The digital divide isn’t just about technology access—it’s become a critical factor in healthcare outcomes. Here’s how we can bridge this gap and create more equitable healthcare for all.
The Internet as a “Super Determinant” of Health
In today’s increasingly digital healthcare landscape, internet access has emerged as what experts now call a “super determinant” of health—a factor that not only directly influences health outcomes but also affects traditional social determinants like education, employment, and healthcare access.
The statistics paint a concerning picture:
- 19 million Americans lack reliable broadband service
- Nearly a quarter of rural residents—14.5 million people—have no high-speed internet
- In tribal areas, almost a third of residents lack reliable internet
- While 80% of households earning over $100,000 have high-speed internet, only 50% of households earning under $25,000 do
- The median monthly broadband bill is approximately $70—a prohibitive expense for many low-income families
These aren’t just numbers. When essential healthcare services move online, those without adequate technology access face significant barriers to care.
How Digital Access Impacts Health Outcomes
Research has identified two primary ways digital inclusion connects to health equity:
The Direct Pathway: Healthcare Access
Digital tools directly enable healthcare access through:
- Telehealth appointments
- Patient portals
- Electronic health records
- Medication management systems
- Remote monitoring devices
When people can’t access these tools, they miss virtual care opportunities, struggle to communicate with providers, and find it difficult to manage their health information.
The Indirect Pathway: Social Determinants
Digital inclusion affects upstream factors that significantly influence health:
- Education opportunities
- Job applications and employment
- Housing searches
- Social connections and support networks
- Access to public benefits
Both pathways are influenced by neighborhood characteristics and geography, creating a complex interplay between place, digital access, and health outcomes.
The Pandemic Exposed and Deepened the Divide
COVID-19 dramatically highlighted the importance of digital access for healthcare. As systems rapidly shifted to virtual care, those without reliable internet or necessary devices faced significant barriers.
In New York alone:
- 25% of residents lacked basic internet connectivity to meet with healthcare providers
- Approximately 1.6 million people had no access to a personal computer
The pandemic also revealed how digital exclusion affects other health determinants:
- Of 50 million students sent home during school closings, over 9 million lacked home internet access
- This disruption to education represents a long-term social determinant with lasting health implications
Digital Redlining: A Modern Health Equity Challenge
One particularly concerning aspect of the digital divide is “digital redlining”—discriminatory disinvestment in broadband infrastructure that disproportionately affects people of color, low-income communities, and rural populations.
This practice manifests through:
- “Tier flattening”—charging those with slow internet the same rates as those with better access
- Limited availability of online services based on neighborhood income, race, or rurality
- Restricted access to telehealth and online health information
As researchers from Boston University School of Public Health note: “The internet is a basic utility, yet the historic systems designed to prevent marginalized communities from accessing home loans are limiting access to broadband today.”
Barriers Beyond Infrastructure
The digital divide in healthcare isn’t just about physical access to technology—multiple overlapping factors create complex challenges:
Socioeconomic Barriers
If a family can’t afford a computer or monthly internet fees, they can’t access telehealth services regardless of how well-designed these systems might be.
Geographic Limitations
Rural areas face significant gaps in broadband infrastructure, creating fundamental barriers to digital health engagement.
Age-Related Challenges
Older adults often struggle with newer technology and may not fully utilize telehealth options available to them.
Digital Literacy Gaps
Even with technology access, many lack the knowledge and skills needed to effectively use digital health tools—from navigating health information online to maintaining digital privacy.
Promising Solutions: A Multi-Faceted Approach
Addressing the digital divide requires comprehensive strategies:
Infrastructure and Affordability Solutions
- The Emergency Broadband Benefits program provides up to $50/month for broadband access
- Canada’s Connecting Families initiative is investing $13.2 million to provide affordable internet to low-income families
- The MetroHealth System in Cleveland received a $1 million grant to provide subsidized broadband to low-income patients
Training and Support Programs
A Baltimore program delivered tablets to older community members and provided broadband access alongside one-on-one training. Participants identified the training as most valuable, noting that previous programs had “given the laptop and then never talked to again,” resulting in unused devices.
Inclusive Design Approaches
Healthcare systems can offer lower-tech alternatives:
- Phone calls or text messages instead of video calls
- Translation services to overcome language barriers
- Designs that work for diverse users from the outset
Community-Based Interventions
UVA Health in Virginia demonstrated the potential of community partnerships by:
- Collaborating with social service providers to connect at-risk populations with telehealth
- Sending COVID patients home with iPads to monitor symptoms and communicate with physicians
Equity-Centered Informatics: A Framework for Progress
Without specific attention to equity considerations, “the rapid expansion of digital health approaches threatens to exacerbate rather than ameliorate existing health disparities.”
Centering equity in digital health means balancing improved reach with increased risk:
- Telehealth can help people with stigmatized diagnoses access specialty care, but data breaches pose greater risks for these patients
- While virtual care expands access for hard-to-reach populations, it shouldn’t create barriers to necessary in-person services
A comprehensive Digital Health Equity Framework addresses multiple dimensions simultaneously:
- Physical access to technology
- Digital literacy
- Inclusive design considerations
- Cultural relevance
- Privacy and security
The Path Forward
Healthcare systems play a pivotal role in addressing the digital divide through their practices and advocacy for broader changes:
Standardized Assessment
Researchers at UCLA, UCSF, and Harvard are developing best practices for screening tools to assess digital health access—helping identify patients at risk of digital exclusion.
Policy Integration
Digital equity considerations must be integrated into broader health policy frameworks, with specific provisions for vulnerable populations.
Cross-Sector Collaboration
Addressing the digital divide requires partnership across healthcare, technology, education, and community development sectors.
Research and Evidence
Continued research is needed to identify effective strategies for bridging the digital divide in healthcare, with particular attention to what works for different populations in different contexts.
The Bottom Line
As healthcare becomes increasingly digitized, ensuring equitable access to digital health tools is essential for preventing the widening of existing health disparities. By designing digital health initiatives with equity at the center, we can help ensure that these technologies advance rather than undermine our collective goal of health equity for all.