VVirtual health capabilities are moving far beyond video consultations with a doctor. They now encompass a wide range of applications, from robots that screened people for common diseases to artificial intelligence that can read x-ray images as well as a human radiologist. Many experts see virtual technology as a promising tool for breaking down barriers to health care and addressing long-standing health inequalities around the world.
But this promise is far from assured. Many people do not have access to the internet or lack the digital literacy necessary to engage remotely with healthcare professionals or receive health promotion services. According to the 2021 report by the International Telecommunication Union (ITU), the United Nations agency for information and communication technologies, 37% of the world’s population, or 2.9 billion people, do not have never used the Internet. Of these, 96% live in low- and middle-income countries. Unless policymakers, healthcare providers and end users work together to better guide the process, the shift to virtual healthcare delivery will create new digital barriers that will prevent millions of people from accessing to the care they need.
Consider how age affects people’s online habits. In the United States, 99% of people between the ages of 18 and 29 are online. Seniors, however, are less connected to the internet – and they are the demographic group for whom reliable access to health care is often a matter of life and death. Along the same lines, people from minority groups and those living in rural areas are much less likely to have broadband access than white Americans and those living in urban or suburban areas. Black Americans of any age are almost twice as likely to lack high-speed internet compared to the general US population.
In India, 67% of people living in urban areas have internet access, compared to 32% of people living in rural areas. Data collected from 34 countries in Africa shows that women are less likely than men to have a smartphone, own a computer or use the internet. In Sweden, a country ranked number one in The Economist’s Inclusive Internet Index, as many as one in five people with disabilities feel excluded from the digital society.
Fortunately, there are pragmatic ways to ensure that virtual technologies make health more equitable rather than less.
The ITU/UNESCO Broadband Commission for Sustainable Development’s Health Working Group released a comprehensive review on Thursday of how age, gender, income, location, race, disability status and other factors determine people’s potential to reap the benefits of virtual health — or risk being left behind. This report highlights several emerging policy areas to address these gaps and provides the clearest guidance yet on how to ensure virtual technology can help make health and care accessible to all.
Governments would benefit from developing national strategies to equitably expand virtual health and care and integrate it into the health care system as a complement to in-person care. (Virtual health solutions are those that aim to keep people healthy; virtual care solutions treat those who are already sick.)
An effective national strategy would provide a coherent vision and policies that support the expansion of virtual health and care across a country, in line with national priorities for strengthening broadband internet and mobile communications infrastructure. . It would also direct public funding towards virtual applications that help a country move towards improving access to virtual health and care.
Virtual app developers can help make access to health care more equitable by consulting with representatives from diverse demographic backgrounds throughout the development process. Apps must then go through rigorous real-world testing to ensure they deliver superior health outcomes over existing solutions.
In Germany, for example, developers of virtual health apps must demonstrate patient benefits before receiving a permanent license. In this way, testing helps direct large investments toward solutions that deliver the greatest impact, while providing developers with insights they can use to optimize apps for diverse populations.
Health authorities and civil society organizations can do more to help consumers develop the skills and digital literacy required by virtual health and care apps. But even when people know how to use an app, they’re less likely to do so if they don’t trust the institutions, industries, or companies behind it. Public policies that ensure transparency in the operation of applications and the use of personal information, and that promote understanding of digital security standards, are essential to help users feel confident and secure when accessing virtual care. Policies should also ensure clear channels for users to express and receive thoughtful responses to their feedback.
The transition to virtual delivery of health and care services will continue even after the end of the Covid-19 pandemic. With the principles of fairness, inclusiveness and transparency guiding this transition, virtual health and care can provide a vital complement to in-person care and make the highest level of health accessible to all.
Tedros Adhanom Ghebreyesus is Director General of the World Health Organization. Ann Aerts heads the Novartis Foundation. They co-chair the ITU/UNESCO Commission on Broadband for Sustainable Development’s Working Group on Virtual Health and Care.