Globalization and equal access to telemedicine in isolated areas

DE ORTÚZAR MARÍA GRACIELA

Rennes

Conferencia; Conference, Ecole des Hautes Etudes en Santé Publique; 2010

EHESP

Globalization is influenced by a number of driving and constraining forces: technological developments, political influences, economic pressure, and increasing social and environmental concerns. There are multiple direct and indirect links between globalization and the determinants of health.  Direct effects include impacts on health systems and policies (WTO, GATs), as well as through international markets (e.g. the effect on pharmaceutical prices, TRIPs); and direct impact on levels of health in populations (e. g., cross border transmission of infectious diseases and marketing of tobacco). The second category includes effects that operate on the health sector through domestic economies (e. g., effects of trade liberalization and financial flows on public health-care systems) and on risk (nutrition and living conditions). While some of the aspects of globalization mentioned above have a negative impact, increased access to information and the social appropriation of Information and Communicational Technologies (ICTs) could have a positive impact on health-care rights, especially in isolated areas as is the case in Cuenca Carbonífera de Río Turbio, Argentina. The "digital gap" can produce inequities in the right to health because imbalance in information is an important determinant of inequality in health-care. Eliminating this imbalance in access to information, particularly through the use of ICTs, could spell a significant progress in terms of guaranteeing the right to health for all.  It emphasizes the role that governments and international organizations should play in order to expand access to the global public good   represented by information. The main ethical problem underscored in the use of telemedicine, however, is not equality but confidentiality. For that reason, I propose to analyze “equality of opportunity” in the access to knowledge and information (information rights) and “equality of opportunity” in the access to health-care (health-care rights). This requires studying access to information by: 1- health care professionals: on 1.1. tele-education and informational capacity, 1.2. tele-practice, 1.3. access to database according to needs, 1.4. access to new drugs and technology for prevention, treatment, cure and rehabilitation.  On the side of: 2. patients: 2.1. access to information on quality in health care-right to information-,2.2.right not to know; 2.3. empowerment, 2.4. equal access to health care; 2.5.multiculturalism; 2.6. gender. An integral ethical framework is required to evaluate and regulate the use of telemedicine programmes in isolated and rural areas, since the impact of equal access by the relevant communities constitutes the only health-care system available in those areas.