New dimensions of social inequality in the context of healthcare digitalization

Elena Bogomiagkova,
Associate Professor,
St. Petersburg State University,

Today, the healthcare digitalization, due to the advent of the Internet Web 1.0 and Web 2.0., ceases to be a distant prospect, and the global COVID-19 pandemic unfolded in 2020 gives this process an additional impetus. The issues of d-Health are included in the agenda of such international organizations as WHO, the UN, the European Commission, and are also becoming a priority area of social policy in many countries. First, it is said about dramatic systemic and institutional transformations of the medical sphere. Here we can mention the spread of online communication within the professional community, the generation and storage of big data, the creation of a unified information system based on a single electronic medical record of a patient, the production and prescription of digital medicines, and much more. At the same time, the integration of digital technologies into diagnosis, treatment and prevention of diseases is becoming a routine of modern people, transforming their patient experience. The ways of using innovations in everyday life vary from telemedicine to digital self-tracking. Today, when healthcare professionals lose their monopoly on providing medical care, the place of interaction with a doctor is occupied by a network where members, in addition to physicians, are bloggers, relatives, Internet sites, gadgets, mobile applications etc., and the patient is in the center.

Digitalization is associated with the hopes of healthcare democratization, personalization and a greater accessibility of medical care for different social groups. Being one of the sides of the movement towards 4-P medicine, d-Health contributes to patient self-empowerment. Today a patient is required to be responsible, conscious, and proactive, independently controlling his well-being and having a significant influence on decision-making. Moreover, a patient is encouraged be digitally engaged and to collaborate with medical institutions. Ultimately, the main aim of d-Health is development and application of the most effective tools for providing high-quality health care, and as a result is improving health of the population.

However, the healthcare digitalization, on the one hand, opens up new prospects for preserving and maintenance health, on the other hand, it also carries new risks and threats. One of these risks is the emergence of new dimensions of social inequality that leads to differences in health. First, we are talking about well-known digital gaps. People who have limited or no access to the Internet and new technologies turn out to be in a vulnerable position, which does not allow them to participate in digital health programs. In addition, such digital competencies as the ability to find, evaluate and analyze online medical information and apply it to solve health problems also contributes to the new discrepancies. As a result, getting medical care is determined not so much by territorial and temporary constraints, that are being overcome, as by the patient integration into digital culture as a whole and the experience in using technological innovations. Thus, the newest differentiation arises between advanced users living in augmented reality, combining online and offline self-care practices, and those who continue to live completely in the analog world. The key resource in this case is the access points to technologies, and therefore, the ability to be involved in technologically mediated ways of taking care of health. Secondly, inequalities arise not only between patients, but also between medical institutions that also act as such access points. Healthcare organizations differ both in the level of equipment with digital technologies, and in the new competencies which medical professionals possess. The patient is faced with a new system of multidimensional inequality.

The consent and ability to live in a hybrid contemporary world, combining online and offline self-care practices, are becoming new determinant of health and well-being today. Differences in intensity, regularity and duration of using digital technologies in health care practices of a modern patient are manifested in increasing inequalities in health. Among the risk groups are the elderly, representatives of low-income groups, people with a low level of education, residents of rural areas, less developed regions and countries. So, those who are not protected in offline space hold this status in online. They use digital technologies less intensively and, as a result, aggravate and deepen social inequality, bringing together existing differences with new ones. Even though digital technologies are implemented to make current healthcare more personalized, democratic and accessible, they contribute to the new gaps, including inequalities in health.


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