Yazar
Zeynep Sedef VAROL
Öğr. Gör. Dr., İzmir Demokrasi Üniversitesi Tıp Fakültesi Halk Sağlığı AD(ORCID No: 0000-0002-6724-1488)

Özet

  • COVID-19 pandemisi, dijital sağlık eşitsizliklerini derinleştirerek bu sorunun sağlık sistemlerinde daha fazla görünür hale gelmesine yol açmıştır. Dijital sağlık eşitsizliklerini etkileyen başlıca etmenler, toplumsal cinsiyet, etnik köken, ekonomik durum, dijital okuryazarlık ve teknolojik erişim gibi sosyal belirleyicilerdir. Özellikle kadınlar, etnik azınlıklar, göçmenler ve düşük gelirli gruplar, yaşlılar dijital sağlık hizmetlerine erişimde önemli zorluklarla karşılaşmaktadır. Bu eşitsizlikler, sağlık hizmetlerinin kalitesini ve erişilebilirliğini olumsuz yönde etkileyerek, sağlıkta daha geniş çaplı eşitsizliklerin derinleşmesine neden olmaktadır. Dijital sağlık eşitsizlikleri, sağlıkta genel eşitsizliklerden bağımsız olarak ele alınamayacak bir sorundur. Bu eşitsizliklerin giderilmesi için hem alana özgü önlemler alınmalı hem de genel eşitsizliklerle mücadeleye yönelik daha geniş kapsamlı ve bütüncül müdahaleler gerekmektedir. 

Summary

  • The COVID-19 pandemic has deepened digital health inequalities, making this issue more visible within health systems. The primary factors influencing digital health inequalities are social determinants such as gender, ethnicity, economic status, digital literacy, and technological access. Particularly, women, ethnic minorities, migrants, low-income groups, and the elderly face significant challenges in accessing digital health services. These inequalities negatively impact the quality and accessibility of healthcare, further deepening broader health disparities. Digital health inequalities cannot be addressed independently of general health inequalities. To address these disparities, both field-specific measures and broader, more comprehensive interventions to combat overall inequalities are required.     

Anahtar Sözcükler / Keywords

  • TR: Dijital sağlık, eşitsizlik, pandemi, toplumsal cinsiyet
    EN: Digital health, inequality, pandemic, gender

Kaynaklar / References

  • Ackerman, S. L., Tebb, K., Stein, J. C., Frazee, B. W., Hendey, G. W., Schmidt, L. A., & Gonzales, R. (2012). Benefit or burden? A sociotechnical analysis of diagnostic computer kiosks in four California hospital emergency departments. Social science & medicine (1982), 75(12), 2378–2385. https://doi.org/10.1016/j.socscimed.2012.09.013 Alajarmeh, N. (2022). Evaluating the accessibility of public health websites: An exploratory cross-country study. Universal access in the information society, 21(3), 771–789. https://doi.org/10.1007/s10209-020-00788-7 Antonio, M. G., & Petrovskaya, O. (2019). Towards Developing an eHealth Equity Conceptual Framework. Studies in health technology and informatics, 257, 24–30. Beasley M. There Is a Supply of Diverse Workers in Tech, So Why Is Silicon Valley So Lacking in Diversity? Center for American Progress; https://www​.americanprogress​.org/article​/supply-diverse-workers-tech-silicon-valley-lacking-diversity/. Erişim tarihi: 18 Mart 2025. Berg, M. (1999). Patient care information systems and health care work: a sociotechnical approach. International journal of medical informatics, 55(2), 87–101. https://doi.org/10.1016/s1386-5056(99)00011-8 Blandford, A., Wesson, J., Amalberti, R., AlHazme, R., & Allwihan, R. (2020). Opportunities and challenges for telehealth within, and beyond, a pandemic. The Lancet. Global health, 8(11), e1364–e1365. https://doi.org/10.1016/S2214-109X(20)30362-4 Curtis, M. E., Clingan, S. E., Guo, H., Zhu, Y., Mooney, L. J., & Hser, Y. I. (2022). Disparities in digital access among American rural and urban households and implications for telemedicine-based services. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 38(3), 512–518. https://doi.org/10.1111/jrh.12614 Doshi, M.J. Barbies, goddesses, and entrepreneurs: discourses of gendered digital embodiment in women’s health apps. Womens Stud Commun 2018; 41: 183–203. Doyal, L. (2003). Sex and gender: the challenges for epidemiologists. International journal of health services: planning, administration, evaluation, 33(3), 569–579. https://doi.org/10.2190/CWK2-U7R6-VCE0-E47P Feldman, S., Ammar, W., Lo, K., Trepman, E., van Zuylen, M., & Etzioni, O. (2019). Quantifying Sex Bias in Clinical Studies at Scale With Automated Data Extraction. JAMA network open, 2(7), e196700. https://doi.org/10.1001/jamanetworkopen.2019.6700 Ferryman, K. (2020). Addressing health disparities in the Food and Drug Administration’s artificial intelligence and machine learning regulatory framework. Journal of the American Medical Informatics Association: JAMIA, 27(12), 2016–2019. https://doi.org/10.1093/jamia/ocaa133 Greenhalgh, T., & Stones, R. (2010). Theorising big IT programmes in healthcare: strong structuration theory meets actor-network theory. Social science & medicine (1982), 70(9), 1285–1294. https://doi.org/10.1016/j.socscimed.2009.12.034 Hamilton, J. (1996). Women and health policy:On the inclusion of females in clinical trials. In C. Sargent, & C. Brettell (Eds.), Gender and health: An international perspective (pp. 292–325). Upper Saddle River, NJ:Prentice Hall. Hippisley-Cox, J., Pringle, M., Crown, N., Meal, A., Wynn, A. Sex inequalities in ischaemic heart disease in general practice: cross sectional survey. Bmj. 2001;322(7290):832-832. Howells, K., Amp, M., Burrows, M., Brown, J., Brennan, R., Dickinson, J., Jackson, S., Yeung, W. L., Ashcroft, D., Campbell, S., Blakeman, T., & Sanders, C. (2022). Remote primary care during the COVID-19 pandemic for people experiencing homelessness: a qualitative study. The British journal of general practice : the journal of the Royal College of General Practitioners, 72(720), e492–e500. https://doi.org/10.3399/BJGP.2021.0596 Inhorn, M. C., & Whittle, K. L. (2001). Feminism meets the “new” epidemiologies: toward an appraisal of antifeminist biases in epidemiological research on women’s health. Social science & medicine (1982), 53(5), 553–567. https://doi.org/10.1016/s0277-9536(00)00360-9 Jacobs, M.,Ellis, C. (2021. Telemedicine disparities during COVID-19: provider offering and individual technology availability J Am Geriatr Soc, 69 (9) (2021), pp. 2432-2434 Jella, T. K., Cwalina, T. B., Sachdev, R. R., et al. (2022). Sociodemographic disparities in the use of health information technology by a national sample of head and neck cancer patients. American journal of otolaryngology, 43(2), 103308. https://doi.org/10.1016/j.amjoto.2021.103308 Johnson, S.M., Karvonen, C.A., Phelps, C.L., Nader, S., Sanborn, B.M. Assessment of analysis by gender in the Cochrane reviews as related to treatment of cardiovascular disease. J Womens Health (Larchmt). 2003; 12: 449–457. Kahn, S. E., Zinman, B., Lachin, J. M., Haffner, S. M., Herman, W. H., Holman, R. R., Kravitz, B. G., Yu, D., Heise, M. A., Aftring, R. P., Viberti, G., & Diabetes Outcome Progression Trial (ADOPT) Study Group (2008). Rosiglitazone-associated fractures in type 2 diabetes: an Analysis from A Diabetes Outcome Progression Trial (ADOPT). Diabetes care, 31(5), 845–851. https://doi.org/10.2337/dc07-2270 Keasberry, J., Scott, I. A., Sullivan, C., et al. (2017). Going digital: a narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice. Australian health review : a publication of the Australian Hospital Association, 41(6), 646–664. https://doi.org/10.1071/AH16233 Lawrence, K. (2022). Digital Health Equity. In: Linwood SL, editor. Digital Health. Brisbane (AU): ExonPublications. Leader, A. E., Capparella, L. M., Waldman, L. B., Cammy, R. B., Petok, A. R., Dean, R., Shimada, A., Yocavitch, L., Rising, K. L., Garber, G. D., Worster, B., & Dicker, A. P. (2021). Digital Literacy at an Urban Cancer Center: Implications for Technology Use and Vulnerable Patients. JCO clinical cancer informatics, 5, 872–880. https://doi.org/10.1200/CCI.21.00039 Mizrachi, Y., Shahrabani, S., Nachmani, M., & Hornik, A. (2020). Obstacles to using online health services among adults age 50 and up and the role of family support in overcoming them. Israel journal of health policy research, 9(1), 42. https://doi.org/10.1186/s13584-020-00398-x Mosnaim, G.S., Stempel, H., Van Sickle, D., Stempel. D.A. (2020). The Adoption and Implementation of Digital Health Care in the Post-COVID-19 Era. J Allergy Clin Immunol Pract. 2020 Sep;8(8):2484-2486. doi: 10.1016/j.jaip.2020.06.006. Epub 2020 Jun 22. PMID: 32585407 Obermeyer, Z., Powers, B., Vogeli, C., & Mullainathan, S. (2019). Dissecting racial bias in an algorithm used to manage the health of populations. Science (New York, N.Y.), 366(6464), 447–453. https://doi.org/10.1126/science.aax2342 Peek, N., Sujan, M., & Scott, P. (2020). Digital health and care in pandemic times: impact of COVID-19. BMJ health & care informatics, 27(1), e100166. https://doi.org/10.1136/bmjhci-2020-100166 Power, C., Freire, A., Petrie, H., Swallow, D. (2012). Guidelines are only half of the story: accessibility problems encountered by blind users on the web. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems; CHI ‘12; May 2012; Austin, USA. 2012. pp. 433–442.  Rajkomar, A., Hardt, M., Howell, M. D., Corrado, G., & Chin, M. H. (2018). Ensuring Fairness in Machine Learning to Advance Health Equity. Annals of internal medicine, 169(12), 866–872. https://doi.org/10.7326/M18-1990 Reti, S.R., Feldman, H.J., Safran, C. (2009). Governance for personal health records. J Am Med Inform Assoc. 2009 Jan-Feb;16(1):14-7. doi: 10.1197/jamia.M2854. Richardson, S., Lawrence, K. (2022). Schoenthaler, A.M. et al. A framework for digital health equity. npj Digit. Med. 5, 119 (2022). https://doi.org/10.1038/s41746-022-00663-0 Sharko, M., Wilcox, L., Hong, M. K., & Ancker, J. S. (2018). Variability in adolescent portal privacy features: how the unique privacy needs of the adolescent patient create a complex decision-making process. Journal of the American Medical Informatics Association : JAMIA, 25(8), 1008–1017. https://doi.org/10.1093/jamia/ocy042 The Lancet Digital Health. (2021). Digital technologies: a new determinant of health. Lancet Digit Health. 2021 Nov;3(11): e684. https://doi​.org/10.1016​/S2589-7500(21)00238-7 . Trendall, S. (2019). Gender bias concerns raised over GP app. Sept 13, 2019. https://www.publictechnology.net/articles/features/gender-biasconcerns-raised-over-gp-app Erişim tarihi: 21 Mart 2025. U.S. Food and Drug Administration. Software as a Medical Device (SaMD). http://www.fda.gov/medical-devices/digital-health/softwaremedical-device-samd Erişim: 18 Mart, 2025. Vandelanotte, C., Müller, A.M., Short, C.E., et al. (2016). Past, present, and future of eHealth and mHealth research to improve physical activity and dietary behaviors. J Nutr Educ Behav 2016; 48: 219–28. e211 Waggoner, M.R., Lyerly, A.D. (2022). Clinical trials in pregnancy and the “shadows of thalidomide”: Revisiting the legacy of Frances Kelsey. Contemp Clin Trials. 2022 Aug;119:106806. doi: 10.1016/j.cct.2022.106806. Epub 2022 May 30. PMID: 35654303; PMCID: PMC9420797.

Geliş Tarihi / Received Date

  • 24.04.2025

Kabul Tarihi / Accepted Date

  • 13.06.2025