Child and adolescent health in the digital age

Lancet Digital Health
Feb 2020 Volume 2 Number 2 e49-e101


Child and adolescent health in the digital age
The Lancet Digital Health
On 18 February, 2020, The Lancet published the report of the WHO-UNICEF-Lancet Commission, calling for a refocus of the Sustainable Development Goals (SDGs) around child and adolescent health. All sectors are responsible for children’s wellbeing, with digital platforms and artificial intelligence (AI) playing an increasing role in child and adolescent health.

The Commission argues that open dialogue across generations is essential to understand the needs of children and adolescents, especially in low- and middle-income countries (LMICs) where 90% of the global youth population currently live. Digital technologies, such as social media and AI-based chatbots, have much to offer in this regard. The Commission highlights that adolescents are enthusiastic users of technology, with those aged 11–16 years posting on social media on average 26 times a day. With a predicted 40 times increase of their global volume of data, adolescents who might seldom access traditional health services, could more easily be reached through digital health platforms. For example, the Commission describes U-Report, a mobile-based online poll for real-time data collection, which collates opinions from approximately 1 million youths from over 50 LMICs to better communicate with government officials to strengthen public health campaigns, such as immunisation awareness.

Despite the development of promising digital interventions, the Commission calls for further research to understand ways to positively engage with adolescents about health issues using digital technology. A paper in The Lancet Digital Health, by Maree Teesson and colleagues, reported a cluster-randomised controlled trial in 71 schools in Australia, which showed efficacy of an online digital intervention for prevention of substance use, depression, and anxiety in adolescents. This digital intervention allows scaling up of prevention programmes, which could reduce costs and increase accessibility to lower resource settings. However, further trials are necessary to determine whether this intervention is cost effective and if the benefits are sustained beyond the trial phase.

The Commission cites several digital interventions that have shown potential in engaging adolescents about health issues; however, the report does not mention augmented reality, a burgeoning area of research in child and adolescent health. In The Lancet Digital Health, Kollins and colleagues describe a randomised controlled trial to test the efficacy of a video game-like interface designed to support children with attention deficit hyperactivity disorder. The results of the trial show that this digital intervention can increase attentional functioning of children with the disorder, but future trials are necessary to examine the durability and time course of the intervention.

The prevalent use of digital platforms, such as social media, has encouraged speculation that their regular use might negatively effect child and adolescent health, a concern echoed within the Commission. However, current evidence supporting this idea is controversial due to the nature of the large-scale social datasets used in many studies which could be prone to potential false positives and conflicting results. A study attempted to address these challenges using three large-scale social datasets and found no significant correlational evidence for detrimental effects of digital technology on adolescent health.

The Commission ends with the quote “what gets measured, gets done”, which highlights a well known barrier to achieving the SDGs: inability to collect the necessary quality and volume of data to monitor progress. Open data is needed to overcome the barriers to collect and share data for SDG progress, and the Commission authors rightly demand better use of data from publicly available sources. However, there are concerns regarding the few safeguards to protect children’s data, especially against data manipulation through black box and biased algorithms. The Commission also highlights the shortcomings of current data privacy regulations, emphasising that public sector bodies and commercial organisations have failed to ensure privacy, transparency, security, and redress when handling children’s data. The assurance of privacy and security of data is key to the success of digital innovation and transformation of health care.

Digital platforms and AI are necessary tools to enable children and adolescents to be agents of change, encouraging open dialogue between children, international agencies, and governments to achieve the SDGs for a better future.