Healthcare faces the dual challenge of digitalisation and illiteracy
In this article, Loick Menvielle, EDHEC Professor and director of the Management in Innovative Health chair, highlights the complex interactions between the digitalisation of healthcare and associated 'objects', and the understanding and control of patients, a significant proportion of whom are victims of e-illiteracy.
Vulnerability in the health sector
Vulnerability, in the context of health, refers to a situation in which a person is likely to suffer harm or disadvantage as a result of various factors. These factors may be physical, psychological, social or environmental.
Health-related vulnerability may be directly linked to an alteration in a person's health, as in the case of chronic pathologies (20 million people in France, or 35% of the population covered by the general health insurance scheme) (1), or it may be a consequence of this alteration, affecting the person physically, socially, psychologically and environmentally (2). It can also be induced by medical progress, which, while aimed at direct benefit for certain segments of the French population, can generate, on the other hand, harmful side-effects or undesirable events for other individuals.
Vulnerability is therefore a complex concept which, if it is to be fully understood and managed, requires a multi-disciplinary approach at the crossroads of ethics and the social and human sciences.
Progress and disparities
In the digital age and with the development of new technologies, the concept of vulnerability is crucial for a number of reasons.
Firstly, technological advances in medicine can create disparities in access to care, making certain groups more vulnerable. Vulnerability to technology contributes to accelerating disparities in care in several ways. According to a Senate report in 2020, around 14 million people in France have limited or no access to digital tools (3). Several factors contribute to this situation: a lack of knowledge about the use of computer technologies, the lack of a personal Internet connection or digital devices in the home, and finally, digital remoteness linked to the geographical area in which they live.
Technological paradoxes in healthcare
This inequality of access to care and technological skills results in a discontinuous distribution of advanced medical treatments. In an era of accelerating digital technology in healthcare, people who have difficulty understanding technologies find themselves in a vulnerable position because they have little understanding of the contributions and benefits of these solutions. These developments can gradually leave certain groups of patients on the sidelines, with little or no comfort with digital tools, which can limit their ability to participate actively in their healthcare and access information about available treatments.
Our last Barometer, carried out in partnership with Ipsos, highlighted the scale and challenges of this illiteracy in the face of the digitalisation of healthcare: the people most at risk of developing pathologies are the least inclined to use connected healthcare - the over-55s (69%) and the least educated (65%). (4)
The same applies to digital tools designed to monitor and support patients, but which may have an impact on the type or quality of care received. These tools are not necessarily synonymous with optimal treatment or successful patient care (5). At a time when questions are being asked about medical deserts in France, this would appear to be difficult to resolve on the basis of a single deployment of the most fashionable technologies.
At the same time, the increasing complexity of medical technologies often requires specialist skills for their use and maintenance. Care facilities located in less developed regions or with fewer resources may not have the qualified staff needed to fully exploit these technologies, which can lead to sub-optimal care for patients in these regions.
It is therefore essential to recognise and address individual vulnerabilities to ensure that technological advances in healthcare benefit everyone equally. This means developing new forms of solidarity and greater responsibility on the part of society towards those affected.
In this sense, it is imperative to integrate the concept of vulnerability into thinking about the evolution of healthcare in the digital age to ensure that technological advances benefit everyone and do not create new forms of exclusion or disadvantage.
(1) Conseil économique, social et environnemental (CESE), « Les maladies chroniques » - https://www.lecese.fr/travaux-publies/les-maladies-chroniques
(2) Maladie psychique (5 millions), handicap (10 millions), proches aidants (11 millions), fracture numérique (13 millions), addictions (5 millions), personnes âgées de plus de 65 ans (13 millions).
(3) Sept. 2020, « Rapport d’information fait au nom de la mission d'information sur la lutte contre l'illectronisme et pour l’inclusion numérique sur la lutte contre l’illectronisme et pour l’inclusion numérique », par M. Raymond Vall, Sénateur - https://www.senat.fr/rap/r19-711/r19-711.html
(4) Baromètre « Perception des Français sur la santé connectée » de la chaire Management in Innovative Health (Bristol Myers Squibb, EDHEC) – sondage 2023 réalisé par Ipsos. https://www.edhec.edu/fr/news/decouvrez-resultats-1er-barometre-sante-connectee-bms-edhec-ipsos
(5) “Empowering health care consumers in the era of Internet of Things”, International Journal of Consumer Studies (2022), https://doi.org/10.1111/ijcs.12887