Digital Is Political: Why We Need a Feminist Conceptual Lens on Determinants of Digital Health.

ABSTRACT

Digital health is a rapidly emerging field that offers several promising potentials health care delivery remotely, in urban and rural areas, in any time zone, and in times of pandemics and ecological crises. Digital health encompasses electronic health, computing science, big data, artificial intelligence, and the Internet of Things, to name but a few technical components. Digital health is part of a vision for systems medicine. The advances in digital health have been, however, uneven and highly variable across communities, countries, medical specialties, and societal contexts. This article critically examines the determinants of digital health (DDH). DDH describes and critically responds to inequities and differences in digital health theory and practice across people, places, spaces, and time. DDH is not limited to studying variability in design and access to digital technologies. DDH is situated within a larger context of the political determinants of health. Hence, this article presents an analysis of DDH, as seen through political science, and the feminist studies of technology and society. A feminist lens would strengthen systems-driven, historically and critically informed governance for DDH. This would be a timely antidote against unchecked destructive/extractive governance narratives (e.g., technocracy and patriarchy) that produce and reproduce the health inequities. Moreover, feminist framing of DDH can help cultivate epistemic competence to detect and reject false equivalences in how we understand the emerging digital world(s). False equivalence, very common in the current pandemic and post-truth era, is a type of flawed reasoning in decision-making where equal weight is given to arguments with concrete material evidence, and those that are conjecture, untrue, or unjust. A feminist conceptual lens on DDH would help remedy what I refer to in this article as "the normative deficits" in science and technology policy that became endemic with the rise of neoliberal governance since the 1980s in particular. In this context, it is helpful to recall the feminist writer Ursula K. Le Guin. Le Guin posed "what if?" questions, to break free from oppressive narratives such as patriarchy and re-imagine technology futures. It is time to envision an emancipated, equitable, and more democratic world by asking "what if we lived in a feminist world?" That would be truly awesome, for everyone, women and men, children, youth, and future generations, to steer digital technologies and the new field of DDH toward broadly relevant, ethical, experiential, democratic, and socially responsive health outcomes.