When Technology Doesn’t Reach Everyone, It’s Part of the Problem
June 11, 2026
Analysis based on the post by Sigrid Berge van Rooijen (LinkedIn, 2026), with context data for the EU, Spain and Catalonia.
Digital health can be the best tool to reduce the health inequalities of our time. Or the worst. The difference is not set by the technology: it is set by the decisions we make when designing, deploying and governing it.
The paradox: the tools meant to level the field are excluding
There is a cruel paradox at the heart of digital health. The tools that promise to improve healthcare tend to benefit first, and far more intensely, those who already started from an advantaged position: people with devices, with a good connection, with digital literacy and in territories where services already work well.
By contrast, those who most need care, older people, people with low literacy, without connectivity or at risk of exclusion, are systematically left at the margins. Not through anyone’s ill will, but through omission: because they were not taken into account in the design. Too many patients are left out of the «party» that was meant to fix healthcare.
An algorithm trained on data from a single slice of the population is not neutral: it is discriminatory by definition. And a health system that digitalizes its services without guaranteeing that everyone can access them does not improve equity: it erodes it.
There is no fair digital transformation without digital equity. Digitalizing without including is a new form of health segregation.
The data confirm it
The gap is not an intuition: it is measured. At the European scale, a substantial part of the population falls below the functional threshold needed to use digital health.
- 60% of EU citizens have at least basic digital skills; for the remaining 40%, digital health is not viable (Eurostat, 2025).
- 14.9 M adults in the United Kingdom with very low digital engagement cannot access online health services (Good Things Foundation, 2024).
- 28% is the proportion of EU citizens who have accessed their health records online (Eurostat, 2024).
The Catalan case nuances the European diagnosis, but confirms the underlying gap. Catalonia starts from a comparatively advanced infrastructure: 71.7% basic digital skills and an index of 92.5/100 in electronic access to health data, with La Meva Salut (CatSalut) available in Catalan, Spanish and Occitan-Aranese. Even so, the segment without basic skills remains the group at risk of digital health exclusion, often overlapping with older age, low educational attainment and rural settings: precisely the predominant profile in counties such as those of the Alt Pirineu and Aran.
Sources: Eurostat 2024–2025; Digital Decade Report 2024 (Spain); Report on the State of the Digital Decade in Catalonia 2025 (Cercle Tecnològic / Generalitat / i2CAT). The indicators are expressed in different units (percentage vs. index out of 100) and are not directly comparable; the comparison is indicative.
Where do we start? A proposal, ten concrete lines of action
The good news is that we know reasonably well which actions make the difference. No great discoveries are needed: what is needed is the will to apply what we already know. Drawing on the available evidence and on fieldwork, we can identify ten fundamental strategic axes.
- Data that represent everyone. Health algorithms learn from the data we give them. If that data excludes vulnerable groups, the predictions will be biased against them. We must demand datasets with broad and diverse demographic, social and clinical representation.
- Identify where the problem is most severe. Not all groups suffer the same shortcomings. We need differential impact studies that direct resources toward the specific needs of minorities and less-favoured territories.
- Co-design: nothing for people without people. Clinical professionals, patients, carers and the community itself must be at the centre of the design. Not as passive end users, but as active co-authors of the solutions.
- Involve end users from day one. Patients and care teams must take part in the whole process, from defining the problem to deployment. Without this involvement, solutions fail when they hit reality.
- Robust ethical and governance frameworks. We must establish structures that protect people’s rights, guarantee the transparency of algorithmic systems and set clear, accessible accountability mechanisms.
- Participatory design with communities. Involving local communities is not a democratic luxury: it is a condition of effectiveness. Solutions imposed from outside rarely work.
- Universal accessibility, not optional. Interfaces usable by people with diverse abilities, multilingual options and varied levels of digital literacy: a design requirement from the very first moment, not a patch added at the end. If it doesn’t work for a 72-year-old without broadband, it doesn’t work.
- Cultural sensitivity in every detail. The user experience must incorporate the cultural nuances of the populations it serves, and family involvement in onboarding markedly improves adoption. Ignoring this is, besides being disrespectful, a cause of failure.
- Measure, monitor and be accountable. Reducing disparities requires measuring them continuously. We need specific indicators, systems for tracking outcomes and periodic public reports that allow the course to be corrected.
- Invest in infrastructure and workforce. Without connectivity, without accessible devices and without professionals trained in diversity and bias, and able to detect patients’ digital literacy gaps, no equity strategy will work. Access is infrastructure, not an optional feature.
The challenge is political, not just technical
It would be a mistake to think the solution is purely technological. Digital inequalities reflect pre-existing social inequalities and, therefore, the solutions must have a political and structural dimension. Reducing the gap is a shared responsibility among healthcare providers, governments, HealthTech companies and payers.
We must work with policymakers to guarantee equitable access, push for public procurement of health technology to include equity criteria, and weave alliances with community organizations, patient associations, social entities and the education sector.
In the Pirineus Project, at InnoHealth Academy, we work in exactly this direction: a Health Living Lab that places equity at the centre and incorporates the voice of the communities of the Alt Pirineu and Aran. The design of the Digital Health Twin and of the Population Health Management model must build in, from the outset, measures of access, literacy and inclusion for a rural and ageing population. Our territory, our people.
Equitable digital health is not a utopia. It is a choice. And we make it today, in every design decision, in every dataset, in every public policy.
I invite you to reflect
→ In your professional setting, which groups are left out of digital health solutions?
→ What barriers have you identified that are systemic and not just individual?
→ Which of these ten lines of action do you think has the greatest potential impact?
References
- Primary source: Berge van Rooijen, S. (2026). «Digital Health Is Increasing Inequality», post and infographic (LinkedIn).
- Eurostat (2024–2025). Level of digital skills and access to online health records. European Commission.
- Good Things Foundation (2024). Digital Nation / Digital exclusion in the UK.
- European Commission (2024). Report on the State of the Digital Decade 2024, Spain (66% basic skills; target 85% by 2030).
- Cercle Tecnològic de Catalunya, with the Generalitat and the i2CAT Foundation (December 2025). Report on the State of the Digital Decade in Catalonia 2025 (71.7%; 92.5/100 in access to health data; 26 of 31 indicators above the EU average).
- Idescat (January 2026). EU indicators, population with at least basic digital skills.
- CatSalut, Generalitat de Catalunya. La Meva Salut (personal digital health space)
