Category Archives: eGovernment

Social determinants of Health and ICT for Health (eHealth) conceptual framework

Lately I have been designing, launching and gathering an online panel survey to a representative sample of Internet users in 14 European countries (approximately 14,000 responses). To ground the questionnaire I have developed a conceptual framework inspired and based on the two main sources. On the one hand, the Marmot Review team:

On the other hand, a Framework for Digital Divide Research developed by Jan van Dijk in several publications:

In a recent presentation about Health and Web 2.0 I tried to match both frameworks and I have posted about Inverse care law 2.0  several times using different scientific and statistical sources.  It is worth pointing out (and obviously reasonable) that I have not found any references or mentions to ICT for Health in the literature about social determinants of Health gathered through Marmot Review team website.


However, both frameworks (see red boxes in both figures) mention individual and social characteristics as social determinants of health and of the Internet usage. Furthermore, van Dijk includes HEALTH and ABILITY as a personal category (and I have added Health as a sphere of participation in Society and emphasis the Divides).


Based on and inspired by this two frameworks I have developed Social determinants of Health and ICT for Health (eHealth) conceptual framework.


All concepts and boxes  of this framework are based on scientific references and the relationships established by arrows have been empirical or theoretical driven. I’m currently working on it, however I have shared this framework to gather inputs to improve it. I would love to know your comments and ideas.

UPDATE: Citizens and ICT for Health in 14 EU countries: results from an online panel survey

Health-related Information as Personal Data in Europe: Results from a Representative Survey in Eu27

On behalf of my co-authors, Wainer Lusoli, Margherita Bacigalupo, Ioannis Maghiros, Norberto Andrade, and Cristiano Codagnone from Information Society Unit – European Commission, DG JRC Institute for Prospective Technological Studies (IPTS), Seville, Spain, I’m presenting “Health-related Information as Personal Data in Europe: Results from a Representative Survey in EU27″ at Medicine 2.0’11 (Stanford University, USA).

Abstract published at Medicine 2.0 website here:


Emerging technological and societal developments have brought new challenges for the protection of personal data and individuals’ rights. The widespread adoption of social networking, participation, apomediation, openness and collaboration stretches even further the concepts of confidentiality, privacy, ethics and legality; it also emphasizes the importance of electronic identity and data protection in the health field.

Governments across the Atlantic have adopted legal instruments to defend personal data and individuals’ rights, such as the Health Information Portability and Accountability Act (1996) in USA, the Recommendation No. R(97)5 on the Protection of Medical Data issued by the Council of Europe (1997) in addition to specific legislation adopted by each EU Member State as part of the Data protection Directive 48/95 transposition process. These reflect policy makers’ concerns about the need to safeguard medical and health-related information. On the other hand, bottom up developments such as the widespread usage of “PatientLikeMe” and the availability of industry based platforms for user-owned electronic medical records (i.e. Google Health or Microsoft Health Vault) are often pointed at, arguing that users do not really care about data protection as long as sharing such data produces more value than it destroys. There is, however, a clear evidence gap as to the attitudes of Europeans with respect to this issue.

The purpose of this paper is to identify and characterize individuals’ perception, behaviors and attitudes towards health-related information and health institutions regarding electronic identity and data protection. The research is based on Eurobarometer 359 “The State of Electronic Identity and Data Protection in Europe”, a representative sample of people in EU27 conducted in December 2010. The survey was conducted in each 27 EU Member States via a national random-stratified samples of ~ 1,000 interviews; overall, 26,574 Europeans aged 15 and over were interviewed face-to-face in their homes. The questionnaire asked questions about data disclosure in different context, including health. Specifically, it included questions related to health and personal information, disclosure in Social Networking Sites and on eCommerce sites, trust in health institutions, approval required for disclosure and sensitivity of DNA data. Specifically, we will provide an encompassing portrait of people’s perceptions, behaviors and attitudes across EU27, we will examine the influence of socio-demographic traits and Internet use on such attitudes and behaviors. We will explore significant differences across major regional block. Finally, we will present results from factor analysis that aimed to identify commonalities between variables, and from cluster analysis, use to create typologies of individuals concerning health-related behaviors. Empirical analysis allows to broaden and deepen understanding of the consequences of data protection in Medicine 2.0. Our data also call for further, joint research on this issue, which links demand and supply of medical and health-related data. Indeed, not all people need or want the same level of detail: researchers and physicians clearly need to access more while end users or insurance companies can live with less information. This is one of the crucial points regarding the revision of the Data Protection Directive in Europe (Directive 95/46).

No eHealth without eInclusion in Europe – Eurostat 2010

Recently, EUROSTAT has published the results from ICT usage household survey 2010. I have been analysing these data developing a Digital Health Care Demand in Europe and I would like also to share my analysis of  “individuals who  used the Internet for seeking health information on injury, disease or nutrition” (European Union 27 Member States), inspired by The Power of Mobile written by Susannah Fox. In my case, I would like to emphasis the raise of the inverse care law 2.0 to justify that there is no eHealth without eInclusion, in other words quoting Europe’s Digital Competitiveness Report 2010:

“In addition, while health-on-the-web may empower in various ways those who have access to the internet, the flip side of this is that those without internet access may become relatively more disadvantaged in health matters. For them, the experience may be more one of disempowerment through inability to take advantage of new opportunities. Factors linked to existing health divides, including lower health literacy and less proactive health attitudes, continue to contribute significantly to unequal health experiences and outcomes among less advantaged socio-economic groups. There is already some evidence that these groups may be experiencing a ‘double jeopardy’ as a result of an intertwining of these traditional health divides with the new digital divides.”

Firstly, since 2004 the percentage of individuals who used the Internet for seeking health information on injury, disease or nutrition (total individuals and individuals who have used the Internet in the last three months) has increased, even though from 2009 we can see a slower increase, specially in those who used the Internet. These trends facilitate the identification of a first gap between users and non-users.


To better capture this gap, I have divided the analysis in two part. On the one hand, considering the total individuals we can see the differences between groups of age and level of education.



Furthermore, we can also identify this gap if we focus on age and education together:




On the other hand, considering  individuals who have used the Internet in the last three months, you can see that there is still a difference between groups of age, level of education and both together:






It has to be remarked that most of these trends show that the divides are not going to disappear with time, in some cases these divides will get wider.  Therefore some groups may be experiencing a ‘double jeopardy’ as a result of an intertwining of these traditional health divides with the new digital divides. THUS, THERE IS NO eHEALTH WITHOUT eINCLUSION. Social care, Health care, Health Professionals and Social workers may work together and play a role not just in eHealth or on eInclusion but both to avoid ‘double jeopardy’ and  the inverse care law 2.0.

Note: I have developed the same analysis for all Member States and the gaps are even wider in some countries.

eHealth Week 2010 – Barcelona

On March 15th to 18th the Ministerial High Level Conference on eHealth and the World Health IT Conference and Exhibition were being held in the same week in a joint initiative called “e-Health Week 2010”. First of all, I would like to congratulate the organizers, specially TICSALUT Foundation and ehealthweek2010, for the very well organized conference and their social media coverage.

The conference was divided into five themes:

Furthermore,  Paralel sessions and Plenary Sessions were coveraged by @ehealthweek2010 using Twitter #hastag as follow:

Paralel Sessions

Plenary Sessions

I also had the opportunity to tweet some of the sessions. On one hand, it was a wonderful opportunity for networking and for watching in action how policy-makers, practicioners (specially Hospital managers and IT managers) and the ICT Health industry work together. On the other hand, there was a lack of analytical/empirical presentations so it was remarked by most of the participants that more research is needed. Furthermore, there are many eHealth, mHealth, Health 2.0,…. Health has been always related to technology so probably it is time to delete all the letters and just talk about HEALTH. Nowadays, HEALTH could not be understood without Information and Communication Technologies and these technologies could not be understood without economic, organization, social and cultural changes.

Health and the Network Society: Spanish/Catalan book launched

I’m delighted to present my book: Health and the Network Society published by Ariel now available at the book stores. I perfectly know that it would not become a best-seller but I hope it could contribute just a little to foster new debates and further research on ICT and Health.Health systems are embedded within technological, economic, social and cultural changes of our current social structure: the network society. This book is based on empirical research about the transition of the Catalan health system towards the network society. The results show how the interaction between the technological, economic, organizational, social and cultural dimensions are facilitating the emergence of new profiles of citizens, patients and healthcare professionals. The determinants that shape these new profiles allow us to identify the inhibitors and drivers of Industrial healthcare systems towards the Network healthcare systems.

Notes from “The Hacker Ethic: The New Culture after the Current Global Economic Crisis”

Today I have the great opportunity to attend at a research seminar entitled “The Hacker Ethic: The New Culture after the Current Global Economic Crisis” led by Prof. Pekka Himanen, who is currently a Visiting Professor at Internet Interdisciplinary Institute.

After a very inspiring presentation, Prof. Himanen has encouraged us to keep the discussion online following an open hacker ethic. So here goes my thoughts about his presentation and his challenges:

  1. I wonder how and to what extend the results of the analysis carried out in collaboration Rita Espanha and Gustavo Cardoso about the Internet users within the World Internet Project could help to identify those users who can easily face the three challenges mentioned by Prof. Himanen, another 3C formula: (Clean = enviromental crisis) + (Care = welfare state 2.0) + (Culture = multicultural life) and also could clearly identify those who will be excluded or disconected.
  2. I wonder how and to what extend the Catalan BioRegion could be considered as part of what Prof. Himanen has called “Innovation center dynamics” due to Prof. Himanen 3C formula:  “culture of creativity” + “community of enrichment” + “creative people”.

I’m excited about the online discussion and Friday meeting.

Measuring digital development for policy-making: Models, stages, characteristics and causes

Yesterday I had the pleasure to attend the defence of Ismael Peña‘ thesis Measuring digital development for policy-making: models, stages, characteristics and causes, “which deals about the digital economy and whether governments should help in its development for it might have a positive impact on the real economy and on the society at large”.

Dissertation supervisor: Tim Kelly

Composition of the committee:

President: Tim Unwin (University of London)
Secretary: Joan Torrent Sellens (UOC)
Members: Robin Mansell (London School of Economics)
Bruno Lanvin (INSEAD)
Laura Sartori (Università di Bologna)

Gustavo Cardoso (Instituto Superior de Ciências do Trabalho e da Empresa)
Rosa Borge Bravo (UOC)

CONGRATULATIONS Dr. Peña-López. I’m proud to work with you in the same research group I2TIC.

Knowledge, networks and economic activity: an analysis of the effects of the network on the knowledge-based economy

I would like to disseminate a paper entitled Knowledge, networks and economic activity: an analysis of the effects of the network on the knowledge-based economy written by Joan Torrent, director of ICTs Interdisciplinary Research Group (i2TIC), brand new research group I belong to.

This paper contextualises the disruptive change of the transition to a knowledge-based economy and discusses the social sciences postulations with regards to this phenomenon. Once the general context is explained, the article focuses on the microeconomic foundations, understanding knowledge as an input and as a commodity. Finally, after discussing the microeconomics of knowledge, the paper tackles network externalities and their  impact on economic functions and market structure.


The progressive consolidation of a knowledge-based economy has caused network effects to become a focal point of analysis into the changes in behaviour evinced by economic agents. This article analyses the changes in production and demand for knowledge commodities arising from network externalities. The analysis reveals two distinct patterns of behaviour in knowledge-based economic activity. Observable knowledge commodities are governed by the effect of direct and indirect network externalities. Also, their demand curve and business strategy depend on new-user entry (marginal value) and the relative size of the network. However, tacit knowledge commodities are governed by learning network externalities and their demand curve and business strategies are dependent on the value generated by the addition of the goods themselves to the network (intrinsic value).

This paper could help towards a better understanding of  health care systems within the network society.

From Excluded to Networked Citizens… The Inverse Care Law

On Wednesday 8th I’m presenting Health and the Internet: Autonomy of the User in the World Internet Project Macao 2009. I have finished the presentation and I would like to share a graphic that clearly represents the difference between Access, Use and Assessment of ICT used by Catalonia citizens (based on a representative survey of Catalonia population).

From Excluded to Networked citizens

Following Dr. Shock comment, age characterization of these citizens suggests that those who are younger and probably in a better health status are also more Networed oriented and those who are older and probably in a worse bad status are Excluded or Disconnected. It looks like sometimes the promises of eHealth and eGovernment forget that Inverse Care Law still matters in the Digital Era. Are online service for-profit and also non-profit providers taking care of these situations?

Doctors, Citizens and the Internet: Brown Bag Seminar Series – SATSU

On 23rd June I had the pleasure to present some of the results of our research in the Brown Bag Seminar Series at Science and Technology Studies Unit (SATSU) in the Department of Sociology at University of York where I’m as a visiting researcher.

I have to thanks all the people who were there for their questions and comments. Special thanks to Michael Hardey who helps me to improve the statistics labels. Now we have to keep working on some papers using these analysis.

From “Disconnected Citizen to “Networked Citizen”

From Disconnected Citizen to Network Citizen

From “Utilized ICT physicians” to “Integrated ICT Physicians”

From Utilised ICT Physician to Integrated ICT Physician

Of course, any comment or suggestion will be very welcomed indeed