I recently had the pleasure of chatting with Beth Wolff, the Director of Digital Solutions in Global  Business Development at biopharmaceutical company Lundbeck in Denmark. Beth is deeply committed to placing equity at the heart of digital health and is offering free virtual workshops on Developing for Equity based on her research and upcoming publication in the field. 

Beth’s masterclass introduces companies and healthcare providers to the barriers that citizens and patients face when using digital health solutions. Successful adoption and equity in digital health require that the tools accurately understand users’ needs and the constraints they face and are developed based on these needs, not on the technology’s potential. Accordingly, participants are offered a method to design solutions and product features that minimise these barriers.

In Beth’s view, health equity as defined by the WHO is often overlooked in digital health. Many digital health solutions are designed such that they are accessible primarily for people with higher education and income, who live in urban areas and already benefit from  healthcare services.  This is leaving out the underserved communities that could benefit greatly  from digital health innovations. Digital solutions therefore have the potential to increase inequity  within the healthcare system if not designed with equity as a goal. 

Yet there is hope. Digital health is a relatively new field, and we have the opportunity to build equity into its foundation.

Beth outlined health equity in the context of the Social Determinants of Health (SDOH) as defined by the WHO, which  are as influential as  healthcare or lifestyle choices in influencing health outcomes. She highlighted Denmark and the US as examples. Here, post codes are frequently used in datasets to reflect the effects of SDOH as where a person lives can often indicate their education, income, access to healthcare, and engagement in the community and thereby their level of health.

She also introduced the Digital Determinants of Health (DDoH). These include barriers like limited access to digital devices and a gap in digital literacy—the skills required to effectively use these devices and apps. Together, the SDoH and the DDoH impact a person’s ability to access and benefit from the emerging digital technologies.

To address these challenges, Beth introduced a practical method for developing equitable digital health solutions. This method involves creating and populating an ‘Equity Mapping Table’ with relevant SDOH, DDoH, and user needs once identified, and then redesigning product features to meet those needs.

She shared an example from an app developed for dementia. This product was assessed in her research to identify barriers to equity and suggest design changes to resolve these challenges. 

The product was originally available for use on new Chrome, Edge and Firefox browsers, as well as newer iOS and Android tablets. From the lens of the SDoH and DDoH, this requirement to buy the newest technology could be a significant barrier for older users, in this case dementia patients and their spousal caregivers. These individuals may be less inclined to adopt new technology or lack the financial means to buy the latest, often expensive, models. 

To increase equity in this case, developers should make the app compatible with older iOS and Android tablet versions to account for all computer types and financial situations. Adding Safari to browser options would also be beneficial. 

Developing for a wide range of devices and platforms is often not favoured by tech developers who aim to minimise business costs and complexity. Additionally, lower-tech requirements may not appeal to developers wanting to incorporate the latest digital features into their products. However, the real-life limitations and needs of populations with conditions like dementia make these changes imperative; otherwise, there is a risk of restricting access for the very people the treatment is intended to help.

It left me thinking: there are countless examples of applications outside of healthcare that alienate segments of the population because they aren’t accessible. QR codes in restaurants to view menus are particularly irritating, and finance apps are another example (indeed, we are too dependent on phones now). It often seems that most consumer tech solutions are designed with younger people in mind. Yet in healthcare, it’s critically important that we get this right.

I gained a great deal from my brief time with Beth, and I highly recommend her workshop.. I would be remiss not to share Beth’s contact information—she can be reached at Beth Wolff | LinkedIn.