2
Recent Development in Digital Technology Relating to Public Health

Key points

• To consider the conceptual landscape of digital technology in public health.
• To discuss recent developments of some familiar technologies used in health arenas, e.g. smartphones and health apps, wearables, social media, social networking sites.
• To discuss the use of digital technology in some areas of healthcare, e.g. telehealth and telecare.
• To explore the concept of gamification and consider active video games and serious games.
• To discuss the use of digital technology among different population groups and different areas of health promotion, such as young people, mental health, sexual health.

Introduction

The development of information communication technology (ICT) has grown exponentially in the past decade, in parallel with technology-based healthcare interventions, impacting on the way we communicate health messages and tackle public health issues. These include mobile phones as communication devices for text messaging (Hazelwood 2008; Head et al. 2013), for informationgiving, confirming appointments, providing test results. Interactive Web 2.0 technologies, such as social media platforms, health apps and tracking technologies, can be downloaded onto smartphones for information provision, health monitoring and tracking purposes (WHO 2011a; Gold et al. 2012; Lewis et al. 2012; Piette et al. 2012; Centre for Health Promotion, Women's and Children's Health Network 2012; Atkin and Rice, 2013; Capurro et al. 2014; Loss et al. 2014; Lupton 2015c). Wearable devices such as Fitbits have become common Christmas or birthday presents for friends and relatives. Anonymity in web information helps with sensitive topics such as sexual health and mental health. The idea of game-playing (gamification) can also help to engage people in health promotion activities. Social networking sites can be used to provide social support to the public, increasing quality of life and self-efficacy (Atkin and Salmon 2010; Atkin and Rice 2013), and to help young people with mental health conditions, as well as improving relationships between patients and healthcare professionals (Martin et al. 2011).

This chapter will provide a review of the literature on the use of digital technology in recent years in different areas of public health practice. It is not a review of the current best digital health applications, nor is it a manual - not a 'how to' guide. It is intended, rather, to give a more conceptual framework on the development of digital technology and its implications, and the potential and challenges for health and healthcare.

Digital technology and health - a changing landscape

This chapter takes a timeline approach, looking at digital health from the Web 1.0 period when technology is about database information-gathering and information-provision and the computer is just a digital library, a one-way communication device, progressing to today's Web 2.0 period, where technology is about interactiveness and connectedness. Today's technology is about both the smart hardware - such as smartphones, tablets, mobile devices - and smart software, such as the sophisticated health apps, and social media, which allow feedback, providing interactive two-way communication for the users. The continuing present timeline of Web 3.0 - such as the Internet of Things, and Artificial Intelligence (AI) technology - will be considered in the last chapter, looking forwards to the future.

Box 2.1 Digital technology and health communication

Twenty years ago, new technology's place was within IT departments developing management information systems and relational databases, helping organizations to be smart, joined-up and paperless. It was about enhancing the conventional usages of media - newsprint, television, radio, cinema . New technology was mainly for communication, information provision, record keeping . The mobile phone was just 'a phone'; 'innovation' was about being able to individualize your phone with a different-coloured clip-on fascia. Usage started to broaden, from the everyday uses of new technology making daily life easier to the remote-controlled assistance of smart technologies in care settings.

In health terms, 20-30 years ago, digital technology was about the increase of capacity, evident in Moore's Law (1965) about the number of transistors in an integrated circuit doubling every two years. By the 1980s, these developments had reached into commercial, public-service and educational organizations - it was about enhancing and developing administrative capacities. IT was a large-scale, 'top down' investment. IT strategies were about existing processes done more cost-effectively and efficiently - payroll, information storage and retrieval. Technology began to migrate from corporate mainframe to mini- and microcomputers. The need was to manage the complexity of data within organizations - Big Data did not exist. The mobile phone was a tool provided by and for the workplace. The improvement of technology began to widen to the delivery of services in the last ten years. Mobile phones were used for service provision such as text messaging. Care was about developing smart homes and smart technology for older and disabled people.

The landscape of today's digital technology is more complex:

• Corporations and public services still invest in major new digital technology. But the corporate interest has expanded beyond the 'internal' organizational capability to the much more societal and commercial 'Big Data' reality.
• Technology has become much more affordable and consumers have rapidly become key players through their purchasing power.
• The technology itself has become much more sophisticated and powerful with comprehensive health applications.
• There is an interplay between individualism, consumerism, globalization and neoliberalism. Consumers are citizens and all citizens are co-equal consumers. The question becomes who is entitled and who is excluded?
• There are major questions about what actually has an impact. Does the 'digital technology' produce a sustained change in behaviour leading to an equally sustained improvement in health?
• Digital developments are also about the harm they may cause in areas such as data security, privacy and confidentiality and cyberbullying.

New digital technologies are increasingly common in high-income, post-industrial countries in Europe, the USA and beyond. For example, in the USA, DeMartini et al. (2013) found a significant increase in digital access and usage in recent years among families in urban areas: 80% of the study families had internet access and 78% reported using Facebook, with more than 70% of the study families owning a smartphone. Their study demonstrated a great potential for the use of digital technologies in health communication. But it's also important to note that technologies are not simply relevant for the technologically rich Global North. In lower-income Global South countries, such as those in Africa, mobile phone coverage is above 79%. It was estimated that 85% of the world's population had access to commercial wireless signals in 2010 (WHO 2011a). The author has been a visiting lecturer teaching health promotion in some African countries for a number of years; the increased use of mobile phones among her students was very evident over these years. The use of iPads and dongles for internet access was also increasingly a familiar sight in her African classrooms. Although internet access tends to be better in cities and in more affluent communities, the progressive use of technologies universally - for example, smartphones - is becoming commonplace.

Mobile technologies used in healthcare, including health promotion, have become a 'new field of eHealth' (WHO 2011a). While there has been a lack of evaluation of eHealth programmes at this earlier stage of eHealth development (WHO 2011a; Gold et al. 2012), there is general agreement that digital technological development has great potential for healthcare and health promotion. It may also help access populations seen as hard-to-reach. However, increased internet dependence also poses challenges, particularly in providing services for socially, economically and digitally disadvantaged groups - e.g. low-income families, disabled people, rural communities - which will be discussed in more depth in chapter 6. As discussed by many authors, disparities remain (Chou et al. 2013; Lupton 2015c; Marschang 2014; Cross et al. 2017; Ren et al. 2017). Online health information can be a useful source (Stevenson et al. 2007; Fox and Jones 2009). Hou and Shim (2010) found a high level of trust in internet health information. As digital technologies progress, Web 2.0 interactive technologies offer great potential, with the ability for two-way information exchanges - an 'indispensable communication tool' (Bennet and Glasgow 2009: 274), and a new 'setting' for health promotion (Loss et al. 2014). However, there are also barriers: inaccurate and misleading information, lack of investment, privacy and safety issues (Ren et al. 2017), which will be discussed further in chapter 5.

From Web 1.0 to Web 2.0 era - some older technologies still...