JMIR Publications

ABSTRACT

The public health crisis posed by COVID-19 has ignited the rapid implementation of digital healthcare. In the current response to the COVID-19 pandemic, digital health has been rightly heralded as an innovative health solution that can ensure ongoing access to clinical care, and allow for public health measures that stem rapid viral transmission and scope of spread. However, we must simultaneously address the often overlooked health equity factors that structure the use of digital health. Unexamined, inequities in access to and implementation of digital health, and the quality of care afforded by digital health, can recapitulate and deepen the inequities that have long existed within our healthcare system. There is emerging evidence that supports the use of implementation science approaches when scaling digital health; however, even these approaches to implementation often fail to incorporate health equity factors or to address social determinants of health. Using COVID-19 as an example, this perspective presents an evidence-based framework for systematically identifying factors that may impact digital health equity. Access to digital health technologies has a direct impact on health access and outcomes across the United States, and globally. Digital health technologies also interact with other social, cultural and economic factors, and with social determinants of health, to indirectly contribute to health equity. The proposed digital health equity framework considers the social stratification process, material circumstances, and social location and the way these interact with individual factors (biology, appraisal and coping, and health behaviours); environmental factors; and health systems factors (health quality, policy, organizational, and governmental).