Digital health and care has the potential to improve clinical outcomes, effectiveness and efficiency across the health and social care system, empowering people to look after their health better. Yet despite its benefits, the introduction of digital health and care solutions risks excluding the most vulnerable and highest need population(s) and perpetuating or exacerbating health inequalities.
Kath Sykes, Implementation Lead at Health Innovation Kent Surrey Sussex, explores what the health and care system can do to help digitally include all parts of our population, to enable everyone that could benefit from digital health and care to do so, and reduce the risk of health inequalities as a result.
Digital inclusion does not just to relate to someone’s access to technology(ies), and their digital skills to be able to use them. While these are essential components to digital inclusion, they are also blunt measures: having an old mobile phone is not the same as having the most up-to-date smart phone, or choosing to, or being able to afford to, prioritise new technologies and associated data. In addition, 35% of the UK population have at best low-level digital skills1, and having the digital skills to be able to access the internet in a limited way is not the same as having the skills to access the numerous software, apps, and devices, which are necessary to be able to engage safely and effectively with digital health and care. If people don’t have the skills needed for digital health and care, they will need to rely on formal or informal support which adds burden to health and care services and informal carers, and can deepen other barriers to inclusion, by reducing trust, motivation, access and usability, and it can exacerbate health inequalities.
Focusing solely on access and skills also fails to consider the many other reasons people can be, or become, excluded from, and disadvantaged by, digital health and care. If the health and care system, and other essential services, are to reduce exclusion and inequalities, all factors leading to digital exclusion need to be understood and mitigated.
So how can health and care systems achieve digital inclusion and reduce associated health inequalities? They can start by doing the following:
- Improve awareness through communication – highlighting the benefits to individuals and communities.
- Facilitate access and affordability – such as provision of technology and data to those most in need and likely to benefit from digital health and care.
- Provide support and also reduce complexity and skills requirements – it is unachievable to expect people to upskill across numerous digital platforms/technologies/pathways when seeking health and care services.
- Ensure the effort that is needed for people to engage with digital health and care is worth it for them. Ensure that people really do understand the personal value, regardless of their individual challenges and barriers.
- Build and maintain trust, ensure clinical and data safety, enable and respond meaningfully to feedback.
- Ensure health and care technologies, pathways, and services are accessible and useable for everyone, including people with physical, mental, cognitive, and sensory disabilities, people with lower literacy and numeracy levels, people who are neurodiverse, and people whose first language is not English.
- Collect and use data to understand who is being excluded and why, and the impact on their health and wellbeing to enable mitigation. There is a risk that by only collecting data digitally we are only collecting data on those who are digitally included, and this risks widening health inequalities.
While we also need to consider populations that are more likely to be excluded, everyone is at risk of digital exclusion over their life course – including due to changes in their health or financial status.
Overall we need to think about digital inclusion as several complex and intersecting factors that all need to be met and maintained. Health and care systems will only reap the full benefits of digital health and care, and reduce health inequalities if our highest-need populations can benefit from it, and we need to start to design our technologies, services and pathways with these populations in mind.
The Sussex Digital Inclusion Framework and associated tools2, aim to help the health and care system design and implement digitally inclusive health and care, by considering all the barriers and enablers to digital inclusion across a person’s journey with these services.
This blog was originally written for the NHS Sussex Population Academy and is available here, along with other resources, for NHS Sussex employees: How can we help reduce health inequalities through digital inclusion? – NHS Sussex (ics.nhs.uk)