Concern over health disparities in the U. S. – the documented difference among racial and ethnic groups in prevalence of diseases like diabetes and cancer and health outcomes – has been high over the past several years. While generally health has improved among all Americans over the past century, due to public health practices (such as handwashing and vaccines), medical care and improved self-care practices, there are still causes for worry, particularly among ethnic minorities and low income Americans. For example, African American women are much more likely to die from cervical and breast cancer than other populations, and Native Americans, African Americans and Hispanics are diagnosed with diabetes much more often than non-Hispanic whites. (See http://www.cdc.gov/omhd/About/disparities.htm.) For this reason, Healthy People 2020 counts eliminating health disparities among its four overarching public health goals for the next decade. (See http://www.healthypeople.gov/2020/default.aspx.)
Of course, that’s easier said than done. The contributing factors underlying health disparities are complex and intertwined, including the social determinants of health (income, education, access to care, etc.), environmental hazards, and some risky health behaviors such as lack of exercise. A recent report by the CDC (2011) recommends a two-pronged approach to amending those contributing factors that can be addressed through general overarching initiatives as well as targeted approaches for those Americans most at risk of poor health outcomes.
Another important factor to consider in eliminating health disparities is access to information and technology. Consumer health technology is evolving rapidly, from online support groups and static web sites to online patient-doctor communication and medical records review, health tools and patient-focused social media venues. High speed broadband access is becoming a vital necessity for these and other aspects of life in the 21st century, but as a recent column in the New York Times pointed out, lower income, rural and minority populations are more likely to miss out on these opportunities due to lack of access to high speed Internet than higher income, urban and suburban residents (Crawford, 2011). And while smartphone ownership is higher among minorities (Fox, 2011a), and more apps are becoming available for mobile technology, the wireless access typically available to support smartphones cannot handle large files easily, limiting their usefulness as replacements for high speed access to the Internet. As the Times piece author notes, it’s like making do with a wireless bike path on the Information superhighway (Crawford, 2011).
But this new “Digital Divide” is a more complex picture than who has or doesn’t have access to high speed broadband. An interesting facet of the use of the Internet among minority populations, according to M. Chris Gibbons of Johns Hopkins Urban Institute (2011) – who, incidentally, received his medical degree from the University of Alabama – is that they’re much more likely than white residents to use social media regularly. Dr. Gibbons points out that minority patients value the ability to “tell their story” as well as share information with peers, supporting their participation in the “Health 2.0” arena of consumer driven health sites (Gibbons, 2011). This social aspect of online usage may be particularly important for those with chronic conditions, as peer support and information for managing these conditions. According to the Pew Internet & American Life Project, at present social media is used “sparingly” for health issues (Fox, 2011b), but the potential is there for much greater use of “crowdsourcing” around health topics, especially among those with serious or chronic illnesses. Indeed, Gibbons points to resources like PatientsLikeMe.com and CureTogether.com as models for the type of consumer empowerment resources online that might prove to be significant tools in the struggle to eliminate health disparities.
So, while the problem of high speed Internet access to obtain personal health information across geographic, income and ethnic population segments is still an issue in eliminating health disparities, there are other reasons to hope for technological avenues to address these disparities, even as we continue to work toward more equal access to broadband.
U. S. Centers for Disease Control. (2011). CDC health disparities and inequalities report – United States, 2011. MMWR Supplement, 60. Retrieved from http://www.cdc.gov/mmwr/pdf/other/su6001.pdf.
Crawford S. P. (2011 December. 4). The new digital divide. New York Times, pp. SR1, SR8.
Fox S. (2011). Mind the gap: peer-to-peer healthcare. Pew Internet & American Life Project. Retrieved from http://www.pewinternet.org/Reports/2011/20-Mind-the-Gap/Part-2/Section-3.aspx.
Fox S. (2011). The social life of health information. Pew Internet & American Life Project. Retrieved from http://pewinternet.org/~/media/Files/Reports/2011/PIP_Social_Life_of_Health_Info.pdf.
Gibbons M. C. (2011). Health IT and healthcare disparities [Powerpoint slides]. Retrieved from http://www.slideshare.net/PlainTalkConf/m-chris-gibbons-health-it-and-healthcare-disparities.