Environmental sustainability in digital health

This blog features an interview with Dr Guillaume Chevance, following his talk about environmental sustainability in digital health delivered as part of a newly formed discussion group on ethical considerations in digital health research, led by UCL researchers Dr Olga Perski, Dr Melissa Oldham and Dr Claire Garnett. You can watch Guillaume’s talk here. If you are a researcher interested in joining the discussion group, please e-mail olga.perski@ucl.ac.uk.

Can you tell me a bit about your research background?

I have a Master’s degree in Sport Sciences, with a focus on rehabilitation and physical activity. After having developed and implemented physical activity interventions for people living with chronic health conditions, I became interested in behavioural science. I therefore did another Master’s degree in Human Movement Sciences with a major in Health Psychology. I then did a PhD at the intersection of Health Psychology and Rehabilitation; the topic of my thesis was to understand the role of specific motivational factors in the regulation of physical activity in adults living with chronic conditions and participating in rehabilitation programs. Following my PhD, I did a post-doc focused on eHealth at the University of California, San Diego.

How did you come become interested in digital health and environmental sustainability?

Thanks to my mother, ecology has always been a frequently discussed topic at home. Similar to most human activities, I knew (or had the feeling, to be more precise) that too much digitalisation in the healthcare sector would not be sustainable. An interview with a French engineer, Philippe Bihouix, further sparked my interest in this topic and after reading a couple of his books, I learnt more about the issue of digital health and environmental sustainability. In 2019, a think tank called the Shift Project wrote a report called “Lean ICT: toward digital sobriety” and their conclusion was pretty straightforward:

“…the current trend of digital consumption in the world is unsustainable in terms of the supply of energy and materials that is required…”

Approximately at the same time, a colleague and good friend of mine, Paquito Bernard from the Université du Quebec à Montréal, wrote a piece for the health psychology community titled “Health Psychology at the age of the Anthropocene”. All these texts combined motivated me to try to disseminate the results from the Shift Project’s report to the eHealth community, summarised in a commentary titled “Digital health at the age of the Anthropocene”.

What’s the Anthropocene?

The Anthropocene is an unofficial geologic epoch, coined by biologist Eugene Stormer and chemist Paul Crutzen in 2000. It is used to describe the most recent period in the Earth’s history when human activity started to have a significant impact on the planet’s climate and ecosystems. Crutzen suggested that the start date of the Anthropocene should be placed near the end of the 18th century, about the same time as the start of the industrial revolution. The Anthropocene is also related to the concept of “The Great Acceleration”, which refers to the increasing human pressures on the Earth’s ecosystems (notably post-World War II) (see Figure 1). To me, the Anthropocene is a kind of a last call to avoid generalised forms of environmental and societal collapses in the next decades.

Figure 1. Illustration of “The Great Acceleration” across different sectors and domains. Reproduced from Steffen et al. 2015.

What are, in your opinion, the most important digital health related threats to the environment?

Technically, and according to the Shift Project and other experts, the two main threats are related to (i) the rapidly growing energy consumption of the information and communication technology sector and (ii) issues of soil pollution and resources scarcity related to the rare metals that are required to build the infrastructures supporting this sector. Specifically, it seems that the explosion of video streaming and consumption of digital devices with short life spans are the main drivers of these threats. The growing electricity consumption is incompatible with the Paris Agreement and the soil pollution issue is related to both the extraction of the metals required for information and communication technologies and the lack of recycling when those digital products reach their end of life. Instead, digital devices are usually exported to low- and middle-income countries as e-waste.

Beyond environmental threats, there is also proven cases of child labour in the mines where the metals required for our digital infrastructures are extracted. Further, most rare metals are produced in conflict zones or areas controlled by monopolistic entities, which causes environmental problems and creates fragility in supply chains. These issues, coupled with inherent planetary resource limits, raise questions about our capacity to continue to access and build health devices in the future.

In my opinion, and more philosophically speaking, we who live in high-income countries are stuck in a “growth mentality”. We are always looking for more and accelerating everything. Instead, I believe it’s time to slow down so as not to further accelerate climate change and mitigate against some of its already observable implications and to leave space to communities in low- and middle- income countries to develop their digital infrastructures and reduce inequalities in this domain.

What suggestions do you have for how to overcome these environmental challenges?

The key thing for me is that we have to slow down our digital consumption. I believe that the healthcare sector, because of its laudable goals, might deserve prioritisation over other sectors (e.g., entertainment; advertising), but the size of the problem is so important that, even for health, environmental consequences should be accounted for when scaling up e- and mHealth technologies. Low-tech options requiring fewer environmental resources (e.g., simpler telemedicine solutions, well-designed text message programmes or phone-based interventions) should be prioritised over high-tech solutions promising a new digital health era made up of artificial intelligence and big data and we need to get better at recycling digital devices (see, for example, this brilliant initiative called RecycleHealth). I am not arguing against scientific and technological progress, but rather that high-tech solutions should be kept for very specific problems of high societal relevance and not scaled-up to everything and for everyone, as is often argued these days. You can read more about suggested mitigation strategies in our commentary.

Biography

Dr Guillaume Chevance is Associate Research Professor and Head of the eHealth Group at the Barcelona Institute for Global Health (ISGlobal).