Digital Equity in healthcare
As technology improves and expands in almost every aspect of our lives, healthcare is an increasingly important field. Major health systems across the globe have rolled out digital health initiatives in recent years, ranging from virtual doctor’s visits and customized patient portals to centralized record-keeping databases and wearable monitors.
Now more than ever, those with access to these digital tools can actively participate in their own healthcare. Those who cannot participate face significant disadvantages in obtaining high-quality healthcare under any conditions.
These disadvantages go beyond physical health and filter into other areas of life. Those in poor health may find it more difficult to hold down a job. Their insurance costs also inflate as minor ailments turn into major health concerns. It is vital that healthcare be accessible to everyone to prevent these escalatory effects.
Underserved populations without access to modern digital healthcare tools are at a disadvantage when it comes to medical care. People in lower socioeconomic brackets are often more severely impacted by health issues and have less of a safety-net than wealthier individuals. Digital equity in healthcare can make a tangible difference in health outcomes, and should be an urgent concern for society to address.
What Digital Health Equity Looks Like
Digital health equity is a facet of the digital divide. Digital equity relates to whether or not people have the resources and ability to participate in a digital world. Unfortunately, digital health equity does not exist globally at this point in time.
Large segments of the global population do not have access to digital health practices and tools, which include
- mobile health apps,
- electronic health and medical records,
- wearable devices, and
- telehealth and telemedicine.
In the United States, the American Hospital Association states that 76 percent of hospitals offer some form of telehealth services. Yet Federal Communications Commission data show that 6 percent of the population does not have access to basic broadband internet service, with the least access in rural and tribal areas, precisely the areas which would benefit the most from telehealth. Even where broadband services exist, approximately one hundred million Americans do not subscribe to them.
Globally, half of the population do not have reliable internet access, according to the United Nations. Health equity is least prevalent in regions like sub-Saharan Africa, which averages two doctors for every ten thousand patients. Offering telehealth services would be a huge advantage for these regions—if the infrastructure was in place to support it.
Health Equity and Why It Matters
Until recently, people may not have needed to use digital health tools to access basic care. The COVID-19 pandemic, however, ripped off the proverbial bandage. It spotlighted the importance of digital health services in the modern healthcare industry.
Patients who feared COVID exposure and did not want to attend a doctor’s office in person, or who were otherwise unable to visit a doctor, could instead participate in whatever digital health options were available to them. Those without access to computers or high-speed broadband internet access were at a distinct disadvantage in obtaining care.
Groups lacking access to digital healthcare typically include:
- those living in rural areas,
- those in low- to middle-income economies,
- women and girls,
- older adults,
- people with disabilities,
- less educated populations,
- communities of color, and
- other marginalized groups.
Health equity helps produce positive life outcomes; the lack of it produces poor outcomes. Those without access to telehealth must make travel arrangements to get to a doctor, increasing costs and potentially exposing themselves to COVID and other challenges. This affects the prognosis of patients and their ability to get adequate treatment for injuries and illnesses.
How to Advance Health Equity
To advance health equity, higher levels of government must create national policies. High-speed internet must be part of national infrastructures. Politicians must prioritize digital health solutions and universal healthcare for underserved populations. Governments must also establish policy guardrails to regulate online healthcare and ensure safe practices.
To implement digital health equity practices, regional and local policy are also critical. In regions with low rates of digital literacy, providing education on using available tools is key. Local governments and agencies should put programs in place to help educate communities. Ideally, everyone will have equal access to a variety of methods to access healthcare.
Importance of Digital Equity in healthcare
Under the extreme pressure of the COVID-19 pandemic, health systems around the globe struggled to cope. The United States was poorly prepared to handle the number of critical cases, particularly in rural areas. Many other nations continue to lag behind on implementation of telehealth laws, as shown by a paper published in Healthcare Informatics Research. According to a report by the World Economic Forum, digital healthcare must play a central role in improving the world’s struggling healthcare systems.
Why Equity Is Important in healthcare and What Happens If It’s Neglected
As digital inclusion is addressed, better care and more varied healthcare options will become available to underserved populations. Life expectancies will rise, quality of life will improve, and the ability to compare prices of care will enable patients to make more informed financial choices.
If digital equity is neglected in healthcare, people without access to broadband and digital technology will fail to achieve health equity. The digital and economic divides will continue to grow.
For example, heart disease is the leading cause of death in most minority populations, causing about 23 percent of all deaths, according to the Centers for Disease Control and Prevention. Yet the biggest risk factors for heart disease are preventable and can be minimized if at-risk patients have access to the right care options. Increasing the life spans of these populations would enable them to participate more fully in work, growing the economy and improving their personal economic circumstances.
The Impacts of Digital Health Equity
Economic implications aside, striving for digital health equity will provide additional support for the many people who currently struggle to find adequate care. For example, telehealth is showing great potential in addressing mental health concerns. In addition to having greater access and choice of provider, patients may also be more comfortable meeting with a mental health provider online. Overcoming 5G deployment challenges is a key step in ensuring that all populations can be served. There are also a growing number of programs like the National Digital Inclusion Alliance’s Digital navigators, which provides help to those who struggle with technology.
For older adults and those living alone, access to assistive and monitoring technology at home will allow them to be more independent as they age. This carries significant health benefits. Nearly ten years ago, Carnegie Mellon University performed a study using cameras and machine learning to detect daily patterns of adults in nursing homes. If their routines changed, the devices alerted somebody to check on them. Further advances in in-home assistive devices will have a significant effect on the health and well-being of older adults.
Understanding the Barriers to Accessing Digital Equity in healthcare
Lower incomes are a major factor in accessing digital healthcare. If a family can’t afford a computer or monthly internet service fees, they won’t be able to access a hospital’s patient portal or telehealth options. Older adults also tend to struggle with newer technology and may not take full advantage of telemedicine options.
How to Optimize Telehealth Services to Address Health Disparities
Health providers can help address health disparities by offering lower-tech solutions to help bridge the gap. This may involve phone calls or text messages in lieu of video calls for patients without computers or tablets. Language barriers also exist between telehealth providers and non-native English speakers. Therefore, health systems must also offer translation services.
Some grant programs exist to aid patients in accessing telehealth tools. For instance, the MetroHealth System in Cleveland, Ohio, received a nearly $1 million grant to provide subsidized broadband access to low-income patients. And in Canada, the Connecting Families initiative is investing $13.2 million over five years to provide affordable internet access to low-income families and seniors.
The Biggest Barriers to Accessing Digital Equity in healthcare
Globally, women have less access to digital technology than men. According to the US Agency for International Development, in some developing countries, women are 25 percent less likely than men to be online. This may cost them vital knowledge about their health. This gender-based digital divide is a huge barrier to overcome, as is improving women’s digital skills.
Patients and providers may also have concerns with patient safety and security when care is provided online. Regulations and laws need to be enacted to mitigate risks. Training and education on how to use digital systems must also be provided.
5G deployment remains a barrier in many areas. Debates continue over whether the public or private sector should lead on installing fixed broadband access in homes and businesses. This will be an ongoing challenge.
How to Overcome Barriers to Digital Health Equity
New developments and applications in 5G technologies should prove beneficial for e-health services. Lower lag times and better connectivity during telehealth visits may reduce the concerns some patients have about engaging in healthcare online versus in person. Providers will also be able to speak with their patients no matter where they are in the world.
Ingrained beliefs that a physician cannot be as effective when they are not treating patients face to face have presented a barrier to telehealth in the past. However, most issues people go to the doctor for are relatively minor and can be diagnosed easily on a video call. Therefore, enabling telehealth as broadly as possible should be a national and global goal.
Health Systems Advancing Digital Equity
A number of health systems are experimenting with initiatives to advance digital equity. One example is UVA Health in Virginia, which is partnering with social service providers to link at-risk populations, including incarcerated individuals, with telehealth services. UVA Health also started a program to send COVID patients home with iPads, helping patients monitor their own symptoms and digitally send information back to their physicians.
The World Health Organization has also established advisory groups on digital health matters and standards for global oversight of digital health and telehealth services.
How Digital Equity Can Be Improved
It goes without saying that underserved communities must be the central points for improving health equity and digital equity overall. As health technology evolves and improves, education on how to use the tools will be vital, particularly for the most disadvantaged groups.
Health providers can also take the lessons learned during the COVID-19 pandemic to continue building trusting relationships with patients, whether in person or online. Doctors Allison Crawford and Eva Serhal have proposed a Digital Health Equity Framework to aid in reaching equity.
Reasonable Timelines for Advancing Digital Equity
The COVID-19 pandemic has demonstrated that the world is further behind on achieving digital equity than hoped. According to Duke Global Health Institute, studies show that most people will experience an extreme pandemic in their lifetime—and that risk is rapidly growing. The situation is urgent, and health equity must be addressed before the next global health crisis erupts.
The 5G initiative to build global 5G infrastructure is advancing more quickly in some countries than others. However, it may take thirty years to have all the infrastructure in place needed to advance digital equity.
Governments may be slow to act, but partnerships with the private sector show promise in addressing digital equity gaps. For example, New Zealand’s government partnered with its largest telecommunications companies during the pandemic’s peak to provide access to major health websites and health service portals free of charge.
Achieving Digital Equity in healthcare
Digital equity in healthcare continues to be a top priority for IEEE. As a human rights issue, access to modern digital healthcare tools is vitally important for underserved populations. Changing the current landscape will reduce social and economic disparities and result in greater quality of life.
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