The Technological Divide and Inequities in Health
If the 2020 COVID 19 crisis has illuminated anything, it is the otherwise overshadowed light on inequities in health. Health inequities are not simply the difference in access to care, in the setting of COVID 19, they can often mean the difference between life and death. At this point, we have all seen the data on the inequities in COVID 19 death rates as well as the disproportionate risk that this pandemic has created for people of color. We know now that in Milwaukee, Blacks represent just 26% of the population but account for 81% of the deaths. This trend continues in Michigan, where Blacks are a mere 16% of the population but account for 40% of the COVID 19 deaths. We are seeing these trends duplicated across the nation. To public health professionals, this is no surprise. We know that rural communities face alarming challenges with access to care, partly due to geography and partly due to the disturbing number of rural hospital closures. We know that low-income urban communities, such as public housing or shelters, have limited ability to comply with social distancing standards because of multigenerational households and close quarters. We know that economically vulnerable ‘gig’ workers are on the front lines serving in grocery stores, food delivery, or driving for a rideshare service providing ‘essential’ services for the shut-in. We also know that some 60 million Americans have no Wi-Fi in their homes and have limited access to data plans on their phones. Another 28 million Americans are without health insurance. For many, staying healthy and virus free is a bigger and more difficult challenge than it is for others.
In the throes of this crisis, states, cities, health insurers, and providers are leveraging technology as a tool to provide care to populations that are sheltered in place. The primary approach has been through web-based tools and telehealth services. The federal government has relaxed regulations surrounding mobile health technology and has expanded both the definition and modalities that are included in this category to accommodate the increase in demand. But, as the health care system runs toward technological innovation, it is important not only to note the digital divide, but also the historical injustice in health that may inhibit adoption and participation by our most vulnerable and marginalized communities. Health care access has historically favored the wealthy and the White, leaving low-income and marginalized communities (be they urban or rural) without access to life-saving information or care.
The uneven distribution of access to technology is more pronounced now, as the healthcare industry leans on technology to expand access to care. What does this technological adoption mean to those populations and communities that are bearing the burden in both mortality and morbidity for COVID 19? The truth is… not much! If you don’t have health insurance, money, or the internet, how can you access these resources? It is not enough to sanitize innovation in the likeness or for the needs of the privileged. Furthermore, for the Black community who has historically borne the brunt of injustice in health including forced sterilization, medical experimentation, or the co-opting of their cells for medical research; mistrust, disengagement, and disenfranchisement prevail. This does not include implicit bias and generally being ignored, disrespected, or devalued in health care interactions. This is the history and also current experience of people of color who seek health care. We must take on this digital divide and commit to expanding access to all, including the most vulnerable populations who are seeking care.
Governor Cuomo of New York said that COVID 19 was the ‘great equalizer’, it is not; it can be a death sentence for the low-income, immigrant communities, and for Black people in these United States. Technological innovation does not have to isolate and segregate access to vital health care services. As the health care system learns to adjust to this new and overwhelming challenge, consideration should be given to equitable access to care. We must ensure that those tools are designed with cultural awareness and competency, but also with consideration to the availability of technology for all communities. This means thinking outside the box, stretching our imaginations, and engaging with the communities you hope to impact. As the health care system embraces technological innovation, our responsibility is to proceed with care and consideration to improve access for ALL people.