Health Technology for All: An Equity-Based Paradigm Shift Opportunity

The health of the U.S. population faces a seemingly intractable shortfall in the prospects for large numbers of people, including and especially people of color, long confronting the consequences of structural racism. Yet, rather than focus on the equitable cultivation of health and wellness, policies and practices most drawing attention and priority of U.S. health care and related organizations have been those of cost and efficiency. Without equity as an intentional foundation, incentives toward cost and efficiency have exacerbated marginalization and resulted in resource optimization for only a select subset of the population—deepening disparities and, paradoxically, ballooning national cost and inefficiency. Compounding the gap has been the impact of limited access to health technology that could otherwise be useful in countering some of the discrepancies. Health-relevant technologies, defined broadly as those technologies that impact individual and population health, have followed the patterns of structural discrimination that result in poorer information, resources, and support. With a paradigm shift centering on equity for individuals, families, and communities, a different future is possible. Health-relevant technologies may provide the capabilities that enable the nation to counter structural impediments, but this will require sustained leadership, intentionality, and tactical action. Addressing structural racism requires structural solutions. Diverse datasets; equitable and person-centered criteria for evaluating and implementing health-relevant technologies; and new policy, incentive, and accountability structures are necessary elements for the future. Importantly, the most essential tenet of an effective future paradigm is to honor and engage the wisdom of individuals, families, and communities that have been marginalized and have too long been striving against inequity themselves. In this paper, the authors prompt an urgent call to action for health sector stakeholders—including academic institutions, funding organizations, health system leaders, technology companies, and policy leaders—to consider their role in a future paradigm where equity and progress are inextricably linked.