The Independent Review on Equity in Medical Devices highlights once again the multiple ways in which medical technology development can lead to solutions that distribute the benefits inequitably across society, or further exacerbate health inequalities (UK report reveals bias within medical tools and devices, 11 March). While the report is welcome, the challenge facing scientists and engineers is how to innovate medical devices differently to respond to long-standing societal biases and inequities.
This means doing two things. First, it is essential to move beyond a superficial interaction with patients. As the report emphasizes, technology development cannot be based solely on the expertise of engineers or the knowledge of healthcare professionals. It must respond to the different social, cultural and health experiences of diverse groups of people. Being effective means recognizing differences and actively supporting marginalized groups to represent themselves.
Second, engineers must recognize that the outcomes of medical technologies are not only produced by the devices themselves – the algorithms or chemicals. How people interact with devices in the environments they live in is just as important. Equal attention should be paid to, for example, how access to health professionals, or the cultural values associated with different social groups, can change the way medical devices are used and how benefits are distributed over time.
To be fair, technology development must be sensitive to how exclusion occurs and involve solutions that are both social and technical. The funding called for by the review will need to be focused on these challenges if the benefits of future medical devices are to be shared by all.
Prof Steven Johnson and Prof Jonathan Ensor
Equitable Technology Laboratory, University of York
