Digital health services are still failing people with the greatest health needs, with language, access and skills barriers limiting use, a World Health Organization (WHO) review has found.
A scoping review led by WHO/Europe and Public Health Wales found that people with greater health needs and language barriers still struggle to use digital health services and technologies, mainly because of limited access, low digital literacy and services that are poorly adapted to diverse needs.
The review also found that gaps in digital infrastructure between regions risk creating uneven access to innovation.
While equity is increasingly referenced in digital health strategies, it is often articulated at a high level, without operational standards to guide its inclusion or mechanisms that enable governments to provide oversight.
Dr Natasha Azzopardi-Muscat, WHO/Europe’s director of health systems, said: “One of our main objectives with this new review was to understand what exactly drives inequity in digital health, and how equity is incorporated into regulation, implementation and evaluation processes globally.
“One of the key takeaways is that equity in digital health cannot be achieved through isolated actions but requires a coordinated, whole-system approach to ensure equitable regulation, implementation and evaluation of digital health.”
The digital transformation of health systems has been accelerating rapidly, changing how people access health information and engage with their health systems.
However, without equity at the core of this transformation, the benefits of digital health and artificial intelligence risk being distributed unevenly, further marginalising populations already experiencing disadvantage.
A 2022 study by WHO/Europe and Public Health Wales had already established that digital health technologies are not equally accessible to all communities and areas in the WHO European Region.
It showed that people with poor health and living with a disability, older people, migrants and those with a lower socioeconomic status are struggling the most in accessing these tools.
This new review covers literature published between 2015 and 2024.
It assessed 154 articles to identify where good practices and persistent gaps exist.
Major regulations in the European Union and the US focus on privacy, safety and accountability. However, they rarely involve vulnerable or marginalised groups in decisions about how digital tools and data are designed and governed, the report found.
Most rules also look at bias in terms of ethnicity and gender, paying less attention to language, income, location or disability status.
In addition, current regulations often overlook whether patients and health professionals have the access or skills needed to use these new tools effectively.
Guidance on digital health often highlights the need for strong governance and infrastructure.
Yet there is still limited clarity on what is required to ensure equity in practice.
Evaluation frameworks remain fragmented, rarely focusing on whether new technologies meet the needs of underserved populations. For AI-driven health technologies in particular, equity, bias and fairness checks are not yet standard practice.
The report recognises that achieving equity in digital transformation is complex.
This is why equity needs to be built into every stage of designing and implementing digital health interventions, rather than as an afterthought.
Alisha Davies, deputy director for research, data and digital at Public Health Wales, said: “Digital health has the potential to transform health and care systems, and improve population outcomes, but only if equity is embedded at every stage.
“Our review shows that while equity is increasingly recognized, its integration into the regulatory, implementation and evaluation frameworks remains inconsistent.
“The findings highlight the need for a socio-technical approach, as digital innovation does not operate in isolation, alongside an equity-by-design approach to ensure digital health reduces, rather than reinforces, health inequities.”
