Abstract
Informed by a discourse analysis, this article examines the framing of equity within the UK's digital health policies between 2010 and 2017, focusing on England's development of NHS Digital and its situation within the UK Government's wider digital strategy. Analysis of significant policy documents reveals three interrelated discourses that are engaged within England's digital health policies: equity as a neoliberal imaginary of digital efficiency and empowerment; digital health as a pathway towards democratising health care through data‐sharing, co‐creation and collaboration; and finally, digital health as a route towards extending citizen autonomy through their access to data systems. It advances knowledge of the relationship between digital health policy and health inequalities. Revealing that while inclusion remains a priority area for policymakers, equity is being constituted in ways that reflect broader discourses of neoliberalism, empowerment and the turn to the market for technological solutionism, which may potentially exacerbate health inequalities.
Highlights
Health inequalities and the social determinants of illness and disease have received growing attention within public health research, which has focused attention on policy making as a route towards making meaningful changes to the fair distribution of healthcare services
By analysing influential digital health policy documents in England over this period, this paper develops our understanding of how health inequalities emerge and persist, which we assert as a crucial complement to other methods of assessing inequalities, such as patient/citizen experience surveys
All policy language around healthcare presently reinforces the centrality of digital solutions but there is only sporadic attention given by authorities to matters of variation in the impact or benefit of digital health technologies for different social groups, including those who are marginalised and underprivileged. Understanding this variance - or not assuming that digital solutions diminish health inequalities - has yet to be fully acknowledged as a key area of concern for policy makers (McAuley, 2014)
Summary
Health inequalities and the social determinants of illness and disease have received growing attention within public health research, which has focused attention on policy making as a route towards making meaningful changes to the fair distribution of healthcare services. Numerous authors note that this is partly due to the ‘lifestyle drift’ (Popay et al, 2010) in which policies begin by recognising the need for upstream action to address wider social and economic determinants of health, only to be reduced to a focus on individual behaviour (Bauman and Fisher, 2014, Williams and Fullagar, 2018) In this context, digital health technologies have been positioned by governments around the world as central to the delivery of a fair healthcare system and ‘promise to transform healthcare systems including strategies of personal risk management, modes of treatment and practices of care’ (Petersen, 2019: 22). Digital health encompasses web-based solutions, mobile phone and tablet applications, the integration of artificially intelligent platforms, the utilisation of wearable devices that track biometric information, and the proliferation of social media environments, each of which may have varying impacts on health care equity
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