ICTlogy

On Wednesday 10th June 2009, I’m giving a conference at the Centre d’Estudis Jurídics i Formació Especialitzada, Justice Department of the Government of Catalonia (Spain). It is framed in the Web Sessions series to debate about the changes and impacts of the Information Society. My conference is called Darwin a la societat de la informació: adaptació (i beneficis) o extinció (Darwin at the Information Society: adaptation (and benefits) or extinction).

As the presentation shows, the speech is made up of four parts or general ideas:

1. The industrial era — or the industrial economy — is based (among many other things) on two main issues: scarcity and transaction costs. These two limitations have shaped the world as we know it, especially institutions: schools, parties and governments, firms, civic associations… When shifting towards a knowledge based economy, both issues of scarcity and transaction costs fall down into pieces. Will institutions, and intermediation in general, follow?
2. Second part is an overview on some of these institutions, and how their models and, sometimes, their sheer survival is threatened by these radical changes on costs and scarcity. Some will violently disappear, some will just fade, some will suffer adaptations along the following years. All in all, it’s about the risk of exclusion from society — not digital exclusion —, the risk of becoming worthless.
3. Thus, there might be a need for new (digital) competences to face the present and the nearest future. These competences (to be acquired both by individuals and institutions) will be necessary to interact with each other and rebuild how we learn, work, or engage in politics or everyday life.
4. To foster the acquisition of these competences some policies to foster the Information Society will have to be put to work, and the role of the government seems to be a crucial one

I will conclude that it all is a matter of bringing on changes while making sense of them.

More information

• Browse: Darwin a la societat de la informació: adaptació (i beneficis) o extinció
• Browse: Darwin at the Information Society: adaptation (and benefits) or extinction
• Download: Darwin a la societat de la informació: adaptació (i beneficis) o extinció ( 10.4 MB)
• Download: Darwin at the Information Society: adaptation (and benefits) or extinction ( 8.68 MB)
• Slides from previous sessions, at Generalitat de Catalunya’s Slideshare
• Briefings from previous sessions, at Generalitat de Catalunya’s Sessions Web website.

I want to heartily thank Jordi Graells for giving me the excuse — actually, to push me — to sit down and put together some ideas that had been rambling on my mind for some time. The title is his and it was great inspiration that helped me in weaving those ideas together. Not surprisingly, his work with the Catalan e-Justice Community (Compartim) is a most inspiring one too.

Some conversations with Ricard Faura — head of the Knowledge Society Service at the Catalan Government — about my recent research have triggered some questions that need being clarified.

The following lines are a very simplified approach on what I think should be the design of public policies to foster ICT usage in a place like Catalonia or Spain, though it is my guess that it can be extrapolated to most developed countries facing similar problems like Spain’s.

Barriers for adoption

In general — and again, being really simplistic with the analysis — there are three main issues identified as a barrier for ICT adoption in Spain and a third issue that, unlike developing countries, it is identified as not being a barrier:

• Age (and some would add gender) is a barrier: younger generations are way more online than older ones, being dramatic in elder people
• Skills present a barrier too, as people do not feel confident, or even threatened, by Information and Telecommunication Technologies
• Indeed, most people not using ICTs also state that they find them useless. Thus, utility and attitude are also a dire barrier and the one with a strongest trend.
• Last, and in general terms, infrastructures and affordability are not a barrier or, at least, they are not stated as being as important as other reasons for lack of usage.

Critique

I believe that the previous barriers can be summed up in just one single barrier: lack of utility of ICTs, with a stress on lack of utility on being online.

This lack of utility can be explained in two ways:

• A real lack of utility, mainly due to lack of digital content and services that fits one’s purposes, be them personal or professional: for leisure, for activism, for work, for training en education, for health, etc.
• A perceived lack of utility, mainly due to lack of e-awareness and not knowing the benefits (or a real measure of the costs) that ICTs can bring to one’s life. This lack of e-awareness, of course, can be accompanied by the lack of several digital skills, which create a vicious circle: less digital skills, less e-awareness; and so.

What about age? I believe that youngsters — besides the fact that they find ICTs not technologies but something that was always there since they were born — have already found ICTs useful: they absolutely fit their needs in matters of education (the Internet is full of stuff) and in matters of socialization (the “communication” part of ICTs), which are the two main “occupations” of people under 16.

Policies

So. We’ve got digitally illiterate people and people that cannot find in the Internet anything worth being connected. What to do from the government?

Concerning utility, my own research shows that pull strategies are the ones that work. It’s absolutely coherent, on the other hand, with trying the Internet to make sense for unconnected people. More hardware or software or broadband will just put stress on the citizen to use something for “nothing at all”. In my opinion, policies should be threefold:

• A high commitment to put public services and the dialogue government-citizenry online, by means of e-Administration and e-Government
• Help the private sector not to have an online presence, but to go beyond and use the Internet for their transactions, with the government (G2B, a part also of the e-Administration strategy) and with their customers (B2B and B2C)
• Last, but not least, empower the citizenry to bring relevant content and debate online. Citizen organizations (political parties, NGOs, neighbourhood associations, patient associations, foundations, clubs, etc.) would be my pick as huge impact collectives which to begin with, as they’ll have manifest multiplier effects by pulling other citizens towards the use of ICTs.

Concerning skills, there three groups of evidences that are worth being remembered:

• People with digital skills are more likely to be more productive and, hence, to earn higher wages. On the other hand, lack of digital skills is likely to reduce employability.
• People with digital skills go more online and happen to meet more people, which improves both their social engagement (and self-esteem and so) and their professional opportunities.
• Digital skills are, by far, acquired on an autodidact basis or, in the best cases, on a P2P basis (family, friends, colleagues). Formal training in digital skills is only partially present in schools and is rare past school age.

That said, and again in my opinion, policies should be threefold:

• Urgently mainstream ICTs — in a very broad and intensive sense — in curricula and syllabuses. This mainstreaming should be based in two approaches: (1) training for trainers and (2) embedding ICT practices in the overall learning process (i.e. not just bound to the computing subject or classroom — though I’m neither saying students should forget about pencil and paper)
• A proactive public strategy aimed to people out of the educational system to catch up with these skills, by means of telecenters and libraries (and other points of access), subsidised courses in computing academies, etc.
• A joint strategy with the private sector to do alike in their in-company training programmes. The public sector could provide training for decision-takers to raise their e-awareness and even help with funding in-company digital skills programmes. But, the private sector should be committed enough, as the benefits are evident and would sooner or later positively impact the firm with higher productivity rates.

Summing up

I honestly think that pull policies to trigger demand (trigger, not contribute to the aggregate demand with direct expenditure) would, sooner or later, trigger to a demand for training in digital skills, which implicitly states in which order I’d be setting these policies.

These what-to-do-policies also, by construction, set aside the what-not-to-do-policies. If we keep in mind we’re talking about (digitally) developed countries and their characteristics, policies not to foster are mainly those aimed at subsidising hardware or connectivity in any way, or fostering the creation and expansion of infrastructures and carriers without anything to be carried on. Static and eminently informational public or corporate websites fully fit in this category; and also fits in this category the creation of content with no further purpose or strategy of usage behind.

Some bibliography

Last May 14th 2009 I imparted a seminar entitled Measuring digital development for policy-making: Models, stages, characteristics and causes. The role of the government in the framework of the Internet, Law and Political science research seminar series that take place at the School of Law and Political Science, Open University of Catalonia (Barcelona, Spain)

Though I had previously presented part of my phd research in public, this is officially the first time that I present final results.

The presentation only shows a brief introduction to Part II (quantitative analysis) and partial highlights from Part III (quantitative/statistical analysis), which makes most slides quite cryptic without a speaker (more cryptic, I mean).

Put short — very short —, after defining a conceptual framework (the 360º digital framework) the research draws 4 stages of digital development (after cluster analysis), the three of which are but different levels of a similar digital development path, and the fourth of them a completely different digital development model: leapfroggers.

These stages of digital development are characterized (a profile for each of them is described), and some determinants (causes) for this digital development (or underdevelopment) are calculated by means of logistic regressions.

Main ideas/findings

The research shows the huge importance of governments in framing and fostering digital development, which is more important and should be more direct the less digitally developed is a specific economy.

It is important to note that government action should be, firstly, focused in framing and give incentives to the real economy, entrepreneurship and innovation; and secondly, to foster the digital economy by means of providing it with an appropriate policy and regulatory framework but also by means of “pull” strategies.

Thus said, the findings show that digital development is compatible with both liberal and Keynesian policies, and that supply-side policies and direct intervention are only worth applying below a minimum threshold of infrastructures. After some infrastructure is installed, policies should especially focus to trigger demand (not to increase the aggregate demand, which is a completely different thing).

This goes against the belief that the government should subsidise computers or content; but it also goes against the belief that the government should just care for the regulatory framework: public policies are a determinant of digital development.

What policies then? Fostering digital services, both private supplied as public e-services, as these services will pull de demand more effectively than other kind of policies.

Two caveats:

• Basic development (income, health, education, equality) accompanies any other kind of digital development, which means that it has to be addressed first hand and, indeed, be the target itself where to apply the benefits of digital development.
• Leapfroggers show that another model from the previous one is possible. It is my concern, nevertheless, how a model based in a powerful ICT Sector aimed towards international trade will impact the domestic economy beyond an eminently direct level. In other words, policies fostering a domestic digital development will have both direct and indirect multiplier effects, the latter being the most powerful ones and, maybe, absent in a leapfrogger model.

Citation and downloads

The World Bank’s last edition of the World Development Indicators stated that Seventy percent of mobile phone subscribers are in developing economies, a mantra that was also repeated on Saturday April 25th, 2009, at Africa Gathering. At least during the second talk it was said that 61% of the 2.7 billion mobile phones in the world are in developing countries, as reported by Ken Banks. Besides whether it is 61% or 70%, the thing is that 83.3% of the World population live in developing countries, a fact that puts in perspective the relative (i.e. per capita) penetration of mobile phones in relationship with the rest of the World’s.

So, is there no reason to be optimistic about mobiles in Africa, then? Well, it depends. Let’s bring some data in for the rescue:

Or, graphically:

Source: ITU ICT Eye

Data don’t clearly show the distinction between developing and developed countries, though it can be roughly inferred at least by (sorry for the rude simplification) looking at Africa and Asia (with mostly Low and Lower-middle income economies with very few exceptions — see the World Bank’s Country Classification). The big highlights are:

• Developing countries have less cellphones per capita than developed ones
• Most phones in developing countries are mobile and digital
• The compound annual growth rate of mobile telephony is higher the less saturated is the market

A logical comment about the last statement would be that it’s natural that less penetration leads to higher annual growth rates. Well, it is not that logical: on the one hand, there are countries with penetration rates above 150% (United Arab Emirates, Macao, Italy, Qatar or Hong Kong), so the concept of “saturation” is a tricky one; on the other hand, there are plenty of other commodities and capital goods (e.g. cars or washing machines) that not even dream of reaching these growth rates.

That said, one need to be cautious when stating that there are “many” cellphones in developing countries: this is true in absolute terms, but most untrue in relative ones. But reality shouts out loud that this is changing at an overwhelming speed and that innovation happens at a terrific pace.

The International Telecommunication Union has published their new ICT Development Index, measuring 11 Information and Communication Technologies indicators for 154 countries, and calculating its value for 2002 and 2007, so that comparisons can be made available.

The ICT Development Index (IDI) is a merger of two previous indices: the Digital Opportunity Index and the ICT Opportunity Index. From the DOI it takes indicators related to households and broadband and the methodology and presentation, while from the ICT-OI it takes indicators related to skills, the normalization method and the digital divide analysis and methodology.

This merger responds to the proposal — and need — of the ITU and other international agencies to concentrate all efforts in just one multi-purpose measuring device, instead of having several complementing indices fostered by different organizations. So we should congratulate all agencies contributing to making this possible for that effort.

But. While some consensus has been reached, the cost of is that the new index has evolved towards a lowest common denominator. In our opinion, losing the information that affordability brought to i.e. the DAI is a loss of shades that were of most utility. This way, the new index is more polarized and is mainly intensive in infrastructures and just shyly on usage and skills, leaving a big void in all other aspects of digital life: the ICT sector, digital skills (the new index uses but proxies) or the legal framework.

On the other hand, the most interesting thing to highlight from this index is that, unlike most other indices, the coefficients of the weigths assigned to each indicator and subindex are calculated statistically, using principal components analysis. Undoubtedly, this provides much legitimacy to the final index values, at least at the formal level.

To clarify the evolution within the UN Sytem of how ICTs have been measured we have prepared the following scheme:

Evolution of the UN System ICT related indices
[click to enlarge]

More brief information related to these indices can bee accessed in the following links:

• Technology Achievement Index
• Digital Divide: ICT Development Indices
• Digital Access Index
• ICT Opportunity Index
• ICT Diffusion Index
• Digital Opportunity Index
• ICT Development Index

More information

• Extensive bibliography on e-Readiness and the measurement of the Information Society
• Selection of concepts, tools and data sources on e-Readiness and the measurement of the Information Society
• ITU Press Release: New ITU ICT Development Index compares 154 countries
• Measuring the Information Society – The ICT Development Index, the official report, including free download (, 1.54 MB)

Note: I want to thank Ivan Vallejo from the ITU for his quick and effective answer to my requirement. ¡Gracias!

The research (partly) belongs to E-Health and Society: An Empirical Study of Catalonia, at its turn belonging to the Project Internet Catalonia (PIC).

Introduction

Francisco Lupiáñez-Villanueva

Historically, the concepts of health, healthiness, public health, etc. lack of consensus. The scientific revolution brings a new approach to these concepts, secularizing the way it is dealt with drawing the biomedical model. But social sciences imply a disruption in the building of consensus and a separation from the usual biomedical model, relating it with society, the relationships of power, human structures, etc. Castells goes one step further stating that the informational paradigm, within the Information Society, brings in yet another change: how (specially) the Internet newly interrelates the different authors around the concept of Health.

The thesis wants to identify and characterize these authors and how and why they use the Internet to get informed and interact amongst them.

Hypotheses

• The Internet is a space for information
• Decision taking determines the uses of the Internet for Health related issues
• A new profile arises between the health professionals: the networked health professional

Methodology

Data come from surveys answered by patients, physicians, nurses and chemists.

(Complex) Information is simplified by factor analysis and cluster analysis.

Binomial logit regressions are used to find the determinants of Internet use for health related issues.

Results

Citizens

patients tend to browse the Internet to get information about their diseases or other health related issues, somewhat limited by the lack of personal infrastructures (hardware, connectivity, skills, etc.). This means that patients are empowered by the Internet to decide about their health based on better grounds. Those are the connected citizens. At the other end, we have the disconnected citizens, mainly due to their socio-economic background: income, education… The relationship (not the causality) between connected citizens, better health and higher socio-economic status is evident.

The Health digital divide excludes 40% of the total population.

Interaction does not happen: Internet is out of the equation in the physician-patient relationship.

Physicians

Three types of Internet use: focus towards research, health information dissemination and institutional information.

The network physician: uses the Internet to get information and communicate with their peers, disseminate their research and spread information about their institutions. These are just 5% of the total physicians.

Networked physicians believe that the Internet is good for their patients, but only half of them encourage their patients in browsing the Internet.

Orientation towards research and intensive search and use of international information mostly determines a physician being or not being a networked physician.

Nurses

The networked nurse follows a similar path than the networked physician: focus on research and lowest proportion in relation to the whole population of nurses (4.5%). As the physicians, networked nurses also believe that the Internet is good and empowers their patients.

Chemists

Just like the prior professional profiles, the networked chemist is research and international information focused, and they also believe that the information in the Internet is good for their patients and has a positive impact on them being autonomous.

Conclusions

1. Internet is a space for information, not interaction.
2. The e-patient is determined by access to information and intensive use of the Internet to get information about health.
3. The health e-professional is determined by orientation towards research and access to international information.

Future lines of research

1. What are the determinants of innovation processes in the health system, including its impact on productivity.
2. What are the determinants of the state of health in the framework of the Information Society
3. What are the public policies to improve the health system in the framework of the Information Society,
4. How the biomedical paradigm evolves within the framework of the Information Society

Discussion

Answers to Joan Torrent

There is a lack of available data about the impact of the use of the Internet on the health of the patients. It is, undoubtedly, a future line of research.

The e-patient paradox: the networked patients are the ones — because they are healthier — that benefit less from e-Health.

The public health system tends to use the Internet to inform, while the private health system has a more intensive use of information technologies for management issues (e.g. e-invoicing), though not necessarily related with physician-patient — or interaction — focused applications.

While physicians see the Internet as a gate to access better information, they are also threatened by a potential use of authority in front of their patients. Thus why they are intensive Internet users, but only for information related issues, not for interaction with their patients. On the other hand, chemists have to ensure their customers’ loyalty, so they have more incentives to share information and open new channels of interaction with them, which might explain why they are more eager to encourage their customers/patients to enter the Internet.

Answers to Gustavo Cardoso

It is very likely that both the methodology and the findings of this research can be applied into other economies that are in their transition towards the Information Society, provided their health and social systems are similar.

It seems there is a new health paradigm: the technoscientific health paradigm, where technology plays an important part along with health infrastructures (e.g. hospitals), culture, etc.

Internet does not replace — in the eyes of the patient — the professional: it’s complementary. Actually, patients are fully aware on who’s behind the information on the Internet, and asks for a professional backup of this information to consider it quality information. But the professionals don’t usually feel alike. A further research, indeed, should analyse the actual relationships of power between patients and professionals, and how these relationships change or can change due to the Internet and the information that it makes broadly available.

A technological layer, in combination with an evolving social layer, has enabled Health “getting out of the closet” and being present in all aspects of life, way beyond the walls of the hospital. This is new, and this issue should be addressed seriously in further research about society in general and Health especially.

Answers to Miquel Àngel Mayer

It’s very difficult to define “quality” in the Internet, specially when speaking about websites about Health. Maybe, the focus should be not quality of the information, but the skills of the one that searches and accesses this information. Indeed, the concept of quality is closely related with the authors that issue and access the information, thus why the stress in capacity building, digital skills and, in general, digital literacy.

Internet is becoming not an exogenous, dependent variable of the Health system, but an endogenous, independent one that should be included in the equation of Health studies.

Answers to Eulàlia Hernández

The e-patient, unlike the networked professionals, cluster around patient associations, engaging into interaction amongst them and not restricting themselves only to access to and use of information.

Answers to Ferran Sanz

There are dire problems in most researchers about Internet uses: how to define the population, how to define the actual use, how to define authorship, how to define jurisdiction, etc. These problems make it difficult to state with statistical significance some findings that might be perfectly valid for the sample.

Bibliography

For a complete listing of references for the PhD Dissertation, please see The definitive references’ collection of my thesis.

NOTE: summa cum laude. Congats!!

Extended information

Thesis defense: The Internet, Health and Network Society, by Francisco Lupiáñez-Villanueva.