The Co-Constitution of Health Systems and Innovation; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review”

Document Type : Commentary


Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, The Netherlands


Lehoux et al provide a timely and relevant turn on the broad and ongoing discussion around the introduction of health technology and innovation. More specifically, the authors suggest a demand-driven approach to health innovation that starts from identifying challenges and demands at the health system level. In this commentary, I review a number of underlying implications of their study in relation to positions of technology push and techno-optimism, and to the narrow focus on health technology assessment on economic and clinical values. While Lehoux et al’s scoping review provides very relevant insights with the potential to drive further empirical research, it is less clear about its conceptual basis. In particular, the somewhat artificial distinction between health innovations and health systems is worth further scrutiny. I discuss some potential risks of this separation, and propose to more openly address the co-constitution of health, health systems and technology in future research along the lines suggested by Lehoux et al.


Main Subjects

  1. Lehoux P, Roncarolo F, Silva HP, Boivin A, Denis JL, Hebert R. What health system challenges should responsible innovation in health address? Insights from an international scoping review. Int J Health Policy Manag. 2018;8(2):63-75. doi:10.15171/ijhpm.2018.110
  2. Faulkner A. Medical technology into healthcare and society: A sociology of devices, innovation and governance. Basingstoke: Palgrave Macmillan; 2009.
  3. Neven L, Peine A. From triple win to triple sin: How a problematic future discourse is shaping the way people age with technology. Societies. 2017;7(3):26. doi:10.3390/soc7030026
  4. Peine A, Faulkner A, Jaeger B, Moors E. Science, technology and the 'grand challenge' of aging: Understanding the socio-material constitution of later life. Technol Forecast Soc Change. 2015;93(9):1-9. doi:10.1016/j.techfore.2014.11.010
  5. Urban M. 'This really takes it out of you!' The senses and emotions in digital health practices of the elderly. Digit Health. 2017;3:2055207617701778. doi:10.1177/2055207617701778
  6. Peine A, Neven L. From Intervention to Co-constitution: New Directions in Theorizing about Aging and Technology. Gerontologist. 2019;59(1):15-21. doi:10.1093/geront/gny050
  7. Felt U, Fouche R, Miller CA, Smith-Doerr L. The Handbook of Science and Technology Studies. Cambridge: The MIT Press; 2017.
  8. Lehoux P. The problem of health technology: policy implications for modern health care systems. New York: Routledge; 2006.
  9. Collingridge D. The social control of technology. London: Frances Pinter; 1982
  10. Hughes TP. The seamless web: technology, science, etcetera, etcetera. Soc Stud Sci. 1986;16(2):281-292.
  11. Rip A, Schot J. Identifying loci for influencing the dynamics of technological development. In: Sorensen KH, Wiliams R, eds. Shaping technology, guiding policy: concepts, spaces, and tools. Cheltenham: Edward Elgar; 2002.
  12. Kiran AH, Oudshoorn N, Verbeek PP. Beyond checklists: toward an ethical-constructive technology assessment. J Responsible Innov. 2015;2(1):5-19. doi:10.1080/23299460.2014.992769
  13. Kudina O, Verbeek P-P. Ethics from within: Google Glass, the Collingridge dilemma, and the mediated value of privacy. Sci Technol Human Values. 2019;44(2):291-314. doi:10.1177/0162243918793711
  14. Lopez Gomez D. Little arrangements that matter. Rethinking autonomy-enabling innovations for later life. Technol Forecast Soc Change. 2015;93:91-101. doi:10.1016/j.techfore.2014.02.015
  15. Milligan C, Roberts C, Mort M. Telecare and older people: who cares where? Soc Sci Med. 2011;72(3):347-354. doi:10.1016/j.socscimed.2010.08.014
  16. Schulz R, Wahl HW, Matthews JT, De Vito Dabbs A, Beach SR, Czaja SJ. Advancing the aging and technology agenda in gerontology. Gerontologist. 2015;55(5):724-734. doi:10.1093/geront/gnu071
  17. Peine A, Moors EHM. Valuing health technology–habilitating and prosthetic strategies in personal health systems. Technol Forecast Soc Change. 2015;93:68-81. doi:10.1016/j.techfore.2014.08.019
  18. Bailey C, Foran TG, Ni Scanaill C, Dromey BEN. Older adults, falls and technologies for independent living: a life space approach. Ageing Soc. 2011;31(5):829-848. doi:10.1017/S0144686X10001170
  19. Berridge C. Breathing room in monitored space: the impact of passive monitoring technology on privacy in independent living. Gerontologist. 2016;56(5):807-816. doi:10.1093/geront/gnv034
  20. Loe M. Comfort and medical ambivalence in old age. Technol Forecast Soc Change. 2015;93:141-146. doi:10.1016/j.techfore.2014.04.013
Volume 8, Issue 11
November 2019
Pages 665-667
  • Receive Date: 18 March 2019
  • Revise Date: 16 July 2019
  • Accept Date: 21 July 2019
  • First Publish Date: 01 November 2019