highlighting pressing issues and thanks to the development of ICTs, inviting everyday citizens to action, the impact of these development initiatives is not proportionality related to the expansion of the field of development. Digital technologies have a potential role to accelerate positive social change as well as to further exacerbate the already existing inequalities of our society. As uneven development, dependency and inequality are inherent factors of capitalist development, the complexity of these multi-purpose technologies need to be conceptualised in order to fully understand the contribution of ICTs[3].
Do we provide access for All and leave No One behind?
Fur sure, we can see improvement of healthcare on a global scale. It has eradicated diseases; it is more inclusive in terms of disease management as well as in the percentage of the population that can access care. However, most health inequalities are attributable to the wider determinants of health: the social, economic, and environmental factors that impact overall wellbeing and shape mental and physical health[4].
Education is one of the vital determinants of health, presenting an intrinsic link between education, health and equity[5].
Regardless of medical advances, being aware of risk factors of various diseases, taking steps of prevention or using appropriate care are only possible if someone has an adequate level of health literacy. Furthermore, the continuous development of eHealth services brings potentials itself to be more inclusive, but at the same time, it can also spiral already existing disease burdens. The lack of health literacy has been formerly a problem of disease management, but often the even lower level of eHealth literacy further questions the equal access for All.
Social exclusion, racial and ethnic inequities also highlight global health challenges[6] as these are defined by unequal power relations that interact across economic, political, social and cultural dimensions.
Social exclusion is associated with the poorest health outcomes, putting those affected beyond the extreme end of the gradient of health inequalities. Many people face multiple barriers in access to health services due to fear, language and communication issues, or past experiences of being turned away4. For instance, age, masculine gender norms, feelings of shame and fear, and poor health awareness are some of the individual barriers to early detection, screening, and diagnosis of cancer. There is also a difference of late stage diagnosis, 35% of low-income countries reported that pathology services were generally available compared to more than 95% of high-income countries[7]
Unfortunately, these disparities are also well presented during the current COVID-19 pandemic.
For instance, the death rate in the US from Covid-19 among African Americans and Latinos has been rising sharply, exacerbating the already staggering racial divide in the impact of the pandemic which has particularly devastated communities of colour[8]. There are also serious public health consequences of COVID-19 in terms of tropical and noncommunicable disease control which has significant implications, especially on low-income countries’ populations.
The right to choose, from access to empowerment
“If a woman has the right to choose an abortion but she cannot afford it and federal Medicaid will not pay for it, does she really have a choice? (Nelson, p.9)9”
During the early 1970s, women’s health movements shifted their focus on ending sexual discrimination and gender stereotypes perpetuated in mainstream media. As for instance, the demand to control their own life has been including the fight for the elimination of stigma associated abortion, one of the most debated healthcare necessities. Women of colour activist broadened the argument asking for reproductive justice which “is not a call for legal right alone. Rather, demands hinge on associations between health promotion and the satisfaction of basic human needs.”(Nelson, p.9)[9]. This is still highly relevant today.
Health inequalities do not stop with economic status and race, it includes gender too. In my first entry, I used endometriosis to demonstrate gender inequalities in public healthcare which also placed emphasis on the role of representation. Although the case study of endometriosis just one of the several examples of the female reproductive system, I believe it clearly showed the need for a more extensive understanding of care and questioned the inclusivity of public health.
Nevertheless, in terms of digital technologies and women health, we can clearly see beneficial impacts.
Digital media can offer unparalleled opportunities to connect with others, sharing experiences, telling illness narratives which enable one to attain a feeling of normalcy that has been questioned[10]. Also, when a disease is narrated on social media accounts[11], it takes advantage of digital technologies to raise awareness which plays an indispensable role of disease management. Thus, digital technologies can empower women, indeed. It can contribute to changing gender relations as digital tools offer opportunities to network, to challenge the structural inequalities that constrain human beings, perpetuate inequalities, and prevent just and sustainable human development[12]. However, in order to do so, we need to have a deep understanding of socio-cultural backgrounds, the question of equal access, and the implications of digital information on our attitudes and beliefs. And even if these are present, ICTs are not the sole solution. Did ICTs prevent to make abortion illegal in Poland just a couple of weeks ago? “Feminist critiques of ICT4D emphasise the need to move beyond the notion of access, affordability, availability and awareness – to address questions of power and inequality. Agency and ability are two more ‘A’s that could be added to the list to help achieve this.” (O’Donnell, Sweetman, p.220)12.
ICT4D
With the advances of digital technologies, the field of development has been also altering and presenting a fundamental shift in the public consciousness. Today digital communication is a vital component of humanitarian work. “A majority of INGO budgets are indeed spent on actual digital technologies and the bulk of the work of marketing, branding, public relations (PR), fundraising, awareness raising and outreach has primarily been taking place on the Internet”. (Shringarpure, p. 181)[13].
To my mind, this shift has advantages as well as obvious drawbacks. Maybe it is thanks to my young professional naivety or the yet limited amount of experience that I still believe of the power of raising awareness. As I have presented this view thorough my posts, I like to think that if more and more people are aware of a certain health issue or more and more people talk openly about a disease, there is a chance to create noise which can influence governmental actions and beneficial health policies. I have participated in several world health day campaigns. Even though the top-down method is still there, I also saw medical students providing free screening in resource-limited settings and children learning about the importance of oral health for general health. These would not have been possible without the inclusion of ICTs. While these are small steps toward equitable care, they should not be dispraised.
Of course, I am well-aware that these campaigns exclude millions of people due to the digital divide. I also see the increasing similarities between social marketing and corporate marketing campaigns, the rapid dissemination of misinformation as well as the digital saviour complex, just to mention a few. Moreover, in the case of INGOs, public health advocacy often frames behaviours associated with health disparities, as one of the personal choices, leading to policy solutions that focus on re-shaping lifestyles of unhealthy populations; often supported by extant government and institutional ideologies[14].
So, what are the lessons learned for volunteers?
Technological advances have also been impacting volunteering. As much as it provides novel opportunities to participate, such as virtual volunteering, it also presents new inequalities of the field. Even though volunteers are “valuable resources” and crucial participants of healthcare, not everyone has an equal chance to participate. The digital skills are increasingly crucial requirements of volunteer employments and higher socioeconomic classes are more likely to have reliable internet connections and devices. Technological developments and digital divide come together as progress and inequality. Nothing is only black and white. Development and communication practices should be seen as complex processes and ICTs should be acknowledged as double-edged swords, or in other words,” useful tools in processes of empowerment”. As Alsop and Heinsohn state;
“They define empowerment as enhancing an individual’s or group’s capacity to make effective choices and translate these choices into desired actions and outcomes” (p. 677)3.
When I started my bachelor studies, I had a clear objective of becoming a journalist one day. However, the more I understood about the media empire, the more I felt fascinated by the industry itself, but at the same time, it became clear that I do not wish to participate in this mass manipulation. This is how ended up learning and writing about development instead. During my current master studies, I also realised that I feel more confident writing a critical academic analysis than a news article or a blog post. Now, I do all of these.
I believe that writing a blog definitely develops creative writing skills and it is an eye-opening experience. I personally find the latter one more significant. Today, as we gather most of the information from different online platforms, the endless amount of information, which is often controversial, is simply overwhelming and tiring. However, reading my fellow students’ writings and familiarising myself with other high-quality contents has been truly refreshing. How I learnt more about the ambivalent characteristics of development, the questionable attitudes of “good-doing” and the interconnected relationship between progress and inequality, I hope future volunteers could also gain more understanding of the complexities of ICT4D.
References
[1] Deaton A. The great escape: health, wealth, and the origins of inequality. Princeton, NJ: Princeton University Press; 2013.
[2] Rana RH, Alam K, Gow J. Development of a richer measure of health outcomes incorporating the impacts of income inequality, ethnic diversity, and ICT development on health. Globalization and Health. 2018;14(1): 1-12.
[3] Kleine D. ICT4what?-using the choice framework to operationalise the capability approach to development. Journal of International Development. 2010;22(5): 674-692.
[4] Campos-Matos I, Stannard J, de Sousa E, O’Connor R, Newton JN. From health for all to leaving no-one behind: public health agencies, inclusion health, and health inequalities. The Lancet Public Health. 2019;4(12): e601-e603.
[5] Baum F. Education Essential Investment in Health Governing for Health: Advancing Health and Equity through Policy and Advocacy. New York, NY : Oxford University Press; 2019.
[6] Miranda DE, García-Ramírez M, Albar-Marín MJ. Building Meaningful Community Advocacy for Ethnic-based Health Equity: The RoAd4Health Experience. American Journal of Community Psychology. 2020; 0: 1–11.
[7] World Cancer Day. World Cancer Day 2019: Global cancer experts call for urgent action to improve early cancer detection. Available from: https://www.worldcancerday.org/world-cancer-day-2019-official-press-release [Accessed 8 November 2020].
[8] Pilkington E. Covid-19 death rate among African Americans and Latinos rising sharply. The Guardian. 8 September 2020. Available from: https://www.theguardian.com/world/2020/sep/08/covid-19-death-rate-african-americans-and-latinos-rising-sharply[Accessed 8 November 2020].
[9] Nelson J. More Than Medicine: A History of the Feminist Women’s Health Movement. New York: New York University Press; 2015.
[10] Petersen A, Schermuly A, Anderson A.Feeling less alone online: patients’ ambivalent engagements with digital media. Sociology of health & Illness. 2020;42(6): 1441-1455.
[11] Melander I. Multimodel Illness Narratives on Instagram. Sharing the Experience of Endometriosis. Diegesis. 2019;8(2).
[12] O’Donnell A, Sweetman C. Introduction: Gender, development and ICTs. Gender & Development. 2018;26(2): 217-229.
[13] Shringarpure B. Africa and the Digital Savior Complex. Journal of African Cultural Studies. 2020;32(2) 178-194.
[14] Cohen BE. Marshall SG. Does public health advocacy seek to redress health inequities? A scoping review. Health & Social Care in the Community. 2017;25(2): 309-328.