Are 'Appropriate Health Technologies 3.0' the Cure for Our Sick Healthcare Systems?

Speaker: Dr Piera Morlacchi # SPRU, University of Sussex

11th Jun 2012

15:30 - 17:00

Seminar Rm 1.06, Old Surgeons' Hall, HSY


Our healthcare systems in developed, emerging and developing countries are sick. In this seminar I will reflect on the development of a possible cure, which I call 'Appropriate Health Technologies 3.0', i.e. health technologies that are affordable, accessible, available and acceptable. The key question is 'how can we change our healthcare innovation systems in order to develop appropriate health technologies for everyone?'. The talk is divided into three parts: in the first two parts I will discuss and problematize the development and use of health technologies respectively in developed countries and in emerging and developing countries, based on my research in the field of medical devices; and in the final part I propose some ideas on how our healthcare innovation systems can be improved.

The main disease of healthcare systems in developed countries is the explosion of healthcare costs. The major drivers of these costs are new technologies and the intensive use of existing technologies. Contemporary high-tech medicine and healthcare are replete with 'halfway technologies' that are very expensive and not curative (e.g. dialysis and heart transplantation). The health technologies that we get through our health innovation systems are not the ones we need to produce better health in our society. However, in many countries like the UK and US there is a lack of real debate about the problem of health technology. Currently, we do not have a 'health technology policy' at national level and we tend to confuse it with 'industrial policy for the healthcare sector'. How can we encourage the development of 'better' (i.e. curative and preventive) health technologies that serve the public good and not only the private interest? I will provide some ideas and illustrate them using empirical material from my research on medical devices in the context of developed countries.

In many emerging and developing countries the main problem is the lack of functioning healthcare systems. For many decades we have tried to diffuse our 'high-tech' health technologies to these countries through mechanisms like 'North to South' technology transfer, the activities of large multinational companies and donations from international health organizations like WHO and Unicef. Debates about Big Pharmas, intellectual property and access to medicines, the 90/10 gap, and the 'hand-me down' of medical devices to developing countries have highlighted the limits of these approaches to healthcare innovation. Private-Public Partnerships for neglected diseases, the development of local capacity for research and production of pharmaceutical drugs, and Bottom of the Pyramid approaches are ongoing social experiments that try to overcome some of these limits.

A different approach that I call 'Appropriate Health Technology 2.0' has been proposed as a new way of helping emerging and developing countries to develop and use health technologies. The movement of Appropriate Health Technologies, born in the 1960s /1970s as an alternative way of thinking about the development of health technologies for developing countries, went underground for a couple of decades until re-surfacing in the last 15 years and taking new forms. I will discuss some of the most recent developments of this movement in relation to its origin and evolution, including examples of collaborative approaches based on 'co-creation' between actors in the North and in the South in the field of global health, 'South to South technology transfer' (called also 'health technology development for poor by the poor' and 'frugal innovation' such as the Jaipur Foot and Aravind eye care), and rare examples of 'South to North technology transfer' or 'trickle-up or reverse innovation' that have attracted some attention more recently in developed countries.

Starting from the lessons that can be derived from past and ongoing social experimentations in different parts of the world, in the final part of the seminar I will argue how reframing health technologies as 'Appropriate Health Technologies 3.0' and reflecting on how healthcare innovation systems could be changed in order to generate health technologies that are appropriate for everyone (i.e. affordable, accessible, available and acceptable) have important implications for health technology theory, policy and practice in developed, emerging and developing countries.


Piera Morlacchi is an organizational scholar who studies the origin and co-evolution of technology and organization. She is particularly interested in the development and use of health technologies and new forms of organizing and work in the fields of healthcare and medicine, with a focus on the empirical phenomena of innovation, entrepreneurship and policy in the medical device field in developed, emerging and developing countries. Methodologically, her research is based on mixed methods approach that includes ethnography, archival work and network analysis. Her recent studies have investigated the changes in the process of venturing over the evolution of the US medical device industry (1950 - 2010), how medical practice evolves in the case of therapies based on implantable devices, the genesis and recent dynamics of the Appropriate Health Technologies movement, and the origin and evolution of academic fields like Science, Technology and Innovation (STI) studies.

Piera Morlacchi's publications include 'How Medical Practice Evolves: Learning to Treat Failing Hearts with an Implantable Device' (2011, with R. Nelson) in Research Policy; 'Emerging Challenges for Science, Technology and Innovation Policy Research: A Reflexive Overview' (2009, with B. Martin) in Research Policy; and 'A Non-Profit Pharmaceutical Company. A New Solution Suggesting the Need for a New Equation' (2007) in Innovations: Technology, Governance and Globalization.

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