By Sascha Marshang, Director for Operations and Membership and Weronika Gryko, Policy Assistant

“Digital technology has become part of the fabric of modern society, and the EU must be at the forefront in creating the right conditions for allowing digital developments to flourish. 52% of citizens wish to have electronic access to their health records. We must work harder to make this happen.”

These comments from Vytenis Andriukaitis’ (European Commissioner for Health and Food Safety) came during e-Health week in May 2017, with the  publication of the mid-term review of the Digital Single Market (DSM) Strategy.   Replacing the mid-term review of the eHealth Action Plan 2012-2020, for the first time health is included in the strategy, with the acknowledgement that “digital technologies can help improve people’s health and contribute to the sustainability and resilience of Europe’s healthcare systems.” 

Digital solutions are increasingly being seen as the answer to meet critical health challenges such as the prevalence of chronic and infectious diseases and to ease the strain that an ageing population puts on national health systems by enabling access to electronic health records (including in a cross-border context) and facilitating interaction between users and health care providers. If digital health is widely adopted and integrated in healthcare systems, annual savings in Europe resulting just from the use of mobile health applications, are estimated at €69 billion. 

But as EPHA highlighted three years ago in the EPHA-led ‘Health inequalities and eHealth’ report by the eHealth Stakeholder Group, these solutions must be affordable and accessible for everyone  otherwise the health inequalities gap will only get larger.

Underpinning a move to digital health is the need for digital literacy[1] to enable people to distinguish between beneficial and detrimental eHealth tools. Most innovative technologies are designed for the general population in order to attract as many people as possible, and their users are expected to be digitally literate to a certain level. Some potentially vulnerable groups such as e.g. older people, the disabled, people with low socio-economic status, migrants and Roma communities, however, might experience serious difficulties with enjoying the benefits of eHealth solutions due to the ‘digital divide’.

 Why is it important to include everybody? 

Digital exclusion drives a vicious circle of negative outcomes for non-traditional eHealth users, and in a broader perspective it creates serious obstacles for the enhancement of eHealth as a public good. The well-being of people from disadvantaged groups is frequently determined by the level and intensity of social interactions. Social media can enable people living in vulnerable or isolated situations to belong to a community, where they may find like-minded individuals with whom they can share their experiences and struggles, and to whom they can turn for practical advice.

However, the digital health revolution has to face and address inequalities affecting ‘non-traditional eHealth users’. Further digital disparities are seen between young users and older people. Youth effortlessly adapts to digital environments, but since they are so strongly drawn to them, they also become easy targets of manipulation and misinformation while older people can experience problems accessing digital solutions and understanding how they work. 

Opening the window to digitally inclusive society: How to ensure digital INclusion? 

For eHealth solutions to become widely accepted, and increase take-up by non-traditional and vulnerable user groups, it is important for them to be as accessible, affordable and user-centric as possible.” 

Social Platform’s strategic action ‘Leaving no one behind – prioritizing people in vulnerable situations,’ which EPHA recently joined, aims to identify crucial challenges, share knowledge and good practices, and advocate for the prevention of digital health exclusion. There are numerous activities which can ensure digital inclusion, such as tailoring digital solutions to the needs of vulnerable and socially isolated groups; creating user-generated content/services; community-building as a place to learn digital skills and counteract exclusion from society and the healthcare system; and ensuring the inclusion of digital health inequalities into national eHealth strategies.

What happens next? 

The Commission is now preparing a Communication that will address the need and scope for further measures in the area of digital health and care, in line with evolving legislation on the protection of personal data, patient rights and electronic identification. It will place emphasis on citizen empowerment and patient-centred care, for example by focusing on tackling chronic diseases and gaining a better understanding of actual health outcomes. A public consultation (replacing the mid-term review of the eHealth Action Plan 2012-2020) will also be launched before the summer to consult stakeholders on how the future of healthcare in digitised world should look like. EPHA states that only inclusive and ethical integration of digital health solutions into national health systems will ensure improved access to healthcare and that everyone benefits from the digital revolution.

[1] Chan, Connie and Kaufman, David (2011), ‘’A Framework for Characterizing eHealth Literacy Demands and Barriers’’. Journal of Medical Internet Research, Vol. 13, No 4.

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