Digital tools and heart health equality – Great potential but many pitfalls

Text: Anni Karjala (MD), Illustration: Outi Kainiemi

In the past decade, we have seen an increase in the number of digital tools used in healthcare. This development has been further accelerated by the Covid-19 pandemic. One of the great promises of digital healthcare is considered to be the possibility of improving health equality.

Despite their promise, as digital tools are being implemented on a broad scale, their effect on health inequality has proven to be somewhat complex.

A problem within the problem

The prevalence of heart diseases is increasing globally. A problem within the problem is the growing disparity. New solutions are needed, as inequality in heart health is profound. For instance, according to estimates, individuals from lower socioeconomic groups have up to 50-80% higher risk of dying from cardiovascular disease than those with higher socioeconomic status. Ethnic disparities are also evident, as black individuals have up to 30% higher risk of dying from cardiovascular disease than white individuals (1).

Closing the gap?

The potential of digital tools in improving health equality is easy to see.

First, digital tools are easier to access than traditional care. Perhaps the most commonly referred benefit is that these tools improve the availability of healthcare services regardless of location. This provides possibilities for more equal care for individuals that live e.g. rural areas that have previously been in an unequal position as the distances to healthcare facilities have been long.

Second, digital tools are often thought to be less costly and sometimes more cost-effective due to their scalability, improving the access to care in this way as well.

Another benefit is the possibility of these tools to be personalized and targeted in an agile manner. The content of these tools can be modified to address the language and health literacy of different patient groups. If, for example, a group is known to have a higher risk for certain condition than others, digital prevention tools and their content could be targeted and personalized for these individuals more effectively than the more rigid, standard paths of care.

Did you know? According to estimates, individuals from lower socioeconomic groups have up to 50-80% higher risk of dying from cardiovascular disease than those with higher socioeconomic status. The same study found that black individuals have 30% higher risk of dying from cardiovascular disease than white individuals (1).

The pitfalls

Despite their potential to reduce health equality gaps, digitizing healthcare also has many pitfalls.

Cost and accessibility. Although potentially improving access to care, many digital health tools require specific devices or a sufficiently fast internet connection for their use – and those come with a cost. This poses a potential barrier for the use of these tools in lower socioeconomic groups.

Knowhow. Another aspect known to limit the use of these tools are digital skills and health literacy,  known to distribute unevenly between different socioeconomic and age groups. (2-5)

Inclusivity. Data used to build these tools has also raised concerns with regards to equality. Many tools in digital healthcare are developed and tested on advantaged groups – possibly leading to solutions that are only suitable for these populations (6). For example, a recent study presented at American College of Cardiology’s 71st Annual Scientific meeting, found that PPG-based devices are less effective at tracking heart rate in those with darker skin tones (7). Older people are also known to be less likely to use digital services to access healthcare information (2). This aspect should be considered in the development of digital devices, making sure the test groups are diverse and representative of real-life populations.

Developing and implementing digital tools only for the wealthy and already health-literate could, in the worst-case scenario, make the inequality gap in health even wider.

Did you know? In the US, nearly one-fourth of the population in rural areas — 14.5 million people — still lack access to fixed broadband internet, but up to 80% of individuals in these areas already own a smartphone.

How to address the equality issue? 

Digital inclusivity with regards to social and economic background, ethnicity, age, and sex is a crucial point to be considered in the realm of digital healthcare.

To address the issue of health inequality with digital tools requires action and caution on many levels: in health policy, development of the technologies as well as their implementation into individuals’ lives and treatment workflows.

What’s more, the impact of these tools on health equality should be actively gathered and researched. If executed correctly, digital healthcare shows great promise in reducing inequality and improving inclusivity within healthcare.

References

1)    Singh GK, Siahpush M, Azuine RE, Williams SD. Widening Socioeconomic and Racial Disparities in Cardiovascular Disease Mortality in the United States, 1969-2013. Int J MCH AIDS. 2015;3(2):106-118.

2)    Heponiemi T, Kaihlanen AM, Kouvonen A, Leemann L, Taipale S, Gluschkoff K. The role of age and digital competence on the use of online health and social care services: A cross-sectional population-based survey. Digit Health. 2022;8:20552076221074485. Published 2022 Jan 28. doi:10.1177/20552076221074485

3)    Neter E, Brainin E. eHealth literacy: extending the digital divide to the realm of health information. J Med Internet Res. 2012;14(1):e19. Published 2012 Jan 27. doi:10.2196/jmir.1619

4)    Kaihlanen AM, Virtanen L, Buchert U, et al. Towards digital health equity - a qualitative study of the challenges experienced by vulnerable groups in using digital health services in the COVID-19 era. BMC Health Serv Res. 2022;22(1):188. Published 2022 Feb 12. doi:10.1186/s12913-022-07584-4

5)    Kontos E, Blake KD, Chou WY, Prestin A. Predictors of eHealth usage: insights on the digital divide from the Health Information National Trends Survey 2012. J Med Internet Res. 2014;16(7):e172. Published 2014 Jul 16. doi:10.2196/jmir.3117

6)    Lyles CR, Wachter RM, Sarkar U. Focusing on Digital Health Equity. JAMA. 2021;326(18):1795–1796. doi:10.1001/jama.2021.18459

7)    Koerber, D., Khan, S., Shamsheri, T., Kirubarajan, A., & Mehta, S. The effect of skin tone on accuracy of heart rate measurement in wearable devices: A systematic review. J Am Coll Cardiol. 79(9), 2022. https://doi.org/10.1016/s0735-1097(22)02981-3