Dr Sabine van der Veer, Senior Lecturer in Health Informatics at the University of Manchester, discusses how the adoption of digital tools in healthcare can impact health inequalities
For many years, healthcare has been progressively embracing digital transformation. What began as a general adoption of electronic medical records has developed into a multiscale discipline known as digital health. This includes everything from personalised digital care programmes to innovative technologies aimed at expanding access to healthcare and delivering better health outcomes.
However, research suggests that there are fundamental inequalities in digital health design and implementation.
Digital health inequality exists and causes harm to many. We’ve learned to examine digital health equality across individual, communal, and societal levels, with each layer presenting unique challenges that complicate access to digital healthcare and impede patients from benefiting equally. This necessitates a better understanding of what these challenges are for different groups, coupled with more targeted solutions to ensure equality, inclusivity, and effectiveness.
Yes, digital health equity is a vitally important topic, but it is also a complex one. This article will touch on a number of the complexities to show how much work—and policy changes—are still required for necessary improvements to take effect.
The current barriers to digital health access and benefits in the NHS
As digital health solutions become more widespread, we’re uncovering a range of barriers that prevent equal access and outcomes. These obstacles are diverse and complex, highlighting the need for nuanced approaches to overcome them.
Some are rooted in cultural differences, with various communities holding unique beliefs about health and treatment. The problem is that this diversity in perspectives isn’t always reflected in digital health design.
Age presents another significant hurdle. Older generations, who typically require more healthcare support, often lack the technological familiarity or access to technology itself. This digital divide can leave them excluded from vital services.
Then, there are healthcare professionals’ perceptions. Doctors may make assumptions about a patient’s ability or willingness to use digital tools based on factors such as age, gender, or ethnicity. While intended to personalise care, these judgments can inadvertently limit access to potentially beneficial resources, including patient portals.
At a societal level, digital health inequality may also arise from how we use health data. Algorithms based on data in which some groups are underrepresented won’t work for everyone. For example, if developers build AI algorithms to predict skin cancer based on a photo of a mole, mainly using photos of people with lighter skin, it may not be accurate for people with darker skin colours.
We must address such inequalities now, as if left unchecked, they’re likely to worsen over time.
How the pandemic affected digital health
In many ways, digital health uptake has increased in recent years – especially during the pandemic. During the lockdowns and their aftermath, we saw that healthcare systems rapidly shifted to delivering their services digitally.
However, such a swift transition had a downside: it highlighted existing inequalities. We saw clearly how a digital-only system excluded those lacking devices, internet access, digital skills, or trust in online services.
This led to recommendations for a mixed-model approach, complementing digital healthcare with in- person alternatives. While this is positive in theory, the reality has been more complex, with healthcare providers struggling to offer both formats to the same standards. Similar to the banking industry, where an ever-decreasing number of physical branches led to greater travel distances and more difficulty getting face-to-face appointments, mixed-model healthcare may ultimately not deliver the expected patient experience and benefits.
So, although maintaining accessible in-person healthcare services alongside digital options seems important, it requires significant investment and careful consideration before it can pave the way for a more equal and effective model of healthcare delivery.
How digital exclusion is compounding inequalities – and what we can do to fix it
The reality is that, as things stand, digital health inequality disproportionately affects groups experiencing inequalities in other areas of society.
Innovations in digital health often benefit people who are already well off instead of reaching those most in need. Addressing this is crucial to ensure equitable access to healthcare advancements. For instance, trending health gadgets, such as WHOOP bands or Zoe blood glucose trackers, require significant upfront costs, up-to-date devices with internet access, and the capacity to change one’s health behaviour based on the tracking results. Many of these things are simply out of reach for many, highlighting the pressing need for more inclusive health technology solutions.
The result is that existing inequalities are only exacerbated, making digital healthcare increasingly inaccessible to already underserved groups.
An example of a policy that would help address digital inequalities in health and in society more broadly is the introduction of minimal digital living standards. These outline how many smartphones each household needs and ensure everyone in the household is confident using a device. Local councils could use them to guide decisions on area-specific measures to support digital equality for their citizens.
By guaranteeing equal access to technology and the skills to use it, we can create a more level playing field in digital health access, potentially leading to improved health outcomes.
Making digital health a force for good
Ultimately, digital health offers a unique opportunity to bridge gaps in healthcare access and outcomes. By developing inclusive, user-focused solutions, we can work towards a future where digital technology becomes a powerful force for achieving health equality and improving healthcare for all members of society.
However, digital solutions are just one component of comprehensive healthcare. The priority should be providing accessible, culturally appropriate services where patients feel safe and understood. By adhering to these core principles, we can harness digital health technology to reduce inequality rather than exacerbate it.
