Technological determinants of health: a proposal for the health-technology relationship in the context of the COVID-19 pandemic

Abstract

This article aims to propose Technological Determinants of Health (TDH) as a complementary category to social determinants, particularly in the context of the COVID-19 pandemic. Through a critical analysis of the literature and case studies, the research examines the impact of technologies such as lung ventilators and monitoring systems on both collective and individual health. The results indicate that while these technological innovations have the potential to improve equity in access to health, they can also amplify existing inequalities, especially in vulnerable populations. The conclusion reinforces the importance of integrating TDH into public policymaking, with the aim of ensuring a more inclusive and resilient health system in the face of future health crises. This study suggests that future research should explore the complex interactions between social and technological determinants in diverse socioeconomic and cultural contexts.

Keywords:
Technological Determinants of Health; COVID-19; Health equity; Public health policies; Health technologies

Resumo

O objetivo deste artigo é propor os Determinantes Tecnológicos da Saúde (DTS) como uma categoria complementar aos determinantes sociais, particularmente no contexto da pandemia de Covid-19. Através de uma análise crítica da literatura e de caso, a pesquisa examina o impacto de tecnologias como ventiladores pulmonares e sistemas de monitoramento na saúde coletiva e individual. Os resultados indicam que, embora essas inovações tecnológicas tenham potencial para melhorar a equidade no acesso à saúde, elas também podem ampliar desigualdades existentes, especialmente em populações vulneráveis. A conclusão reforça a importância de integrar os DTS na formulação de políticas públicas, com o objetivo de garantir um sistema de saúde mais inclusivo e resiliente frente a futuras crises sanitárias. O estudo sugere que pesquisas futuras devem explorar as interações complexas entre os determinantes sociais e tecnológicos em diversos contextos socioeconômicos e culturais.

Palavras-chave:
Determinantes Tecnológicos da Saúde; Covid-19; Equidade em saúde; Políticas públicas de saúde; Tecnologias de saúde

Introduction

Technologies have become essential in contemporary daily lives, influencing a wide range of aspects, including health. The COVID-19 pandemic, which impacted the planet in the early years of the 21st century, highlighted the important role of technologies in the health field - not only in the development of vaccines and treatments, but also in information management, telemedicine, and epidemiological surveillance. This scenario triggered an unprecedented acceleration in the adoption of technological solutions in the health sector, exposing weaknesses in health systems and exacerbating social inequalities.

The need for rapid responses led to a reassessment of practices and the use of technological resources, emphasizing the intersection between health and technology as an essential field of study. Technologies such as mechanical ventilators, vaccines, and hospital management platforms became pillars of contemporary healthcare, evidencing a shift in the perception and use of technology, while also underscoring the importance of equity in access to these innovations.

However, the impact of technologies on public health was uneven, often reinforcing existing inequalities. Vulnerable communities faced significant barriers to access, revealing a digital divide that compromised the effectiveness of responses. In Brazil, for instance, the dependence on imported technologies exposed an economic structure that denies access to healthcare for large segments of the population.

From this perspective, understanding technological determinants is essential for guiding public policies that promote equity and efficiency. The analysis of these determinants, especially during public health crises, can contribute to building more resilient and inclusive healthcare systems. The relevance of technological determinants lies in their potential to improve both the quality and accessibility of care, particularly in times of crisis. In the political sphere, they are essential for the formulation of effective and equitable policies.

The study of technological determinants of health allows for a critical understanding of how innovations influence population health outcomes. Furthermore, the analysis of these determinants can support preparedness and response to future public health emergencies, strengthening the resilience of health systems in the face of global challenges.

In this context, the aim of this article is to propose a perspective of the technological determinants of health as a parallel and complementary dimension to the Social Determinants of Health (SDH), critically exploring the relationship between technologies and health during the COVID-19 pandemic. The study seeks to discuss how technological dependencies are shaping both collective and individual health, with a focus on their ethical, social, and political implications.

Body, health, and technology relations

The relationship between humans and technology is inseparable (Latour, 1994). Since ancient times, humans have defined themselves through their relationship with tools, even the simplest ones, being by nature a sociotechnical being. Continuing to view humans and technology as separate entities, as in Descartes’ dualisms, which distinguish between nature and culture, body and mind, spirit and matter, is to ignore the complex interactions and fusions that exist between these domains. Far from being mere instruments, techniques generate profound transformations in social, cultural, and political contexts, at times enabling progress, at others creating challenges, and in some cases even imposing limitations. In contemporary society, technology permeates all aspects of daily life, influencing everything from communication to work, consumption, and social relationships. Technology has become an inseparable part of modern human existence.

Consider, for example, the impact of two technological innovations in health: radiography and the development of vaccines. The discovery of X-rays by Wilhelm Conrad Roentgen in 1895 revolutionized medicine by enabling non-invasive visualization of the human body’s interior. Radiography, a practical application of X-rays, became an indispensable tool in medical diagnostics, allowing for the early detection of fractures, tumors, and other internal conditions. This innovation transformed medical practice by making it possible to visualize internal structures without invasive surgical interventions, enhancing diagnostic accuracy and enabling more effective treatments. In addition to significantly improving diagnostic capabilities, radiography laid the foundation for the development of other imaging technologies such as computed tomography (CT) and magnetic resonance imaging (MRI), further expanding the range of diagnostic tools in modern medicine.

From this perspective, the development of radiology can be seen as a process of coevolution between technology and society. As X-rays became integrated into medical practice, new demands emerged, such as the need to standardize procedures, provide specialized training for equipment operation, and create safety regulations to protect patients and professionals from radiation exposure. These elements interact continuously, feeding back into each other and shaping both the technology and the social and professional practices that surround it. Vaccination, in turn, has not only saved countless lives but also transformed societies by enabling economic and social development that would be impossible in a world constantly afflicted by epidemic diseases. Furthermore, vaccination catalyzed the creation of public health infrastructures and regulations that ensure the safe and equitable distribution of immunizations, reinforcing the interdependence of science, technology, and politics.

In this scenario, the human body has become a project in eternal construction, shaped by technological and biomedical interventions. This transformation is not limited to the physical but also encompasses aspects such as pregnancy, genetics, prosthetics, and artificial intelligence. As a result, the notion of health assumes new meanings, culminating in the search for the ‘post-organic human’, a concept that signifies the transition to forms of existence that depart from traditional conceptions of body and technology. From this perspective, the concept of the cyborg, coined by Manfred Clynes and Nathan Kline in 1960, refers to the fusion between organism and machine, the cybernetic organism. In modern healthcare, the cyborg is no longer a futuristic abstraction but has become an everyday reality that redefines the limits of the human body and therapeutic possibilities. This symbiosis between human and machine is transforming not only physical capabilities but also conceptions of normality and human enhancement.

Technological integration into the human body occurs in various ways: implants, pacemakers, neural prostheses, automated insulin pumps, subcutaneous monitoring sensors, robotic exoskeletons, robotic surgeries, and mRNA vaccines using biotechnology to instruct the body to produce specific proteins. In light of this, could vaccination be considered a subtle form of cyborgization, in which an external agent created by technology is inserted into the human body to reinforce its biology and protect it from microbial threats?

Amber Case (2010) suggests that contemporary society already lives in a cyborg condition, not because individuals possess visible robotic parts, but because of the deep integration of technology into daily life. Devices like smartphones and computers expand cognitive and sensory capacities, creating a digital “second self” that interacts in virtual space and influences identity and social perception. In this way, the cyborg condition in the modern era is less about physical modifications and more about the technological amplification of human life.

Health as an interwoven concept

The concept of health has undergone remarkable transformations throughout history, reflecting social changes and technological advancements. Initially, health was understood in a narrow sense, directly associated with the absence of disease and the proper functioning of the physical body. However, the definition proposed by the World Health Organization (WHO) broadened this concept, defining health as a state of complete physical, mental, and social well-being. Although still abstract, this broader view shifts the understanding of health from a mere absence of illness to a condition that also encompasses emotional and social factors. Yet, this expanded concept has not escaped criticism.

According to Reis (2016), understanding health and illness requires considering different perspectives and dimensions, recognizing that these concepts are multifaceted and influenced by diverse contexts. He argues that the perception of health and illness may vary depending on the observer’s viewpoint but always involves three interconnected aspects. First, illness manifests as a physical or functional alteration in the body, such as an infection or organ failure, which can be observed and measured in various ways. From these observations, interpretations are formed based on available scientific knowledge, the consequences of the illness, and the cultural values of the time. A condition such as depression may, for instance, be understood in different ways. In the past, depression may have been interpreted primarily as a moral weakness, whereas today it is understood as a disease with biological and psychological causes. Moreover, illness is assessed not only scientifically but also ethically, considering the values and interests of society.

In this discussion, Georges Canguilhem (2009) contributes to the understanding of health and illness as manifestations of a society’s way of life. According to him, health is the capacity to face risks and respond to new situations, while disease represents one of life’s normal variations. In agreement with Canguilhem, Langdon (2005) highlights that health and illness are not immutable categories, but dynamic processes resulting from complex sociocultural negotiations. Health, in this context, emerges from the interactions and negotiations between individuals and the environment in which they live, reflecting both individual perceptions and the notions shared by a group about the body and its functioning. Deciding whether someone is sick or healthy is a collective process that involves interpreting bodily signals and assessing the severity of a situation (Langdon apud Becker, 2009). This approach suggests that health is a journey, an itinerary involving constant mediation between balance and imbalance, organization and disorganization, as also described by Reis (2016).

In this approach, health is no longer seen as a static condition but as a continuous process of adaptation and mediation. This conception highlights the symbiotic relationship between human beings and technologies, in which each technological advancement not only expands but also transforms human capabilities. In its interaction with technology, the body is shaped and mediated by these techniques, which expand the possibilities of health. Thus, health manifests as the capacity to maintain the balance of bodily functions and to rebuild ways of living, even in the face of adversity. Therefore, health must be understood as a dynamic experience, in constant interaction with technologies and the environment, at the same time shaping and being shaped by these elements in this ongoing symbiosis. Health represents our entanglement with life itself.

A network of humans and non-humans

Actor-Network Theory (ANT), proposed by Bruno Latour, reconfigures the understanding of interactions between humans and non-humans by suggesting that these interactions should be seen as complex networks in which subjects, objects, technologies, and practices are inseparably interconnected. Instead of clearly separating elements of nature and culture, Latour (2012) emphasizes how they co-construct one another within networks that shape outcomes in various fields, including health.

In the context of health, ANT allows for a detailed analysis of how medical technologies function not merely as passive tools, but as mediators that transform medical practices, redefining roles and responsibilities within healthcare systems. For example, an MRI machine goes beyond simply producing images of the body; it influences medical interpretation, the patient’s perception of their condition, and subsequent clinical decisions. These images become agents that mediate the understanding of health and illness, altering the power dynamics between physician and patient, and directly influencing the therapeutic pathway.

Thus, magnetic resonance imaging is not a neutral tool; it modifies medical practice by enhancing objectivity and rationality through the production of evidence-images. For instance, before technologies like this, doctors had to rely more heavily on physical examinations and conversations with patients to understand what was happening inside the body. With magnetic resonance imaging, this dynamic changes as the device becomes an important “voice” in the room, revealing what is happening inside the body without the need for surgery or other invasive methods.

Latour (2012) argues that these technologies act as mediators, expanding the possibilities of diagnosis and treatment and, at the same time, redefining what is considered viable or acceptable in medical practice. Health, therefore, emerges as the result of these complex networks, in which technologies play a formative role, shaping both care practices and the very conceptions of health and illness.

Moreover, there is a process through which the actors within a network negotiate and modify their identities and interests to achieve a common goal: translation. In the field of health, this is manifested in the interactions among doctors, patients, technological devices, and information systems, where each actor adjusts their expectations and actions based on the responses of others. For example, the adoption of a telemedicine system may require doctors to alter their consultation practices, patients to adapt their expectations regarding care, and the technology to be adjusted to meet the specific needs of the clinical context (Latour, 2012). This process of translation not only facilitates the integration of new technologies into clinical practice but also reveals how these technologies can transform power and knowledge relations in the field of health.

This means that health or care networks are dynamic and constantly evolving. The introduction of new actors, such as new medical technologies, changes in health policies, or COVID-19, triggers the need for renegotiation and reconfiguration of relationships within these networks. This can lead to significant changes in health practices. Thus, incorporating non-humans into the health debate, attributing agency to them and recognizing them as actors, broadens the understanding of what it means to be human and aligns with the “One Health” approach.

Technological Determinants of Health

Understanding health as a social and relational phenomenon makes it essential to move beyond strictly biomedical approaches and adopt broader perspectives on health determinants. In this context, including technology as a determining factor, as well as the discussion of its public policies, can contribute to more integrated, equitable, and effective strategies for health promotion.

The concept

The concept of Technological Determinants of Health (TDH) refers to technological factors that directly impact the health of individuals and communities. It complements the broader concept of Health Determinants by acknowledging the growing importance of technologies, such as medical devices, vaccines, tests, telemedicine, and artificial intelligence, in the promotion, prevention, diagnosis, treatment, and monitoring of health. TDH encompasses factors that affect the health conditions of populations. These go beyond the simple application of technology in medicine, including how technologies influence the organization and delivery of services, shaping accessibility, quality, and efficiency. It includes technological infrastructure and the policies that govern their implementation, which have a decisive impact on health outcomes.

From this perspective, Dusek (2009) proposes that technology can be divided into three typologies: instrument, rule, and system. The first, referring to the use of tools and equipment, includes technologies for diagnosis, therapy, prevention, monitoring, and care, such as medical devices, surgical instruments, prosthetics, diagnostic tests, and Personal Protective Equipment (PPE). Technology as rule involves standardized methods for the proper operation of tools and equipment, such as clinical protocols and therapeutic guidelines that standardize the treatment of health conditions. It also includes procedures, norms, and clinical decision-support software.

Finally, technological systems, although not directly applicable to an individual’ health status, provide the infrastructure and support for the technological apparatus, such as information technologies - telemedicine, teleconsultation, electronic medical records, hospital information systems, mobile health applications, big data analytics, telemonitoring systems, patient and epidemiological data management, clinical software, etc -, and hygiene and environmental control systems. These systems are essential for the effective management of healthcare resources, including the allocation of beds and equipment in hospitals.

These three categories of technology are interconnected and interdependent in the field of health. Understanding these categories is essential to visualize how different health technologies complement each other and are fundamental to healthcare. The goal is not to rigidly categorize each technology, but to provide a broad view of the term.

Technological determinants do not operate in isolation; they are interconnected with biological and sociocultural factors that also influence health. The interaction among these dimensions reflects the complexity of public health, in which the implementation of and access to technologies are shaped by socioeconomic conditions, public policies, and cultural beliefs. Although technologies such as vaccines and diagnostics can save lives, their effectiveness is constrained by sociocultural barriers and inequalities in access. Therefore, integrating technological determinants with other factors is essential for achieving efficient, equitable, and inclusive public health. Figure 1 outlines the technological determinants of health.

Figure 1
The technological determinants of health

Just as the social determinants of health involve complex and often non-correlational mediation with health outcomes (Buss and Pellegrini Filho, 2007), technological determinants present their own specificities, in which the benefits depend on factors such as equity of access, implementation context, and ethical use. Given the diversity of technologies, there is no simple and direct relationship between technological determinants and health. The mere acquisition of equipment does not guarantee positive outcomes, as these technologies operate within a complex network involving social, environmental, biological, political, and technological factors. As technologies advance, it is imperative that policies incorporate a critical perspective on the ways in which these innovations can promote social justice. This includes ensuring equitable access to new technologies and developing strategies that reduce rather than increase social disparities. The future of health policy will depend on a careful balance between technological advances and social justice.

It is important to highlight that health technologies, often promoted as innovative solutions to improve health outcomes, embed values and assumptions that are not neutral in their design or application. According to Feenberg (2013), technology is not just a set of tools that operate independently of social and cultural contexts; it is shaped by specific interests that often reflect the priorities of dominant corporations and markets. From their inception, these technologies are developed based on specific conceptions of the body and health, reflecting values, interests, and priorities that are not universal (Mangini; Kocourek; Silveira, 2018). Frequently, they are designed to meet the demands of large corporations and influential markets, rather than prioritizing the equitable and accessible promotion of public health. In this way, conceptualizing technological determinants also means questioning them and, therefore, opening the possibility of subverting technology toward true universality, integrality, and equity in access to health.

A distinct category

The decision to treat TDH as an analytical category in its own right is based on three main pillars: the insufficiency of traditional health determinants to capture the specific impacts of technologies, the theoretical basis provided by Actor-Network Theory, and the unique dynamics and specificities of technologies within the health field. Although Social Determinants of Health are widely used to analyze health conditions, they often lack the tools to address the particular transformations introduced by technologies. These transformations transcend traditional sociocultural frameworks, reconfiguring care practices and access in ways that demand a distinct analytical approach.

The absence of an explicit focus on technological impacts within the traditional framework is not merely a technical gap; it also reflects an analytical limitation. By treating technology as a secondary means or an extension of the social, SDH diminish the relevance of technological innovations as active and transformative agents in health. This invisibilization reveals a blind spot in the model, reinforcing the need for a specific category to explore the unique contributions of technology to the reconfiguration of sociotechnical networks.

According to Latour (2012), technologies possess their own agency, acting as mediators that shape social practices and networks. They are not merely subordinate tools, but active participants in sociotechnical networks. This perspective justifies analyzing technologies independently, highlighting their ability to reorganize power dynamics, access, and decision-making processes within health systems.

In line with Actor-Network Theory, the concept of the social does not refer to a particular type of material or category, such as biological or economic, but rather to a process of association among heterogeneous elements, whether human or non-human. In this sense, “social facts” do not exist as stable objects to be analyzed isolated but emerge from networks that connect humans, artifacts, institutions, and other entities. Therefore, proposing TDH as an independent analytical category aligns with the ontology of Actor-Network Theory, which emphasizes the human-technology interdependence. The autonomous categorization does not aim to exclude TDH from the social sphere but instead to illuminate their specific dynamics and transformative agency within networks. This strategy enriches the public health debate by broadening the understanding of the complex interactions between sociocultural and technological factors, without reducing the analysis to the homogeneity of a single category.

Just as Commercial Determinants of Health (CDoH) can be distinguished by their unique corporate dynamics, TDH possess structural impacts that justify their specific categorization. This approach expands the understanding of the challenges and opportunities posed by technologies, highlighting their ability to reconfigure health practices, social relations, and public policies, while fostering a critical analysis of how these innovations may either mitigate or exacerbate existing inequalities.

The COVID-19 pandemic and technological dependence

The COVID-19 pandemic, which began in December 2019 in Wuhan, China, quickly evolved into a global public health crisis. The rapid spread of the virus, combined with the lack of immunity and effective treatments, led to a surge in cases and deaths, overwhelming health systems around the world. The WHO declared COVID-19 a pandemic in March 2020, marking the beginning of a global response that would heavily rely on technological solutions.

From the outset, it became clear that technology would be indispensable in the global response to the crisis. With the rapid transmission of the virus and the strain on health systems, it emerged as imperative to rely on technological solutions to mitigate the impacts and ensure the continuity of healthcare services. Technologies not only enabled the accelerated development of vaccines and treatments, but also facilitated new forms of epidemiological monitoring, remote medical care, and real-time data management, proving to be essential at every stage of the pandemic response. The urgency imposed by COVID-19 drove innovations that, under normal circumstances, might have taken years to implement.

Advancements in diagnostic technologies were crucial for identifying and containing the spread of the virus. Rapid antigen tests, known for their practicality and near-immediate results, enabled large-scale screening strategies essential for controlling community transmission. At the same time, improved RT-PCR (Reverse Transcription Polymerase Chain Reaction) techniques allowed for the precise detection of viral genetic material, establishing themselves as the gold standard in COVID-19 diagnostics. RT-PCR has an accuracy greater than 95%, while rapid antigen tests for COVID-19 have an accuracy exceeding 80%, delivering results in 10-15 minutes and at a lower cost (Rao et al., 2024).

In addition to testing, imaging exams such as CT scans and chest X-rays were essential for assessing the severity of lung infections in COVID-19 patients, helping to identify cases of viral pneumonia and monitor disease progression. Assessing severity and standardizing pulmonary lesions was made possible with the help of high-resolution CT (HRCT). A literature review indicates that chest CT has a sensitivity ranging from 44% to 98%, and a specificity between 25% and 96% when compared to RT-PCR (Al-momani, 2024). With the use of advanced machine learning techniques, both sensitivity and specificity can reach up to 99% (Chang et al., 2024). Thus, CT scans can be a valuable resource for symptomatic patients, but their use should be considered alongside RT-PCR results.

The accelerated development of vaccines against SARS-CoV-2 represented an unprecedented scientific and technological achievement. The use of innovative platforms, such as mRNA vaccines, revolutionized immunization against COVID-19 and opened new perspectives for vaccinology. These vaccines, approved for emergency use in less than a year, were made possible by the integration of advanced biotechnology. Viral vector vaccines also played a key role, using cutting-edge technologies to induce effective immune responses, while inactivated vaccines were widely used and contributed significantly to pandemic control.

In Brazil, COVID-19 vaccines showed the following efficacy rates for moderate and severe cases: Fiocruz/Oxford/AstraZeneca®: 70.42%; Instituto Butantan/Sinovac (CoronaVac®): 50.39%; Janssen/Johnson & Johnson®: 66% in Latin America; Pfizer/BioNTech®: 95% (Sobreira et al., 2021). A study in Rio Grande do Norte revealed that vaccination led to a sharp drop in hospitalizations and deaths, especially among the elderly, with hospitalizations cut in half and mortality rates declined substantially after vaccination (Sales-Moioli et al., 2022). With these efficacy rates, vaccines were essential in reducing the severity of COVID-19 and protecting public health on a global scale.

Telemedicine emerged as an indispensable solution during the pandemic, ensuring the continuity of medical care in a context of social distancing and isolation (Messias, 2023). With in-person consultations no longer possible, telemedicine enabled patients to continue receiving essential care. However, the adoption of this technology also highlighted significant inequalities in access, particularly in rural communities and regions with poor digital infrastructure. Limited availability of quality internet and technological devices prevented everyone from benefiting equally, revealing a new layer of inequality in healthcare service delivery.

Information systems and artificial intelligence were employed in the tracking of cases and contacts, as well as in the analysis of epidemiological data. Digital platforms enabled the rapid sharing of information across different levels of healthcare, facilitating evidence-based decision-making. AI was used to analyze large volumes of data, allowing the identification of transmission patterns, outbreak forecasting, and the optimization of resource allocation (Freitas, 2020). The development and adoption of health and symptom monitoring apps represented an innovation in epidemiological surveillance and self-care, establishing a new interface between the population and health systems.

In the hospital setting, dependence on specific medical equipment became critical. Pulse oximeters were widely used to monitor oxygen saturation, enabling early detection of hypoxemia while mechanical ventilators were essential for treating severe cases. Global demand for ventilators far exceeded supply, exposing many countries’ reliance on imported technologies. In Brazil, the shortage of ventilators was a major problem, worsened by reliance on international supply chains, leading to treatment delays and potentially avoidable deaths. Moreover, the need for trained professionals to operate biomedical equipment highlighted the importance of the human-technology interface in healthcare, demonstrating that technological dependence goes beyond the mere availability of devices.

In 2020, the Northeast Consortium, an alliance formed by governors of Brazil’s Northeast Region, purchased ventilators from China to treat COVID-19 patients. However, the ventilators did not arrive in Brazil as planned, as the equipment was retained in the United States and sold to another buyer (Spigariol, 2020). This episode reflected the global tensions and logistical challenges of international medical equipment trade during the pandemic, when worldwide demand for these devices reached unprecedented levels. This incident was not isolated. In early 2020, the U.S. deployed 23 cargo planes to retrieve tons of medical equipment from China, paying above-market prices to override contracts with other countries, including Brazil (Bergamo, 2020). As then-U.S. President Donald Trump stated, “We need the masks. We don’t want others getting the masks” (Oliveira, 2020, online). In China, the price of ventilators increased by more than 200% in a single week in 2020 (Landim, 2020).

Similarly, the supply of Personal Protective Equipment, including masks, gloves, impermeable gowns, face shields, and protective goggles, was critical and fluctuated repeatedly during the pandemic. Health professionals found themselves in vulnerable positions due to the lack of these basic protective materials. The shortage of gloves and masks not only compromised worker safety but also increased the risk of nosocomial transmission of SARS-CoV-2, exacerbating the already severe situation of the pandemic. There is a measurable correlation between the effectiveness of specific types of PPE and their ability to reduce infection rates among healthcare workers (Liu, 2024).

An alarming fact is that, in 2020, around 70% of the world’s latex gloves came from a single manufacturing country, Malaysia (Smil, 2024; MITI, 2023). Additionally, a study by Fiocruz on healthcare professionals’ working conditions during COVID-19 revealed that 43.2% of healthcare workers did not feel adequately protected (Machado et al., 2023). For 23% of these professionals, this sense of insecurity was directly related to the insufficiency, shortage, and inadequacy of PPE. Moreover, 64% of respondents reported having to frequently improvise protective equipment due to a lack of proper resources. These difficulties highlight the direct impact of limited tools and equipment on worker safety and the effectiveness of the pandemic response.

The widespread shortage of PPE and the collapse of the healthcare system in Manaus illustrated the consequences of lacking essential resources. In January 2021, the severe deficit of medical oxygen in Manaus resulted in a humanitarian tragedy, with countless patients dying due to the absence of proper treatment (Lavour, 2021). The pandemic exposed the need for a robust supply chain and the importance of adequate stockpiles and logistics to handle public health emergencies.

One of the most critical aspects of technological dependence in healthcare is the amplification of inequalities in access to care. The disparity in access to advanced medical technologies - whether for geographic, economic, or social reasons - creates a "two-speed healthcare" system in which part of the population benefits from innovation while others are left behind. According to Gadelha et al. (2021), in Brazil, this inequality is worsened by the dependence on imported inputs and technologies, undermining the autonomy of the Unified Health System (SUS). In 2020, 88% of all health-related patents were concentrated in only ten countries - the United States, China, Japan, South Korea, Germany, Switzerland, France, the United Kingdom, the Netherlands, and Israel - intensifying the inequality in access to essential technologies, especially during crises like the COVID-19 pandemic (Gadelha et al., 2021; Aragão; Funcia, 2022). Health in Brazil is conditioned by these ten nations.

Thus, the analysis of technological dependence in health must consider patents and the Health Economic-Industrial Complex (HEIC). According to Gadelha et al. (2021), HEIC includes the chemical, biotechnological, medical equipment, and health services industries and has the potential to reduce these inequalities if well-structured and directed toward public health needs. However, a study by Gadelha, Gimenez, and Cassiolato (2022) revealed that HEIC relies on approximately 20 billion dollars annually in imports, highlighting a significant economic dependency and an underlying model of exclusion. Therefore, the lack of robust industrial policies and reliance on foreign supplies represent major barriers to technological sovereignty and equity in health.

The intersection between technology and health presents complex challenges that require attention from public health managers, policymakers, and civil society. The first challenge is to ensure equitable access to health technologies, avoiding the exacerbation of preexisting inequalities. Technologies can perpetuate privilege, and another critical challenge is the sustainability of health systems in the face of rapid technological innovation, which often introduces costly solutions without demonstrating superior cost-effectiveness compared to existing approaches. The pressure to quickly incorporate new technologies may lead to hasty decisions, without proper evaluation of their long-term impact.

On the other hand, the relationship between technology and health offers opportunities to improve care. Greater efficiency and broader reach of healthcare services emerge as promising prospects, with the potential to optimize resource allocation, reduce wait times, and expand access to specialized care, especially in remote areas through telemedicine. Portable technologies and non-invasive sensors stand out in disease prevention and early detection, allowing continuous monitoring and timely interventions, with the potential to reduce the burden of chronic diseases. Technological innovations have also demonstrated the ability to strengthen the resilience of health systems, as evidenced during the COVID-19 pandemic, with the rapid development of vaccines, real-time epidemiological surveillance systems, and digital health communication platforms. Therefore, it is urgent to broaden the interdisciplinary approach to health determinants and relate technologies to their direct impact on the health of individuals and populations, integrating this discussion into health policies.

Final considerations

In a world increasingly permeated by technological innovations, overlooking their impact means neglecting a significant force that shapes both individual and collective health. This study seeks to explore and define the technological determinants of health as a new analytical category, intended to complement the already established social determinants of health. The findings indicate that, during the COVID-19 pandemic, the challenges arising in the implementation and access to essential technologies, such as mechanical ventilators and monitoring devices, reinforce the relevance of this new concept in understanding inequalities and assessing the effectiveness of public health responses.

Therefore, in the context of the pandemic, the concept of Technological Determinants of Health emerges as an essential perspective for understanding the influence of technologies on collective and individual health. Rather than diluting the focus on social determinants, this approach expands and enriches the analysis, allowing health policies to be more attuned to current technological realities. The research contributes to the advancement of the field by introducing a new dimension that recognizes technologies not merely as tools, but as agents capable of reshaping care practices and transforming power and knowledge relationships in the health sector.

However, the study presents certain limitations, such as the difficulty of isolating the effects of technological determinants from social ones, and the generalizability of the results may be limited due to the specific focus on the COVID-19 pandemic context. Future research could explore the application of this concept in different public health contexts, investigating more deeply the interaction between social and technological determinants. Additionally, it would be important to analyze how public policies can be designed to integrate these determinants effectively, ensuring that technological innovations promote equity and accessibility across diverse socioeconomic realities, as well as exploring these interactions in various geographic and cultural settings.

Thus, the incorporation of this perspective is a step toward a more integrated and multidimensional approach that considers not only socioeconomic conditions but also how technological innovations can be used to reduce or exacerbate inequalities. By incorporating this new dimension, we reinforce the commitment to social justice and equity, ensuring that technological innovations are implemented in a way that benefits all segments of the population. Public policies that integrate a critical view of technological determinants will be better equipped to ensure that technological advances serve as tools for inclusion and health improvement, rather than mechanisms of exclusion.

Ultimately, the question is: what is the place of technology in the field of health? Deterministic silencing, anti-capitalist denial, or technocratic trust? There are various approaches to thinking about technology, and the idea of the technological determinant of health is one such path that seeks to broaden the debate and go beyond the shifting ground of historical dichotomies.

References

• AL-MOMANI, H. A Literature Review on the Relative Diagnostic Accuracy of Chest CT Scans versus RT-PCR Testing for COVID-19 Diagnosis. Tomography, [S. l.], v. 10, n. 6, p. 935-948, 14 jun. 2024. Disponível em: https://www.mdpi.com/2379-139X/10/6/71 Acesso em: 19 ago. 2024.
  » https://www.mdpi.com/2379-139X/10/6/71
• CASE, A. We are all cyborgs now. Palestra proferida no TEDWomen 2010. Dez. 2010. Disponível em: https://www.ted.com/talks/amber_case_we_are_all_cyborgs_now?subtitle=en&lng=pt-br&geo=pt-br Acesso em: 01 ago. 2024.
  » https://www.ted.com/talks/amber_case_we_are_all_cyborgs_now?subtitle=en&lng=pt-br&geo=pt-br
• ARAGÃO, E. S.; FUNCIA, F. R. Austeridade fiscal e seus efeitos no Complexo Econômico-Industrial da Saúde no contexto da pandemia da Covid-19. Cadernos de Saúde Pública, [S. l.], v. 37, n. 9, p. e00100521, 2021. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2021000900603&tlng=pt Acesso em: 20 ago. 2024.
  » http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2021000900603&tlng=pt
• BECKER, S. G. et al. Dialogando sobre o processo saúde/doença com a Antropologia: entrevista com Esther Jean Langdon. Revista Brasileira de Enfermagem, v. 62, p. 323-326, 2009.
• BERGAMO, M. EUA enviam 23 aviões à China e acendem alerta de desabastecimento para hospitais do Brasil. Folha, 2020. Disponível em: https://www1.folha.uol.com.br/colunas/monicabergamo/2020/04/alta-procura-por-itens-hospitalares-na-china-gera-alerta-em-abastecimento-no-brasil.shtml Acesso em: 18 ago. 2024.
  » https://www1.folha.uol.com.br/colunas/monicabergamo/2020/04/alta-procura-por-itens-hospitalares-na-china-gera-alerta-em-abastecimento-no-brasil.shtml
• BUSS, P.; PELLEGRINI FILHO, A. A saúde e seus determinantes sociais. Physis: Revista de Saúde Coletiva, Rio de Janeiro, v. 17, n. 1, p. 77-93, 2007.
• CANGUILHEM, G. O Normal e o Patológico. 6. ed. Rio de Janeiro: Forense Universitária, 2009.
• CHANG, Victor et al. Diagnosis of COVID-19 CT Scans Using Convolutional Neural Networks. SN Computer Science, [S. l.], v. 5, n. 5, p. 625, 7 jun. 2024. Disponível em: https://link.springer.com/10.1007/s42979-024-02878-2 Acesso em: 19 ago. 2024.
  » https://link.springer.com/10.1007/s42979-024-02878-2
• DUSEK, V. Filosofia da tecnologia. São Paulo: Loyola, 2009.
• FEENBERG, A. Racionalização subversiva: tecnologia, poder e democracia. In: NEDER, R. T. (org.). Andrew Feenberg: racionalização democrática, poder e tecnologia. 2. ed. Brasília. Observatório do Movimento pela Tecnologia Social na América Latina/Centro de Desenvolvimento Sustentável / CDS / UnB / Capes, 2013.
• FREITAS, R. A. B. et al. Prospecção Científica sobre Epidemiologia e Prevenção da Covid-19 Aliada à Inteligência Artificial. Cadernos de Prospecção, [S. l.], v. 13, n. 2, p. 543, 16 abr. 2020. Disponível em: https://periodicos.ufba.br/index.php/nit/article/view/36190 Acesso em: 19 ago. 2024.
  » https://periodicos.ufba.br/index.php/nit/article/view/36190
• GADELHA, C. A. G.; KAMIA, F. D.; MOREIRA, J. D. D.; MONTENEGRO, K. B. M.; SAFATLE, L. P. Dinâmica global, impasses do SUS e o CEIS como saída estruturante da crise. Cadernos do Desenvolvimento, v.16, p. 281-302, 2021.
• GADELHA, C. A. G., GIMENEZ, D. M.; CASSIOLATO, J. E. Saúde é desenvolvimento: o Complexo Econômico-Industrial da Saúde como opção estratégica nacional. Rio de Janeiro: Centro de Estudos Estratégicos da Fiocruz, 2022. Disponível em: https://mooc.campusvirtual.fiocruz.br/rea/introducao-sus/assets/docs/CEE-Fiocruz-Saude-e-desenvolvimento.pdf Acesso em: 10 ago. 2024.
  » https://mooc.campusvirtual.fiocruz.br/rea/introducao-sus/assets/docs/CEE-Fiocruz-Saude-e-desenvolvimento.pdf
• LANDIM, R. Preço de respiradores sobe mais de 200% na China em uma semana. CNN, 2020. Disponível em: https://www.cnnbrasil.com.br/economia/macroeconomia/preco-de-respiradores-sobe-mais-de-200-na-china-em-uma-semana/. Acesso em: 18 ago. 2024.
  » https://www.cnnbrasil.com.br/economia/macroeconomia/preco-de-respiradores-sobe-mais-de-200-na-china-em-uma-semana
• LANGDON, E. J. A doença como experiência: a construção da doença e seu desafio para a prática médica. In: BARUZZI, R.; JUNQUEIRA, C. (orgs.). Parque Indígena do Xingu: saúde, cultura e história. São Paulo, UNIFESP/Terra Virgem, 2005. p. 115-134.
• LATOUR, B. Jamais fomos modernos: ensaio de antropologia simétrica. Rio de Janeiro: Ed. 34 Letras, 1994.
• LATOUR, B. Reagregando o social. Salvador: EDUFBA, 2012; Bauru. São Paulo: EDUSC, 2012.
• LAVOUR, A. Amazônia sem respirar. Radis Comunicação e Saúde, 2021. Disponível em https://radis.ensp.fiocruz.br/reportagem/amazonia-sem-respirar/. Acesso em: 18 ago. 2024.
  » https://radis.ensp.fiocruz.br/reportagem/amazonia-sem-respirar
• LIU, C. PPE-Based Strategies For COVID-19 Prevention Amongst Healthcare Workers. Highlights in Science, Engineering and Technology, [S. l.], v. 102, p. 709-717, 11 jul. 2024. Disponível em: https://drpress.org/ojs/index.php/HSET/article/view/23285 Acesso em: 19 ago. 2024.
  » https://drpress.org/ojs/index.php/HSET/article/view/23285
• MACHADO, M. H. et al. Condições de trabalho e biossegurança dos profissionais de saúde e trabalhadores invisíveis da saúde no contexto da COVID-19 no Brasil. Ciência & Saúde Coletiva, [S. l.], v. 28, n. 10, p. 2809-2822, out. 2023. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232023001002809&tlng=pt Acesso em: 18 ago. 2024.
  » http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232023001002809&tlng=pt
• MANGINI, F. N. R.; KOCOUREK, S.; SILVEIRA, L. V. Serviço Social e tecnologias de saúde. Serviço Social e Saúde, [S. l.], v. 17, n. 1, p. 65-94, 30 jun. 2018. Disponível em: https://periodicos.sbu.unicamp.br/ojs/index.php/sss/article/view/8655203 Acesso em: 14 ago. 2024.
  » https://periodicos.sbu.unicamp.br/ojs/index.php/sss/article/view/8655203
• MESSIAS, J. R. et al. Telemedicina durante a pandemia de Covid-19. Brazilian Journal of Implantology and Health Sciences, [S. l.], v. 5, n. 4, p. 2409-2420, 20 set. 2023. Disponível em: https://bjihs.emnuvens.com.br/bjihs/article/view/557 Acesso em: 19 ago. 2024.
  » https://bjihs.emnuvens.com.br/bjihs/article/view/557
• MITI. Ministry of Investment, Trade and Industry. New Industrial Master Plan 2030: Rubber-based Products Industry. 2023. Disponível em: https://www.nimp2030.gov.my/nimp2030/modules_resources/bookshelf/e-18-Sectoral_NIMP-Rubber-based_Products_Industry/e-18-Sectoral_NIMP-Rubber-based_Products_Industry.pdf Acesso em: 18 ago. 2024.
  » https://www.nimp2030.gov.my/nimp2030/modules_resources/bookshelf/e-18-Sectoral_NIMP-Rubber-based_Products_Industry/e-18-Sectoral_NIMP-Rubber-based_Products_Industry.pdf
• OLIVEIRA, C. Trump confessa que não quer “outros países conseguindo máscaras”. Brasil de Fato. 2020. Disponível em: https://www.brasildefato.com.br/2020/04/06/trump-confessa-que-nao-quer-outros-paises-conseguindo-mascaras Acesso em: 18 ago. 2024.
  » https://www.brasildefato.com.br/2020/04/06/trump-confessa-que-nao-quer-outros-paises-conseguindo-mascaras
• RAO, A.; SONI, A.; HAFER, N. COVID-19 rapid tests still work against new variants - researchers keep ‘testing the tests,’ and they pass. The Conversation, 2024. Disponível em: http://theconversation.com/covid-19-rapid-tests-still-work-against-new-variants-researchers-keep-testing-the-tests-and-they-pass-221603 Acesso em: 19 ago. 2024.
  » http://theconversation.com/covid-19-rapid-tests-still-work-against-new-variants-researchers-keep-testing-the-tests-and-they-pass-221603
• REIS, A. A. C. Saúde, terapias integrativas e espiritualidade: uma visão ampliada da medicina e do cuidado integral à saúde. Religião, Saúde e Terapias integrativas, p. 11-44, 2016.
• ROS, M. A.; MAEYAMA, M. A.; LEOPARDI, M. T. Tecnologia na área da saúde: de que tecnologia estamos falando? Saúde & Transformação Social, Florianópolis, v. 3, n. 3, p. 29-35, 2012.
• SALES-MOIOLI, A. I. L. et al. Effectiveness of COVID-19 Vaccination on Reduction of Hospitalizations and Deaths in Elderly Patients in Rio Grande do Norte, Brazil. International Journal of Environmental Research and Public Health, [S. l.], v. 19, n. 21, p. 13902, 26 out. 2022. Disponível em: https://www.mdpi.com/1660-4601/19/21/13902 Acesso em: 19 ago. 2024.
  » https://www.mdpi.com/1660-4601/19/21/13902
• SMIL, V. Como o mundo funciona: Um guia científico para o passado, o presente e o futuro. Rio de Janeiro: Intrínseca, 2023.
• SOBREIRA, M. L. et al. Vacinas para covid-19 e complicações tromboembólicas. Jornal Vascular Brasileiro, [S. l.], v. 20, p. e20210167, 2021. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-54492021000100204&tlng=pt Acesso em: 19 ago. 2024.
  » http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1677-54492021000100204&tlng=pt
• SPIGARIOL A. China afirma que EUA retiveram respiradores comprados por estados do Nordeste. CNN. 2020. Disponível em: https://www.cnnbrasil.com.br/saude/china-afirma-que-eua-retiveram-respiradores-comprados-por-estados-do-nordeste/. Acesso em: 18 ago. 2024.
  » https://www.cnnbrasil.com.br/saude/china-afirma-que-eua-retiveram-respiradores-comprados-por-estados-do-nordeste

• All research data are available in this text

• Editor:
  Jane Russo

Data availability

All research data are available in this text

Publication Dates

• Publication in this collection
  08 Dec 2025
• Date of issue
  2025

History

• Received
  21 Aug 2024
• Reviewed
  11 Dec 2024
• Accepted
  31 Dec 2024