Access to digital tools and platforms has improved the way health information is shared, treatment regimens are coordinated, and outbreaks are monitored in communities around the world. But there's a downside to technology-based health care: it has the potential to further marginalize populations that already experience inequities when it comes to health-care access, including new immigrants.
Digital dividends—the benefits achieved using technologies—aren't available to everyone across the globe. Four billion people worldwide lack access to the internet. Due to the proliferation and increased interest in using technology as a tool to support health, research and guidelines are needed to ensure global health systems are effectively investing resources in inclusive, accessible, evidence-based digital health strategies.
The World Health Organization's 2019 "Recommendations on Digital Interventions for Health System Strengthening" aim to provide evidence-based guidance that helps countries respond appropriately to the health needs of immigrants and others at risk for experiencing health disparities. The recommendations provide directions on how to navigate the implementation of accessible and sustainable digital health platforms.
Four billion people worldwide lack access to the internet
In order to achieve digital inclusion, health-care systems must consider digital access and digital skills as social determinants of health. Co-designing digital health services (DHSs) with users, improving digital literacy among populations, and establishing and maintaining trust among communities that are not served adequately is foundational to building inclusive DHSs.
Ontario, Canada, is an example of a region where there is a paucity of reports outlining considerations for digital health technologies among new immigrants and immigrant communities. This indicates that more research is required to build empirical evidence that aids policymakers in developing strategies, guidelines, and frameworks that respond to immigrant groups' needs for digital health technology implementation. Expanding understanding of digital health accessibility can strengthen health service delivery in Ontario and build trust in an increasingly common form of health-care communication.
The COVID-19 Pandemic and Digital Health Systems
During the pandemic, Canadian residents have reported increased challenges when it comes to accessing family doctors, specialists, and advanced diagnostic tests. According to 2020 research by the Canadian non-profit organization Angus Reid Institute, Ontario residents were most likely to say they had missed out on at least one appointment or procedure during COVID-19 compared to people in other provinces.
The coronavirus pandemic and the necessity to physically distance in order to mitigate disease transmission has led to an increased dependence on digital health services. And the Canadian health-care system has seen rapid growth in digital health technologies that support public health disease management and routine health care services. Notably, Canada has increased its use of virtual care, including virtual emergency department visits, primary care appointments, and mental health consultations. COVID-related health services have also been managed digitally to deliver test result notifications and book vaccination appointments. As of last October, the COVID Alert app had been downloaded by almost 4.7 million Canadians to notify people of potential exposures to the virus.
New Immigrant Health Inequities
At the same time that digital health services have been on the upswing, the COVID-19 pandemic has exacerbated many pre-existing health disparities among immigrant populations distancing them from the digital health care. Increased job and financial insecurity and the inadequate dissemination of public health information as the pandemic unfolded — including a lack of translated health information — have put immigrants at a disadvantage, compounding the challenges of learning to navigate a new health-care system.
As many health-care services shift to online platforms, ensuring newcomers have equitable, inclusive, and accessible health-care services—including e-health, remote consultations, and telehealth services—is crucial to ensuring immigrants are not further marginalized in when it comes to health-care access. With immigrants experiencing increased health risks and as our system adjusts to widespread digital health-care access, Ontario needs to address the barriers disproportionately impairing new immigrants' digital health accessibility during the COVID-19 pandemic.
Reducing Digital Inequities
Governments need to ensure that reliable access to the internet, adequate digital literacy skills, and data privacy and protection are available to all new immigrants. Free or subsidized internet programs promote access to information and online health services and remove barriers to empowering individuals to be active decision makers in their own health outcomes. Governments can assist by incentivizing internet service providers so that they offer low-cost options. Government-led initiatives, such as the Connecting Families program that offers internet access for $10 a month to those receiving the maximum Canada Child Benefit, should be more broadly available to others with lower incomes.
Moreover, digital infrastructure including rural and remote broadband service provisions is crucial to reaching communities in need. Adequate internet speed that supports multiple devices, video conferencing, and the ability to upload images shared via digital health interactions are necessary. Additional funding that supports extended telehealth hours could offer patients living in shared housing more options for private health communications.
Regulations governing private companies' collection and use of health data in Canada need to be tightened. One study in The BMJ of top-rated Android health apps reported that sharing of user data was routine. Health-care providers need to be aware of the security risks of promoting digital health applications to patients.
It is especially important for the country to create an inclusive, accessible, and robust digital health services
The Ontario digital health landscape provides a strong foundation upon which policymakers can build a more inclusive system. Inclusive digital health technologies and services for new immigrants should be a social and public health priority and will assist in achieving the pillars of universal health coverage that promote equity and equality, improve health care for immigrants, and reduce health risks.
Further data collection pertaining to immigrant usage of digital health pathways in Ontario during the COVID-19 pandemic, new immigrant lived experiences in digital health systems, and insights from health-care providers are fundamental to guiding future digital health systems policy interventions. A robust system-wide collaboration involving provincial and federal health authorities, non-governmental organizations, social services, health care providers, and new immigrant community partners is necessary.
As the Canadian government commits to accepting over 400,000 new immigrants per year from 2021 to 2023 to assist with economic recovery, it is especially important for the country to create an inclusive, accessible, and robust digital health services. They will be fundamental in protecting newcomers and reducing health disparities and ultimately, will promote optimal health outcomes for all Canadians.
