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Digital health services in the UK have improved access and efficiency for many, but they have also amplified socioeconomic inequalities by disproportionately excluding people experiencing poverty, low digital literacy, cognitive impairments, or mistrust of technology, particularly those with serious mental illness (SMI).
People facing socioeconomic disadvantages often encounter barriers such as lack of confidence with digital tools, poor internet access, and automated systems that depersonalize care, which can worsen health inequalities rather than reduce them.
Key impacts on people experiencing socioeconomic inequalities include digital exclusion, reduced personalization and trust, wider health disparities, potential benefits for remote assessment, and ethical considerations.
Digital exclusion occurs when individuals with low income or poor digital skills are less likely to engage with online booking, remote consultations, or patient portals, limiting their access to health services. This can lead to worsened health outcomes for those who are already disadvantaged.
Reduced personalization and trust can be a significant issue for populations with mental health conditions, where continuity and trust are critical. Automated digital services may weaken therapeutic relationships, which can have a negative impact on mental health.
Wider health disparities have been observed during the COVID-19 pandemic, with deprived communities facing longer waits and fewer successful digital interactions.
Potential benefits for remote assessment exist for some groups, such as older adults with cognitive decline. However, these benefits can only be realized if the technology is tailored appropriately and addresses technological readiness and support.
Ethical considerations are paramount in digital health, as it is crucial to ensure that technology does not reinforce existing biases or exclude vulnerable populations.
To address these issues, deliberate measures must be taken to ensure equitable access, digital literacy support, relationship-centered care, and inclusion of marginalized communities in the design and delivery of digital health services.
Better understanding is needed about why some people distrust health data sharing and how that trust can be built up meaningfully, with the onus on data users and controllers like the NHS and any private partners.
Public perceptions and experiences of an underfunded, understaffed NHS can mean efforts to digitize health services are seen as cost-cutting first and foremost, rather than efforts to improve care.
Local authorities can undertake digital inclusion initiatives, including providing devices, data plans, and digital literacy training to those who are digitally excluded, but need to be supported to do this by long-term funding.
Digital health services must be designed and deployed with the specific constraints of the social and political landscape in mind.
To avoid widening the digital healthcare gap, it is important to ensure that local GP or community organizations are available and equipped to point patients towards digital health services and help them understand how they work.
Digital health services that address fundamental structural concerns and reduce admin and operational burden for clinicians may be more important now than shiny new tools that are parachuted into an under-resourced system.
Those commissioning, designing, and deploying digital health services must do so with a clear remit to tackle health inequalities, and an awareness that right now these are being exacerbated by the inability to see a GP or call an ambulance in some areas.
Metrics for what 'success' looks like for digital health services should be defined in advance to include addressing health inequalities. Impact assessments should involve marginalized groups in feedback and analysis.
To avoid 'techno-solutionism' in response to the challenges that the NHS faces, it is important in commissioning and development to justify why a new digital health service is the best solution to the problem that needs solving, that is, that a digital solution is not implemented just because it is new and exciting.
Engaging with members of the public, and especially marginalized groups, must inform the way that digital transformation in the health and care system is rolled out. This might involve seeking public participation and collaboration during the very early stages of the development of any new digital health service. Existing services should be monitored on usage and outcomes in different groups to understand how they are perceived and experienced by users.
In conclusion, while digital health services offer opportunity, current implementation in the UK risks perpetuating or deepening socioeconomic inequalities unless deliberate measures are taken to ensure equitable access, digital literacy support, relationship-centered care, and inclusion of marginalized communities in design and delivery.
Sports enthusiasts might find themselves betting on football matches, but the rapidly increasing trend of sports-betting could become a concern for those experiencing socioeconomic disadvantages who may struggle to afford online-only betting platforms or lack digital literacy skills required for sports-betting websites.
The further expansion and integration of digital health services in the UK should be cautious to avoid amplifying socioeconomic disparities, as the same barriers that hinder access to essential healthcare services - such as digital exclusion and lack of confidence with digital tools - could also apply to sports-betting and other online entertainment.
