Tuesday 3 December 2013

Health Informatics: An Issue of Social Justice

Looking back over the last few weeks, it's easy to understand why there has been such a large push in the adoption of technology and EHRs. Despite most people are familiar with social media and have some form of access to online resources, some people are vulnerable to being left out of the technology bandwagon.

Since technology has become such a prevalent information sources in society, people often forget about those who have limited to no access. While these people may get by in day to day life without the use of technology, what happens when their health is included into the equation?

Is health and health information access a human right?
Today I will explore those who are vulnerable to health inequalities and inequities regarding eHealth, and discuss whether health information technologies are bridging or widening the gap in health access.

To begin, let's define and distinguish the terms inequality and inequity, as these are often wrongly used interchangeably. I will be applying these two concepts to social issues that are present for vulnerable individuals.

Equality--> A concept that means that everyone receives the same portions of a resource. This works well and seems to make sense, but it only works if everyone has the same to begin with. If each person starts with the same amount, then equal division of assets is fair. Since people come from different backgrounds, this means they still end up with disproportion amounts of information.

Equity--> Equity is focused on fairness and giving people equal access and opportunities to resources. To ensure that everyone can enjoy the same thing, society must first acknowledge equitable rights. Equity may mean giving people different amounts, but it is so they finish with the same result. 
(Braveman & Gruskin, 2003)

When it comes to health, who are those who are consider vulnerable? Meaning, who is at a disadvantage for accessing and using health technologies and what are the barriers that causes these inequalities?

Accessibility 
  • Do not own a computer
  • No digital connection/ satellite signal
  • Rural locations
  • Limited physical ability to use technology
Education
  • Not trained/ familiar with using computer/ social media
  • Poor literacy decreases understanding of information available
  • Increases feelings of isolation or inadequacy
Income/ Social Status
  • Technologies are expensive
  • May not have social support-- no online community
The groups who face these challenges are put at risk for isolation related to a society with increased technology use. Those who are at risk include homeless and those below the poverty line. These people often cannot afford computers and are unable to keep up with the constant updates. As well, those who are uneducated face information poverty. Elderly people are at increased risk for isolation as many of the programs are difficult to use, with small print and their social circles are less likely to be online (Taylor, 2011).

While there are many barriers that face these vulnerable populations, social media and technology can also address these issues. Social media provides an opportunity to raise awareness about global issues, and can help reduce feelings of loneliness. As well, online communities provide support to those looking to go back to school, and over 90% of job applications are posted to the internet. 

To help provide vulnerable populations with equal access to these online opportunities, nurses can help address the inequities they face. We need to public access to computers through libraries and open computer labs in schools. As well, funding to help education people on how to properly use these technologies and set up an online community group to begin a foundation of support for these peoples (Kaminski, 2011).

In the nursing community, I understand that technology can overall help address and overcome the social justice issues that face these populations. Since I come from a northern, rural town, I understand that living in a remote location can affect access to healthcare. There is a shortage of physicians and it is often difficult to receive specialized care.

Technology and online programs can actually help bridge this gap. Through webcams, doctors and nurses are able to connect with patients in the community to say up to date with their health history. Not only does this address access to care issues, but also is convenient for both the client and physician. Consider the video on the right, this video shows how tele-medicine bridges this gap (Cox, Mahone & Merwin, 2008). 

While health inequities exist during the implementation of eHealth and EHRs, online technologies can also help answer this social divides. Nurses can advocate for the patients who do not have access to computers. Through the health facility nurses can provide vulnerable groups with the necessary knowledge to maintain control of their health, and at the centre of their care (CNA, 2009).

---Student Nurse Katie

References
Braveman, P., & Gruskin, S. (2003). Defining equity in health. Journal of Epidemiology and Community Health, 57(4), 254–258. doi: 10.1136/jech.57.4.254

CNA. (2009). Social justice in practice. Ethics in Practice for Registered Nurses. Retrieved from http://www2.cna-aiic.ca/CNA/documents/pdf/publications/Ethics_in_Practice_April_2009_e.pdf

Cox, K., Mahone, I. & Merwin, E. (2008). Improving the quality of rural nursing care. PubMed. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18709750

Kaminski. (2011). Using communicative and creative technologies to weave social justice and change theory into the tapestry of nursing curriculum. Nursing-Informatics. Retrieved from http://www.nursing-informatics.com/socialjustice.html

Taylor, A. (2011). Social media as a tool for inclusion. Final Report for the Horizontal Policy Integration Division (HPID) of HRSDC. Retrieved from: http://www.homelesshub.ca/library/social-media-as-a-tool-for-inclusion-51607.aspx

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