The World Health Organization classifies ‘digital technologies’ used for health and health services into four distinct categories:

• Interventions for clients.

• Interventions for healthcare providers.

• Interventions for health system or resource management.

• Interventions for data services.

 In Low and Middle income countries, Digital health can positively influence health equity.

In developing countries with human resource poor settings, there is the potential for digital technologies to assist in the monitoring of patients who may otherwise be lost to follow up through gaps in the system. 

As every individual has Right to have healthcare facilities when needed. It is basic Human right. With the help of Digital Health technology it is accessible to those who are residing in difficult Geographical terrain. It is a way to bring Healthcare for every citizen equally. Considering the aspects of Digital health literacy, how to use technology, adoption rate, advanced technology infrastructure, socio economic factors are some variables which make it unequal and created discrimination among the society. And because of the aim of Digital health technology to reach all is getting hindered.

The exponential growth of digital health in public health sector such as exercise tracker, Heart rate monitors and other devices has impacted population health significantly. However, people with limited resources might not be able to take full advantage of digital health technologies. The paper “Back to the Future: Achieving Health Equity through Health Informatics and Digital Health” discusses the best practices with community for engagement in digital innovation.

Following are the recommendations given in the paper for strategic design and implementation of health informatics and digital health interventions in underserved communities:

• to reduce the preference to certain population,  heterogeneous population should be involved and engaged throughout the research and development process of technologies.
•  Established stakeholders and trusted social networks should be engaged to understand the different characteristics of underserved communities
• Understand the social context and determinates of potential end users within underserved communities
• For meaningful intervention and culturally relevant interventions community should be engaged via user-centered design or participatory design
• to support and strengthen community-based health informatics interventions understanding and building capacity of community partner technology infrastructure should be gained 
• For intervention development and sustainability considerable amount of time should be devoted to community engagement processes

//www.ncbi.nlm.nih.gov/pmc/articles/PMC6996775/

We all are living in an era of major technological change, headed by the digital revolution. There is an enormous potential to ease inequities through the use of digital technologies. Today’s technological transition includes advances in computer systems and decision support systems, mobile health, digital platforms, robotics, cloud computing, and artificial intelligence. Digital technologies hold the potential to unlock employment chances, bridge the rural divide, and empower youth and women to access information, and technology. Additionally, digital innovation can make a substantial impact on eradicating poverty and hunger. Another important area where digital technology is helpful is vaccination equity. Improved decision support systems and GIS are powerful tools in recognizing gaps and inequities in access to vaccination and to support better decision making around targeting vaccine resources. It helps combine, visualize, and analyze data on immunization resources, population scattering, and the connecting geographical environment (e.g. transport network, geographic barriers). However, Digital technology can promote social equity only if governments guarantee that virtually one and all have access to digital infrastructure.

Read More : //www.ncbi.nlm.nih.gov/pmc/articles/PMC5327933/
//www.ncbi.nlm.nih.gov/pmc/articles/PMC6237177/

In an era where big data is getting utilized for healthcare purposes and intensified technologies are playing a key role in health care services, it becomes essential that various mechanisms and pathways are understood through which innovative health technologies reduce social inequalities. In the review of published literature done in “Towards an equitable digital public health era: promoting equity through a health literacy perspective” various studies conducted in LMIC (low- and middle-income countries) has the evidence that health equity can be positively influenced by digital health for which it is critical to strengthen the upward and downward accountability.

In the study “Innovative technologies and social inequalities in health: a scoping review of the literature” by Weiss D, et al, 2018 factors like context, cultural attitudes, baseline penetration levels, and infrastructure around digital health technology play a crucial role in mediating health outcomes in regards to health equity.

According to the National Institute of Children’s Health Quality (US), health literacy can definitely bridge the gap between digital health technologies and health inequalities as better health and digital literacy interventions will facilitate addressing and reducing health disparity and also increasing health equity.

So there is an urgent requirement for a robust e-health literacy framework that can provide new insights into the user’s understanding of the digital health technologies which will definitely enhance their accessibility and usability and can be a stepping stone towards promoting equity and establishing an equitable digital health era.

Read more about this interesting topic on “Towards an equitable digital public health era: promoting equity through a health literacy perspective” available at //academic.oup.com/eurpub/article/29/Supplement_3/13/5628050

@shyamlithakur

I agree with you on the fact that e-health has a great potential to improve health outcomes. However, e-health literacy is generally overlooked while developing relevant e-health interventions. These computer-based systems need to coincide with the e-health literacy needs of the service users to be equitably adopted. The socially-disadvantaged populations often have less access and skills to use these technologies which make them digitally marginalised resulting in widened health disparities. Hence, it is important to study the involvement of service users specifically targeting socially-disadvantaged populations prior to the development of relevant e-health interventions. Fabrication of an e-health literacy framework could aid in understanding the e-health literacy components of interventions, ensure equitable access, inclusiveness and circumvent digital divide.

Digital interventions have the potential to transform the healthcare particularly in developing countries. Moreover, technological innovations have helped to bridge the gap in providing solutions to the health delivery challenges during the ongoing COVID-19 pandemic. However, inequities in access, implementation and quality of care can further compound the preexisting disparities. This paper talks about the digital health equity framework wherein digital determinants of health interact with other intermediate health factors, such as psychosocial stressors, preexisting health conditions, health-related beliefs and behaviors, and the environment, along with the person’s current health state and needs.

//www.ncbi.nlm.nih.gov/pmc/articles/PMC7268667/

Despite expectations to the contrary, social inequalities in health appear to be increasing in many of the world’s most developed countries during an era of rapid innovative technological development. As the quantification of health in modern society intensifies and innovative health technologies become the cornerstone of this transition, the connection between technology and health has been gardening increased attention. Recent years have witnessed an era of intensified technology use in health care services as well as developments in personalized medicine and the use of big data for health purposes. These advances have promoted a growing dependency on technology in society and the collection of advanced information, which are then used to influence the decisions and behaviors of not just ordinary citizens but also health personnel, private companies, and large institutions. These innovations are generally seen as positive developments, improving the diagnostics and treatment of disease as well as general public health, however their wider societal implications can be questioned. It appears likely that these technologies could be improving general public health but at the cost of increasing inequalities in health.

It is, nevertheless, becoming increasingly important to investigate the social implications and consequences of a society increasingly influenced by technological innovations, including the ways in which these technologies may influence the unequal distribution of health as a human right.

Read more about this interesting topic at //www.ncbi.nlm.nih.gov/pmc/articles/PMC5882163/

Healthcare systems are facing so many challenges such as lack of access of healthcare services, inequality and many more that are associated with increasing and improving the demand for new technologies. Digital technologies are one of the solutions. The development of data-driven and modernized solutions for every sector of society will help to achieve health equity for all.

Health informatics and digitalization of healthcare will help to create major changes in clinical and research practice. There are many trends of arising technologies in healthcare sector like; Telemedicines, Artificial Intelligence, Block chain with the help of these things we can help to predict the disease in early stage or before outbreak and aware the community also. So we can say that now Healthcare is moving from prevention is better than cure to prediction is better than cure. The use of digital technologies is reshaping our healthcare system and will help to mitigate health disparities and create health equity.

Digital health technologies generally aim to improve the quality and access of health services and it is for sure that digital technologies will continue to grow and create major impact on population health but major concerns are how these technological will helpful for perpetuating health and health care disparities for under resourced populations.

 Office of the National Coordinator for Health Information Technology’s (ONC) rules encourage patient- centered  goals.  Multidimensional approach and design is required to reduce the digital health disparities.

  In the article, Digital health equity as a necessity in the 21^st Century Cures Act Era for promoting health equity in digital health tools , inclusive approach is recommended to create equitable health technology.

 The article suggested following recommendations  for promoting equitable technology in health care 

Broadband access should be increased by federal, state and local programs and collaboration with health care institutions is important to identify patient’s knowledge and access to technology  

Population characteristics and literacy measurements should be incorporated in new digital health initiatives

Design of mobile app and patient portal interfaces should be culturally and linguistically tailored

Federal mandates, such as the Culturally and Linguistically Appropriate Services (CLAS), standards should be included in technology powered care.

read here : //www.researchgate.net/publication/341714811_Digital_Health_Equity_as_a_Necessity_in_the_21st_Century_Cures_Act_Era

Health inequity is the root cause of all the health disparities which exist among different groups within societies or between societies. This inequity arises due to structural, environmental, social or economic disparities and these factors are evolving with time. In order to achieve health equity, it is important to understand the causes and conditions leading to existing disparities so as to come up with effective interventions. Before going into creating digital solutions for addressing the health disparities it is important to leverage the technology to understand the existing research gaps on various factors causing Health inequity and further Health disparities. New digital health interventions should be data driven with data framework based on factors causing health disparities. The existing digital health interventions should also be linked with data sets based on disparity causing factors. Once the contributing factors of health disparity have been studied upon and a research and evidence based customised digital health solution has been created, it is important to understand the affordability, accessibility of the intervention by the target group. On the other hand, the health disparity is not just dependent upon the factors mentioned above which are causing health inequity but in addition, health literacy of an individual is also one of the limiting factor causing health disparity. Effectiveness of any digital health intervention which has been created keeping in view all other disparity causing factors would also depend on the health literacy of the target group. Amalgamation of Community based Participatory research, Citizens Science and Systems Science in the era of technology to design digital interventions can prove to be a promising framework for reducing the health disparities.

Below is an interesting read

  //mhealth.jmir.org/2019/8/e14056/

Digital technologies shape the way in which individuals and health systems interact to promote health and treat illness. Their propensity to exacerbate inequalities is increasingly being highlighted as a concern for public health. Personal, contextual and technological factors all interact and determine uptake and consequent use of digital technologies for health. Digital transformation of health and medical care, both in its practice and its governance has its optimistic promoters and its pessimistic detractors. Irrespective of where public health professionals position themselves on this spectrum, it is of paramount importance to engage in order to safeguard the health of the most vulnerable.

Health equity can be promoted through attention to product development by employing the concept of frugal innovation, which heeds affordability and distinguishes between essential function and additional extras. Products should be invented based on health literacy design, co-creation and user-involvement. Using the universal precaution approach by default all will be benefit, not only people low on the health literacy spectrum.

One of the challenges for healthcare services in the digital health era is to ensure that everyone is covered under Digital health care and no one is excluded. It is observed that people who are less likely to be online are those who experience the greatest burden of ill health and who make the most use of healthcare services. The digital transformation threatens to increase the digital divide. There are various reasons for the existing inequity. Some of them include lack of access to technology and lack of knowledge to use the technology. Digital inclusion can be attained by identifying the population who are health deprived and have low digital adoption, educate them about technology in their own spaces. 

Digital inclusion will help us reduce the disparities, resulting in significant benefits and cost savings to the health care systems.

Even though innovative health technologies reduce social inequalities in health among varied populations, new forms of inequality have appeared. Digital inequality is one of the most noticeable of these new forms. Digital inequalities continue to combine with race, class, gender, and other forms of inequality. Even in countries with high levels of smartphone adoption, basic access to digital resources and the skills to use them effectively avoid many economically disadvantaged segments of the population. Digital inequity can also arise from differences in digital literacy. Digital Literacy is the level to which individuals have the capacity, knowledge, motivation, and competence to access and understand the information needed to attain benefits from the use of digital technologies. Research on digital inequality is in its rudimentary phase and more research is needed to study the factors that increase the effectiveness of digital interventions aimed at reducing the digital divide. (Read More: //www.lauracrobinson.com/Article_Digital_Inequalities_and_Why_They_Matter.pdf)

For instance: The dawn of COVID-19 has thrown a light on the digital divide. The internet became a crucial source for governments to transfer knowledge and awareness to the population at large. Low-income households, low literacy, education, economic and social resources, no internet access, and internet skills, suffered from the consequences of the COVID-19 crisis more severely. Read More: The paper proposed mitigation strategies aimed at reducing the effects of digital inequalities and the COVID- 19 crisis ( //europepmc.org/backend/ptpmcrender.fcgi?accid=PMC7213963&blobtype=pdf)