For over a decade, not-for-profit organisations and governments have worked to close the so-called ‘digital divide’, a term for the gap in access to information and education between those with access computers and the Internet, and those without. This has largely been a gap between the rich and the poor, with the rich able to afford computers and Internet access. In the developed world at least, this divide is closing thanks in part to the work of such charities and governments, and partly to the increasing ease and reduction of cost of access. There’s still a long way to go and we’re privileged to have worked with some of the people making a real difference in this area.
Meanwhile, the concept of a ‘health divide’ between nations in the developed and developing world has been a well-documented reality for many years. In 2001, the British Medical Journal quoted Canadian bioethicist Peter Singer who argued that most of the sickness in the world is in the developing world, but most of the health care is in the developed world.
Explaining the background to the health divide, the British Medical Journal went on to point out that poor countries are deprived not only of drugs but also of scientific information:
The digital divide (measured by access to information on the internet) is more extreme than any financial or health divide [between rich and poor countries].
More recently in an interview with the World Health Organization, Dr Denny Vågerö, Scientific Advisor to the Swedish National Board of Health and Welfare, said that health outcomes in Europe are linked with social patterns.
“People in high-income and high-education groups have better health”, said Dr Vågerö.
The Internet empowers health consumers and patients
Today, a digital health revolution is taking place in the developed world. Patients and consumers are empowered to self-diagnose, research their conditions, share experiences with other patients and carers, discover learn about treatment options and clinical trials. People carry out research about their health using Youtube, and then go on to change their healthcare professional. Members of online patient networks discover that they have been misdiagnosed and their lives are dramatically changed as a result (for examples of where this is happening, see some of our articles on healthcare engagement).
It’s easy in English
From an English-speaking, Internet-connected viewpoint it is easy to celebrate the digital health revolution that’s taking place. A huge amount of information is available from all over the world in English. Research from Hitwise, for example, shows that UK Internet users favour certain US-based medicine websites amongst their most-visited health sites. Local country constraints placed by regulators on medicine information communication are effectively irrelevant to health consumers searching the entire world of English-language health information.
But what if you do not speak English? Search for health information in your preferred non-English language and you will be limited to information in that language. In many cases that information will come primarily from your own country.
The most successful social media initiatives, for example, have been launched first in the United States. Patientslikeme, for example, is proof of the impact of connecting thousands of patients together to share information and experiences.
A new digital health divide
Social media initiatives in English are able to engage a huge worldwide English-speaking population. So there is a risk of assuming that the English language – for many the primary language for international business and science – is able to bridge every international boundary and reach everybody in the developed world. The truth, of course, is that there are many people who are not able to understand English and for these, the vast wealth of online health information in English is effectively invisible.
The effect of this is that whilst the ‘digital divide’ separating the rich and the poor may be closing in the developed world as more people gain access to the Internet, there is a significant risk of creating a new ‘digital health divide’ between those confident in the English language and those not.
Evidence of the effect of language barriers on healthcare engagement can be seen in Europe, where there are very few successful healthcare social media initiatives amongst the 50 countries speaking an even greater number of languages. Some may consider that the primary challenge in Europe is lack of guidance from regulators. However I would suggest that the single biggest barrier to successfully connecting patients online in Europe is language. Cultural differences must surely play a role too, but without solving the language challenge, these will be insignificant.
The poor lose out once more
Now let’s consider the difference between those who can and cannot speak English. My understanding is that non-English speakers in the developed world include two, sometimes overlapping groups: the poor, and the aged.
The aged, who grew up in an era before the Internet, may never have learned English because it did not seem necessary. The poor, of all ages, are widely less likely to have accessed education at the same level as the rich and are generally less likely to speak English.
So, whilst the digital divide continues to keep the poor from accessing the Internet, even where this battle is being won, the digital health divide caused by language barriers keeps many of those who do get online from accessing resources that could result in better health outcomes. Once again we see Dr Vågerö’s point about high-income and high-education groups having better health.
What is being done?
The challenge of language barriers online is not a brand new concept. Tudiabetes.org, the online network for diabetes patients launched in the US and with an international membership, discovered early on that Spanish-speaking users were unable to use the website, so launched a Spanish-language version estudiabetes.org.
Google have also been successfully innovating in the area of languages, providing tools like Google Translate which will detect the language of a website and translate it to your preferred language. Covering 52 languages to date, this service has gone a long way towards breaking down the language barriers online.
There is much innovation still required to break down the digital health divide created by language barriers. And the prize is great – better health outcomes for everybody, regardless of education, wealth, language or nation.
New technologies or tools may be required, or new paradigms. The answer may be in existing digital platforms like social networks as we know them today, or in something entirely new. Google are currently working on automated voice translation – perhaps this will play a role when it emerges?
If you’re planning an international digital health strategy and want to avoid increasing the digital health divide, consider some of these ideas for connecting people across languages:
- Manual translation: translate content manually for use by other language speakers. This can be impractical for a dynamic, ‘web 2.0’ website or tool.
- Automated translation: encourage user to make use of tools such as Google Translate to read content in their own language
- Community translation using ‘crowd-sourcing’: encourage members of the community to translate content into their local language.
- Allow for language-specific resources such as language sub-networks in a social network, so that people in single language groups can at least connect easily with each other
- Make use of language-independent media such as photos, movies, and music
Finally, employ the services of a global healthcare engagement strategy consultancy like Creation Healthcare. Our international team of consultants means we have people located near you, who understand your culture and speak your language and the language of your patients. Why not get in touch to find out how we could help you.