A recent scoping review led by WHO/Europe and Public Health Wales has found that people with greater health needs and language barriers still struggle to use digital health services and technologies, mainly due to limited access, low digital literacy and services being poorly adapted to diverse needs.

The review also found that inequities 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 enabling governments to provide oversight, the review found.

WHO/Europe’s Director of Health Systems Dr Natasha Azzopardi-Muscat said one of the main objectives of the 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.”

Equity in digital 

The review notes 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 (AI) risk being distributed unevenly, further marginalizing populations already experiencing disadvantage.

WHO/Europe Regional Adviser for Data, Artificial Intelligence and Digital Health Dr David Novillo Ortiz said “equity should never be treated as an afterthought in the development and implementation of digital health technologies.”

“If someone in a rural area cannot access a telehealth consultation because it requires high-speed internet that is unavailable in their village, then innovation is failing the very people it should serve.”

“By understanding social and technical factors that shape digital health inequalities, we can remove barriers and help underserved communities fully benefit from digital health technologies.”

An earlier 2022 study by WHO/Europe and Public Health Wales had established that digital health technologies were 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.

Regulation, implementation and evaluation

The new review covered literature published between 2015 and 2024 and assessed 154 articles to identify where good practices and persistent gaps exist.

Public Health Wales Deputy Director for Research, Data and Digital Alisha Davies said digital health had the potential to transform health 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.”

Next steps

The report notes that achieving equity in digital transformation is complex and suggests this as is why equity needs to be built into every stage of designing and implementing digital health interventions – rather than as an afterthought.

Moving forward, the review highlights several considerations to advance equity in digital health across the WHO European Region. 

These include using a whole-system approach, strengthening regulation and governance, ensuring equitable financing and building capacity across sectors.

Achieving digital health systems that deliver equitable benefits for all populations remains a central priority for WHO under the Regional Digital Health Action Plan for the WHO European Region 2023–2030 and the Global Strategy on Digital Health 2020–2025.