"EDITORIAL Over the past decade consumers and patients and improve chronic conditions or health needs. Such Population have been exposed to a surge of disease management, as well as approaches are people-centered, digital health technologies and telemedicine to improve provider engage sectors beyond health Health and other technological innovations practiceandpatientcenteredcare. care,andincorporatethelocalized including health informatics tools, They also include mobile medical realities of the determinants of Technology: health information technology in devices and remote patient moni- healthsuchassocialandeconomic health care, as well as the use of toring devices and sensors with circumstances at the community 3,4 Placing People medical devices within clinical patient-generated data. The level. care. Consumer health informa- ultimate goals are to improve Incorporating the use of tech- tion is now easily accessible and patient outcomes and patient nology within population health First downloadable through mobile experience with care, and to in- approaches requires an under- phone applications and freely crease ef?ciency and reduce costs standing and acceptance that available from health information within the health care system. people come ?rst and technology Web sites and through social Innovations in technology are second. Placing people ?rst drives media. Advances in technology— not limited to health care. Initia- efforts to identify and leverage the use of Web-based resources, tives in public health as well as the strengths and assets within social media and smart phones— other sectors, such as education, a targeted population, and pay have contributed to efforts to in- are being built on the foundation attention to health through a crease equity through affordable of promoting health in all policy social-ecological lens. It enables 5 access to health information. areas. This rising interest in the the development of partnerships Theseadvanceshavehelpedopen use of technology for health and the sharing of resources and the door to health-related inno- across various sectors presents data during all phases, identi?es vations that are reaching the most great potential for innovation in the most appropriate technologi- vulnerable in society, including population health approaches to cal strategies based on population populations in the United States reduce racial and ethnic health feedback, and aids in the process that are historically underserved disparities. of continuous learning for both because of race and ethnicity. health system stakeholders and 7 Health workers and health care POPULATIONHEALTH the targeted population. systems have embraced technol- APPROACHESAND Placing people ?rst yields in- ogy as a powerful tool for reach- TECHNOLOGY formation on the most effective ing and engaging historically processes for sharing knowledge underserved populations for Utilizing technology as part of and timely information when re- health education and promotion, abroader effort to improve health quired, and supports systems and chronic disease prevention, and outcomes beyond the individual processes that intertwine knowl- care management. Technological patient requires the adoption of edge, behavior, and action within innovationsarenowbeingusedin population health approaches. thecontextofthelocalenvironment. health care to enhance the per- Population health is de?ned as It facilitates a better understand- formance of clinical delivery sys- “the health outcomes of a group ing of how the social-ecological tems, to improve the quality of of individuals, including the dis- context shapes health outcomes care delivered to patients, as well tribution of such outcomes within andthedeliveryofservices.Italso 6(p381) as to promote and strengthen the group,” and includes helps pinpoint opportunities for 1,2 patient-centered care. These in- “health outcomes, patterns of investing in structured upstream novations include health informa- health determinants, and policies and midstream interventions tion technology to support the use and interventions that link these across different sectors, with the 6(p380) of electronic medical records and two.” Population health ap- goalofimprovinghealthoutcomes. personal health records, technol- proaches provide opportunities to Apeople ?rst approach may shed ogy to promote communication improve the health of populations light on areas for technology in- between health care providers that are de?ned by geography, vestment in the non---health care 2246 | Editorial American Journal of Public Health | December 2014, Vol 104, No. 12EDITORIAL This editorial was accepted September sectors that are known to be asso- Americans and Hispanics have for reducing racial and ethnic dis- 22, 2014. ciated with improving health out- lower rates of access to Internet parities and this should not be lost doi:10.2105/AJPH.2014.302334 5 comes, with the goal of aligning broadband services and com- or substituted with the introduction efforts in health care as well as puters, they own and use mobile of technology. People who are Contributors G.Barclayconceptualizedanddraftedthe contributing to long-term improve- phones at higher rates compared placed ?rst represent the targeted article.A.Sabinaassistedwithdraftingand 11 ments in health. Examples include with Whites. To date, however, populations that are in?uenced by revisions.G.Grahamassistedwiththe potential technological invest- limited information exists about technology use, and may include articlereview. ments in early childhood devel- the utility of technology within healthandhealthcareprofessionals, opment, perinatal care, primary population health approaches to patients with health conditions in References 1. Bauer AM, Thielke SM, Katon W, and secondary education, local reduce racial and ethnic disparities common, or other groups such as Unützer J, Areán P. Aligning health infor- food systems, and agriculture. For in health. community members within spe- mation technologies with effective service example, mobile health (mHealth) The high adoption and utili- ci?c settings. Placing people ?rst deliverymodelstoimprovechronicdisease care. Prev Med. 2014;66:167---172. in the form of apps has been zation rates of mobile phones facilitates integrating technological 2. Shekelle PG, Morton SC, Keeler EB. developed to assist individuals with among racial and ethnic minorities innovations into the strengths, as- Costs and bene?ts of health information making healthful choices by track- provide a ready-made foundation sets and collective intelligence technology. Evid Rep Technol Assess (Full ing diet and physical activity, iden- for interventions in partnership within targeted populations. Re- Rep). 2006;(132):1---71. tifyingoptionsfornutritiousfoodor with these population groups spectfully and successfully engaging 3. Riley WT, Keberlein P, Sorenson G, et al. Program evaluation of remote heart nearby recreation, and providing through the development, imple- people—ascertaining the needs, pri- failure monitoring: healthcare utilization customized feedback and sugges- mentation, and adoption of people- orities, solutions, and processes that analysisinaruralregionalmedicalcenter. 8 tions. mHealth texting platforms centered approaches. It cannot be they may recommend and devel- Telemed J E Health. 2014; Epub ahead of print. can help improve maternal and assumed that technology itself will oping technology in collaboration 4. Bonato P. Wearable sensors and childhealthoutcomesasseeninthe be a panacea for long-standing dis- with them—may help ensure suit- 9 systems. From enabling technology to Text4Baby program. These parities in health that are anchored able levels of digital literacy, clinical applications. IEEE Eng Med Biol mHealth innovations not only im- in intractable, historical inequities. e-health literacy, and media literacy Mag. 2010;29(3):25---36. pactindividualhealth,butalsohave Integrating technology within through the lens of cultural com- 5. Rudolph L, Caplan J, Ben-Moshe K, DillonL.HealthinAllPolicies:AGuidefor the potential to target broader pop- population health approaches to petency and sensitivity. StateandLocalGovernments.Washington, ulation health outcomes. These reduce health disparities may Keepingafocusontheneedsand DC, and Oakland, CA: American Public tools have the potential for people seem to be a prolonged, time- opinions of people and the users Health Association and Public Health Institute; 2013. to access the same health informa- consuming and labor-intensive involved, as well as the solutions 6. Kindig D, Stoddart G. What is pop- tion and health care services, pro- process, but the potential payback that they may recommend within ulation health? Am J Public Health.2003; moting health equity—and ulti- to expanding our knowledge of the realities of their environments 93(3):380---383. matelyreducinghealthdisparitiesin technology’s potential to reduce shouldbeconsidered?rstpriorityin 7. Wallerstein N, Duran B, Minkler M, different racial, ethnic, and social- health disparities could be signi?- advancing innovations to improve Foley K. Developing and maintaining economic groups. cant. Based on lessons learned population health. In summary, it partnerships with communities. In: Israel BA, Eng E, Schulz AJ, Parker EA, eds. from other promising efforts to is all about people and the users. Methods in Community-Based Participa- IMPLICATIONSFOR reduce racial and ethnic health Engagingthepopulationatallpoints tory Research for Health. San Francisco, CA: Jossey-Bass; 2005:31---51. RACIAL ANDETHNIC disparities, we know that multi- is critical to achieving a culturally HEALTHDISPARITIES sectoral approaches should be competent, tailored and appropriate 8. LevineDM,SavarimuthuS,SquiresA, Nicholson J, Jay M. Technology-assisted utilized that address the social de- strategy for using technology weight loss interventions in primary care: By 2050, racial and ethnic terminants of health and equity, to improve population health.j a systematic review. J Gen Intern Med. 2014;Epub ahead of print. minorities are projected to be interventions should be culturally approximately 40% of the US informed, and methods and pro- Gillian Barclay, DDS, DrPH 9. Whittaker R,Matoff-Stepp S,Meehan 10 Alyse Sabina, MPH J, et al. Text4baby: development and population. Given the increas- cesses should be well-documented implementation of a national text messag- Garth Graham, MD, MPH ing use of technology in health, this and evaluated. This approach calls ing healthinformation service. Am J Public Health. 2012;102(12):2207---2213. demographic shift underscores the for the need to ground the devel- About the Authors needtounderstandhowtechnology opment and testing of technological 10. Day J. Population Projections of the Gillian Barclay, Alyse Sabina, and Garth United States by Age, Sex, Race, and His- can be used in efforts to improve innovations in behavioral or appli- GrahamarewiththeAetnaFoundationInc., panicOrigin:1995to2050,USBureauof Hartford,CT.Theyarealsoguesteditorsfor health outcomes among racial and cable theories, and to identify poli- the Census, Current Population Reports. this special theme issue. ethnic minority populations in the cies that enable the effective use of Washington, DC: US Government Print- CorrespondenceshouldbesenttoGillian ing Of?ce; 1996:25---1130. United States. Tremendous oppor- technology to reduce racial and BarclayDDS,DrPH,AetnaFoundation,Inc, 151FarmingtonAvenue, RT 63,Hartford, 11. Zickuhr K, Smith A. Digital Differ- tunity exists to examine the utility ethnic health disparities. CT06156,E-mail:[email protected].) ences. Washington, DC: Pew Internet and of technology such as smart Placingpeople?rst,orengaging Reprintscanbeorderedathttp://www.ajph. American Life Project, Pew Charitable phones because although African people ?rst, is a critical approach orgby clickingthe “Reprints” link. Trusts; 2012. December 2014, Vol 104, No. 12 | American Journal of Public Health Editorial | 2247Copyright of American Journal of Public Health is the property of American Public Health Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use."