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Medical devices
Equity in medical devices: a socio-technical approach
  1. Jonathan Ensor,
  2. Robert Farnan,
  3. Steven Johnson
  1. Equitable Technology Laboratory, University of York, York, UK
  1. Correspondence to Professor Jonathan Ensor; jon.ensor{at}york.ac.uk

Abstract

Medical devices risk reinforcing societal inequalities unless we rethink how they are designed, developed and deployed. The UK government’s recent independent review on Equity in Medical Devices highlights how biases in the design and use of medical devices can lead to solutions that fail to equitably distribute benefits or can further exacerbate health inequalities. In this paper, we draw attention to how wider social, cultural, political and economic factors can also shape the way medical devices are designed, developed and deployed, and how individuals can access or come to be excluded from the associated benefits. Using the example of continuous glucose monitoring devices, we show the potential for medical devices to undermine patient well-being, to occlude patient expertise, and to reflect the priorities of politics rather than patients. These systemic failures highlight the urgent need to reconsider innovation and to develop processes where equity is a fundamental goal and moral responsibility. Here, we suggest a framework for equitable innovation that combines a process of co-design that accounts for knowledge, power and social differences among stakeholders, with considerations of technical needs alongside the institutional arrangements that mediate how devices are deployed in different social contexts.

  • Biomedical Engineering
  • Equipment and Supplies
  • Ethics
  • Socioeconomic Factors

https://doi.org/10.1136/bmjinnov-2024-001306

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    Footnotes

    • Contributors This article arises from work undertaken within the York Equitable Technology Laboratory (ETL). The ETL is concerned with understanding how technology can be designed that respond to societal needs is appropriate for the context of use, and actively contributes to transforming drivers of inequality. The ETL is led by JE (a social scientist) and SJ (a physicist and engineer) who have worked together to place equity at the centre of innovation since 2015. JE brings nearly 20 years of experience in participatory technology development from within critical social science research and international development practice. SJ has over 15 years of experience in the design of medical devices, particularly point-of-use diagnostic technologies. RF is an early career, a postdoctoral researcher working under the supervision of JE and SJ, and undertook an extensive literature review and, during 2023 and 2024, held conversations with type 1 diabetes patients, grounding the illustrative example of continuous glucose monitoring technology that appears in the article. The authors made equal contributions to framing and drafting, and JE is the guarantor of this submission.

    • Funding This work was funded by the United Kingdom Research and Innovation (UKRI) under Engineering and Physical Sciences Research Council (EPSRC) grant EP/P027571/1 and an institutional award (York Equitable Technology Lab) from the University of York. We express our gratitude to all research participants for their time and willingness to participate in this research.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.