Virtual health capabilities are evolving far beyond video consultations with a doctor. They now encompass a vast array of applications, from bots that screen people for common illnesses 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 eliminating barriers to health care and addressing long-standing global health inequities.
But that promise is far from assured. Many people have no internet access or lack the digital literacy needed to engage remotely with care practitioners or benefit from health-promoting services. According to the 2021 report of the International Telecommunication Union (ITU), the United Nations agency for information and communication technologies, 37% of the world’s population — that’s 2.9 billion people — have never used the Internet. Of these, 96% live in low- and middle-income countries. Unless policymakers, health providers, and end users work together to better guide the process, the shift to virtually delivering health and care will create new digital barriers that leave millions of people unable to access the care they need.
Consider how age factors into people’s online habits. In the United States, 99% of people between the ages of 18 and 29 years are online. Older people, though, are less connected to the internet — and they are the demographic for whom reliable health care access is often a matter of life and death. In the same vein, people in minoritized groups and those living in rural areas are far less likely to have access to broadband than white Americans and those living in urban or suburban areas. Black Americans of any age are almost twice as likely to lack access to broadband internet compared with the general U.S. population.
In India, 67% of people living in urban areas have internet access compared with 32% of people living rurally. Data collected across 34 countries in Africa show that women are less likely than men to have a smartphone, own a computer, or use the internet. In Sweden, a country that ranks number one in The Economist’s Inclusive Internet Index, up to one in five people with a disability 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 working group on health published Thursday a comprehensive review of the ways in which 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 policy areas that are emerging to close these gaps and provides the clearest guidance to date on how to ensure that virtual technology can help make health and care accessible to all.
Governments would benefit from developing national strategies for equitably expanding virtual health and care and integrating it into the health care system as a complement to in-person care. (Virtual health solutions are those that seek 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 toward virtual applications that help a country make strides toward improving access to virtual health and care.
Developers of virtual applications can help make access to health care more equitable by consulting representatives from diverse demographic backgrounds throughout the development process. Applications should then be subject to rigorous real-world testing to ensure they deliver superior health outcomes when compared with existing solutions.
In Germany, for example, developers of virtual health applications must demonstrate benefits for patients before receiving permanent licensing. In this way, testing helps guide significant investment toward solutions that deliver the greatest impact, while providing developers with insights they can use to optimize applications for diverse populations.
Both health authorities and civil society organizations can do more to help consumers develop the skills and digital literacy that virtual health and care applications require. But even when people know how to use an application, they’re less likely to do that if they don’t trust the institutions, industries, or companies behind it. Public policies that ensure transparency in how applications work and how personal information is used, and that promote understanding of digital security standards, are critical to helping users feel confident and safe when accessing virtual care. Policies should also guarantee users clear avenues for expressing and receiving thoughtful responses to their feedback.
The transition to virtual delivery of health and care services will continue even after the Covid-19 pandemic ends. With the principles of equity, inclusivity, and transparency guiding that transition, virtual health and care can provide a vital complement to in-person care and make the highest level of health attainable for all.
Tedros Adhanom Ghebreyesus is Director-General of the World Health Organization. Ann Aerts heads the Novartis Foundation. They co-chair the ITU/UNESCO Broadband Commission for Sustainable Development Working Group on Virtual Health and Care.