Dr. Ivar Mendez is a neurosurgeon in Saskatoon who uses remote presence technology, what he calls a doctor-in-a-box, to see patients at a distance. It consists of a screen and attachments for clinical exams such as a stethoscope or a special camera for examining skin lesions. Using a cellphone connection, this tool allows him to effectively assess and diagnose patients from anywhere that has access to one of these devices. Such technology could easily allow a physician to set up a boutique practice, offering wealthy patients from any country in the world special access to his services from the comfort of their homes. Instead, he uses the doctor-in-the-box and a type of robot with similar capabilities to see patients in remote areas such as Labrador, Northern Saskatchewan and the Bolivian Andes.
Our health system is not generally designed upon equitable lines; more and better health services tend to be located in areas of greater wealth. Less access to health services combines with differences in income, education, employment, housing and food security, among other upstream determinants of health, to create deep inequities in health outcomes. New technologies in health can, and often do, exacerbate these health inequities, with facilities in more affluent communities often first in line to benefit from innovations. This doesn’t have to be the case, as evidenced by the work of Mendez and others who use technology to offer enhanced services where they are most needed. On a larger scale, this requires intentionality on the part of governments. How can regulations around the implementation of new technologies be designed to ensure universal access, or even preferred access for those with greater risks of illness such as people living with lower incomes, so that health inequities are decreased rather than deepened?