Digital health in pursuit of universal health coverage and equity challenges

Abstract

The COVID-19 pandemic has accelerated the adoption of digital health technologies worldwide, positioning them as pivotal tools in the pursuit of universal health coverage (UHC). This commentary critically examines the dual potential of digital health: while innovations such as telemedicine, mobile health applications, and electronic health records have, in certain contexts, expanded access, improved efficiency, and strengthened health system resilience, they have also exposed and exacerbated longstanding inequities. The analysis drawing on examples from both high-income and low- and middle-income countries, highlights how the digital divide rooted in disparities of infrastructure, affordability, digital literacy, and trust systematically excludes marginalized groups including the poor, elderly, rural residents, and people with disabilities. Case studies from diverse global settings reveal both the transformative promise of inclusive digital health initiatives and the persistent risks of digital exclusion. This positioning is particularly relevant to social, cultural, and nature-based prescribing, where digital systems may support referral, navigation, follow-up, and equity monitoring, but may also exclude populations with limited digital access, low digital literacy, disability, language barriers, or mistrust of digital platforms. To ensure digital health acts as a bridge, not a barrier, to UHC, this commentary reinforces and refines evidence-based policy recommendations previously proposed in the literature, updating them with insights from recent global health crises like COVID-19 and emerging data on digital exclusion. Building on established frameworks, we advocate for prioritizing inclusive design with a focus on intersectional barriers, investing in infrastructure and digital literacy tailored to post-pandemic recovery needs, enacting robust data protection regulations informed by recent cybersecurity challenges, fostering community engagement through localized trust-building models, and embedding equity-focused monitoring and evaluation using real-time, disaggregated data to address persistent gaps. These refinements aim to bridge the gap between high-level policy and actionable, context-sensitive implementation, enhancing their relevance and impact for achieving UHC. The conclusion underscores that digital health is not a panacea; its impact on health equity depends on deliberate, context-sensitive strategies that centre the needs of the most vulnerable. As health systems increasingly digitize, the imperative remains to ask: who benefits, and who is left behind? Only by addressing these questions can digital health truly advance the goal of health for all.