Technology, innovation and health equity

Editorials 438 Innovative technologies have enormous potential to improve human well-being. However, technological progress does not guarantee equitable health outcomes. As advances in technology redefine the ways people, systems and information interact, resource-poor communities are often excluded. Where technological fixes have been imposed on communities, the results have included abandoned equipment , incompatible computer programs and ineffective policies. A shift in values among leadership, communities and the creators of technology is critical to implementing technology sustainably and equitably. Numerous examples exist of technological applications that undermine equity, fairness and human rights: for example, the use of high-tech medical interventions in preference to simpler preventive measures or terminator genes that prevent the re-use of seeds for food crops. To ensure equitable outcomes, the design and implementation of technology need to respect ethical principles and local values. Decisions on the use of new technology should be made by local users , and implementation needs long-term commitment and local ownership. Here, we discuss features of technology implementation that can promote health equity, using a range of examples from the health, agriculture and economic sectors. Successful examples of technological implementation illustrate the core values of equity. The Sustainable Sciences Institute (SSI) helps develop and implement technologies , in partnership with local communities , to combat infectious diseases in low-income settings. SSI's approach involves community-centred capacity building including training programmes, small grants, material aid and partnerships to provide long-term support. Laboratory techniques such as reverse transcription polymerase chain reaction (RT–PCR), enzyme linked immunosorbent assay, cell culture and flow cytometry have been applied in resource-poor settings by adapting these technologies on-site and strengthening local knowledge of the principles and limitations of each technique. 1 In Nicaragua, scientists can now develop diagnostic kits locally for diseases including dengue, leptospirosis and American trypanosomiasis, and diagnosis can be done by regional as well as central laboratories. Real-time RT–PCR testing for pandemic influenza was operational before the first case presented in the 2009 pandemic. The Nicaraguan National Virology Laboratory recently developed and implemented diagnostic tests for Chikungunya, a mosquito-borne viral disease that was recently introduced into Central America and the Caribbean. Training local scientists, reducing scientific isolation and promoting international collaboration enables rapid, local response to communicable disease outbreaks. Related examples exist worldwide in the arena of information and communication technologies for health. Infectious disease surveillance and laboratory and clinical management can be improved using low-cost information systems, but these …