The North-South divide in mHealth

There's a North-South divide on the mobile healthcare landscape that needs to be addressed by the larger mHealth community. No, I'm not talking about some legacy of the American Civil War. What I'm referring to is the socio-economic division between North and South on a global scale that is standing in the way of an equitable, worldwide healthcare transformation from wireless technology.

Our world is split between the wealthy developed countries of the North and the poor developing countries of the South. Globally, inequality and poverty is disproportionately represented by this dividing line that separates the two hemispheres. Most of the world's population lives in poverty in the global South. The North--U.S., Canada, Europe, and developed parts of East Asia--controls four-fifths of world income, while the South--Africa, Latin America, and developing Asia--only holds one-fifth of world income.

It's no surprise that the burgeoning field of mHealth is not immune to the North-South polarity that divides our planet. A study published last week in the Journal of Medical Internet Research's mHealth and uHealth found that "in general, apps for common diseases of low- and middle-income countries are not as abundant as those for typical diseases of developed countries." 

The study compared the amount of research and the number of mobile apps dedicated to the diseases and health conditions that are the leading causes of death in different income regions globally. The study's authors argue that researchers and app developers tend to focus on the typical diseases in high-income countries due to the fact that the diseases that are common in low-income regions of the world are "where the technology for smartphones and tablets is not widespread and, therefore, there are no market opportunities."

Still, we live in both an increasingly interdependent and politicized global economy. It's for this reason that the broader mHealth community needs to be aware of North-South issues and to work deliberately to remove the barriers and inequities that divide us. Low socio-economic status has been shown to contribute to poor health in several ways, including less access to healthcare, lower health literacy and a higher prevalence of risk factors. However, mobile health technology holds great promise for bridging the digital divide between developed and developing countries, improving health outcomes and helping save millions of lives across the developing world.

Here, in this country, mobile technology has become critical for low-income minorities who otherwise couldn't afford desktop and laptop computers to gain access to the Internet. This is good news for minorities because smartphones, as platforms for running mobile health apps, could not only reduce the digital divide, but also could serve as a catalyst for reducing health disparities among racial/ethnic groups in the United States.

Globally, the large majority of countries have launched 3G mobile-broadband services, and an increasing percentage of the population are covered by a high-speed mobile broadband signal. Nevertheless, though broadband is becoming more widely available and affordable worldwide, it is still out of reach for many in developing countries. And, while developed countries have mobile-broadband penetration rates of 75 percent, the rate for developing countries stands at only 20 percent for mobile-broadband subscriptions.

Last month, at the U.S. Federal Communications Commission's inaugural mHealth Innovation Expo, FCC Commissioner Mignon Clyburn told the audience that broadband-powered health solutions have the potential to be a "great equalizer" in poor and underserved communities in this country. However, Clyburn warned that "if these 21st century health solutions are only available at our most advanced research hospitals and to our wealthiest of citizens then, my friends, we have failed." 

The same can be said internationally about mHealth in wealthy versus poor countries. If we turn a blind eye to this global problem of disparity, we simply reinforce the digital divide and perpetuate the existing socio-economic imbalances in our world. Then, the lyrics of a U2 song become self-fulfilling prophecy: "The rich stay healthy, the sick stay poor." - Greg (@Slabodkin)