The covid-19 pandemic has reshaped our lives in numerous ways and one of these is digital health. We have witnessed the revolutionizing of telemedicine, digital therapeutics, and digital innovations in medicine. Despite the digitalization & innovation in medicine and healthcare, health inequity has increased majorly. There are 3 prime factors that are important to be addressed to attain health equity. The first is related to improving access to healthcare, the second one is related to addressing the unmet needs of the population and the third one is digital health & literacy. There are various other factors also that limit health equity in digital health.
Improving Access to healthcare is one of the key components when we talk about health equity. WHO defines digital health as “Digital health is the field of knowledge and practice associated with the development and use of digital technologies to improve health.” The digital health ecosystem is inclusive of components related to “artificial intelligence, big data, blockchain, health data, health information systems, the infodemic, the Internet of Things, interoperability and telemedicine.” Access to digital healthcare includes a focus on improving access to all these components. Primarily, the transparency & regulations in using patient’s/disease data and information, access & ease to feed these data and storage of this information from both patient’s & healthcare providers’ perspectives. The operations and integration of healthcare digitally right from the symptoms to diagnosis, treatment, prognosis & follow-up aspects in a patient’s journey including the test reports & radiographic tests information storage and sharing digitally between patients & healthcare providers. While focusing on making digital health tools equitable & accessible, it is important that at the time of tool design and defining the scope, the patient’s journey, the healthcare provider expertise /medical expertise is considered along with IT expertise. Therefore, improving access to healthcare is an important aspect to be focused on for achieving health equity in digital health.
The unmet Needs of the Population are the prime aspect of the health system in general. Hence, it is important to focus on this aspect when we speak about digital health. Imagine a digital health tool focusing on a rare disease but unaware of the patient’s journey in terms of identifying the pain points in that journey. It will never meet the needs of that rare disease population in this instance. Unmet needs do not include just knowing the needs of the population but also are inclusive of understanding the feasibility of digital health tools and their acceptance of it by the population. Even if the patient overcomes the barriers in accessibility (geographical /financial barriers) still the patient might face a mismatch between the healthcare provider’s information and the disease representation based on signs and symptoms. It is also important to understand the lack of provider/clinician information & knowledge of the patients in digital health. It is important a patient is comfortable and knowledgeable/informative about the healthcare provider/clinician they are connecting & trusting with for their treatment.
Digital health & literacy is one of the major factors in improving health equity. We need to understand the social determinants of digital health. This includes gender factors, socio-economic factors like income, general education & literacy factors, and cultural factors. If a community’s socioeconomic factor is low, the affordability, accessibility & literacy for utilization of smartphones or computers becomes minimal which creates a barrier to accessing digital health services. Similarly, ethnicity factors to attain health equity in digital health. These aspects should be prioritized at the micro, mezzo and macro level in policy-making and intervention plans. Even with the global south & global north, within the countries also there might be sharp differences in utilization of digital health based on their literacy & knowledge of digital health. In addition, a community/population’s historical context also plays a crucial role in seeking care via digital health services. Therefore, there is a need to focus on social determinants as well as digital determinants of health in achieving health equity in digital health.
To summarize, innovations and revolutionization of digital health globally can be successful and impactful when we focus on the attainment of equitable digital health which can only happen if we focus and try to understand & overcome the challenges related to improving access to healthcare, unmet needs of the population and digital health & literacy. A comprehensive effort & interdisciplinary strategy is required in order to improve health equity in digital health. World health organization has drafted a framework to achieve digital health equity which is based on “four major components: commit, catalyse, measure, and enhance and iterate.” As the benchmark of the WHO framework and modifying it based on the regional, geographical, and global context, we can together attain health equity in digital health.
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Dr Darshita Singh is a researcher at LSE health in the London School of Economics and Political Sciences, London. She has worked extensively in public health, digital health and equitable healthcare services in India, the USA, the UK and Canada in the past. She was also one of the speakers at the World Federation of Public Health Associations (WFPHA) to speak on digital health - opportunities & challenges.