This post is the second in a five-part series on disparities and digital health. The first was about measuring what you want to manage.
This time I want to talk about the “Digital Divide,” a phrase that’s been bandied about for the more than 15 years that I’ve been in this field. Before we look at how the divide impacts health specifically, let’s see better understand its impact on digital technology generally.
It’s Real, But it’s Complicated
Race is among the most pronounced lines in the Digital Divide in the US. While overall 74% of Whites have a Broadband connection at home, only 62% of African Americans do. But the divide isn’t uniform. Among the young (under 29), highly educated (college plus) and wealthy ($75K or more per household per year), Whites and African Americans show equal amounts of Broadband use. The ones “left behind” are the most vulnerable populations—elderly, less educated, and poor—whose ranks are also disproportionately African American.
But just because people aren’t using Broadband a lot or at home doesn’t mean they aren’t using digital technology. Households that make less than $30K per year text twice as much as those who make more than $75K a year. Hispanics text 1.6 times, and African Americans text 2.4 times as often as Whites. (Source: Pew via Institute for eHealth Equity).
When it comes to phones, among both Whites and African Americans, 92% own cell phones, 56% own smart phones. Progress! Interestingly, though, according to Nielsen, African Americans use smart phone apps more than any other racial group, and they also lead in Twitter use (16% of online Whites use Twitter, compared to 22% of online African Americans, predominantly among younger populations, according to Pew).
The Digital Divide in Health
According to the Office of the National Coordinator for Health IT (ONC), the overall proportion of Americans using health IT (defined as texting or emailing healthcare providers, using health apps, and accessing online test results) has been increasing for the last several years, though it’s still under 50%. Not surprisingly, people who use health IT most are the wealthiest and most highly-educated. African Americans and Hispanics use it the least, while Whites and Asians use it the most.
But here’s something pretty interesting. When populations who are “underserved” do access their health information online, they tend to benefit disproportionately. The graph below is from a survey I worked on with the California Healthcare Foundation back in 2010. It shows the proportion of people with access to a personal health record (PHR) who took positive steps to improve their health (such as asking their doctor questions, or changing a behavior) as a result. People with the lowest incomes and education levels were most likely to take action as a result of digital health. This isn’t the only time I’ve seen this phenomenon, though I wonder how much it continues as technology becomes increasingly ubiquitous.
What do these stats mean for you? Well, you need to understand the specific digital channels favored by members of the group you are trying to reach—don’t make generalized assumptions about who will or won’t use technology, and who might benefit most. Tailor your programs to meet people on the platforms they are already using.
The Federal Communications Commission’s (FCC) Lifeline program has subsidized low income Americans using landline phone service for 30 years, and, as of 2008, wireless service. In June of 2015, the FCC voted to expand the program to include Broadband Internet.
Check out this post by HIMSS’ John Sharp for more.
VozMob is a platform for immigrant and/or low-wage workers in Los Angeles to create and share stories about their lives and communities directly from cell phones. Stories can be about any topic, but sometimes they feature health and healthcare themes. VozMob helps people with the least sophisticated technology share their voices with a broad audience. It was created via a collaborative process based on significant input from members of the community.
What aspects of the Digital Divide have you encountered? How have you addressed them? Please share your thoughts and experience! And stay tuned for the next installment in this series, Leveraging Digital Strategies to Address Health Disparities: Design for Your Population’s Needs.