Centering Equity in the Implementation of Emerging Digital Health Technologies: AI, genomic medicine, digital media

Despite unprecedented spending on health in the United States and the rapid expansion in types and innovations of digital health technologies, many populations still get sick and die at higher rates than others. 

To address these persistent health inequities in the US, it will be crucial to center health equity in the implementation of digital health technologies, such as artificial intelligence or personalized genomic medicine. As the two nascent fields of health equity and digital equity find their footing after rapid implementation and scale-up in the post–coronavirus disease 2019 pandemic world, a focus on equitable implementation is particularly important to ensure that digital health technologies do not perpetuate or create new health inequities. However, to date, these fields have had a limited or siloed focus on equitable implementation.

This paper is the inaugural report in the RAND Center to Advance Racial Equity Policy Methods Volume series. This paper will be the first to center health equity in the implementation of digital health technologies by adapting a methodological framework for its implementation to support the planning and evaluation of digital health technologies. Without an explicit focus on equitable implementation, digital health technologies run the risk of further exacerbating existing health inequities or creating new ones. This paper offers approaches to policymakers, implementation scientists, clinical scientists, government regulatory bodies, and those working in the health and digital technology fields to take the lead in centering equity.

The paper, first describe the persistent health inequities in the United States and how the rapid adoption of digital health technologies can perpetuate those inequities. Then they discuss challenges and limitations of Implementation Science (IS) in centering equity in the rapid adoption of digital health technologies and translating these technologies into equitable improvements in public health. Next, they provide examples of how IS process and evaluation frameworks can be adapted to focus on digital and health equity to leverage emerging health technologies to course correct and address inequitable health outcomes.

Finally, they discuss how these adapted IS process and evaluation frameworks can be applied to address the pitfalls—and realize the promise—of three emerging fields at the intersection of racial and digital health equity: (1) genomic medicine, (2) artificial intelligence (AI) (specifically large language models [LLMs]), and (3) participatory digital media (e.g., blogs, digital stories).

Photo Jordi Soldevila. Gaza. Geometries de la injustícia

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What builds good health? An introduction to the building blocks of health

Health is our most precious asset. Good health and wellbeing enable us to live happy, fulfilling lives and free us up to achieve our potential, supporting positive social and economic outcomes for individuals and society. But we don’t all have the same opportunities to live healthy lives. Right now, in our country, some people are dying years earlier than they should. This isn’t inevitable. There is much we can do to reduce these unfair differences by improving the things that underpin our health.

Many aspects of our lives impact our health and how long we live. These include our jobs and homes, our access to education, public transport and safe green spaces with clean air, and whether we experience poverty or discrimination. These things are often referred to as the ‘wider determinants of health’, and they are all essential building blocks of our health.

Building a healthy society is like constructing a building. To succeed, we need all the right blocks in place. The building blocks of health are: the food we eat; the work; the family, friends and communities; the transport; the housing; the money and resources; the education and skills; and the surroundings.

The The Health Foundation from the UK has published a guide that it is a brief introduction to the building blocks of health. It explains how a person’s opportunity for health is influenced by much more than the NHS, and why people in the UK don’t all have the same chance to be healthy. It also sets out how action to strengthen the building blocks of health can lead to improvements in the health of the whole population, for the benefit of individuals, society and the economy.

Guide (pdf)

Photo Jordi Soldevila. Èxode. Geometries de la injustícia

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Yes, Minister

Yes, Minister is a British political satire sitcom written by Antony Jay and Jonathan Lynn. Comprising three seven-episode series, it was first transmitted on BBC2 from 1980 to 1984. A sequel, Yes, Prime Minister, ran for 16 episodes from 1986 to 1988.

It is a satirical sitcom set in the office of a UK Cabinet minister, Jim Hacker MP, who struggles with Civil Service bureaucracy and political machinations as he tries to get on with government business

Video: Funniest moments 

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Human resources in the National Health System. SESPAS Report 2024 (part 3)

The Spanish Society of Public Health and Health Administration publishes in Gaceta Sanitaria its biennial SESPAS 2024 Report, which shows a series of artices analysing the current situation of the National Health System in terms of Human Resources.

• Pay for performance in public directly managed healthcare centers. Part 1: General framework.  José-Ramón Repullo y JM Freire

• Pay for performance in public directly managed healthcare centers. Part 2: The Spanish National Health System.  José-Ramón Repullo y JM Freire

• Dual practice in the Spanish health system: problem or solution? Ariadna García-Prado, Paula González

• Recruitment, selection and retention of health professionals in indirect management and private management entities Olga Pané Mena y Pau Gomar Sánchez

• Health and well-being of healthcare workers: employment and working conditions beyond the pandemic Fernando G. Benavides et. al

Video: Rosa Urbanos entrevista a J.R.Repullo y J.M Freire

Video: Vicente Ortún entrevista a R.Meneu, O.Pané, P. González, P.Gomar 

Photo Jordi Soldevila. Geometries de la injustícia. Navalni

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Human resources in the National Health System. SESPAS Report 2024 (part 2)

The Spanish Society of Public Health and Health Administration publishes in Gaceta Sanitaria its biennial SESPAS 2024 Report, which shows a series of artices analysing the current situation of the National Health System in terms of Human Resources.

• Human resource management in health. Consensual paths forward 
• Miguel Angel Negrín, Vicente Ortún
• An overview of health workforce mobility in the European Union under the current supply challenges. Angela Blanco Moreno
• Dual practice in the Spanish health system: problem or solution? Ariadna García-Prado, Paula González
• Recruitment, selection and retention staffing policies in health services directly managed. Ricard Meneu

Photo Jordi Soldevila. Deconstruccions i iteracions de la realitat. Iteració lliure en blau

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Human resources in the National Health System. SESPAS Report 2024

The Spanish Society of Public Health and Health Administration publishes in Gaceta Sanitaria its biennial SESPAS 2024 Report, which shows a series of artices analysing the current situation of the National Health System in terms of Human Resources.

• Human resources in the National Health System. Medical education. Felipe Rodríguez de Castro, Teresa Carrillo Díaz, Arcadi Gual i Sala, Jordi Palés Argullós
• Experiences in human resources planning for health: The case of physicians. Data and models. Patricia Barber Pérez, Beatriz González López-Valcárcel
• What do we know and what should we know about the imbalances of doctors in Spain? Diagnosis and proposals. Beatriz González López-Valcárcel, Patricia Barber Pérez
• Shortage of nurses in Spain: from the global case to particular situation. Paola Galbany-Estragués, Pere Millán-Martínez
• The challenges of human resources governance in public healthcare. Javier Hernández Pascual

Press conference video

Photo Jordi Soldevila. Homenatge a Toni Catany. Plats vells.

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CEO Life Cycle

No leadership position has a greater impact on an organization’s success than the CEO. Very little data exists on how CEOs tend to perform over time; CEOs, often fill the knowledge vacuum with anecdotes, assumptions, and rules of thumb.

When someone asks CEOs about the ideal tenure for the role, many mention seven-year average. They often argue that it takes minimum five years for a CEO to make a difference in their organization, to change things.

But the reality specially in the public companies is much shorter than that. The average tenure for the C-suite executives in public sector, in general, is 4.6 years. In the English NHS the average is 3.8 years. We have no data from Spain niether from the Catalan Health Service. 

CEOs in the NHS system have short tenure. 

 

To better understand the typical course of value creation over a leader’s tenure, Spencer Stuart launched what they call they CEO Life Cycle Project

Article: The CEO life-cycle

The study reveals a surprising pattern of headwinds and tailwinds that CEOs are likely to face during their years in the role and upends some common views about CEO tenure and value creation. For example, it suggests that some boards part ways with a strong CEO too early after a predictable and often temporary performance slump, while others tolerate a mediocre performer for too long.

Rarely do any two CEO tenures look alike. Each leader is on his or her own journey and faces very specific circumstances. Still, by comparing CEO performance on the basis of years in office rather than calendar years, and by viewing a composite of individual journeys, they have identified five distinct stages of value creation that many CEOs will experience during their tenure

• Year 1: The Honeymoon
• Year 2: The Sophomore Slump
• Years 3 to 5: The Recovery
• Years 6 to 10: The Complacency Trap
• Years 11 to 15: The Golden Years

CEOs in the NHS are underpressure by their politicians who have come adept at exerting outsize influence and keeping directors on their toes.The CEO life cycle gives executives, members of the boards and also politicians a common language about potential risks and opportunities at each stage. It can help boards view performance in a larger context and avoid overreacting in moments of doubt "like a political election" —or tolerating mediocrity for too long. It can also help to identify an optimal moment for the leader to step down (if he can).

Photo Jordi Soldevila. Els Monstres d'Ingres. La hipocresia 

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