JMIR Publications

ABSTRACT

Digital technologies have produced many innovations in care delivery and enabled continuity of care for many people when in-person care was impossible. However, a growing body of research suggests that digital health can also exacerbate health inequities for those excluded from its benefits for reasons of cost, digital literacy, and structural discrimination related to characteristics such as age, race/ethnicity, and socioeconomic status. In this paper we draw on a political economy perspective to examine structural barriers to progress in advancing digital health equity at the policy level. Considering the incentive structures and investments of powerful actors in the field, we outline how characteristics of neoliberal capitalism produce and sustain digital health inequities by describing six structural challenges to the effort to promote health equity through digital health: (1) the revenue-first incentives of technology corporations, (2) the influence of venture capital, (3) inequitable access to Internet and digital devices, (4) under-investment in digital health literacy, (5) uncertainty about future reimbursement of digital health, and (6) justified mistrust of digital health. Building on these important challenges, we propose two parallel directions for work to support meaningful change for digital health equity.