Digital Inclusion – A Determinant of Health?

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Globally, where you live, work, pray, play, and learn impacts your health and wellbeing, often called the social determinants of health. More attention is being paid to the context of our lives and the actions we take daily. It has become even more apparent how challenged many people are accessing opportunities due to inadequate or low-quality internet and wifi access in a pandemic. This is true of children attending school online and for people who have been working from home this past year.

A new paper in Nature Digital Medicine by Cynthia Sieck and colleagues from Ohio State University explores digital inclusion as a social determinant of health. A recent report from the Brookings Institution reflects 15-24% do not have access to a broadband connection or internet. Given healthcare shifted to virtual delivery in the pandemic, this data point suggests the digital divide will further exacerbate the lack of access to care.

If we look through the lens of income, 38% of households earning $20,000 lack a broadband subscription. This discrepancy exists in urban and rural areas. The author’s commentary leans into the intersection of the digital divide as it relates to health. The figure below outlines aspects of digital literacy and internet connectivity and sheds light on how they touch all the other social determinants of health. Imagine you are looking for a new job; most applications are exclusively completed online. What do you do if you don’t have the internet? These opportunities are not available to you. When you weigh the costs of providing internet access against healthcare costs, the former is considerably lower than the latter.

Source : Sieck, C.J., Sheon, A., Ancker, J.S. et al. Digital inclusion as a social determinant of health. npj Digit. Med. 4, 52 (2021).

The authors lay out a blueprint for health systems to adopt as they design for digital inclusion, which pertains to the necessary elements that need to be in place to ensure equitable access to digital modalities.

Dimensions in the blueprint include:
-Assessing connectivity at a community level- who has access to smartphones and the internet
-Supporting ongoing patients use of technology to manage their health beyond the initial stages
-Considering what training needs to be developed and what level of tech support is necessary to meet the needs of the community being served
-Tailoring content and apps to diverse populations that foster collaboration and self-sufficiency

A deeper systematic consideration of individuals patient’s access to digital tools and their digital literacy levels will be necessary as the shift to digital is likely to persist post-pandemic. These questions are not the norm in clinical settings but have likely come up a lot in the pivot to virtual care delivery. Assessing these levels could determine the technology-enabled prescription a clinical provides.

To advance digital inclusion and digital literacy, health systems may also widen their community partnerships to collaborate with local services, like libraries, so people can learn about technology and develop specific skills when using their phones. New opportunities are emerging with the pandemic that can close the digital divide, but it will take planning, strategy, and financial commitment to close the gap.

Thanks for reading – Trina

(Opinions are my own)


Sieck, C.J., Sheon, A., Ancker, J.S. et al. Digital inclusion as a social determinant of health. npj Digit. Med. 4, 52 (2021).

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