- Reflect on the concept of social determinants of health as presented in the resources.
- Contemplate whether digital inclusion or broad band access should be added to the 5 key areas of social determinants of health.
- Using the optional outside resources or other peer reviewed journal articles, consider how electronic health records, mobile health, patient portals, or telemedicine can impact and be impacted by the social determinants of health.
Social Determinants of Health and the Role of Digital Inclusion in Modern Healthcare
The concept of social determinants of health (SDOH) encompasses the non-medical factors that significantly influence individual and community health outcomes. According to the U.S. Department of Health and Human Services (HHS) and Healthy People 2030, there are five key areas of SDOH: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context. These interconnected domains capture the various environmental conditions in which people are born, grow, live, work, and age. These conditions often shape health risks and outcomes far more than clinical care alone. However, with the advancement of digital technology and increasing reliance on virtual health services, it is worth contemplating whether digital inclusion and broadband access should be formally recognized as a sixth domain of SDOH.
Digital inclusion refers to equitable access to technology and the internet, along with the skills to use them effectively. In today’s health care landscape, where telemedicine, electronic health records (EHRs), patient portals, and mobile health (mHealth) applications are rapidly becoming standard components of care delivery, digital access is no longer a luxury but a necessity. Broadband access in particular is a foundational enabler of telehealth services, virtual consultations, and the use of health-related technologies. Therefore, integrating digital inclusion as a formal SDOH acknowledges its critical role in shaping healthcare accessibility and equity.
The COVID-19 pandemic further emphasized the disparities in digital access. A 2021 study published in JAMA Network Open found that patients in lower-income, rural, and older populations were significantly less likely to utilize telehealth services due to lack of broadband access or digital literacy. These digital divides mirror existing inequities in other SDOH domains, such as education and economic stability, and compound barriers to care for vulnerable populations. As a result, people without reliable internet access are left out of modern health systems, perpetuating health inequities.
Moreover, tools like EHRs and patient portals offer considerable potential to improve health outcomes but only when patients can effectively access and use them. EHRs allow for streamlined communication among healthcare providers, enhancing care coordination and patient safety. Patient portals provide individuals with direct access to their health information, test results, and medical histories, empowering them to participate more actively in their care. However, a study published in Health Affairs in 2020 reported that individuals with limited health literacy, lower education levels, or limited English proficiency are far less likely to use these digital tools. These factors intersect with social determinants like education quality and language access, highlighting how technology can either mitigate or exacerbate disparities.
Mobile health (mHealth) applications also show promise in engaging patients in managing chronic conditions such as diabetes, hypertension, or mental health disorders. Yet, their effectiveness is dependent on digital literacy and smartphone or internet access. This further underscores the need for digital inclusion as a core SDOH. Telemedicine, in particular, has transformed health care delivery by increasing access for patients in geographically remote or underserved areas. However, these benefits are unevenly distributed due to existing disparities in broadband infrastructure. Without addressing this digital divide, technological innovation in healthcare risks reinforcing existing inequities rather than alleviating them.
The intersection of SDOH and digital health also brings new responsibilities to healthcare systems and policymakers. Health organizations must adopt inclusive digital health strategies that account for social risk factors. For instance, offering multilingual interfaces, simplified mobile apps, or technology navigation assistance can bridge some of the access gaps. Additionally, policy efforts to expand broadband infrastructure—especially in rural and low-income urban communities—are essential. Recognizing broadband access as a public utility, akin to water or electricity, would reflect its importance to public health.
In conclusion, the landscape of healthcare is rapidly evolving, and so must our understanding of what influences health outcomes. Digital inclusion—encompassing broadband access, digital literacy, and access to health technologies—intersects with and magnifies each of the existing five social determinants of health. It directly affects an individual’s ability to access, understand, and benefit from modern healthcare innovations such as EHRs, mHealth apps, and telemedicine. Therefore, it is both timely and necessary to consider digital inclusion as a sixth domain of SDOH. Doing so would help ensure that advancements in health technology serve all populations equitably, bridging rather than widening the health divide.