Discussion responses
Laura Garcia
Jul 22 8:10am| Last reply Jul 23 10:18am
Manage Discussion by Laura Garcia
Reply from Laura Garcia
In the modern age, digital inclusion and broadband access should be treated as an additional social determinant of health (SDH), or at least an important extension to the other SDHs. Healthy People 2030 lists five areas: access to and quality of health care, access to and quality of education, social and community context, economic stability, and neighborhoods and the built environment. Yet, as the health system and society as a whole become more digitalized, access to a reliable internet connection and skills to navigate the web have a direct effect on health (Turcios, 2023). Digital connectivity is necessary for accessing trustworthy health information, communicating with providers, participating in public health programs, and in some cases, even receiving medical care remotely. A lack of digital inclusion therefore hinders the ability of individuals, particularly in rural or low-income communities, to benefit from these health services. For instance, during the COVID-19 pandemic, many communities with limited internet access were unable to take full advantage of telemedicine services, which affected continuity of care (Early & Hernandez, 2021).
Digital health, including electronic health records, patient portals, mobile health apps, and telemedicine platforms, can help reduce social and health inequalities but also exacerbate them. On one hand, these innovations help patients be more engaged in their healthcare. EHRs with patient portals provide access to lab results, medication lists, reminders, and health education messages that can be tailored to individuals’ needs. Patients can reach their providers or seek medical help without the delay or cost of an in-person visit by using telemedicine platforms. On the other hand, these resources have their use restricted for people with low digital literacy, poor devices, or no reliable internet connection. For example, an older adult with multiple chronic conditions may benefit from a mobile health app that helps them monitor blood pressure and provide feedback on self-care, but only if they have broadband access and can use the technology (Sieck, et al., 2021).
Telemedicine may be the most straightforward example of the interaction between digital inclusion and the other SDHs. Virtual visits with a provider are a convenient and often more affordable alternative to in-person appointments, which can take time off work or require transportation. But the lack of high-quality internet or suitable devices precludes people from using this care delivery modality. Patient portals have the potential to make doctor-patient communication easier, leading to better treatment adherence and health outcomes, but are underused among communities that face the digital divide. Digital inclusion is best either added as a new SDH or included as a cross-cutting issue that directly impacts each of the other five domains. This is necessary to close the gaps, move toward equity, and make sure that digital health innovations reach all members of society and leave no one behind (Sieck, et al., 2021).
References
Early, J., & Hernandez, A. (2021, May 6). Digital Disenfranchisement and COVID-19: Broadband Internet Access as a Social Determinant of Health.
Sieck, C. J., Sheon, A., Ancker, J. S., Castek, J., Callahan, B., & Siefer, A. (2021, March 17). Digital inclusion as a social determinant of health.
NPJ Digit Med. 4, 52.
Turcios, Y. (2023, March 22). Digital Access: A Super Determinant of Health.
Substance Abuse and Mental Health Services Administration [SAMHSA].
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IB
Jul 23 12:43am| Last reply Jul 23 7:36pm
Manage Discussion by Isata Bangura
Reply from Isata Bangura
Digital Inclusion as a Social Determinant of Health
In my view, digital inclusion and broadband access should be added as a key area of the social determinants of health (SDOH). In today’s healthcare landscape, digital tools like telemedicine, electronic health records (EHRs), and patient portals are integral to receiving timely, quality care. Without broadband access, marginalized populations, especially in rural or low-income areas, face barriers to engaging with these tools, thus deepening health inequities (Campos-Castillo & Anthony, 2021). For example, telehealth can reduce transportation barriers, but it’s only effective when patients have reliable internet and digital literacy. Similarly, patient portals help individuals manage chronic conditions, but those without internet or adequate devices miss out on benefits like medication tracking or appointment scheduling (Walker et al., 2022). As broadband becomes essential to health service delivery, its absence directly limits access and quality of care.
Including broadband access among SDOH is a matter that should be handled with urgency. According to Sieck et al. (2021), digital exclusion disproportionately affects the elderly, low-income, and racially marginalized populations, exacerbating existing disparities in health outcomes. Including broadband access in SDOH frameworks would prompt policy-level investments and interventions aimed at digital equity, such as subsidized internet or community tech education. Therefore, just as housing, education, and income are essential to health, so too is the ability to engage with digital health tools.
References
Campos-Castillo, C., & Anthony, D. L. (2021). Racial and ethnic differences in self-reported telehealth use during the COVID-19 pandemic: A secondary analysis of a US survey of internet users from late March.
Journal of the American Medical Informatics Association, 28(1), 119–125.
Sieck, C. J., Sheon, A., Ancker, J. S., Castek, J., Callahan, B., & Siefer, A. (2021). Digital inclusion as a social determinant of health.
NPJ Digital Medicine, 4(1), 52.
Walker, D. M., Hefner, J. L., Fareed, N., Huerta, T. R., & McAlearney, A. S. (2022). Exploring the digital divide: Age and race disparities in use of an inpatient portal.
Telemedicine and e-Health, 28(1), 64–70.
