How Can We Promote Trust in Technology to Increase Access and Equity in Health Care?

Abstract

The impacts of the COVID-19 pandemic have been the focus of much discussion and debate, and history will be the arbitrator of truth about its legacies for society in general and health care specifically. The COVID-19 pandemic has been a rapid catalyst for technological innovation. The pandemic also has been a stark accelerant for increased inequity, distrust and misinformation (Jaiswal, LoSchiavo, and Perlman 2020). Seizing the current appetite for change amidst the uncertainty and chaos is an opportunity for advancing health care as well as ethically and sustainably addressing the health disparities. Technology is the application of scientific knowledge, skills and competencies to solve practical problems. Changes in health care have accelerated since the industrial revolution, and we now in the Fourth Industrial Revolution, highlighting trends such as the Internet of Things (IoT), robotics, wearables, sensors, big data, machine learning and artificial intelligence. Concurrently, we have witnessed in the last four years the pivotal role that advances in biotechnologies are playing in testing and treating COVID-19-related illnesses, from new vaccines to affordable and widely accessible rapid antigen tests. These technologies demonstrate the potential role in managing rapidly emerging public health crises, and the continuing necessity to invest in basic research that leads to new insights and new tools to manage complex global challenges. We are now also observing the nascence of the Fifth Industrial Revolution where there is greater collaboration between advanced technologies and humans, while at the same time recognising the challenges that advanced technologies may pose for exploitation of vulnerable communities, breach of privacy and the increased corporatisation of health care. The huge financial incentives associated with technology mean that innovation often outpaces ethical debate, regulatory frameworks, traditional research methods, and the education of health and social professionals. The increasing focus of generative artificial intelligence has heralded a new era in delivering clinical services and health care, directly challenging many traditional paradigms (Khera et al. 2024). In addition to the hype of innovation, there are legitimate risks to vulnerable communities and fear of the potentiation of worsening health disparities among many. Trust refers to the belief in the validity, transparency, honesty and reliability of an individual, organisation or institution (Mangion and Frendo 2022). The clinician–patient relationship is at the crux of healthcare delivery and also the adoption of new and emerging therapies. The absence or lack of trust can lead to a fear of seeking help and avoiding treatments because the therapeutic relationship has not been established or has been eroded. Multiple data sources have emphasised the loss of trust in governments and institutions. In particular, the COVID-19 pandemic has highlighted the fragility of the relationship between individuals and many organisations and governments. With good reason, many communities (such as Indigenous, LGBT, migrant and refugee communities) as well as those that have been historically marginalised due to ethnic, racial or socioeconomic bias view authorities and their recommendations with scepticism. A recent report identified that misinformation and disinformation were identified to be the major risks over the coming years (World Economic Forum 2024). There is a perception that technological solutions are less personal but, when applied equitably and guided by ethical reasoning, they can provide an opportunity to tailor and target care to specific individuals and reach populations for whom health care has been limited. Increasingly, technology can augment established models of care, in many cases provide better care and, at times, replace it. How technology is introduced and implemented in the context of care is important, and we must consider the a