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An illegal coltan mine in the Democratic Republic of the Congo.
An illegal coltan mine in the Democratic Republic of the Congo. Erberto Zani/Alamy Stock Photo

Digital health is a vital tool: here’s how we can make it more sustainable

The pandemic has shown us the extraordinary potential of digital health to fight global health inequalities by providing expanded access to healthcare: as well as by better informing our responses to health crises.

Tools such as wearable monitoring devices, video consultations, and even chat-bots driven by AI can provide care from a distance and often cost less than a face-to-face meeting with a doctor or nurse. This, in turn, can improve global access to high-quality treatment.

Throughout the pandemic, being able to collect real-time data from cases across the world has been vital to local and global responses to combat the virus and track its progress. Machine learning analysis of viral gene sequences, track-and-trace mobile apps and telehealth services have also played their part. But as this monumental shift towards digital health accelerates, the environmental issues it raises are often overlooked.

Recommendations for improving digital health practices
Nine recommendations from the Riyadh Declaration on Digital Health. RGDHS 2020

Climate change disproportionately affects developing countries. Places that already face poor health outcomes are further subjected to the health effects of environmental change. Plus, considering that emissions from computing devices, data centres and communications networks already account for up to 4% of global carbon emissions, leaving environmental factors out of digital health debates is a significant omission.

As we continue to roll out this indispensable infrastructure, we also need to assess how we can minimise its environmental impact. My research shows three main ways that digital health technologies can contribute to environmental change and what can be done.

Green mining

First, raw materials needed to produce digital health technologies including robotic tools, smartphones and cameras are taken from mines, which are mostly located in developing countries.

The toxic waste spillages that can occur when mining these materials create serious environmental degradation, potentially exposing workers to dangerous toxins. Meanwhile, at the other end of the process, the mishandling of discarded electrical devices can also release toxic chemicals into the environment, creating severe health risks for local populations – including organ damage.

On top of this, the carbon required to produce electronic devices makes up around 8% of all carbon produced globally. Increased demand for devices driven by digital health’s expansion will only push emissions higher.

Steps including developing “green mining” – mining practices that minimise environmental damage and emissions while maximising recycling and supply-chain efficiency – are vital to protect our planet alongside our health.

Green cloud computing

Second, from electronic health records to biometric data collected by wearable technologies, the digital health industry produces vast amounts of information. Health data accounts for around 30% of the world’s data.

A white hand holds a phone displaying a COVID vaccination passport screen.
Digital health tools, such as COVID-related apps, are generating more and more data globally. Marco Verch/Flickr, CC BY

This data and the insights it provides on population health are key to improving people’s health. But due to the electricity needed to run the huge servers that host cloud services, safely storing data in the cloud can take up to one million times more energy than saving data directly to devices.

To reduce the environmental impacts of data centres, initiatives like green cloud computing (which aims for carbon-neutral data processing, for example, by investing in carbon offsets) and virtualisation (which reduces the physical numbers of servers needed to store data by shifting that data to virtual servers) should become key priorities.

The carbon costs of running artificial intelligence and blockchain health technologies to better support patients are also significant. As such, the use of environmentally conscious technologies such as tiny machine learning and compact AI, that reduce software size and power, need to be implemented.

Green IT

Third, we need to consider whether the promise that digital health will lower carbon emissions due to reducing travel to physical health centres is likely to materialise.

Although the increase in telehealth tech means that more patients are accessing healthcare from their homes or workplaces, these reductions in local travel are shown to have minimal effects on emissions and only become cost-effective when telehealth replaces local trips of at least 7.2km (or just over four miles).

A more pressing – and overlooked – concern, however, is the cost associated with housing large telehealth operations in call centres. As with cloud servers, telecommunications centres need vast amounts of energy to power and cool equipment.

A stack of computer servers with brightly coloured wires
The servers required to host digital health data consume huge amounts of energy. Wikimedia

The NHS has recently pledged to achieve a net zero carbon footprint by 2040. However, as the recent IPCC report assessing the state of the world’s climate indicates, change must be more rapid.

In the Philippines – home to a large hub of international telehealth operators – green information technologies such as recyclable office equipment and remote working are used to reduce the environmental costs associated with communication. Such practices must become commonplace.

Green initiatives should be adopted across the healthcare sector as far as possible. The problem is that many digital health technologies result from design decisions beyond the field of healthcare: so big tech must also do its part in creating more sustainable systems.

Without taking such steps, we run the risk that digital health will only lead to additional global health burdens, particularly among the world’s most vulnerable populations.

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