A WHO symposium on the Future of Digital Health Systems in the European Region gathered a diverse group of high-level stakeholders on 6-8 February 2019 in Copenhagen. EPHA has been highlighting the need to tackle health inequalities in the digital sphere for many years (notably, by drafting the European Commission’s eHealth Stakeholder Group report on this topic), and the Symposium proved that the message did not fall on deaf ears. It was highly reassuring hearing the words of Hans Kluge, Director of the Health Systems and Public Health Division who repeatedly emphasised that digitalisation must not only focus on creating a vibrant industry environment but that it also involves a social solidarity commitment. As Regional Director Zsuzsanna Jakab stated, technology also facilitates being human, which is why it is important that services are available to the most disadvantaged and marginalised, including e.g. Roma and migrant communities.
The Symposium enabled discussions about the future of national health systems as a follow-up to a dialogue instigated by WHO Europe in June 2018, with the aim of developing a Roadmap for digital health services. Commendably, WHO’s vision foresees an inclusive approach in which policymakers, industry and civil society are working side-by-side in the implementation of digital health to ensure that “no-one is left behind”, led by the Sustainable Development Goals. The sharing of experiences at country level is key in this regard, and examples were provided from Denmark, Finland, Malta, Kazakhstan and other countries of how digital health can be applied in practical, inclusive ways. To further accentuate these points, EPHA deputy director Sascha Marschang moderated a workshop, “Digital health: reducing or exacerbating health inequalities?” The workshop included a presentation by EUPHA President Dr Natasha Azzopardi-Muscat who talked about the fundamental role played by public health in shaping digital health ecosystems that foster health equity.
Crucially, the impact of digital technology on population health and health equity must be evaluated, and its embedding in population health approaches should be accompanied by an “understanding and acceptance that people come first and technology second”. That small steps can make a difference to democratising healthcare was demonstrated by Dr Vesna Miranović, Director-General at the Montenegrin Ministry of Health who described how the introduction of an electronic appointment scheduling system has brought concrete benefits – as well as some unforeseen challenges – for patients, health insurance funds and healthcare managers. Finally, Cristian Grasu, State Secretary of State at the Romanian Ministry of Health outlined the ambitions of the Romanian Presidency in the context of implementing Romania’s own digital strategy.
As Mrs Jakab noted, IT solutions must not be orphaned from the broader health system, as otherwise digitalisation would be a wasted opportunity for health system integration. Digital health offers important opportunities to drive forward integrated care, make best (ethical) use of Big Data and Artificial Intelligence, and place patient-centredness at the core of health systems. However, evidence and implementation are still trailing, the digital divide is real, and public health goals can only be achieved by offering safe, affordable and effective solutions that reach all people in Europe. In health as in other sectors, the key words are thus safety, security, trust, credibility, transparency, good governance and confidence; without these, patient rights cannot be safeguarded and empowerment cannot be achieved. Policy and regulation have a key role in this as digitalisation is changing every aspect of our lives, in the process also posing a challenge to democracy. Europe can set an example by ensuring a rights-based approach and, as Hans Kluge rightly argued, “marrying digital health and public health”.
As Dr Tedros will present a new global strategy at the World Health Assembly in Geneva in May, EPHA welcomes WHO Europe’s leadership in this area and looks forward to supporting this work as part of a new platform that will be created. Hopefully, Brussels policymakers will follow suit by scaling up dialogues about health inequalities in the digital sphere.