Getting Digital Health Equity Right

Digital health has the potential to make healthcare more equitable for everyone, however, rapidly advancing technologies may also exacerbate exclusion, introduce unexpected biases and widen the digital divide, leaving those most in need behind. The push towards digital health equity has become more apparent in recent years and has been included in the World Health Organizations (WHO) Global Strategy 2020-2025. Following the COVID-19 pandemic, there has been an accelerated pace of digital innovation, and adoption, including the widespread use of virtual care, and development of digital health tools and apps.

In this blog, we explore some of the current sources of inequalities in digital health and how these could be improved to narrow the gap of digital health inequalities. 

Quality and Diversity of Data

Improving the quality and diversity of data is a key factor for improving health equity. A lack of diversity in research has been a longstanding issue, exacerbating health disparities and restricting research discoveries. Digital health technologies have the capacity to reduce this disparity, using technology to recruit more diverse populations for research studies. 

Artificial Intelligence (AI) technologies are being adopted rapidly across a range of industries using algorithms to automatically analyze data, however, as these technologies evolve so quickly, examples of bias within algorithms are emerging.  In a high profile example of this, researchers found an AI-based U.S. hospital programme, less likely to refer those who identified as black into programmes for improving patient care compared to their equally sick white counterparts. Similar bias in algorithms  has been seen in facial-analysis software, previously found to have up to 34% more error rates in women of color compared to 0.8% in light skinned men. However, findings like this are rare, as they require access to entire algorithms which is unlikely.

How to resolve bias within algorithms is another issue entirely, resolving one bias may create another, and anecdotal evidence has found that some bias algorithms are still less biased than people.  Likely the resolution will come from improving data quality as data sets often misrepresent people of color, women and participants in lower socioeconomic groups. This can be improved by diversifying the populations included in the research studies, diverse product teams, and improved design processes. 

Digital Health Literacy 

Digital literacy refers to the skills and experience necessary for digital access, including understanding the hardware and software to navigate the technology.  The National Center for Education Statistics, found that 16% of US adults are not digitally literate. Adults that weren’t digitally literate were more likely, older, less educated, black or hispanic, or born outside of the U.S. Language is also an important factor in digital literacy. A patient may know how to use the technology and understand the information, but if the information is not in a preferred language, it’s not practical. 

Easy use of digital health technologies is a key factor in digital access. Simple navigation steps, application download, account creation and a simple to use platform, as well as including features such as chatbots, will ease use for those less familiar with technology. 

Making language easy to understand, for example, Teladoc keeps their communications below a 4th grade reading level, will allow understanding at a population level.

Diversifying health technologies further to include multiple languages is also an important consideration. Galileo recently launched a telehealth service providing virtual care in both English and Spanish. They have joined a number of digital health companies offering services in multiple languages, such as Pear Therapeutics, Blue Note Therapeutics and Everly Health. These companies are taking a step in the right direction, however, most seem to be focused on English/Spanish translation, the need for expansion to a wider range of language options is apparent and could be the next step in improving language inclusivity. 

Access for Underserved Communities

Improving access to digital health for underserved communities is vital to improving digital health equity.  Defined previously, these communities include, racial and ethnic minorities, socioeconomically disadvantaged populations, undersevered rural populations, sexual and gender minorities and those with diabilities. 

For example, virtual care has significant potential for serving the needs of rural communities, it can increase access to care, as well as improving access to specialists, however, basic issues such as, access affordability and quality of wireless broadband can create barriers to its use. People of lower income are less likely to have access to smartphones, and be on more expensive data plans, increasing the costs of internet access. Designing digital health solutions that work offline, or on low bandwidth, can mitigate some of these issues. 

Having an inclusive product design team will bring more perspective to app and digital health design. This not only increases inclusivity, but is also good for business, as demonstrated by Shine app. Shine, an inclusive mental health and wellness app, was created by a black woman and a half-Japanese woman and was specifically created to address the unique stressors of women of color. Shine has been accessed by over 6M users and was recently acquired by Headspace to improve their Diversity Equality Inclusion and Belonging  efforts. 

The unique needs of people with disabilities need to be considered in any attempt for inclusivity in digital health. Digital health apps and services such as telehealth will often address chronic conditions, hence taking into consideration physical limitations as well as health issues that could impair usage should be anticipated. 

How to make already existing digital health solutions more equitable needs to be considered, but there is also a large market for solutions that target specific groups and their needs to fulfill the gap in this space. 

Improving digital health equity is a complex issue, involving multiple stakeholders. Creating a more inclusive environment, improving diversity in research and product design are some of the ways in which digital health companies can help to tackle this issue.