T here are high expectations for the public health impact of digital health in low- and middle- income countries. It is often assumed that widespread and growing access to mobile phones will allow mobile health interventions (mHealth) to reach families across the globe. Such enthusiasm should be tempered by an understanding of health equity principles. Hart’s 1971 ‘inverse care law’ stated that the availability of quality medical care is often inversely proportional to the population’s need for it. In 2000, I came up with a corollary to this law – the inverse equity hypothesis – proposing that new health interventions, particularly those resulting from technological innovations, will tend to be initially adopted by and benefit the most advantaged populations, thereby increasing health inequalities, at least in the short term. DIGITALLY DISCONNECTED, DECLINING OUTCOMES My colleagues and I recently applied these principles to mHealth efforts aimed at reaching unvaccinated, or zero-dose, children. By analysing pooled data from recent national surveys in 70 LMICs, we found a clear link between a lack of immunisations and digital exclusion by
Poor, sick and unconnected: The paradox of digital health
Digital health promises to transform healthcare access, but the poorest and most vulnerable risk being left behind. Unless digital and social exclusion is addressed, innovations could deepen, rather than reduce, health inequities
Cesar Victora, professor emeritus of epidemiology, Federal University of Pelotas, Brazil
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Health: A Political Choice – The Future of Health in a Fractured World
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