Greater incidences of cardiovascular disease, diabetes and mental health disorders; rising costs for treating those and other non-communicable diseases; and a tight fiscal environment after a punishing COVID-19 pandemic. Latin America and the Caribbean face these difficult health challenges in the coming decades. With an aging population and limited resources, the region must tackle serious epidemiologic and economic burdens, while also ensuring that poorer and more geographically isolated populations are included in all solutions.
Digitalization holds immense potential in tackling critical health challenges in a cost-effective and scalable way. The vast majority of people in the region own a mobile phone and three-quarters of the population use the internet. Ever more people have smartphones. These digital tools can play a pivotal role in optimizing healthcare delivery by encouraging healthier behaviors and improving access to specialized care. They can also help overcome income and geographical barriers and allow healthcare workers to extend their services to a larger share of the population.
Digital Solutions to Depression
Consider the case of depression, a debilitating mental disorder that interferes with virtually all aspects of daily life and whose treatment is constricted by limited spending on mental health and the concentration of mental health specialists in urban areas far from rural populations. As we note in a recent study of digitalization’s challenges and benefits, depression can be effectively treated with cognitive behavioral therapy (CBT), which provides skills for dealing with unproductive thoughts. The good news is that CBT has been adapted to multiple digital tools, including websites, apps and chatbots. Those tools, including interactive and multimedia ones, can be productively used by patients without the intervention of a mental health professional, especially for milder cases of depression.
For more serious cases, the mixture of digital tools and some contact with a psychologist or specially trained health worker through guided internet-based cognitive behavioral therapy (ICBT) can yield impressive results. It can yield outcomes as significant as in-person or telephone-based therapy. And it can save a health worker two-thirds of the time they would usually commit to each patient for in-person treatment. Healthcare workers are freed up to attend to other patients in the process. An analysis of a hypothetical program in Peru, found that 70 psychologists could provide a complete course of CBT treatment over a year to 13,300 patients face-to-face or by telephone but 30,600 patients under the guided ICBT modality. The cost savings would be significant. For the equivalent of every US dollar invested, society would receive $5 in benefits for in-person treatment, $7 for a telephone-based option, and $15 for guided ICBT, including savings on therapists’ fees and patients’ time and transportation costs.
A Dose of Prevention
Providing education, reminders and notifications through websites, apps, and short message service (SMS) add a strong dose of prevention. They can help people to engage in healthier lifestyles through better diet, more physical exercise, and the avoidance of unhealthy products, like tobacco, just as tracking devices, including apps and wearable devices, help them monitor their progress. All that is critical in fighting the onset of serious health problems, like diabetes and cardiovascular disease, as well as other non-communicable ailments. For example, experiments using SMS to promote healthy eating and physical activity in pre-diabetic patients in China, India and the United Kingdom showed a 5% to 30% reduction in the onset of diabetes after two years.
The key is ensuring that such benefits reach the largest share of population, that the demands of equity are served. Remote types of care such as telemedicine, telephone-therapy and ICBT can increase access to health services for people in areas with no specialists, with limited mobility, or where stigma can hinder access to care. And because wider use of digital tools frees up health workers and government budgets, they also make it more possible for them to see patients in remote areas where digital services are unavailable or where poverty makes them inaccessible.
The Importance of Digital Infrastructure and Strategies
None of the transformation to a more digitally-based health system will be easy, of course. Governments will have to invest effectively in digital infrastructure and strategies. Only half of the 26 IDB member countries, for example, currently have national norms that authorize telemedicine. Governments have to review digital therapeutics and software to ensure patient safety and effectiveness. And they must find ways to guarantee cybersecurity, privacy and widespread connectivity. Crucially, since most of the evidence on the effectiveness of digital interventions comes from high-income countries, they also have to design, adapt, test and implement digital applications for the Latin American and Caribbean context.
The prevention and treatment of disease in a region of immense socioeconomic, educational and geographic diversity is inherently complex, requiring multi-faceted and integrated care. There are no panaceas. But given their low cost, high scalability, and impressive effectiveness on many fronts, digital approaches to health offer immense promise and should become key components of health systems throughout the region.
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