Is digital health closing gaps in health equity in New Zealand?

Health equity refers to the absence of health inequities, differences in health that are unnecessary, avoidable, unfair, and unjust. Decades of research have identified health differences, based on one or more health outcomes, that adversely affect several defined populations, including rural populations, persons with low incomes, racial and ethnic, and sexual and gender minorities.

The COVID-19 pandemic has placed health care systems globally in an unprecedented position. The sudden spread of COVID-19 cases have required urgent actions and extension of services to digital form to maintain health care operations and reduce face-to-face encounters. The variety and the number of digital health services has increased significantly over the past decade already before the pandemic, but it has been argued that the COVID-19 crisis will revolutionize the delivery of health services through digital technology.

Inequity in society is reflected in digital health equity, thus, those at risk of social exclusion (ie, those at a disadvantage due to, for example, unemployment, low education, and a weak economic situation) are also at greater risk of being excluded from digital health services  

The rapid digitalisation of health services has posed a considerable risk of increasing digital inequality, which in turn may cause significant disadvantages such as an increased risk of health deterioration, if the necessary services cannot be obtained remotely, and social isolation, especially for those who already are in a vulnerable position. Concerns have been raised about whether particularly those, who may not have equal access, ability or resources to use digital services have received the health services they need.

Facilitating appropriate use of digital technologies without leaving anyone behind, thus ensuring digital health equity is one of the guiding principles in the WHO global strategy on digital health 2020-2025. 

The realisation of digital health equity is closely linked to realisation of “digital determinants of health” , which, in turn, reflects the socio-economic and socio-cultural context of individuals and the intermediate health factors. 

These determinants are conditions in the digital environment that affect a wide range of health, functioning, and quality of life outcomes and risks, including access to technological tools, digital literacy, and community infrastructure like broadband internet and operates at the individual, interpersonal, community, and societal levels. They impact digital health equity, which is equitable access to digital healthcare, equitable outcomes from and experience with digital healthcare, and equity in the design of digital health solutions.

Mitigating strategies such as increasing physical access, digital skills and social support and improving the digital remote support infrastructures have previously been proposed to reduce digital inequalities and increase the use of technology and digital services.