Health, equity and gender: can digitization narrow the gaps in access to healthcare?

The differences between men and women have a significant impact on health, both from a biological standpoint and from a gender perspective. According to the World Health Organization (WHO), the health of women and girls is of particular concern because, in almost all societies, they are disadvantaged by discrimination rooted in sociocultural factors, such as unequal power relationships between men and women, experience of physical, sexual and emotional violence, and an exclusive focus on women's reproductive role.

But how do gender biases affect healthcare policies and education in terms of their design, recommendations and implementation? What challenges do these and other biases pose for access to health services? What is e-health's role in overcoming them? Is it a help or a hindrance? These are some of the questions covered in the webinar Exploring the nexus between health, equity, and gender, organized by the global cluster of universities for Sustainable Development Goal 3, led by the UOC through its eHealth Center, and the International Association of Universities (IAU).

Moderated by Gemma Marfany, professor of Biology and Genetics at the University of Barcelona, the webinar's participants were Lídia Arroyo, sociologist and member of the UOC's Gender and ICT research group; Edward Bichetero, Senior Technical Officer of the Data Science and Informatics, Monitoring and Evaluation Technical Support programme at Uganda's Makerere University; Hannah Dahlen, Professor of Midwifery and Midwifery Discipline Lead at Australia's Western Sydney University, and Retna Siwi, member of the Division of Public Health at Indonesia's Universitas Gadjah Mada.

Hilligje van't Land, Secretary General of the International Association of Universities, and Marta Aymerich, UOC Vice President for Strategic Planning and Research and Executive President of the eHealth Center, also shared their impressions during the webinar.

"The aim of initiatives like the International Association of Universities and the eHealth Center is to create a network of knowledge from different parts of the world that recognizes the importance of diversity. Such associations have the potential to drive innovation, transformation and collaborative knowledge," said van't Land.

"Gender equality is a very important aspect in health – probably one of the most important of our time in terms of access to quality healthcare services. We need to commit to a process of cultural transformation designed to help us avoid conscious and unconscious gender biases in healthcare," added Aymerich.

In the opinion of the experts, the following are the key points in the relationship between gender equality, equity, access to healthcare services and digital health.

1. Gender inequality affects women's health

Although sociocultural factors vary greatly from country to country and even within the same territory, inequality and gender discrimination affect women's health in terms of both access to healthcare services, and vulnerability and exposure to disease. In the specific case of Indonesia, Siwi explained how gender social roles have an impact on access to healthcare. Women, who are responsible for domestic well-being, do not prioritize their health treatment over their household responsibilities and feel selfish if they place their own needs over those of their family.

"It's important to improve knowledge about how the gender roles we internalize as children have different effects on men's and women's exposure to disease. Moreover, research into diseases and their possible treatments should pay more attention to the differences between genders, as well between ethnic groups, ages and social groups," said Arroyo. "An important part of improving health is tackling inequality," she concluded.

2. Lessons from the pandemic that can be applied to future crises

The responsibility for care has mainly fallen to women throughout the two years of the pandemic. First, they suffered an increase in their domestic responsibilities that, in many cases, affected their professional careers and both their physical and mental health. Additionally, many of the jobs with most exposure to COVID-19 (a good deal of them considered to be essential during the initial lockdowns) are predominantly done by women, such as those in the care and healthcare sectors or those dealing directly with the public.

"In many senses, women have been abandoned during the pandemic and this is having – and will continue to have for many years – consequences for their physical and mental health, as well as for child development," said Dahlen. "We have to be effective when learning lessons from the pandemic in order to deal with any new crises of this type that may come in the future, whether they are due to emerging diseases or the impact of climate change."

3. Digital health to close the access gap

Technology and mobile communications networks have facilitated a boom in digital and remote healthcare in recent years. These tools may allow us to broaden access to healthcare, reduce the costs of such access, close the gender gap and tackle inequality.

"Digital health has the potential to seriously increase people's ability to access healthcare while also reducing its cost," said Bichetero. "In any case, digital health should only be a means of reinforcing and expanding our healthcare systems, not a replacement for them. We shouldn't lose sight of the fact that the most important thing is to invest in healthcare workers and infrastructure."

The experts also agreed that the implementation of e-health also poses challenges that need to be addressed. For example, digital health could mean that families are saddled with paying for electronic devices and internet access, or it could accentuate digital skills gaps, running the risk of excluding more vulnerable sectors of society.

Moreover, reducing visual interaction and limiting micro-conversations may affect the level of trust generated between patients and healthcare professionals. Likewise, differences in the use that men and women make of the internet and other biases caused by socio-economic, geographic, age, gender and education level factors should be taken into account in the design and implementation of e-health interventions. Overcoming these gaps is a global challenge.

"Finally, in relation to digital health, we need to make a great effort to ensure the quality of the information available on the internet, to make sure it's scientifically correct," said Siwi. "It's also necessary to educate women and men so they can better discern the quality of information and improve their critical thinking, which will also help men recognize the burdens and barriers that affect women."

"Digital health, when it's people-centric, can help reduce the risks associated with inequality, but we must pay close attention to its social and healthcare implications in each context. The UOC is very happy to be able to run the eHealth Center. Universities play a fundamental role in leading scientific debate and research in such aspects," concluded Aymerich.

This webinar forms part of the framework of actions to achieve Sustainable Development Goal (SDG) 3, which seeks to ensure healthy lives and promote well-being for all at all ages.

UOC R&I

The UOC's research and innovation (R&I) is helping overcome pressing challenges faced by global societies in the 21st century, by studying interactions between technology and human & social sciences with a specific focus on the network society, e-learning and e-health.

The UOC's research is conducted by over 500 researchers and 51 research groups distributed between the university's seven faculties, the E-learning Research programme, and two research centres: the Internet Interdisciplinary Institute (IN3) and the eHealth Center (eHC).

The University also cultivates online learning innovations at its eLearning Innovation Center (eLinC), as well as UOC community entrepreneurship and knowledge transfer via the Hubbik platform.

The United Nations' 2030 Agenda for Sustainable Development and open knowledge serve as strategic pillars for the UOC's teaching, research and innovation. More information: research.uoc.edu #UOC25years