Digital access: a cause and solution to health inequality
Globally, more people own a mobile phone than they do a toothbrush. But currently, lack of access to technology is deepening inequalities across the country.
The benefits of enhancing our digital health offerings can be limitless for both the patient and the providers. But unless appropriate focus is given to improving digital access to all, an increasingly digital NHS will only monopolise its services to the detriment of those who need it most.
Covid-19 has shone a light on the UK’s ‘digital divide’ (referring to the division between those who have access to technology and those who don’t). The pandemic has accelerated the digital infrastructure of the world (McKinsey predicts that digital transformation has advanced seven years because of Covid-19) – yet those without access have been left behind.1
As children have collectively missed nearly a year of school, remote learning has become the default as the UK has experienced three national lockdowns. But while educational disparities as a result of digital access is widely known, the digital divide plays a huge role in increasing health inequality across the UK.
In 2019, the Office for National Statistics (ONS) found that 54 percent of those with digital access use the internet for researching health-related matters and a further 13 percent fully engage with healthcare practitioners online,2 nine percent of adults own a fitness tracker. 3 With a rapidly increasing number of users interacting with public services and authorities online as a primary means of communication, the digitally excluded are more likely to also be socially and economically excluded – and more likely to find themselves in poorer health.
The NHS states that digital health is beneficial for both the patient and the healthcare provider. For the patient; improved self-care for minor ailments, improved self-management for long-term conditions, time and cost saved through digital access and reduced isolation leads to better health outcomes. For the healthcare system, the benefits include lower cost by digital delivery, more appropriate use of services and better patient compliance to treatment.4
The health tech industry continues to boom (according to McKinsey, as of 2019 digital health represented a global market of approximately $350 billion). However, the unintended consequence of health tech developments is widening
developments is the widening of health inequality. Any development that cannot be available to all inevitably fuels the health gap. Currently, there is no national dataset tracking the correlation between exclusion from digital healthcare and health outcomes but the relationship between digital exclusion and poverty, education and unemployment offers a probable estimation.
That the NHS has recognised digital access as a determinant of health alongside factors such as housing, education and employment is a welcome development. Older people, those of lower socioeconomic status (SES), the homeless and those with less formal educational qualifications are most likely to be digitally excluded.
In collaboration with the Good Things Foundation, the NHS launched its Widening Digital Participation Programme (WDP) in 2013. By using the Foundation’s network of online centres in deprived areas, phase one (2013-16) focused on improving digital literacy by providing a safe place to learn the necessary skills. Phase two (2017-20) concentrated on finding areas within health and care systems where digital access could be improved for vulnerable groups.
As a result of participating in the WDP, 65 percent of learners felt more informed about their health and 54 percent in need of non-urgent medical advice would use the internet first. Most staggering is the financial benefits of the programme. Overall digital inclusion interventions showed a return on investment of £6.40 for every £1 spent.5 Looking closer at this data, £2.3 million was saved in A&E visits and £3.7 million saved in GP visits in just one year.
While positive progress is being made, nearly 12 million people in the UK still remain without access, and digital exclusion accounts for half of NHS spending.6 Over the next four years, the NHS plans to develop and pilot user-centred approaches to addressing digital exclusion, engage with a variety of digital health stakeholders to develop products available to all, and raise awareness of the problem.
However, it is up to policy makers to focus their attentions on improving digital access as a national priority. If digital access continues to lag behind digital healthcare, the UK faces a huge and avoidable health crisis.