How Do We Shape a More Inclusive Future in Digital Health?

As published on Devex on November 1, 2024.

While digital health tools are growing rapidly, there’s a risk that these advancements could deepen existing divides. Devex speaks to Rabin Martin’s Rajni Samavedam about the challenges and opportunities at the intersection of digital health and equity.

In the wake of the recent United Nations General Assembly and ongoing global conversations around digital health, particularly the digital divide, the role of equity in health technology calls for increasing attention.

“It’s really important that we keep these discussions alive,” said Rajni Samavedam, CEO of global health strategy consulting firm Rabin Martin. While digital health tools are growing rapidly, there’s a risk that without a deliberate focus on equity — including gender and other intersectional factors — these advancements could deepen existing divides, Samavedam explained.

Speaking with Devex, Samavedam shared insights on the challenges and opportunities at the intersection of digital health and equity, and how public, private, and nonprofit sectors can work together to shape a more inclusive health ecosystem. She also highlighted the critical role of women and diverse communities in these efforts, offering a forward-looking perspective on the future of health equity.

“We have an opportunity now, before it gets too far ahead of us and creates further divides, to rework existing and develop new frameworks, policies and regulations that reduce inequities,” Samavedam said.

This conversation has been edited for length and clarity.

Where do you see the most significant gaps in digital health and data equity when it comes to gender equity?

Despite women representing 51% of the global population, they remain significantly underrepresented in clinical trials and research, which drive much of the innovation in therapeutics and digital health tools. There are several hundreds of thousands of digital health applications that are direct to consumers — and maybe tens of thousands that are for providers — but how many of those have really been designed with a lens that considered equity?

There are several areas that we have to be thinking about when it comes to the gaps in gender and digital health equity.

First, women, particularly in low- and middle-income countries, face barriers with digital health technology. That may be a lack of education, the autonomy to freely purchase and incorporate the tools, or culturally driven restrictions. Many tools do not account for the different cultural contexts. Experience varies across age groups, regions, and communities. Not only do they have different rules and regulations in place, but culturally, how they might be perceived and accepted varies.

Second, if you don’t have the right data representation, tools could be misrepresenting health needs and treatment protocols.

About 70% of community health workers are women — these are the individuals who are delivering essential health care. So when we are talking about the gender divide, we are not only talking about women as patients, we are talking about the health care workforce too.

Also, there may also be hesitancy in using some of these technologies if you don’t understand the privacy and security aspects. You have to be able to trust that the tool is going to keep your information private and that it’s going to be used for health purposes.

When developing and disseminating these tools, we must ask: Who is benefitting and who is not, where does this tool fit in the larger digital ecosystem for that user, and are we creating or exacerbating existing inequities?

In what ways is digital health transforming women’s health outcomes, particularly in underserved regions?

The fact that we are having discussions on the essential nature of digital tools and technology at many of the larger public and global health convenings — such as the World Health Assembly and the U.N. General Assembly — is exciting and important. These tools are increasingly integral to the entire health care ecosystem, and so elevating the concerns about gender equity and the digital divide at these events will aid in influencing policy, strategy, and process.

In a recent article, Bill Gates writes about the promise we are already seeing from a Digital Public Infrastructure, for example, in vaccination campaigns in Africa where vaccinators are being paid for their services. Per the point earlier about community health workers, we hope this helps with this gender pay disparity.

There’s also significant investment in “femtech” — some estimates that it will be a $1 trillion industry by 2027 — with companies like Maven Clinic focusing on women’s health and reproductive care. These issues weren’t in everyday conversations. So we are bringing them to the forefront of health and other sector conversations recognizing the positive impact that this has on the health of women as well as the global economy.

There are also a lot of digital platforms out there offering information and education to women, as well as telemedicine and mobile health apps. We are allowing people in different regions, especially those far from medical centers or lacking convenient access to care, to receive care in a timely way. But we do have a ways to go.

What emerging technologies or innovations in digital health stand out when thinking about advancing gender equity and improving women’s health outcomes in the future?

We are fortunate to work with programs like MSD for Mothers that are investing in digital tools to improve maternal health outcomes. One of those areas is the gender digital divide, including a Safe Delivery App for health care workers.

We can also learn from other applications of digital tools or AI. For example, we work with the Global Commission to End the Diagnostic Odyssey for Children with Rare Diseases, which is a multidisciplinary group committed to timely, accurate diagnosis for children. There’s one case study in particular that uses AI to speed up insights for rare disease diagnoses. AI is definitely a tool in the arsenal to help us better analyze what and who we are missing when we use certain technologies.

How can the health care sector better support marginalized women in accessing digital health services?

We need to give time, build trust, and invest resources. They understand their needs and their abilities to uptake and use the tools. They need to be brought to the table throughout — from identifying the needs to developing the tool, to deploying it to scale. A comprehensive approach that combines technology, community engagement, and policy advocacy is what we need.

What’s your call to action for the global health community when it comes to addressing the gaps in digital health and data equity? And how is Rabin Martin part of this action?

We tend to work at an intersection of bringing together different types of organizations. Forming partnerships is a big part of what we do so that our clients can have a seat at the table, contribute, and have their voices heard in the larger health ecosystem. That’s what is needed when addressing the gender digital divide — a multidisciplinary and multisectoral response.

We live in this world of intersectionality, where many different components make us who we are and therefore affect our health behaviors and outcomes. We need to reflect that when personalizing tools and technologies to meet people where they are. So, when developing digital health tools, we really need to build trust in the health care ecosystem so that data can be exchanged. Patients need to trust the tools and their providers — clinicians, and community health workers — who, in turn, also must have confidence in the tools they’re using. To provide better care, they must also be trained and supported in evaluating the information.

We need for all to recognize their contributions to health care and where they can influence, support, or direct resources and efforts to address digital divides. There have been efforts by multiple organizations on frameworks in digital health. We now need the public and private sector to implement these frameworks and pay attention to perspectives of equity to maximize the potential of these tools and technologies that are here to stay.