Growing Up in a Digital World with COVID-19 and Governing Health Futures: Who Guards the Guards?

Abstract

OMICS: A Journal of Integrative BiologyVol. 24, No. 11 EditorialFree AccessGrowing Up in a Digital World with COVID-19 and Governing Health Futures: Who Guards the Guards?Vural ÖzdemirVural ÖzdemirAddress correspondence to: Vural Özdemir, MD, PhD, DABCP, Editor-in-Chief, OMICS: A Journal of Integrative Biology, New Rochelle, NY 10801, USA E-mail Address: ojib@liebertpub.comE-mail Address: vural.ozdemir@protonmail.comOMICS: A Journal of Integrative Biology, New Rochelle, New York, USA.Search for more papers by this authorPublished Online:4 Nov 2020https://doi.org/10.1089/omi.2020.0170AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Digital technologies such as the Internet of Things (IoT) and artificial intelligence (AI) have found new applications in medicine, for example, to achieve the twin goals of social distancing and health care delivery in an era of the COVID-19 pandemic. Although social distancing was an initial acute phase response to the pandemic in schools and at work, it will remain relevant until a safe and effective vaccine and therapeutics are available. Meanwhile, a new generation has been growing up over the past decade in a digital world, long before the pandemic. Governance frames and instruments have not kept pace, however, with emerging digital technologies and applications in health (Kickbusch et al., 2019).Frames and framings of governance are particularly important for they determine what knowledge is included and omitted (Barad, 2011; Özdemir, 2020), not to mention the methods by which governance is accomplished, how knowledge is organized, and the ends to which governance instruments serve (Özdemir et al., 2020; Rubin et al., 2006).In this editorial analysis, I highlight four new frames for innovation in governance of digital health futures.First, health is ultimately analog, not digital. Despite digital technologies, let us not forget we still have material, analog, bodies. Digital health is a proxy, a tool, not an end point, to improve analog health, in some ways similar to cholesterol as proxy to improve cardiovascular health.The recognition that digital health ought to impact on analog health has important corollaries. For example, we are facing novel interfaces in translational medicine: analog to digital translation and back to analog.Second, health in the 21st century is a cyberphysical system (CPS), a frame that underscores the entanglement of analog and digital components of health. The CPS has roots, in part, in the concept of Industry 4.0 that builds on three digital technical pillars of importance for governance design: 1.extreme planetary scale digital connectivity by the IoT,2.embedded sensors and smart architecture design such as smart hospitals, and3.real-time large-scale data analysis tools such as AI.The CPS frame has several governance implications. We need to consider governance coordinately, in both digital and analog health. A key challenge is different data and knowledge flow speeds in analog versus digital health. What works as governance in digital health may not work for analog health, and vice versa. CPS and associated extreme digital connectivity can also create an “all eggs in one basket” vulnerability for whole digital health system collapse through domino effects and echo chambers.Third, there is an urgent need to shift toward critically informed governance in the 21st century (Ravetz, 2016; Waltner-Toews et al., 2020). Since the 1980s, governance frames have focused narrowly on market efficiency criterion in particular, and bracketed out power asymmetries and politics in health and society (Springer, 2020). This has paved the way for greater political risks in governance of science and technology futures (Thorp, 2020; Von Schomberg and Özdemir, 2020).Of note, analyses that put power, politics, and agency at their center, and examine not only knowledge but also framings of knowledge, offer the strengths of feminist technology governance frames, and ought to be considered for equitable and critically informed design of governance for digital health futures. A feminist studies of digital health would allow a deeper examination of the vast disinformation and post-truth prevalent in digital ecosystems and, additionally, help move beyond anthropocentrism to take into account the systems level and sociomaterial impacts of digital technologies on nonhuman animals, plants, and ecosystems (Barad, 2007).Fourth, our collective ability to govern digital health futures on a planetary scale depends on strong democratic institutions, and youth and public literacy on democratic theory. Democracy is not an externality for digital health governance but a key pillar and driver (Von Schomberg and Özdemir, 2020). The rise of global populism, concentration of political power by authoritarian leaders around the world and threats to democratic practices are causing polarization and impediments to collective action, and collective governance of digital futures. With COVID-19, these regressive changes have, unfortunately, coalesced further.Recognition of the linkages between strong democracy and robust critically informed governance for health demands that we put the democratic determinants of governance on the map for digital health futures.Concluding ThoughtsIn the 1st century AD, the Roman poet Juvenal asked, “Who guards the guards themselves?” This question relates to whether any group, or elected leaders, can be trusted to look past their own interests for the common good (Frodeman, 2019). For example, in the current global populism era, and with weakening of democratic institutions, elections, alone, are not a guarantee for robust democracy or to prevent the majoritarian rule. For robust democracies, we also need free and fair elections, not merely presence of elections; separation of powers; rule of law; and free, independent, and critical press and journalism to hold political and digital powers to account. Public literacy on democratic theory, particularly of the youth and at high school stage, is, therefore, essential for critical governance of digital health futures.There are unique opportunities and responsibilities to cultivate public literacy on democratic theory among next generations, to hold power to account, and to buttress democracies and governance design for digital health futures.These four points on digital health governance frames invite us to rethink our unchecked assumptions in the global governance field, and might offer creative new solutions to ensure digital health innovations progress in ways that are broadly relevant, experiential, democratic, and socially just.DisclaimerThe views expressed are the personal opinions of the author only.Author Disclosure StatementThe author declares there are no competing financial interests.Funding InformationNo funding was received in support of this editorial analysis.ReferencesBarad K. (2007). Meeting the Universe Halfway: Quantum Physics and the Entanglement of Matter and Meaning. Durham and London: Duke University Press. Google ScholarBarad K. (2011). Erasers and erasures: Pinch's unfortunate ‘uncertainty principle’. Social Stud Sci 41, 443–454. Crossref, Google ScholarFrodeman R. (2019). Review of international handbook on responsible innovation. A global resource. J Responsible Innovation 6, 255–257. Crossref, Google ScholarKickbusch I, Agrawal A, Jack A, Lee N, and Horton R. (2019). Governing health futures 2030: Growing up in a digital world—a joint The Lancet and Financial Times Commission. Lancet 394, 1309. Crossref, Medline, Google ScholarÖzdemir V. (2020). Why are some omics biotechnologies more popular than others? The sociomateriality of glycans offers new clues. OMICS 24, 57–59. Link, Google ScholarÖzdemir V, Springer S, Garvey CK, and Bayram M. (2020). COVID-19 health technology governance, epistemic competence, and the future of knowledge in an uncertain world. OMICS 24, 451–453. Link, Google ScholarRavetz J. (2016). How should we treat science's growing pains? The Guardian. https://www.theguardian.com/science/political-science/2016/jun/08/how-should-we-treat-sciences-growing-pains Accessed September 9, 2020. Google ScholarRubin DL, Lewis SE, Mungall CJ, et al. (2006). National center for biomedical ontology: Advancing biomedicine through structured organization of scientific knowledge. OMICS 10, 185–198. Link, Google ScholarSpringer S. (2020). Caring geographies: The COVID-19 interregnum and a return to mutual aid. Dialogues Hum Geogr 10, 112–115. Crossref, Google ScholarThorp HH. (2020). Science has always been political. Science 369, 227. Crossref, Medline, Google ScholarVon Schomberg R, and Özdemir V. (2020). Full throttle: COVID-19 open science to build planetary public goods. OMICS 24, 509–511. Link, Google ScholarWaltner-Toews D, Biggeri A, De Marchi B, et al. (2020). Post-normal pandemics: Why COVID-19 requires a new approach to science. Discovery Society. https://discoversociety.org/2020/03/27/post-normal-pandemics-why-covid-19-requires-a-new-approach-to-science/ Accessed September 9, 2020. Google ScholarAbbreviations UsedAIartificial intelligenceCPScyberphysical systemIoTInternet of ThingsFiguresReferencesRelatedDetailsCited byDigital Is Political: Why We Need a Feminist Conceptual Lens on Determinants of Digital Health Vural Özdemir8 April 2021 | OMICS: A Journal of Integrative Biology, Vol. 25, No. 4 Volume 24Issue 11Nov 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Vural Özdemir.Growing Up in a Digital World with COVID-19 and Governing Health Futures: Who Guards the Guards?.OMICS: A Journal of Integrative Biology.Nov 2020.619-620.http://doi.org/10.1089/omi.2020.0170Published in Volume: 24 Issue 11: November 4, 2020Online Ahead of Print:September 24, 2020KeywordsCOVID-19digital healthhealth futurestechnology governanceInternet of ThingsIndustry 4.0PDF download