Potential impact of telehealth on socio-economic stability and sustainability in the process of globalization.

AuthorStachura, Max E.
PositionReport

Abstract

Sustainable socio-economic development depends upon a well-trained and healthy workforce. Family health also influences worker stability. Access to healthcare in both rural and urban settings is a world-wide challenge: No nation can afford to replicate comprehensive health care resources in every large and small community. On the other hand, as the potential for Internet access approaches universality, consumer access to health information potentially will cease to be a limiting factor, and this fact will change the role of healthcare providers. Previously the custodians of health information, providers are now becoming advisers about the use, specific relevance, and applicability of that health information in individual situations. Telenetworking may be the only economically viable way to make healthcare resources available to individuals throughout communities, regions, or nations. However, although clinicians in different settings will use the same information to address a problem, they will do so using perspectives modified by their local cultural, ethnic, and socio-economic environment. The broadband infrastructure required for cost-effective, sustainable telehealthcare has much in common with the infrastructure requirements for tele-education, tele-business, and tele-government: A unique healthcare telecommunication infrastructure is not necessary. Telehealth can leverage commercial telecommunications networks, but universal access to basic healthcare services and health information must be, at least in part, a governmental responsibility. Thus, it is essential that barriers to universal broadband access be overcome through combinations of commercial business activity and public policy. The resulting general access will contribute importantly to long-term economic and political stability and sustainability. Tele-optimized population health is a nationally-, ethnically-, religiously-, governmentally-, and racially-neutral bonus that can result from coordinated application of medical and telecommunication resources and capacity.

Introduction

"Globalization" has been defined as the several processes leading toward a world relatively undivided by national, social, economic, environmental, technological, and cultural barriers (1, 2). There is general agreement that globalization has an impact on the socio-economic status of all countries. However, opinions differ as to whether globalization's effects on individuals and societies are consistently positive or negative. One driving force that facilitates the processes of globalization is the ongoing revolution in both the technology and accessibility of telecommunications and information. Walker: "With astonishing speed, the Internet has evolved from an obscure communications environment for computer science researchers to an essential element of the communications infrastructure used by virtually all segments of society" (3).

In the healthcare arena, globalized advanced telecommunication capabilities facilitate both universal access to health-related information and enhanced service delivery across geographic, cultural, and socio-economic barriers. Universal access to health-related information makes it possible to (a) rapidly disseminate new discoveries, (b) enhance the diffusion and adoption of standards for diagnosis, treatment, and practice, (c) promulgate new healthcare-related tools such as pharmaceuticals and diagnostic/treatment equipment, and (d) enable new services. Beyond information access and sharing is "telehealth", defined as "... the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration" (4).

Advanced telecommunication enhances global knowledge of what is possible in many areas of endeavor, including healthcare. That knowledge then drives both expectations and the identification of goals that target what can and should be achieved. Development and achievement of these goals depends upon overcoming a variety of barriers that encompass issues of policy, economics, law, education, culture, technology, and labor. Our purpose in this paper is to explore some of these issues, specifically in terms of the globalization of healthcare. Our perspective is that the process of globalization of healthcare will in balance be beneficial, but that complete global homogeneity in healthcare is neither achievable nor desirable.

Stage Setting: Healthcare of the Individual, the Community, and the Whole

Healthcare is comprised of two broad components: (a) care provided to an individual, including that individual's personal responsibility for compliance and chronic self-care, and (b) maintenance of a community environment that is sanitary, safe, and health-promotional by means of active prevention, screening, and education programs.

The intimate interaction between a patient and a clinician is the core element in individual healthcare. It is initiated when an individual seeks medical services; it is paid for by the individual and/or the individual's private or governmental insurer. Many argue that it is intuitively obvious that healthcare services are therefore locally provided activities. The historical evolution of healthcare and healthcare delivery systems appears to have affirmed that view (5). Others identify this presumption that healthcare services must be provided locally as a root reason for the continual rise in the cost of medical care (6).

On the other hand, individual care occurs in the context of, and is greatly influenced by, the individual's health environment: clean water, sanitation and pollution control, health screening, immunization, workplace safety, and child and maternal health. This societal context requires socio-technical systems that are not individually initiated, but originate out of a collaboration among national and international health organizations that set minimal and optimal standards. These stakeholder organizations then work in collaboration with governments to implement those standards. To the extent that globalization of healthcare progresses, it is critical that developed nations share their experience in these contextual areas with the developing world, but do so respecting regional differences.

Stage Setting: The Advent of Advanced Telecommunication Technologies

With widespread adoption of the Internet and World Wide Web in the mid-1990's it became apparent that telehealth had the potential to distribute and make accessible health-related information and contribute to individual healthcare access by the geographically and socio-economically underserved as well as by the physically challenged. Further, telehealth offered the opportunity to develop and promote uniform world-wide expectations for basic community health. In 1996 Hoben proposed several areas in which the Internet could be used for healthcare including continuing medical education, online collaboration, broad distribution of standardized clinical practice guidelines, collection of disease management outcome information and health care trends, health services planning, patient record access, and consumer access to health-related information (7). Each of these proposals is at least a partial reality today.

The Internet's communication power has the potential to globalize medical knowledge and best practices, increase research collaboration and sophistication, and facilitate rapid adoption of new medical discoveries. However, reaping the benefits of this potential will require core changes in individual attitudes, healthcare systems, and governmental policies (8) because of healthcare disparities based on socio-economic status, geography, gender, physical ability, race, and ethnicity that persist worldwide (9). Access to health information and services is critical for health promotion, disease prevention, and medical therapy, but the strongest predictors of population health are income levels, education levels, and gender equality (10), all of which can be strongly influenced in general by globalization and specifically by global communication capabilities.

Workforce Health Underlies Sustainable Socio-Economic Development

While the economic growth of developing countries outpaced that in developed countries during the 1960s, increased global market integration since 1980 reversed the trend in favor of the world's wealthiest nations (11). As a consequence, globalization of the world's economies is altering global health patterns. Where economic growth reduces poverty, health status improves because higher household incomes improve access to health-related goods and services (12). The reverse is...

To continue reading

Request your trial

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT