Equity in medical devices:a socio-technical approach

Medical devices risk reinforcing societal inequalities unless we rethink how they are designed, developed and deployed. The UK government's recent independent review on Equity in Medical Devices highlights how biases in the design and use of medical devices can lead to solutions that fail to equitably distribute benefits or can further exacerbate health inequalities. In this paper, we draw attention to how wider social, cultural, political and economic factors can also shape the way medical devices are designed, developed and deployed, and how individuals can access or come to be excluded from the associated benefits. Using the example of continuous glucose monitoring devices, we show the potential for medical devices to undermine patient well-being, to occlude patient expertise, and to reflect the priorities of politics rather than patients. These systemic failures highlight the urgent need to reconsider innovation and to develop processes where equity is a fundamental goal and moral responsibility. Here, we suggest a framework for equitable innovation that combines a process of co-design that accounts for knowledge, power and social differences among stakeholders, with considerations of technical needs alongside the institutional arrangements that mediate how devices are deployed in different social contexts.