The digital [app] divide is bad for our health
Michael Kende posted an intriguing piece on TechCrunch about the digital divide in the app world. In it, he argues that the rapid but uneven proliferation of apps may widen global disparities in access. This is because smartphones not as widely used in the developing world, but also because app developers are restricted in terms of the types of apps they can offer.
He presents an example from Sub-Saharan Africa:
In 22 [sub-Saharan African] countries users are able to download free and paid apps, but developers can only make free apps. In another five countries, there are further restrictions on the ability to use apps or make them available. In the remaining 23 countries developers have no options, and it is not clear whether users can even download free apps.
He’s right. This is bad for the global digital access divide, which has ramifications for things like commerce, education and health. But – this isn’t just a problem in sub-Saharan Africa. It’s a problem here in the US, as well. In our lab, I can’t tell you how many times we’ve said to each other, “I just had this great idea for an app–hm, let’s look at how to do this via text message.” We’ve read the Pew reports. Of the 92% of people who own cell phones nationally, about 68% of them own smartphones. That isn’t bad – in fact, 68% is pretty good. It’s the majority! But it’s not enough, and (importantly) smartphone ownership isn’t randomly assigned.
Take a look at the table on the right, from a Pew survey last year. Specifically, check out smartphone ownership by income, educational attainment, and community type
- Half of those with a household income under $30,000 own a smartphone
- Only 41% of people with less than a high school education have smartphones
- Just over half (52%) of those who live in a rural area of the US own a smartphone
From our experience, even when the people we work with (mostly the ones described above) do have smartphones, they usually have the minimum data plan, and/or at times struggle to keep up with the charges, or don’t have broadband/wifi at home – so they’re reticent to use apps that will use a lot of data. They don’t want to risk going over their allotted time or data plan.
The good news
I know, you’re bummed about this – technology widening health disparities! ugh, it’s the worst. Let’s give up. Cancel digital health.
Not so fast – there’s some good news! In the US, cell (aka dumb aka feature aka not smart) phone adoption is nearing saturation levels among all groups- nearly 9 in 10 rural residents have cell phones, and 86% of those who make less than $30,000/year also have cell phones. There’s good news globally, also – cell phones are now as common in certain sub-Saharan African countries (i.e., South Africa and Nigeria), as they are here. Even better, due to the wide proliferation of mobile banking, Africans who are connected are used to using their phones to do more than just text/talk to friends and family. Presumably that would make them more open to using their phones to talk to automated systems, or answer surveys, get appointment reminders, etc.
We have to do some more creative thinking on the software side in order to make “dumb tech” smarter. But that’s fun! And on the plus side, once you design software that can send a text to one person, you can send it to a million (or a billion) people. With appropriate translation and adaptation, of course.