The power and influence of large companies in the digital economy and the need for stronger regulation continues to be at the centre of public debate. Even Facebook’s vice-president, Sir Nick Clegg, is now on record as calling for closer regulation of big tech firms.
From the scrutiny of American companies such as Facebook and their use of data for commercial gain and aggressive expansion in developing countries, to the increasing role of large Chinese firms, such as Huawei in providing the infrastructure of the digital economy and the implications for national security – what is clear from these debates is that effective governance of big tech firms (American, Chinese or otherwise) is absolutely critical to the future of the global economy and the health and wellbeing of citizens everywhere. Without it, the benefits to people’s lives associated with data flows and 5G technologies may not be fully realised, while at the same time the harms caused by data being used inappropriately or communications systems being disrupted could go unchecked.
New thinking on global governance for the digital economy
One striking feature of current debates is the degree to which they focus on American and Chinese companies and governments. Some commentators have suggested that other countries may face a choice between integration into an American or a Chinese internet and, in consequence, the Chinese or American approach to governance, including access to data for purposes of national security. Neither are attractive options, and underline the need for new thinking on global governance of the rapidly changing digital economy.
Improving people’s health through effective governance of digital economy
Changes in the health sector illustrate the importance of these issues, and the choices governments make in relation to governing the digital economy will fundamentally shape health outcomes. The following factors are opening up big opportunities to increase access to health care:
- Rapid increases in mobile phone use and in access to the internet.
- Growing availability of treatment guidelines (algorithms) in the form of mobile phone applications.
- Rapid development of low cost point-of-care diagnostic technologies
- Existence of networks that make most common drugs easily available from government health facilities, retail pharmacies and informal drug shops.
- Increasing possibilities of the use of electronic patient records to facilitate referrals, enable monitoring of the quality of care and the analysis of big data to improve treatment guidelines.
Taken together, these developments could substantially increase the availability of competent advice, informed by diagnostic tests, and the supply of appropriate drugs, all enabled by information technology. This is especially important for residents of a number of low- and middle-income countries where many people do not have access to safe, effective and affordable health care. The direction of development of the digital health sector is not pre-determined and there are several possible trajectories. Health systems could become increasingly segmented, with a portfolio of very high quality IT-enabled services for those who can afford them, and minimal levels of care for everyone else. They could be strongly influenced by producers of drugs and diagnostic devices, leading to an increasingly expensive service. Or, they could become a means for providing access to evidence-based care for all at an affordable price. Government actions will influence the choice of trajectory.
From national to personal security – the implications of the digital economy
The focus of current discussions about the digital economy has been on ‘national security’ and the way that governments might use data to which they have access. The rapid development of digital health services raises other security issues. Many people already provide a significant amount of health-related data to companies in the US, China and elsewhere. So far, these data have mostly concerned relatively young people with an interest in fitness. However, an increasing number of applications focusing on the management of chronic illnesses are encouraging people to measure a number of health-related indicators.
Moreover, government health services are moving towards the use of electronic patient records to improve health system performance. These developments raise a number of issues concerning privacy and the ownership and use of data. The analysis of big data opens up possibilities for improving the effectiveness of health services. But, it also creates opportunities for the pursuit of commercial or security interests. These issues are particularly pressing when companies provide services across national borders and when the boundaries between personal and national security and commercial interests become blurred.
Mechanisms are needed to ensure that the perspectives of all countries, in terms of size and level of development, and of different social groups within these countries can participate in the creation of new governance arrangements. The health sector may provide a useful entry point to begin to explore these issues, because there is a wide consensus on the need to ensure access to safe and effective services. A recent policy brief aimed at the G20 has called for the creation of an inter-country working group to begin to discuss regulatory issues associated with the spread of digital health. It is time that we give serious attention to this very important issue.