Digital solutions can increase health inequalities for people in rural areas

Most of us wake up not to the sound of birds chirping, but to the tones of our iPhone or Samsung. These little devices not only replace the old landline phone, but often also serve as our alarm clock, egg timer, guide, email, calendar, workout buddy and audiobook reader.  

We have become digital by default, not just as individuals but as a society, and this naturally places demands on our digital and technical skills.

But while many of us check e-Boks as easily as we used to check the physical mailbox, the digital reality is not quite so straightforward for a larger group, including the elderly and the resource-poor, who often need analogue alternatives to digital solutions.

And since this group is largest in areas with the longest distances to health services, presenting technology as part of the solution to reducing distances to health services could end up increasing social inequalities in health for people in rural areas, warns Egon Noe, head of the Centre for Rural Research at the University of Southern Denmark in Esbjerg. 

Weaker digital skills

Together with a colleague, he has just completed a new study that reviews existing research in rural health. Among other things, the study shows that people in rural areas generally have poorer health skills than those in urban areas.  

Health competences are about the ability of individuals to take care of themselves in relation to healthy lifestyles and to manage chronic diseases such as diabetes, heart problems and COPD. And it's about our skills to navigate the healthcare system to get the right help and treatment.

- It's not as if living in rural areas automatically makes you less competent. But demographic change has meant that a larger group of elderly and resource-poor people live in rural areas than in cities, and this group generally has poorer health skills, says Egon Noe.

He explains that the elderly and resource-poor have particularly poorer health skills in terms of understanding information about healthy living and generally have poorer digital skills. They are also less likely to seek out health services themselves and often do not search for health information online.  

Technology can generate inequality

According to the rural researcher, there are some clear geographical arguments that digital solutions can help reduce health inequalities in rural areas, as technology reduces the importance of geographical distance.

However, each technology also places varying demands on users, which can increase mental distance and thus social inequality.

- You need to be technically able to use the technology and understand the digital language. If digital solutions are to compensate for physical contact, then this requires knowledge of how to express oneself digitally rather than analogically, explains Egon Noe.

- That's why the people who benefit most from technology are those who use it best, and that's rarely the elderly or the resource-poor. Instead of reducing health inequalities, digital solutions can unintentionally become a generator of inequalities.

The technology must be adapted

The rural researcher points out that it's not about communication technologies being bad. We just can't naively think that they solve the whole inequality problem.

- This should not be understood as a romantic idea of the old days. We should not roll back history, but we should be interested in what new types of inequality-generating mechanisms we are creating with new technology and how we can mitigate them.

According to Egon Noe, this is partly about adapting the technology to the patient. And then we need to keep in mind how we develop and implement the digital solutions in practice.

- That's another aspect of mental distance. Technologies can help enable and maintain greater mental distance because you are training and practising in a different area to where the technology is being used. We train health professionals and develop the technologies in urban areas, but use it in rural areas, and that can help maintain inequality," he concludes:

- We may be digital by default, but if we want to address health inequalities in rural areas, we need to devote more resources to making focused interventions for the resource-poor. And we need more research into digital solutions that focuses not only on the positive effects, but also the negative ones.

You can read the report on health inequalities here