The Failure Of Silicon Valley To Address Health Equity


The combination of big data and well-funded technology, buoyed by a renewed recognition in the wake of the pandemic that social and economic circumstances are directly related to health outcomes, augured in a general feeling of optimism across the health care landscape. This optimism was fueled by the preponderance of well-funded digital health companies focused on addressing Social Determinants of Health (SDoH).

But, if we reflect on the last year, it is fair to say that many of these much hailed new technologies fall short due to their “one-size-fits-all” philosophy.


Many people now believe that we should have foreseen this outcome.

The need to scale is one of the fundamental tenets of the Silicon Valley mindset, which is held by both technologists and venture capitalists. However, this tenet is frequently incompatible with the infinite complexity inherent in dealing with people, their environments, and the enormous variety of cultural, familial, biological, and socioeconomic factors that have an impact on them.

These new technology-driven health plays attempting to address SDoH far too frequently fall short of understanding the fundamental dynamics that underlie health equity disparities, despite literally billions of dollars in VC-backed funding, some of which have propelled digital health companies into the exclusive air of “unicorn” status.

After receiving a variety of resources aimed at enhancing their health and wellbeing, many underserved communities have expressed that access is still too far out of reach for too many people due to a number of social and cultural factors as well as the fact that many programs are still not included in benefits available to the general public.


1. Enhancing Diversity In Healthcare At All Organizational Levels

Far too often, engineers and business leaders driving new technologies have only an academic understanding of what it’s like to live in a food or transportation desert or not have access to broadband—their inexperience with these and myriad other factors contribute to poor designs and continued impediments to access.

2. Better Coding And Reporting Requirements

When it comes to classifying non-health care problems, the health care industry still faces difficulties. The reporting codes for homelessness and housing instability were expanded in October 2022, and new codes were also added for food insecurity; nonetheless, their utilization is still extremely sparse.

Without this vital information, EHRs continue to generate incomplete beneficiary profiles, which frequently have an influence on a person’s health treatment. Although nothing has been decided upon yet, CMS has proposed adding incentives and Star Rating metrics around these domains.

3. Enhancing User Experience

If only patient-facing health care technology followed the lead of TikTok or Instagram. With a user interface that is neither intuitive nor appropriate for certain ethnolinguistic and cultural target groups, many SDoH systems are overly complex, limiting patient and beneficiary utilization. Furthermore, these programs do not keep up with changing conditions; a person who may be housed today may become homeless in six months. Programs frequently fall short of dynamically responding to changing demands or circumstances.

Have a look at a few examples of SDoH programs’ frequent shortcomings to put these difficulties into context.

4. Food Insecurity

Unused food is delivered to households by well-intentioned initiatives to close nutritional gaps with the goal of being frozen; however, lower-income housing units frequently have smaller freezer units, thus food that should be frozen goes to waste.

5. Dietary Constraints

Religiously devout people are frequently sent to food pantries that do not provide the necessary dietary requirements in accordance with their religion, forcing them to choose between hunger and religious adherence.

Childcare Gaps, No. 6

Recipients might not receive ride-share vouchers but instead free public transportation coupons, which can make finding childcare for low-wage hourly workers with children a nightmare. To avoid paying the per-minute rate imposed for daycare pick-up delays, which may easily wipe out a whole day’s pay, caregivers must drop off their kids at daycare, get to work on time, and cross their fingers that there are no glitches in the public transportation system.

7. Proximity to Risk

When people in rehab for substance use disorders are placed in public housing, they are more likely to relapse since they are in close proximity to active drug users and traffickers.

Accessibility issues with current technology are numerous, yet they are also manageable.

Whole-person data collection, connected stakeholders, and empathic navigation are the keys to successful solutions.

While the data must be able to produce an accurate portrait of the recipient, this information must also express the wide-ranging, always changing issues the beneficiary faces. The beneficiary must once again take center stage in an environment of external forces that is constantly shifting. Most SDoH digital solutions are not built using this strategy.

Better Options And Higher ROI

In fact, addressing SDoH issues including housing, food, and transportation lowers the cost of care for complicated patients, yielding a positive return on investment, according to a recent Commonwealth Fund analysis.

Also, starting in 2024, the Centers for Medicare and Medicaid Services (CMS) will start requiring hospitals to do routine health and social needs assessments as well as screen patients for SDoH upon admission.

Thus, will technology-driven SDoH solutions finally succeed in 2023?

It’s too early to tell, but fortunately there are some early promising signs coming from pilot programs being conducted across the nation in locales as diverse as North Carolina and Nebraska, where some businesses have adopted a beneficiary-centered design approach that has seen improved outcomes and ROI. And as we are all aware, success may spread.

We now just need a laser-focused industry to develop applications and design user interfaces that can scale up to close current gaps.


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