Moving beyond magical thinking on the NBN to address health inequities

Ben O’Mara writes:

The introduction of new government policy on the National Broadband Network (NBN) is a chance to re-imagine how we use the internet to help address inequities in health.

Recent media coverage (see here and here) has identified the flaws in the rollout of the NBN, and questioned the quality of its proposed upload and download speeds.

Professor Rod Tucker notes that the Coalition’s mixed technology approach lacks support for mobile broadband, and differing connection types and fibre-on-demand may create inequitable access to fast broadband.

These perspectives indicate that the NBN’s technical capacity and reach will be limited. This is not great news for the health sector.

We know that fast, reliable and affordable broadband can support individuals, families and their communities in canny and practical ways.

Telehealth trials are providing healthcare monitoring and consultations to people in the comfort of their homes. Remote assistance of chronically ill and elderly participants can help reduce hospitalisations and reduce health care costs.

Researchers are also exploring how the self-management of diabetes can be supported through the use of in-home monitors, videoconferencing and complementary healthcare from health professionals.

In the field of mental health and online technology, the Young and Well Cooperative Research Centre is determining how young people find and share information, support their friends and reach out for help via social networks.

These are valuable emerging areas of work. The effectiveness of these approaches and others in achieving better health outcomes is made more difficult by a slower and less physically extensive NBN.

But there are greater forces at work influencing our health beyond good access to robust technological infrastructure. Croakey writers have been wise to regularly discuss the social determinants of health and relevant work being performed in Australia to help address health inequalities.

How we support education, employment, housing and other factors can help to alleviate the “unfair and avoidable differences in health status between different population groups”. The conditions in which we grow, live, work, and age shape our ability to use the internet, too.

CSIRO research found that around four millions Australians still do not use the internet because they do not know how to, are unable to connect or cannot afford a connection.

In a relatively small but important study conducted by Flinders University, researchers note that people experiencing economic disadvantage are “being caught in a vicious cycle whereby lack of digital access or the inability to make beneficial use reinforces and amplifies existing disadvantage including low levels of reading and writing literacy”.

Other exploratory research performed by Victoria University with refugee and migrant communities from non-English speaking backgrounds found that study participants with limited and/or disrupted formal education are relatively disadvantaged in accessing health information through various technologies due to their poor computer literacy, limited print literacy and numeracy, and limited time to develop technological literacy.

It’s not just about the availability of those cables, thick with optical fibre carrying all those gigabytes of data to and from our homes – although they are important. Everyone needs to have the educational, physical and employment foundations that make the use and access of technology easy to assist with their health.

Community-based projects using technology offer a useful glimpse of what is possible when we flip our understanding of how it can help people by tackling the conditions in which they live.

Researchers at Latrobe University used mobile phone-based peer support with a small group of Nuer refugee women to improve their psychosocial health and facilitate their settlement in Melbourne. Participants were provided with mobile phone re-charge vouchers and training to encourage peer support. These were important in helping the group provide mutual support to each other and improve relationships with friends, family and the community.

Wired Community @ Collingwood provided communication, learning and employment opportunities through technology to residents of a public housing estate. It installed a network-ready computer in each apartment at no cost to the resident, set up an intranet and a communications network within the buildings and across the estate, created an ICT training hub, and provided email and affordable internet access for residents.

An evaluation noted the ambitious and difficult nature of the work, but that there were positive health outcomes reported by some residents, including through greater connection to social networks and services.

These are only a few examples of relatively small pieces of work. But they demonstrate how we might support skills development and pathway connections through technology that can help with health.

The Victorian Council of Social Services recently advocated for engagement on the social determinants of health through the new Social Determinants of Health Alliance.

This could be a strategic way to build on the learning from community technology projects, and explore how the NBN, now and in the future, can more rigorously and in an expanded manner address the conditions underpinning health inequities.

It may also be an opportunity to bring together related areas of work in health literacy performed by organisations like the Centre for Culture Ethnicity and Health and the Ophelia Project, and digital capacity building with community organisations being led by Australian Council for Social Services and Infoxchange.

The British writer Arthur C. Clarke famously declared, “Any sufficiently advanced technology is indistinguishable from magic”.

In our quest for better broadband, a kind of magical thinking has disguised the nitty gritty reality of human-computer experience.

The best technological innovation for health lies beyond the glamorous high definition and high speed wonders of our online worlds, and in how we use it to help those who need it most.

• Ben O’Mara is a writer, academic and health worker from Melbourne’s west. At the Centre for Community Networking Research, Monash University, he is writing research articles on information technology, health communication and cultural and linguistic diversity.