Enabling digital health companionship is better than empowerment

In June 2019, WHO and the Organisation for Economic Co-operation and Development convened a meeting to discuss how best to implement digital health for the purpose of transforming health systems, empowering individuals, and improving the delivery of high-quality health care. This meeting followed the April 2018 communication1 from the European Commission on “enabling the digital transformation of health and care in the Digital Single Market; empowering citizens and building a healthier society” (appendix). Such international calls to action have been effective at spreading the message that digital health will bring patient empowerment to health-care policy makers across the globe. Consequently, empowerment plays a prominent role in many national-level policy documents, including National Health Service England’s Empower the Person strategy (appendix), the eHealth Strategy for Ireland, and the National eHealth Strategy of Australia.

The issues with this empowerment narrative are varied and covered in more detail elsewhere.2 We are primarily concerned with the fact that because these strategies largely fail to detail how digital health tools (DHTs) empower citizens or patients, governments risk using this rhetoric in a potentially deceptive manner. The aforementioned strategies seek to encourage the adoption of technologies that might make individuals responsible for self-surveilling all aspects of their life through the digital medical gaze (appendix), instead of focusing on how data derived from DHTs can enable better care at the level of systems, population, group, or individuals.