Health equity in the digital age: Exploring health policy and inclusive digital care

Objectives: The digitalisation of care, whilst beneficial for some, also risks exacerbating health inequities if existing health (and social) disparities are not considered. Literature has indicated the broad, systemic causes of digital health inequities could be addressed through policy. This article aims to explore how health inequities are rendered (in)visible in and by digital care policies. Methods: We inductively analysed sixteen Dutch health policy documents focusing on digital care. Employing a constructivist grounded theory approach, we analysed documents to determine how health equity is addressed in relation to digital care. Results: Although Dutch health policies do consider health inequities, it is not always shown in policies as a concept related to digital care. Health policies portray digital care as progressive and innovative, being able to shape healthcare in several positive ways. The risks of digital care are attended to less, with focus being placed mostly on privacy and data-security rather than also paying attention to digital health inequities. Conclusions: Policies either ignore digital health equity entirely or present digital health equity in ways that risk overlooking how digital care may subtly aggravate health inequities. This creates a blind spot in which technological deterministic narratives can be disguised. Current policies could unintentionally perpetuate exclusion by not highlighting the role of digital health inequities as a part of the health equity landscape. Policy needs to allow for digital health inequities to be better recognised, allowing digital care to drive, rather than limit, the possibilities for a more equitable future. Lay Summary: Digital care is increasing in popularity, but risks excluding a significant number of people who usually already experience health inequities. Although Dutch health policy does consider health inequities, it is not shown in policies as a concept related to digital care. As a result, health equity risks being forgotten in the development of digital care. Policies portray digital care as being able to shape healthcare in a number of positive ways but do not address the risks it may pose in widening health inequities. Instead, issues like ensuring privacy receive more attention. By being overly optimistic about technology without being cautious about its other social consequences, achieving aims such as affordable and accessible care could be negatively impacted. Policy needs to allow for digital health inequities to be better recognised, allowing digital care to drive, rather than limit, the possibilities for a more equitable future.