To what extent do current Biodesign and biomedical engineering needs identification processes adequately account for the social determinants and underserved communities to improve public health?

Introduction: In both the U.S and globally, burgeoning health inequities and disparities are a major concern [1]. There is a growing recognition that the biomedical engineering field must play a stronger role in reducing these health disparities collectively [2,3]. One avenue of change through biomedical engineering education involves reevaluating traditional needs identification processes. These processes are a foundation of engineering design in identifying and addressing unmet healthcare needs but may have operated independently of public health considerations. Underrepresentation of certain populations during needs identification could cause disparities present in design and premarket testing, leading to worse health outcomes [4]. Given the complex intersections between health technology and the social determinants of health (SDOH), limited needs identification frameworks may not support developing comprehensive biomedical engineering solutions.

Given the multifaceted nature of unmet health needs and rapidly growing health inequity, there is an urgent opportunity to expand and refine needs identification training in biomedical engineering education. Specifically, integrating SDOH into these processes could empower more holistic solutions for unmet health needs. The purpose of this systematic literature review is to examine the extent to which current Biodesign and biomedical engineering needs identification processes consider social determinants and underserved communities to reduce health disparities.

Materials and

Methods: To explore the intersection of public health and biomedical health needs identification, we are in the process of conducting a Systematic Literature Review (SLR). This evidence-based approach is widely used to inform education, research, and policy by summarizing the existing literature. Utilizing conventional SLR processes, keywords are recognized and used to filter and identify literature that is relevant to the topic. These keywords include “human-centered engineering”, “healthcare needs engineering”, “biodesign needs identification”, “social determinant engineering”, “health systems engineering”, and “public health engineering” to analyze publications from the past two decades. Specific literature is highlighted, including the Biodesign process as well as common public health needs assessments, such as Community Health Improvement Plans (CHIP) and Community Health Assessments (CHA). Moreover, conclusions from existing literature are drawn to understand the scope of current work and future work to be explored within this intersection.

Results, Conclusions, and Discussions: This systematic literature review synthesizes existing literature to evaluate the integration of social determinants and underserved communities in Biodesign and biomedical engineering practices aimed at improving public health. Preliminary results indicate that existing intersections of public health and biomedical engineering focus on addressing inequities during the innovation and implementation stages of design rather than problem and needs identification. Furthermore, there is a lack of addressing underrepresented and underserved populations in early biomedical design thinking.

The preliminary results speak to a need to remodel the health needs identification process in biodesign and biomedical engineering education. Public health approaches play a pivotal role in fostering health and empowering individuals. Both biomedical engineering and public health employ distinct approaches to identifying health needs and designing interventions. Despite their shared objective, our SLR analysis shows these disciplines often operate in isolation. Consequently, biomedical technologies may lack adequate representation of certain populations, leading to unfavorable outcomes in real-world applications [4]. This indicates a pressing need to address and include SDOH during needs identification to properly bridge the gap between health inequities.

Biomedical technologies currently have a data gap when it comes to the social influences that consequently affect device design, utility, usage, and accessibility. Biomedical engineering education plays a vital role in ensuring the future biomedical engineering workforce is positioned to contribute to holistic solutions that improve health equity, particularly for vulnerable populations. Future work includes the expansion of needs identification frameworks to introduce SDOH and public health expertise in biomedical engineering education through stakeholder and community engagement. Furthermore, there is an opportunity to collaboratively develop new design frameworks for biomedical engineering education that adequately capture these intersections and mitigate health disparities.

Acknowledgements (Optional): [1] A. Baciu, Y. Negussie, A. Geller, and J. N. Weinstein, “The state of health disparities in the United States,” Communities in Action - NCBI Bookshelf, Jan. 11, 2017. https://www.ncbi.nlm.nih.gov/books/NBK425844/

[2] M. Vazquez, O. Marte, J. Barba, and K. Hubbard, “An Approach to Integrating Health Disparities within Undergraduate Biomedical Engineering Education,” Annals of Biomedical Engineering, vol. 45, no. 11, pp. 2703–2715, Aug. 2017, doi: 10.1007/s10439-017-1903-8.

[3] R. Benabentos, P. Ray, and D. Kumar, “Addressing Health Disparities in the Undergraduate Curriculum: An approach to develop a knowledgeable biomedical workforce,” CBE Life Sciences Education, vol. 13, no. 4, pp. 636–640, Dec. 2014, doi: 10.1187/cbe.14-06-0101.

[4] K. T. Kadakia, V. K. Rathi, R. Ramachandran, J. L. Johnston, J. S. Ross, and S. S. Dhruva, “Challenges and solutions to advancing health equity with medical devices,” Nature Biotechnology, vol. 41, no. 5, pp. 607–609, Apr. 2023, doi: 10.1038/s41587-023-01746-3