Health inequalities and diffusion of innovative technologies
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Social inequalities in health have been severely documented in many countries, between many social categories, and for many health outcomes. The persistence of these inequalities has been paired with substantial technological development within and outside of the health care system. Though being proposed as a remedy for several of the challenges facing public health in the 21st century, including health inequalities, much research has indicated that the introduction of innovative health technologies in many cases has contributed to producing and widening these inequalities. Support for technology as an inequality generator is also found among seminal theories on social inequalities in health. The fundamental cause theory has proposed that health inequalities will grow as our ability to control disease and death increases, and that access to and use of health technologies may be a pathway between social position and health outcomes. Within the diffusion of innovations theoretical framework, technologies spread across population segments unequally, reaching resourceful social groups first, reproducing and widening stratification patterns. In this dissertation, I seek to further understand the mechanisms producing and reproducing health inequalities by asking how innovative technologies affect social inequalities in preventable health conditions. This overarching aim is empirically investigated through four secondary research objectives. The dissertation consists of an introduction and four research papers. First, a systematic review was performed using scoping review techniques. Our search terms and inclusion criteria were concentrated on empirical, peer-reviewed articles studying technologies with an innovative component and comparing people of different social categories. From a final sample of 33 articles, we extracted that the novel research field of technology and health inequality showed thematic and methodological variety, with results mostly supporting the expectation that innovative technologies contribute to increase health inequalities. Results also suggested future research to put more emphasis on how these processes are context-dependent; how the choice of indicators (particularly of social position) may matter for conclusions; and to further explore the pathways connecting social position, innovative technologies, and health outcomes. The second paper is a cross-national study of social inequalities in high- and low preventable health problems, utilizing the health module in the 2014 round of the European Social Survey. Results show overall more educational gaps among health problems classified as high-preventable, but also substantial variation across genders, countries, and health problems, leading us to argue for the importance of institutional perspectives when investigating health inequalities. In the third paper, I look at social inequalities in use of an innovative health technology, blood pressure monitors. Using the second and third wave of the Nord-Trøndelag Health Study and Norwegian data on income and education, results showed a decrease in inequalities over the two survey waves. This was interpreted as supporting a model of hierarchical diffusion, where an innovative technology over time have reached across all social strata. Fourth, a paper investigates how technological advances, operationalized as blood pressure lowering medication, were associated with social inequalities in health outcomes. Analyses of three waves of the Nord-Trøndelag Health Study indicated that the use of medication may have had a levelling effect on systolic and diastolic blood pressure. One suggested explanation is that blood pressure medication is an innovation late in its diffusion process, where it has reached a point of saturation for people in higher socioeconomic positions, giving greater marginal returns for people with low income and education. The findings of the empirical papers are in large supportive of the expectations derived from the fundamental cause theory and diffusion of innovations literature: the introduction of innovative health technologies initially is associated with social inequalities in use and access, but with the potential for later levelling. However, this dissertation questions whether the widening and narrowing of inequalities result from a one-dimensional diffusion, where technologies are continuously adopted by people of lower social positions, or whether the process is more dynamic and multifaceted, with institutional contexts and the technologies’ inherent characteristics among the contributing factors.
Has partsPaper 1: Weiss, Daniel; Rydland, Håvard T.; Øversveen, Emil; Jensen, Magnus Rom; Solhaug, Solvor; Krokstad, Steinar. Innovative technologies and social inequalities in health: A scoping review of the literature. PLOS ONE 2018 ;Volum 13:e0195447.(4) s. 1-20 https://doi.org/10.1371/journal.pone.0195447 This is an open access article distributed under the terms of the Creative Commons Attribution License, (CC BY 4.0)
Paper 2: Rydland, Håvard T.; Solheim, Erling F.; Eikemo,Terje A. Educational inequalities in high- vs. low-preventable health conditions: Exploring the Fundamental Cause Theory. The final published version is available in Social Science & Medicine, p.113145. https://doi.org/10.1016/j.socscimed.2020.113145
Paper 3: Rydland, Håvard T.; Monitoring the social gradient: Inequalities in use of blood pressure monitors in the HUNT study. The final published version is available in Technology in Society, p.101336. https://doi.org/10.1016/j.techsoc.2020.101336
Paper 4: Rydland, Håvard T.; Medical innovations can reduce social inequalities in health: An analysis of blood pressure and medication in the HUNT study. The final published version is available in Health Sociology Review, pp.1-17. https://doi.org/10.1080/14461242.2020.1811748