Dr Azzopardi Muscat, irector of health systems at the World Health Organisation/Europe (Credit: WHO)
People with greater health needs and language barriers still struggle to use digital health services and technologies, according to research led by the World Health Organization (WHO) and Public Health Wales.
The scoping review, published in March 2026, found that these groups experience difficulties accessing technology because of limited access, low digital literacy and services being poorly adapted to diverse needs.
It also identified that inequities in digital infrastructure between regions risk creating uneven access to innovation.
Dr Natasha Azzopardi-Muscat, director of health systems at WHO/Europe, said: “One of our main objectives with this new review was to understand what exactly drives inequity in digital health, and how equity is incorporated into regulation, implementation and evaluation processes globally.
“One of the key takeaways is that equity in digital health cannot be achieved through isolated actions but requires a coordinated, whole-system approach to ensure equitable regulation, implementation and evaluation of digital health.”
The scoping review covers literature published between 2015 and 2024, assessing 154 articles to identify where good practices and persistent gaps exist.
While equity is increasingly referenced in digital health strategies, it often lacks operational standards to guide its inclusion or mechanisms enabling governments to provide oversight, risking the benefits of digital health and AI being unevenly distributed.
Dr David Novillo Ortiz, regional adviser for data, AI and digital health at WHO/Europe, said: “Equity should never be treated as an afterthought in the development and implementation of digital health technologies.
“If someone in a rural area cannot access a telehealth consultation because it requires high-speed internet that is unavailable in their village, then innovation is failing the very people it should serve.”
Guidance on digital health often highlights the need for strong governance and infrastructure, but there is limited clarity on what is required to ensure equity in practice. Equity, bias and fairness checks are not standard practice for AI-driven health technologies in particular.
Alisha Davies, deputy director for research, data and digital at Public Health Wales, said: “Our review shows that while equity is increasingly recognised, its integration into the regulatory, implementation and evaluation frameworks remains inconsistent.
“The findings highlight the need for a socio-technical approach, as digital innovation does not operate in isolation, alongside an equity-by-design approach to ensure digital health reduces, rather than reinforces, health inequities.”
The review highlights several considerations to advance equity in digital health across the WHO European region, including using a whole-system approach, strengthening regulation and governance, ensuring equitable financing, and building capacity across sectors.
WHO is working towards digital health systems that deliver equitable benefits for all through its ‘Regional digital health action plan for the WHO European region 2023–2030‘ and the ‘Global strategy on digital health 2020–2025‘.
A 2022 study by WHO/Europe and Public Health Wales found that people with poor health and living with a disability, older people, migrants and those with a lower socioeconomic status struggle the most to access digital health technologies.
Meanwhile in November 2025, WHO announced that it had designated Public Health Wales as a collaborating centre for digital health equity.
