As healthcare systems rapidly embrace digital technologies, a new international review has raised concerns that millions of people are being left behind — particularly those who need care the most.

A recent scoping review led by WHO/Europe in collaboration with Public Health Wales has found that people with greater health needs, limited digital access, and language barriers continue to struggle to benefit from digital health services.

The findings point to a growing “digital divide” in healthcare, driven by limited internet access, low digital literacy, and technologies that are not designed for diverse populations. Experts warn that unless these gaps are addressed, the digital transformation of healthcare could end up widening existing inequalities instead of reducing them.

The review highlights that while many countries now mention “equity” in their digital health strategies, it is often only in principle. In practice, there are few clear standards or systems in place to ensure that these technologies are accessible and inclusive for all.

Natasha Azzopardi-Muscat said the goal of the review was to understand what is truly driving inequality in digital health systems worldwide.

“One of the key takeaways is that equity cannot be achieved through isolated efforts,” she explained. “It requires a coordinated, whole-system approach — from regulation and design to implementation and evaluation.”

The report comes at a time when digital health tools — including telemedicine, mobile health apps, and artificial intelligence — are transforming how patients access care and interact with health systems. But experts caution that innovation without inclusion risks leaving vulnerable populations further behind.

David Novillo Ortiz stressed that equity must be built into the system from the start. “If someone in a rural area cannot access telehealth because of poor internet connectivity, then the system is failing them,” he said.

Earlier research conducted in 2022 had already shown that access to digital health tools is uneven across the WHO European region. Groups most affected include older adults, people with disabilities, migrants, and those from lower socioeconomic backgrounds.

The latest review, which analysed 154 studies published between 2015 and 2024, found that these disparities persist — and in some cases, are deepening.

Alisha Davies noted that while digital health has enormous potential to improve care and outcomes, equity must be embedded at every stage.

“Digital innovation does not exist in isolation,” she said. “We need a socio-technical approach — one that considers both the technology and the real-world conditions in which people use it.”

One of the key concerns raised in the report is that current regulations in regions such as the European Union and the United States tend to focus heavily on privacy, safety, and accountability, but often overlook inclusion.

Vulnerable groups are rarely involved in decisions about how digital tools are designed or governed. In addition, most regulations focus on biases related to gender and ethnicity, while paying less attention to factors such as language, income, geographic location, or disability.

The review also points out that many policies fail to consider whether patients — and even healthcare providers — have the necessary skills, resources, or infrastructure to effectively use digital tools.

Despite growing awareness, there is still little clarity on how to translate the idea of “equity” into real-world practice. Evaluation systems remain fragmented, and few frameworks specifically measure whether digital health technologies are reaching underserved populations.

This gap is particularly concerning in the case of AI-driven healthcare tools, where checks for bias, fairness, and accessibility are not yet standard practice.

Experts say the message is clear: digital health can transform care, but only if it is designed for everyone.

Without stronger policies, better infrastructure, and a focus on inclusivity, the very technologies meant to improve healthcare could end up reinforcing the inequalities they aim to solve.