Digital Health in Brazil: imperial threat or promise of sovereignty?

Experts agree that the benefits of telehealth programs are clear, but they warn that without massive investment in public technologies, there is a major risk of handing over health data to foreign corporations

April 23, 2024 by Outra Saude
Health worker providing telemedicine consultations. (Source: Wikimedia Commons)

Is the rapid digital transformation of healthcare an advancement or a setback? According to Raquel Rachid, a researcher at the Laboratory of Public Policy and Internet (Lapin), it’s not best understood simply by weighing its “benefits and drawbacks.” Rather, it’s better to view it through the lens of the conflicts and contradictions driving its implementation today, both in Brazil and globally.

This conflict, evident in foundational policy documents like the World Health Organization’s (WHO) Global strategy on digital health and Brazil’s National Digital Health Strategy, revolves around a struggle between two ideologies. One, championed by Big Tech and wealthy capitalist nations, aims to commodify health data for market interests. The other, aligned with right-to-health principles, “guarantees the privacy of citizens and ensures that data is used to advance science,” as described by Joyce Souza, a scientist at the Free Technologies Laboratory (LabLivre) of the Federal University of Santo André and São Bernardo do Campo.

Ironically, Brazilian public authorities have largely sided with the former, becoming major funders of capitalist digital health endeavors. “The state has become the primary financier of digital health initiatives driven by capital, rather than developing its own digital health infrastructure,” explains Souza.

Rachid and Souza explain how the private sector has infiltrated Brazil’s healthcare digitalization, as well as important reasons for aligning the project with the principles of the SUS (Unified Health System). While telehealth and data interoperability offer significant benefits, they caution that without an economic policy focused on building public capacities in the background, Brazil risks forfeiting sovereignty and progress.

A decades-long conflict

The emergence of e-Health in the 1990s, coinciding with the prime of neoliberalism, laid the groundwork for significant corporate influence.

WHO documents published since that era emphasize the “cooperation” between public and private sectors, masking the encroachment of markets into public health. This notion absolves states of financing obligations for health digitalization models, notes Rachid.

One way corporations gain entry is by promoting interoperability, enabling data flow across systems. In the context of the SUS, this could mean, for example, the creation of a single electronic medical record, which could be accessed by health professionals from any facility in the country–something that is already in the plans of the Ministry of Health. However, in most countries, there won’t be the resources– or the political will – to invest even more into adequate protection of this data.

“Interoperability rhetoric is used to amass huge databases” and data lakes, repositories of unprocessed data, according to Rachid and Souza. In the absence of government initiative to manage them, these repositories end up being managed by the private sector.

Brazil mirrors this trend, with private entities involved in key government infrastructures like the National Healthcare Data Network (RNDS). “When we look at the Federal Government’s technological infrastructures, including the RNDS, both the way the data is being stored and the way it is being processed by algorithmic systems has been set up by the private sector,” she says.

“Even non-profit organizations rely on state resources to run programs like Proadi [a program to support institutional development of the SUS],” adds Rachid.

It’s not possible to hold any illusions about the intentions of the technology companies that are entering the health market, the experts stress. “Google is entering the area of health by offering dermatological analysis services, but it is also offering [the same technology] to Israel, which has used it to target 34,000 people and drop bombs,” emphasizes Souza. “We can’t ignore the imperialist context of these issues.”

By allowing the private sector, especially large transnational companies, to hold and control citizens’ data, “we are transferring the value of knowledge and deepening our technological dependence on them,” Souza says.

Promoting a public alternative

Despite challenges, Brazil has taken steps towards a public-interest-led Digital Health approach. The creation of institutions like Seidigi, the Ministry of Health’s Digital Health and Information Secretariat, and the National Data Protection Authority (ANPD) signal progress in the eyes of Rachid and Souza. However, there is more to be done.

According to Souza, in addition to expressing solidarity with movements who warn about potential problems in the field, “the ANPD needs to talk more about the issue of health data protection.” It also needs to make a bigger effort to bring the RNDS into line with the General Data Protection Law (LGPD).

The alternative to Brazilians’ health dana being taken over by private corporations or foreign powers lies in more incisive action by these bodies, as well as in a massive public investment in the conditions for the state to be able to store and process the material completely autonomously – and to formulate comprehensive public health policies. Yet, current economic policies favor disinvestment in public technological infrastructure, perpetuating technological dependence, caution the experts.

“When the private sector is invited to ‘innovate’ [in health], it is ‘innovating’ with public inputs. It is parasitism,” Rachid warns. “Seidigi would be fully capable of developing a national Digital Health policy,” says Souza. What is needed now is the boldness – and the budget – to actually take this forward.

This article was written by Guilherme Arruda and published in Portuguese on Outra Saúde.

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