Technology’s Impact on Infrastructure is a Health Concern
From disaster relief to autonomous vehicles, data-centric technologies influence health outcomes in unexpected ways
This blogpost–written by Data & Society Researcher Mikaela Pitcan, Researcher Alex Rosenblat, Health + Tech Research Lead Mary Madden, and Postdoctoral Scholar Kadija Ferryman–is the result of a collaboration between Data & Society and the Robert Wood Johnson Foundation to research and explore topic areas for a featured call for brief proposals focused on the impact of technology on health. Learn more here.*
Patterns of human behavior in the physical world — how we get around, where we live, how we work and play — are increasingly influenced by digital and data-driven technologies. As digital and internet technologies become more deeply embedded in our everyday lives, they create a critical layer of infrastructure that affects the distribution of health resources across society. At the same time, decision-makers are already accommodating the growing consumer demand for digital technologies in planning and infrastructure projects — whether allocating rural land for data centers instead of parks or reducing public transportation due to the increased availability of on-demand car services. In each of these cases, rapid technological change produces radically different outcomes for different communities.
Regardless of type, all infrastructure has the potential to affect our collective health and well-being.
There are many types of infrastructures; beyond physical infrastructures like bridges and roads, data infrastructures increasingly knit our world together. And human infrastructure (how people are connected and organized) has always been a part of society. Regardless of type, all infrastructure has the potential to affect our collective health and well-being. And when we consider the range of social and cultural impacts from technology that we are likely to see in the near future, we anticipate that changes to physical infrastructure, data infrastructure, and human infrastructure will all have profound effects health equity in the United States. Understanding the transformative quality of digital technologies — the electronic tools, systems, and devices that generate, store, and interpret data — is increasingly critical to supporting a more equitable future for health and health care.
Writing about internet infrastructure, artist and researcher Ingrid Burrington observes:
As the millions of Floridians left without power or internet access following Irma are well aware, these devices, platforms, and the infrastructure that makes them possible aren’t immune to the effects of climate change. […] To some extent, affected citizens’ concerns apply to water, food-supply chains, and shelter construction just as readily — the only difference is that network infrastructure is crucial to how those basic survival needs are distributed and allocated. Without the internet, much of the rest is now no longer possible.
As Burrington so aptly points out, we often think of the digital devices we use as being singular entities that exist in some sort of “cloud,” independent of any changes in the natural or built environment surrounding us. But, as she also notes, our devices are really a “neat assembly of toxic rocks” that require a complex network of physical, data, and human infrastructures to function as expected.
When Hurricane Harvey struck Puerto Rico, it knocked out the power-grid and limited residents’ ability to let family, friends, and news sources know their status. Without the ability to call emergency services, many, particularly those who were already vulnerable (e.g., the elderly, chronically ill, or those with disabilities), became ill and even died. Infrastructure failures, among other factors, contributed greatly to the loss of life in the weeks and months following the hurricane. Natural disasters are just one example of how public health is affected by vulnerabilities in physical and internet infrastructure, vulnerabilities which ultimately exacerbate longstanding structural inequalities in society.
But as researchers like Greta Byrum have illustrated, technology can also be leveraged to avoid these kinds of scenarios if we build more resilient communities in the long-term. By forecasting where climate change might affect the physical infrastructure of the internet, assessing the potential impacts on human infrastructure, and anticipating how data infrastructure such as heat maps can be used to signal where resources are needed, technology can play a role in helping to improve the collective health of vulnerable communities.
Technology can also transform the distribution of human infrastructure through the introduction of algorithmic decision-making. For example, as Virginia Eubank’s book Automating Inequality illustrates, when the state of Indiana implemented an automated system for determining welfare eligibility it entirely reconfigured the relationship between case workers and applicants. Case workers’ primary role shifted from supporting and guiding families through the process of applying for benefits in person, to doing data entry and fielding questions from a centralized call center.
Under this new automated system, many people were wrongfully denied access to benefits without explanation and had little ability to challenge these decisions. While Indiana lawmakers may have started with a goal of reducing costs and improving efficiency, the actual use of this technology ultimately resulted in higher costs and a more complex system for applicants.
Innovations that might create largely positive effects for already-privileged majority groups could have dramatically different implications for marginalized or otherwise vulnerable minority groups.
One of the more polarizing connected-technology trends that will have direct and immediate impacts on infrastructure and public health is the future deployment of autonomous vehicles. Already in use in several pilot communities, self-driving cars and trucks are being promoted as a way to greatly improve the safety of travel. But early testing of these vehicles has already produced several high-profile fatalities, and security experts have raised concerns about the vulnerability of connected vehicles to remote hacking and associated safety concerns. In addition, the proliferation of autonomous vehicles is expected to have dramatic economic impacts, with the potential to wipe out an entire workforce of taxi drivers, bus drivers, and long-haul truck drivers. In each of these instances of emerging technology the expected health-related benefits must be weighed against social, cultural, and economic impacts on a range of different communities. Innovations that might create largely positive effects for already-privileged majority groups could have dramatically different implications for marginalized or otherwise vulnerable minority groups.
The impact of technology on infrastructure has been widely discussed by scholars, journalists, and technologists. Similarly, the impact of technology on health and healthcare is now a robust field of research and policy. However, there is an urgent need to understand the interdependencies between technology, infrastructure and health, and how these relationships affect Americans’ ability to live the healthiest lives possible. How can we support design, decision-making, and governance of our infrastructures in order to ensure more equitable health outcomes for all Americans?
Editor’s Note:
*Over the past eight months, Data & Society has collaborated with colleagues from Robert Wood Johnson Foundation to research and explore topic areas for a featured call for brief proposals focused on the impact of technology on health. The funding opportunity includes $2.4M to support projects focused on technology, infrastructure, and health. Learn more here: https://rwjf.ws/2wnC5le
