Special Issue: Medical Devices for Economically Disadvantaged People and Populations: Perspective Problems and Prospective Solutions

Abstract

R. Lyle Hood, Ph.D.Advances in science and technology have led to phenomenal breakthroughs in medical device technologies that allow clinicians to image, diagnose, and treat pathologies like never before. Complex approaches such as modern surgical robots [1], exoskeletal prostheses [2], and magnetic resonance imaging (MRI) systems [3] provide treatment options unimagined two generations ago; complicated interventions such as left ventricular-assisting devices [4], irreversible electroporation [5], implantable nanotechnology [6], and enhanced preservation strategies of organs for transplants [7] dominate popular science. However, much of this intricate technology comes at a high price tag only accessible to a small percentage of the world's patients. Projections indicate that the total worldwide cost burden of medical devices will reach over $510 billion in 2020 [8].Boris Rubinsky, Ph.D.The increasing cost of medical technology has led to a surge in total healthcare expenditures in most economically developed countries. Health cost in Organization for Economic Co-operation and Development (OECD) member countries grows faster than their corresponding gross domestic products (GDP). In the USA, healthcare expenditures in 2019 amounted to 17.7% of its GDP [9]. This is exacerbated by the uneven wealth distribution in the world. The October 2019 Global Wealth Report from Credit Swiss [10] reports that the top 1% of the population own 45% of the global wealth, the richest 10% own 82%, and the bottom half hold less than 1%. While the wealthy and upper middle class have access to costly medical technology, the poor do not benefit from these advances, particularly within high-income countries with privatized healthcare [11]. The increasing cost of medical devices is disproportionately affecting economically disadvantaged people around the world. As of 2017, over half of the world population is too poor to access health services and related expenses are impoverishing hundreds of millions [12]. Among those that can afford healthcare, nearly a billion people spend 10% or more of their household income on health expenses for themselves or a family member. For almost 100 million of these, the expenses are high enough to push them into extreme poverty, forcing them to survive on the equivalent of just $1.90 or less a day [13].The objective of this special issue of the Journal of Medical Devices is to alert and provoke the engineering community regarding the healthcare needs of economically and sociologically disadvantaged populations (ESDPs). Many of the findings and discussions relevant to medical devices in ESDPs are published outside the engineering community. However, it is the opinion of these editors that a concerted engineering effort is essential to addressing and overcoming the current challenges being faced. This introduction was written to highlight reports from other fields on some of the common medical device issues and technological obstacles within ESDPs and provide a preface to the issue's articles showcasing relevant, current advancements from the engineering community. In addition, this section is intended to direct our readers to sources and sites typically unfamiliar to engineers and motivate increased activity within this field.While the wealthy and upper middle class of both economically advantaged and disadvantaged countries have access to costly medical device technologies, the poor do not benefit from these advances [11]. It is interesting to note that while major U.S. philanthropic organizations focus on improving healthcare in economically disadvantaged parts of the world, the healthcare available to their domestic poor is frequently overlooked [14]. The fact that Native American Reservations are a recognized “food desert” without access to staple essentials such as fresh produce is often ignored [15,16]. In global food studies, diabetes is a recognized epidemic among the poor in emerging and developing countries. As