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August 6, 2021

A look at how health policy can support universal, equitable and efficient access to digital healthcare

Commentary
Kate McNaughton
&

In this blog, we look at the intersection of digital health and health policy. Worldwide eHealth policy stems from recommendations from the WHO’s ‘Global Strategy on Digital Health 2020-2025’ which is being implemented in more than 120 Member States, including low and middle-income countries. The UN’s Sustainable Development Goals (SDGs) are also accelerating worldwide digital health policy implementation, as digital health is seen to provide an opportunity to accelerate our progress in attaining health and well-being related SDGs, especially Goal 3: ‘Good Health and Wellbeing’. More than 90% of WHO Member States now have an eHealth strategy that has been designed with their country’s specific health priorities and resources in mind. However, despite these developments, COVID-19 forced healthcare over its ‘digital tipping point’ and eHealth policy has been playing catch up to meet the needs of this digital revolution. 

Where policy is being implemented so rapidly and in flux, it is important to remember the key goal of advancing eHealth policy: creating an infrastructure that promotes universal, equitable and efficient access to digital healthcare for all groups. 

Digital health has been designated as one of the main solutions afforded to tackle our overwhelmed healthcare systems - which are in crisis due to a rise in chronic illness and an ageing population. The COVID-19 pandemic and reduced ability to offer in-person services has shown that lack of access to digital health exacerbates existing inequalities already present within our healthcare systems.

Policy Suggestion 1: Increase Access to High-Speed Internet

Social conditions determine disease burden. Social and Community context is one of many Social Determinants of Health (SDOH) that have an impact on nearly 70% of individual health outcomes.

Source: Socioeconomic Factors Play Significant Role in Health Outcomes | Duke Health Referring Physicians

While digital health solutions offer many potential benefits to address SDOH, entry barriers remain high for those with limited access. Often impacting individuals living in rural areas with limited infrastructure. In the US, a Pew Research Report in 2019 noted that 37% of rural Americans did not have an internet connection at home. This can be fixed, and is being tackled in the US by the Federal Communications Commission’s Connect America Fund, which aims to expand broadband access to millions of Americans who lack access to high-speed internet. In Europe, there is a growing trend for municipalities in rural communities to drive broadband expansion projects. The European Commission recently published a ‘rural broadband handbook’ to help communities plan for these projects. In Africa where less than one third of the population has access to broadband connectivity, the World Bank’s Working Group on Broadband for All aims to increase universal, affordable, and good quality internet access by 2030. Broadband access in both urban and rural communities across the world will be crucial in achieving digital health adoption and equitable access.

Policy Suggestion 2: Increase integration and interoperability across the care chain

Other policy opportunities such as the integration of the SDOH into EHRs - can help to identify trends, connect patients to social services, while at the same time, avoiding clinician burden and protecting patient privacy. Data pertaining to the SDOH has the opportunity to reveal disparities in a clear and quantitative manner. Electronic health records are the information backbone of digital health - and utilising technology to enable interoperability across both disease and geography will drastically boost efficiency while also improving health outcomes. 

Lack of interoperability across the care chain is also a great challenge to healthcare ecosystems that is detrimental to both patient outcomes and cost efficiency. On the one hand, healthcare silos between therapeutic expertise prevent holistic care - however, there are additional silos pertaining to ICT and technology, which further undermine integrated care provision, and lead to issues of access.

According to the 2030 Agenda for Sustainable Development Goals, “the spread of information and communications technology and global interconnectedness has great potential to accelerate human progress, to bridge the digital divide and to develop knowledge societies.” There is a need for an integrated approach to healthcare that involves all stakeholders and connects all the dots along a patient’s healthcare journey taking into account comorbidities. Many eHealth policies, for example Tanzania’s, have been developed with the core aim of addressing these silos. The success of eHealth policies such as Tanzania’s may pave the way for success in other countries with similar issues.

Policy Suggestion 3: Increase Inclusivity 

When we think of the ‘digital divide’, our minds may go straight to thinking about older adults and difficulties related to technological advancements. However, it is more nuanced than that – those without the infrastructure to support digital health interventions (for example due to language barriers, disability or structural inequality) may get left behind when it comes to digital health. Looking specifically at groups with disabilities, the UNCRPD has highlighted the need to provide “accessible information, communications and other services”, for example by incorporating Braille access or “other appropriate forms of assistance and support to persons to ensure their access to information.” eHealth policy and emerging digital health interventions must be conscious that there is a need to be disability-inclusive.

Future gazing: The intersection of digital health and health policy

Digital health policy has a dualistic aim: the unburdening of overcrowded healthcare systems, and the empowerment of both patient and healthcare providers to improve health outcomes. Policy must focus on the structures which need to be put in place to address individuals with more complex needs, and those suffering due to the digital divide. We know that the digital divide affects women more than men, and that fewer than 1 out of 5 people in the least developed countries are connected. Robust digital health policy and its implementation are crucial in promoting an equitable, affordable and universal healthcare ecosystem for all. Digital health should be envisioned as a complementary measure to improve our current care provision systems - by breaking down silos, improving interoperability, and tackling SDOH to create a system which is not only more efficient, but also more fair and inclusive. 

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