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More often than not, ground-breaking health care advancements are disproportionately accessible for those who already have favorable social determinants of health.
Improving cost, access, and quality, but for whom?
The boom of telehealth and digital health during the pandemic was a necessary shift to bridge the critical access gap while also supporting the public health measures implemented to slow the spread of COVID-19 – but did this change unintentionally widen the health equity gap?
During my research, I was surprised to learn about a health equity concept I had never heard of, digital determinants of health (DDOH), born from the traditional social determinants of health (SDOH) model. These include “access to digital resources, use of digital resources for health seeking or health avoidance, digital health literacy, beliefs about potential for digital health to be helpful or harmful, values and cultural norms/preferences for use of digital resources, and integration of digital resources into community and health infrastructure.” Similar to traditional SDOH, DDOH are believed to interact with other intermediate health factors, such as biology and pre-existing conditions. The DDOH are generally formed in the context of an individual’s relationship with, and fundamental understanding of the crossroads between technology and health, an extension of the foundational conditions established in the SDOH.
The pandemic and subsequent acceleration of telehealth usage widened the already inequitable “digital divide.” Patient-facing tools have been proven to further drive disparities in cost and access with lower adoption of patient portals in “older adults, racial or ethnic minorities, and those with low socioeconomic status, low educational attainment, limited health literacy, and chronic illness” when compared with advantaged populations. Research also suggests digital health tools that are patient-facing might even exacerbate health disparities. Despite this fact, there is little evidence that health systems and technology organizations have “incorporated approaches to address health disparities in the development, implementation, and use of patient portals.” Considering vulnerable populations are disproportionately less likely to benefit from digital health efforts, and are already disadvantaged in terms of cost, access, and quality of care, the benefits associated with health technologies are not reaching the very populations who could benefit from them the most.