Digitalization in Health: how to avoid new forms of exclusion?
Digitalization has become one of the biggest drivers of healthcare modernization around the world. From electronic medical record systems to AI applied to diagnostics, telemedicine and remote monitoring solutions, technology is opening doors to more effective, efficient and potentially more equitable care. However, in less developed countries, where deep structural and social weaknesses persist, this digital revolution requires a close look. If it is not handled with sensitivity, planning and inclusion, it risks becoming a new factor of exclusion for the most vulnerable populations.
According to a report by the International Telecommunication Union (ITU), 2.6 billion people – around a third of the world’s population – still don’t have access to the internet. This reality is mainly concentrated in regions of sub-Saharan Africa, South Asia and rural areas of Latin America, where access to digital devices, electricity and connectivity infrastructure remains limited. Even where there is network coverage, factors such as the high cost of mobile data, the sharing of devices in the household and the lack of digital literacy prevent effective use of digital services. So while in some regions the transition to digital health systems represents a natural evolution, in other contexts it can pose a barrier to access.
The World Health Organization (WHO), in its Global Strategy for Digital Health 2020-2025, recognizes the potential of digital technologies to improve the coverage and quality of services, but warns that their implementation must be aligned with the principles of equity, ethics and human rights. The WHO stresses that countries must ensure that their populations have the capacity to use, understand and benefit from these technologies, which requires structural investments in digital literacy and professional training, particularly in the most fragile contexts.
AI represents a particularly promising emerging field, but one that also requires caution. AI tools have already shown positive results in supporting the diagnosis of diseases such as tuberculosis, diabetic retinopathy and certain types of cancer, even in contexts with a shortage of specialized professionals. However, the WHO itself, in its 2021 report on the ethics and management of AI, warns of the risk of bias in algorithms. AI systems are trained with large volumes of data, and if that data doesn’t properly represent global diversity (just remember that it mostly comes from more developed countries) – the results could be inaccurate or unfair. The WHO argues that algorithms should be transparent, auditable and tested on different populations before being implemented on a large scale.
Despite the risks, the benefits already demonstrated in various contexts show that digitalization in health significantly improves the realities in which it is applied. In several countries with less economic capacity, simple programs based on text messages have contributed to improving adherence to prenatal consultations, increasing vaccination rates and strengthening the follow-up of chronically ill patients. The WHO and UNICEF themselves have highlighted in recent reports, the role of digital technologies in the response to the COVID-19 pandemic, particularly in communicating with the population, contact tracing and logistical coordination in socio-economically vulnerable regions. These examples show that, when well planned and executed, digital solutions can have a real and positive impact on public health, even in environments with limited infrastructure.
For the digitalization of health to be inclusive, strategies are needed that combine technological innovation with social responsibility. This implies a coordinated effort to ensure that no one is left behind. Governments must invest in creating environments conducive to innovation, but also in strengthening digital infrastructure, training professionals and the digital literacy of populations. It is essential that technological solutions are designed in dialogue with their users, respecting their needs, contexts and capabilities. No technology is a panacea in itself – the great differentiator lies in how we use it. By recognizing and tackling ethical obstacles, and investing in solutions that prioritize fairness and safety, we can prevent advances from becoming a new kind of exclusion. On the contrary, there is an opportunity to turn them into tools for unprecedented inclusion.
The digital transformation of health, when guided by human values and local adaptability, has the potential to strengthen health systems and reduce inequalities, promoting a future in which innovation belongs to everyone.
* This article was originally published in Jornal Médico.
