Digital Health Promotion

A Critical Introduction

Ivy O'Neil

• Publisher: Polity
• Year: 2019
• ISBN:
  9781509533336
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

Searching the internet for health information or using health apps on mobile devices has become part of our daily routine, yet can be just as disempowering as empowering. This engaging overview critically examines the theoretical underpinning of digital health promotion and the use of digital tools and strategies to promote health.

Ivy O'Neil investigates how modern technologies can enhance health services provision and increase the accessibility and efficiency of health communication and promotion. She also looks at the challenges they bring to the social model of health, as they often focus on the individual and neglect the many social, environmental and economic determinants of health. Digital technologies, O'Neil argues, can have negative as well as positive implications and may be contributing to the ever-widening health inequality gap, thereby failing to be compatible with health promotion principles and values.

Offering a critical, practical and thoughtful overview of the application and usefulness of digital technology, this book will appeal to students of public health and health promotion, communication and policy.

1
Introduction

This chapter provides an introduction to the topic area, the rationale for the book and an outline of the areas to be covered in relation to the development and the practical uses of digital technologies in promoting health; the underpinning health promotion theories; the Big Data phenomenon; tackling and managing public health issues and improving health outcomes. The chapter will introduce the reader to digital technology within a behaviour approach to health promotion and its potential effects on health inequalities. An explanation will be given regarding the organization of the book. A chapter-by-chapter introduction of its content will also be given to point readers to specific chapters. The book focuses specifically on public health and health promotion and will not cover technological developments in acute secondary healthcare.

This book is primarily for postgraduate-level students studying public health and health promotion, and final-year students at undergraduate level in all health-related courses. It is also useful for students on a professional course such as medicine, nurses, public health practitioners, professions allied to health and environmental health, primary care, practitioners in a wide range of health and social care environments who are interested in health promotion, as well as anyone with a role in health improvements. Because of the connectivity of digital technologies, the sharing of the complex web of information and the Big Data phenomenon, the impacts of eHealth development spread out broadly and globally. Therefore, this book would be useful for students and practitioners both in the UK and internationally. The implications of neoliberalism are particularly relevant for a ‘westernized / Global North’ policy context, such as in the USA, Canada, European countries or Australia. Many of the examples are from the Global South (particularly Africa) and the underlying health promotion principles are, and should be, global.

It is inevitable that technology will develop beyond the publication of this text. This book is not primarily intended as a ‘best apps’ or ‘how to’ manual, guiding readers in using current digital applications. It is about becoming Health Promotion literate regarding digital technologies. The crucial element is about teasing out the health promotion principles and underpinning theories to be applied to digital health technology as it develops. The intention is to be able to assess future as well as current developments in a way that gives us confidence to critique and become better informed in the use of new technologies as they emerge.

Digital technology – an unprecedented series of developments

The realities of digital technological change are a part of everyday life, both in technological advancement and in societal behaviours. In 1994, the internet in the UK was only used by 0.5% of the population. By 2014, 84% had internet access, and 76% accessed the internet every day (Office for National Statistics 2014). People over 65 increasingly use the internet, rising from 9% in 2006 to 42% in 2014 (Ofcom 2014). Approximately four in five UK households have fixed broadband, and three in five adults access the internet through their mobile phone. In 2015, 68% of adults aged 75+ would miss having a TV set in their home as compared to 17% of 16- to 24-year-olds. However, 59% of those aged 16–24 are more likely to miss their mobile phone, as compared with just 2% of those aged 75+ (Ofcom 2015). The use of tablets and smartphones continues to increase. However, there are still 12% of people unable to use the internet and some with no plans for future use (Coulter and Mearns 2016).

In the USA, 79% of online adults use the internet, and half of older adults have home broadband and 42% reportedly own a smartphone (PEW 2016). According to Burke-Garcia and Scally (2014), internet use is fairly broadly distributed across race, gender, income and education. However, a study by Duggan and Brenner in the USA in 2012 shows that women, people from urban settings and people under 50 are more likely to use social networking sites, particularly those aged 18–29 (83%, as against 32% of the 65+). Similarly, there are more young people and people in urban areas who use Twitter. Young people and women, as well as African Americans and Hispanics, are also more likely to use Instagram. Facebook, however, remains the most popular social networking site for younger people aged 18–29 (86%, as against 35% of the 65+), and for women more than men (72%, against 62%) (Duggan and Brenner 2013). According to Mark Zuckerberg, founder and CEO at Facebook, as from June 2017, there are officially 2 billion people on Facebook, the biggest online social networking site globally (PEW 2016), and 1.5 billion users on YouTube, the second-most-used search engine in the world (Techcrunch 2017). This sets a context for the potential importance of digital technologies in health. Chapter 2 will provide a critical review of the current usage of digital technology in the public health arena.

Communicating health

With the rapid pace of development, digital technologies offer a wide range of potential influences on health and health behaviours. Increased usages of social media (for example, among young people and ethnic minority groups) make such sites a potentially good channel for health communication. It is also useful for sharing health messages among friends and families in social groups in a speedy manner. Web 2.0 technology with its specific interactive functionality offers new dimensions for health communications such as interpersonal communication, narrowcasting and tailored messaging (Atkin and Rice 2013). Views and information can be shared in blogs, podcasts, via Twitter, interactive video, Instagram, WhatsApp and many social networking sites such as Facebook; narrowcasting via audience segmentation can be used in social marketing strategies via media campaigns; tailored messages can be sent to target audiences via text messaging; data can also be tracked and used for large-scale research (Ofcom 2015). Interpersonal communication can be improved via online mentors and email. Health messages can be put on online banners (Atkin and Rice 2013). New technology to improve efficiency of service provision is being seen as a solution in the age of austerity when funding is limited. However, many people who lack access to the internet or the required skills may not be able to benefit from the advance of technology.

For example, in the UK, efforts to digitize the healthcare system have been ongoing and can be dated back to the 1960s, with the first national information technology (IT) strategy for the NHS in 1992 (NHS Management Executive 1992). Connecting for Health was a strategy aimed at creating a single electronic health record for patients, connecting primary and secondary care IT systems, providing a single platform for health professionals. Almost all general practices in England were using electronic health records by mid-2000 (Wachter 2016). Progress was made in the 2000s particularly in primary care, whereas secondary care lagged behind significantly (National Audit Office 2013). In England in 2013, the Secretary of State for Health challenged the NHS to ‘go paperless’ by 2018, with the publication of the NHS Five Year Forward View in 2014 (subsequently extended to 2020). The National Information Board (2014) set out to enable people to make the right health and care choices through full access to their care records, access to the use of health and care apps and digital information services. Care professionals and carers should also have access to all the data, information and knowledge they need by 2020 for quality care provision, supporting research and ensuring cost-effectiveness through the use of technology. Its report Personalised Health and Care: A Framework for Action 2020 (National Information Board 2014) set out the implementation plan aimed at improving ‘digital maturity’. Funding was set aside to meet this challenge. Recommendations were also made by the Wachter review (2016) to digitize secondary care. It was proposed all Health Trusts should achieve ‘digital maturity’ by 2023.

The development of modern health technology is swift. Clearly, there are potential benefits in the use of technology to improve healthcare. Care services can be better planned and co-ordinated. More effective and efficient services can be provided by healthcare professionals. People can take a more active role in and control of their own health and care (Klasnja and Pratt 2012). Cyberspace can be an effective platform for health promotion. However, as we will discuss in the coming chapters, there is still a lack of research on the use of social media in the public health field (Burke-Garcia and Scally 2014). The quality and accuracy of internet information, as well as data security, are of concern (Ahmad et al. 2006; Hou and Shim 2010; Ratzan 2011). The NHS-HE Forum Connectivity Best Practice Working Group identified risks in the use of social media, including confidentiality, ownership issues and cyberbullying (Lafferty 2013).

Drawing information together, Gretton and Honeyman (2016) from The King’s Fund looked at new developing technologies, identifying eight technologies, with examples from both the UK and the USA, that will change health and care, making it more effective, efficient and sophisticated in modern-day healthcare provision:

1. The smartphone – a mobile device with internet connectivity and computing ability, sensors for tracking health data and many downloadable health apps. It can serve as the hub for diagnostic and health management technology, e.g. management of type 1 diabetes.
2. At-home or portable diagnostics – devices and apps such as portable X-ray machines, blood-testing kits, the AliveCor Heart monitor and Alive ECG app. Smart assistive technology can be accessed and used at home to assess and monitor patients’ progress, e.g. in Parkinson’s disease or asthma.
3. Smart or implantable drug delivery mechanisms – implanted drug delivery devices can be used to deliver medications, monitor drug compliance – e.g., via smart pills – and help people with long-term conditions such as dementia or Parkinson’s disease.
4. Digital therapeutics – digital therapy platforms that can connect people with their peers and health professionals in the management of long-term conditions, e.g. computerized cognitive behavioural therapy. Preventative interventions such as lifestyle coaching and group therapy can be used in the prevention of chronic conditions, e.g. diabetes.
5. Genome sequencing – a new technology such as nanopore technology can help to improve understanding of the development of illness and its treatment in an individual. Population-level genome data can also be collected to understand population health.
6. Machine learning – a type of artificial intelligence that enables a computer to learn and make sense of large amounts of unstructured data for health service provision.
7. Blockchain technology – a decentralized database can be used (for example) in improving existing electronic health records. One of the most well-known applications in this area is the digital currency Bitcoin.
8. The connected community – internet space has become a venue for people from across the world to meet, support and share information with each other.

However, all the above are still overly focused on service-centred usages and, as this book will discuss, the concept of health and health improvement is much broader. In this book, we will explore in more depth the meaning of health and healthcare in the context of public health, look more fundamentally at health and digital developments, and discuss the nature and wider impacts of digital technologies on health.

Overview and rationale of the book

In the short space of a decade, the development of digital technology has radically and unimaginably reshaped our world, and continues to impact on our lives. We have become technologically dependent on the use of interactive technologies in modern living (Gold et al. 2012; Atkin and Rice 2013; Capurro et al. 2014; Lupton 2015c), and particularly so for young people (Centre for Health Promotion, Women’s and Children’s Health Network 2012; Loss et al. 2014). Within health fields, modern technologies can potentially enhance health services provision, increasing accessibility, effectiveness and efficiency, both on healthcare provision and in the management of healthcare services. We have seen examples of this in terms of organizations such as the English NHS going paperless (Department of Health 2013b), and the Scottish Government committing to a world-class digital service (Scottish Government 2013). The transformation of health and social care is about empowering everyone to live longer and healthier. Health-promoting services need interconnectedness for efficient and effective service provision.

The use of social media and electronic communication technologies in tackling public health issues is increasingly common. Internet searching for health information and the use of health apps on mobile devices can be seen as a daily activity for many. Initiatives on eHealth and mHealth, such as electronic health records, mobile telemedicine, health call centres, telephone helplines, as well as text mess...