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Healthcare, Poverty, and Technology: Connecting the Dots

Healthcare, Poverty, and Technology: Connecting the Dots
A new nongovernmental organization is seeking to leverage mobile and connected health technologies to improve healthcare access for the poor in the United States.  

A new nongovernmental organization is seeking to leverage mobile and connected health technologies to improve healthcare access for the poor in the United States. 

By Bradley Merrill Thompson

I mentioned to a friend that a group I am involved with is launching an NGO called Aventor, the mission of which is to encourage the use of connected health—technologies like mobile apps and telemedicine—to increase access to healthcare for the poor in America.

He looked at me like I was daft, then asked me three questions:

  1. Anatomically speaking, aren’t the poor somewhat similar to the rich? (According to research, it turns out they are!) So how can technology be more useful to the poor? Doesn’t all technology simply help everyone?
  2. Isn’t it just a matter of insurance? If we can fix our health insurance system so the poor have either public or private insurance, isn’t that enough?
  3. Do the poor even have cell phones? Would they have access to this technology?

I’ll try to provide high-level answers those questions. There are numerous barriers to healthcare for the poor that go well beyond what insurance covers. I have provided a half-dozen examples in the following table.

Poverty-Related Barriers to Healthcare that Technology Can Help

Barrier Impact Technology Solution
Transportation and mobility
  1. The rural poor have to travel great distances for healthcare not just because they live in the country, but because our healthcare system underserves rural environments. Only about one in 10 physicians practice in rural America, despite the fact that nearly one-quarter of the population lives there. That means nearby cities may not have primary care, let alone specialists.
  2. The urban poor often do not have cars and may face significant transportation challenges when visiting healthcare facilities.
  3. The poor are often disabled, and indeed disabilities can cause of poverty. Among children who use wheelchairs, almost six in 10 are covered under Medicaid. Among working-age wheelchair users, Medicaid covers 30% . Their lack of mobility can be an added obstacle to obtaining care.
Telemedicine and mHealth technology bring healthcare right into the home. They create mechanisms for communicating with doctors on a meaningful level, allowing the doctor to get real data on the patient’s condition from images of or sensors placed on the body. They are especially useful in connecting patients to faraway specialists.
Business hours Medicaid populations have lower education levels and tend to work in hourly jobs that do not let them take off without clocking out. Yet, most clinics and doctors’ offices are open during business hours, which means seeing a doctor in an ambulatory setting likely costs Medicaid beneficiaries income they may not be able to lose. Technology can allow for asynchronous communication. As with E-mail, a patient can send information—both healthcare data as well as written questions—to a healthcare professional after hours, and the professional can respond during business hours.
Diseases caused by poverty The conditions in which the poor must live cause physical ailments, such as asthma and obesity. So if we choose to focus on those particular ailments in order to increase access, we are improving the access of the poor. mHealth is tailor-made for chronic disease management because it’s always on. People nearly always have their cell phones with them, so they can transmitting data and receive instructions any time. The development of sophisticated new sensors will only increase the utility of these technologies.
Diseases that cause poverty On the other side of the coin, certain diseases, such as mental illness and substance abuse, disproportionately lead to poverty. So if we focus on those diseases, we are likewise helping those in poverty get access to care. mHealth technologies can be particularly useful in treating mental illness and substance abuse because they accompany the patient at all times, which is useful both for reporting symptoms as well as for getting therapeutic guidance.
 Language  Many of those living in poverty are recent immigrants for whom English is not their primary language. Not speaking English can be a substantial barrier to getting quality healthcare in the United States  Translation technology can be a bridge that allows for communication substantively, with regard to symptoms and medical history, as well as procedurally, in setting up appointments and otherwise navigating the healthcare system.
Costs that insurance does not cover Insurance is never going to cover all care. Wherever we can drive down the cost of uninsured care, we will help the poor gain access.  Telemedicine and mHealth can help drive down the cost of care delivery, especially for preventative care. Healthcare providers are experimenting with using text messaging and other such vehicles to provide basic prenatal care and reminders. Further, companies are developing ways to use mobile apps to assess vision, potentially driving down the cost of getting prescription glasses. Telemedicine and mHealth are perhaps most useful in driving down the cost of managing long-term chronic disease or disability. 

That table addresses the first and second questions, but now for the third question: Do the poor have cell phones? I’ll break my answer down more specifically based on the subpopulations identified above in terms of the barriers that exist.

Access to mHealth for the Poor

Population Level of Access
The poor generally
  • 86% of households making less than $30,000 a year have a mobile phone
  • 43% of those households have a smart phone
The young poor
  • The poor tend to be disproportionately younger households
  • 97% of those between the ages of 18 and 29 have a mobile phone
  • 70% of homeless people visiting an emergency room have a cell phone
  • 89% of homeless vets have a cell phone
  • 33% of those homeless vets have a smart phone
Rural poor
  • 85% of rural households have a mobile phone
  • Nearly 50% of Hispanics own a smart phone, compared with 27% for non-Hispanic whites

The bottom line is that of course not all poor people have cell phones and certainly not all have smart phones, but a huge proportion of them do. Moreover, I think most people would predict that percentage will increase.


There is an opportunity here to improve access to healthcare for the poor using technology. With that in mind, Aventor’s mission is to help social entrepreneurs trying to bring these important technologies to market by helping them cope with the legal, regulatory, and policy obstacles that lie in their way. Mobile health and telemedicine have great potential, but that potential also makes them disruptive to the current healthcare system. That disruption brings many social entrepreneurs squarely up against the enormous body of regulation that characterizes American healthcare. Our goal is to help them help the poor. And in particular, we propose to do that by helping them navigate healthcare regulation using the pro bono services of legal, regulatory, reimbursement, and policy professionals.

If you'd like to get involved, Aventor is currently recruiting:

  • Social entrepreneurs trying to bring connected health to the impoverished.
  • Legal, policy, and regulatory experts with experience in connected health.
  • Clinicians, business people, and poverty health experts who might be willing to serve on the selection committee.

We are taking applications until February 1, 2015, to select the first batch of social entrepreneurs we will support.

Brad Thompson is a member of the firm at Epstein Becker & Green, P.C. There, he counsels medical device, drug, and combination product companies on a wide range of FDA regulatory, reimbursement, and clinical trial issues. He also heads up the firm's Connected Health Initiative, and blogs for


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