When the COVID-19 pandemic forced a rapid shift toward telemedicine and digital health services, policymakers and healthcare providers framed it as a necessary evolution in care delivery. Governments around the world invested heavily in telehealth initiatives, with organizations like the Australian Digital Health Agency leading national implementation efforts.
However, new research published in PLOS Digital Health suggests that these advancements have also introduced new layers of exclusion, creating what researchers call the Digital Determinants of Health (DDOH)—a new category of health inequities that intersect with existing social determinants of health (SDOH).
A team led by Swathikan Chidambaram at the University of Melbourne argues that digital access, literacy, and bias in health technology design must be understood as structural barriers to health equity. They write:
“There is a paucity of literature addressing how the intrinsic design, implementation, and use of technology interact with SDOH to influence health outcomes. Such interactions are termed digital determinants of health (DDOH)… DDOH is implicit in the design of artificial intelligence systems, mobile phone applications, telemedicine, digital health literacy [DHL], and other forms of digital technology.”
While digital health has often been framed as a way to close health disparities, the reality is that it reinforces existing social hierarchies. Millions of people worldwide lack digital literacy, internet access, or the financial resources to navigate online health platforms. According to a report from the UK, 11 million people do not have the skills to participate in the digital economy, meaning they also lack access to basic telehealth services. These gaps, the researchers argue, mirror broader political and economic inequalities:
“Regardless of the exact terminology, all previous work agrees on the contextualization of DDOH with respect to the broader political, societal, and economic processes that they are embedded in. Namely, differences in societal preferences, socioeconomic contexts, and political and institutional configurations will generate variations in how digital technologies are incorporated and consumed in the healthcare ecosystem.”
By analyzing digital determinants of health, researchers hope to illuminate how new healthcare technologies—rather than democratizing access—are further marginalizing those already affected by economic and social oppression.
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