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22 Understanding Emerging Digital Health Disparities

  • Trisha Greenhalgh , Tiffany Veinot und Laiba Husain
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De Gruyter Handbook of Digital Health and Society
Ein Kapitel aus dem Buch De Gruyter Handbook of Digital Health and Society

Abstract

Inequities in digital health should be interpreted in the context of inequities more generally. Social determinants (upstream or ‘structural’ causes of inequity) include poverty, poor living conditions, racism and discrimination, exposure to crime and adverse childhood experiences; they exert their effects through multiple, mutually reinforcing mechanisms. Social determinants may become built into technologies and technology-supported pathways (e.g., as algorithmic biases), leading to entrenchment of inequities – but there is also the potential proactively to harness technologies to reveal inequities and contribute to mitigating them. Bourdieu’s theory of capital, in which privileged individuals are seen as amassing and exchanging various forms of capital (economic, cultural, symbolic) has been extended to embrace ‘digital capital’ (devices, technical knowledge and social connections on which to draw when using technologies). Crenshaw’s intersectionality theory cautions against using single-axis categories of disadvantage (‘race’, ‘gender’) since individual identity, shaped by multiple influences, is unique and singular; designing for inclusivity should embrace diversity but avoid stereotyping. We discuss various approaches to increase equity in digital health, including fairer AI design, development of ‘upstream’ digital interventions, human intermediaries such as digital navigators, participatory research and design, and personas. We conclude with a call to action to design and implement theory-informed initiatives that address social determinants, engage marginalised communities, and prospectively guard against bias and potential intervention-generated inequalities.

Abstract

Inequities in digital health should be interpreted in the context of inequities more generally. Social determinants (upstream or ‘structural’ causes of inequity) include poverty, poor living conditions, racism and discrimination, exposure to crime and adverse childhood experiences; they exert their effects through multiple, mutually reinforcing mechanisms. Social determinants may become built into technologies and technology-supported pathways (e.g., as algorithmic biases), leading to entrenchment of inequities – but there is also the potential proactively to harness technologies to reveal inequities and contribute to mitigating them. Bourdieu’s theory of capital, in which privileged individuals are seen as amassing and exchanging various forms of capital (economic, cultural, symbolic) has been extended to embrace ‘digital capital’ (devices, technical knowledge and social connections on which to draw when using technologies). Crenshaw’s intersectionality theory cautions against using single-axis categories of disadvantage (‘race’, ‘gender’) since individual identity, shaped by multiple influences, is unique and singular; designing for inclusivity should embrace diversity but avoid stereotyping. We discuss various approaches to increase equity in digital health, including fairer AI design, development of ‘upstream’ digital interventions, human intermediaries such as digital navigators, participatory research and design, and personas. We conclude with a call to action to design and implement theory-informed initiatives that address social determinants, engage marginalised communities, and prospectively guard against bias and potential intervention-generated inequalities.

Kapitel in diesem Buch

  1. Frontmatter I
  2. Acknowledgements
  3. Contents V
  4. I Theorising Digital Health & Society
  5. 1 Digital Health and Society: A Research Agenda 1
  6. 2 Foucault, Governmentality, and the Biopolitics of Digital Health 25
  7. 3 New Materialist Approaches to Digital Health 41
  8. 4 Postphenomenology and Affordances of Digital Health Technologies 59
  9. 5 Therapeutic Encounters with Chatbots: Towards a Sociological Approach to Human–Machine Communication 77
  10. II Digital Technologies & Health Practices
  11. 6 Expert Patients and Evil Technology? Situating Users, Platforms and Expertise in Social Media Health Content 95
  12. 7 Digital-Sensory Work in Diagnosis 113
  13. 8 The Digital Clinician–Patient Consultation 127
  14. 9 Care By, For, and With Robots: Re-Thinking Agency at the Human–Machine Interface 147
  15. 10 Analysing the Value of Community Assets for Mental Health Support: Digital Assemblages, Creative Arts and Peer Support 163
  16. 11 Digital Pharmaceuticals in Emerging Forms of Mental Health Care 183
  17. III Organising & Managing Digital Transformation
  18. 12 Unintended Consequences of Digitalisation in Health Care 199
  19. 13 Medical Work in the Wake of Machine Learning 217
  20. 14 Organising Cross-Border Health Data Infrastructures 233
  21. 15 Governing Citizen-Patients: The Digital Infrastructuring of Health and Care in Europe 255
  22. 16 Digital Therapeutics (DTx) As a ‘Technical Milieu’: Overcoming Psychic and Economic Alienation Rather Than Playing Catch-Up 279
  23. IV Methods For Digital Health R esearch & Innovation
  24. 17 Ethnographic Approaches for Researching Digital Health Environments 303
  25. 18 Creative and More-Than-Human Approaches to Digital Health Research 327
  26. 19 How to Use Feature Analysis to Reveal Dominant Norms and Assumptions in a Set of Apps 345
  27. 20 Norms of Co-design for Digital Health Innovation 363
  28. 21 Data-driven Approaches in Biomedical Research 381
  29. V Socio-Political Challenges & The Governance Of Digital Health
  30. 22 Understanding Emerging Digital Health Disparities 401
  31. 23 Digital Technologies and Loneliness: Towards a Sociological Approach 425
  32. 24 Digital Health Citizenship – a Spectrum from Invited to Uninvited Participation 443
  33. 25 Digitalisation in the Global South: Health Platforms and the Phenomenon of Epistemic Colonialism 463
  34. 26 Data Solidarity, Public Value and the Future of Health Data Governance 481
  35. 27 Governing Digital Transformations for Health 499
  36. List of Contributors
  37. Index
https://doi.org/10.1515/9783111247854-022

Kapitel in diesem Buch

  1. Frontmatter I
  2. Acknowledgements
  3. Contents V
  4. I Theorising Digital Health & Society
  5. 1 Digital Health and Society: A Research Agenda 1
  6. 2 Foucault, Governmentality, and the Biopolitics of Digital Health 25
  7. 3 New Materialist Approaches to Digital Health 41
  8. 4 Postphenomenology and Affordances of Digital Health Technologies 59
  9. 5 Therapeutic Encounters with Chatbots: Towards a Sociological Approach to Human–Machine Communication 77
  10. II Digital Technologies & Health Practices
  11. 6 Expert Patients and Evil Technology? Situating Users, Platforms and Expertise in Social Media Health Content 95
  12. 7 Digital-Sensory Work in Diagnosis 113
  13. 8 The Digital Clinician–Patient Consultation 127
  14. 9 Care By, For, and With Robots: Re-Thinking Agency at the Human–Machine Interface 147
  15. 10 Analysing the Value of Community Assets for Mental Health Support: Digital Assemblages, Creative Arts and Peer Support 163
  16. 11 Digital Pharmaceuticals in Emerging Forms of Mental Health Care 183
  17. III Organising & Managing Digital Transformation
  18. 12 Unintended Consequences of Digitalisation in Health Care 199
  19. 13 Medical Work in the Wake of Machine Learning 217
  20. 14 Organising Cross-Border Health Data Infrastructures 233
  21. 15 Governing Citizen-Patients: The Digital Infrastructuring of Health and Care in Europe 255
  22. 16 Digital Therapeutics (DTx) As a ‘Technical Milieu’: Overcoming Psychic and Economic Alienation Rather Than Playing Catch-Up 279
  23. IV Methods For Digital Health R esearch & Innovation
  24. 17 Ethnographic Approaches for Researching Digital Health Environments 303
  25. 18 Creative and More-Than-Human Approaches to Digital Health Research 327
  26. 19 How to Use Feature Analysis to Reveal Dominant Norms and Assumptions in a Set of Apps 345
  27. 20 Norms of Co-design for Digital Health Innovation 363
  28. 21 Data-driven Approaches in Biomedical Research 381
  29. V Socio-Political Challenges & The Governance Of Digital Health
  30. 22 Understanding Emerging Digital Health Disparities 401
  31. 23 Digital Technologies and Loneliness: Towards a Sociological Approach 425
  32. 24 Digital Health Citizenship – a Spectrum from Invited to Uninvited Participation 443
  33. 25 Digitalisation in the Global South: Health Platforms and the Phenomenon of Epistemic Colonialism 463
  34. 26 Data Solidarity, Public Value and the Future of Health Data Governance 481
  35. 27 Governing Digital Transformations for Health 499
  36. List of Contributors
  37. Index
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Heruntergeladen am 26.1.2026 von https://www.degruyterbrill.com/document/doi/10.1515/9783111247854-022/html
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