Telehealth & Health Equity Toolkit

Utilizing Telehealth to Ensure Health Equity

This toolkit is intended to provide a closer look at telehealth and health equity. Feel free to contact us at [email protected] with any questions about this toolkit or with any additional questions about health equity.

Jump To Sections

What is Health Equity?
Utilizing Telehealth
Seizing the Opportunities
Meeting the Challenges
The Future of Telehealth and Health Equity
Further Reading and More Information

What is Health Equity?

Health equity is the ability of all people in a society to live the healthiest possible life. This means that to achieve health equity all people must have access to the care they need to be healthy. The amount and type of care vary significantly from person to person – health equity does not mean that all people receive exactly identical care. It means that each person receives the care they need to be healthy. Different people have different health needs, based on a variety of different factors. These factors include social determinants of health, genetics, personal experience, behaviors, and many others.

A major step in achieving health equity is providing equitable access to all types of care – people should be able to obtain the care easily they need to be healthy, no matter what kind of care that may be. Because of this, it is vital to identify historically underserved and disenfranchised communities and deliberately provide access to care they lack. Telehealth can be a powerful tool when determining how best to provide care to underserved communities, allowing all people a greater understanding of their health and promoting greater societal health and wellness.

Identifying Underserved Communities

Underserved communities include those communities that lack access to sufficient medical care. These communities include, but are not limited to:

These underserved populations are at a greater risk of health inequities, resulting in a preventable disparity between their health outcomes and those with better access to care. Equitable health care means providing accessible care to these underserved communities, allowing them to achieve optimal health outcomes. There are many tools and strategies that can and should be used to work towards health equity, including telehealth.

Utilizing Telehealth

Telehealth can be a uniquely useful tool when aiming to provide equitable access to care. Because telehealth can be provided remotely and in multiple forms, it can reach a large subset of the population with difficulties engaging with in-person or traditional care. While telehealth cannot replace all types of in-person care, it can provide a wide range of different care options in an accessible way.

Below, we will provide an overview of some of the challenges telehealth faces when working towards health equity and look at some of the many opportunities that exist when utilizing telehealth.

Seizing the Opportunities

Telehealth has the potential to address and mitigate many of the barriers that stand in the way of health equity. Because it can be accessed outside of traditional care settings, it can allow patients to reach providers and specialty care that would otherwise be outside of their reach. Telehealth also allows flexibility for patients, letting them seek care without having to consider extraneous factors like childcare and travel distance. By taking advantage of these and other opportunities provided by telehealth, we can advance health equity and bring care to those who might otherwise go without.

Increasing Accessibility

Though telehealth has been in use for decades, it did not see widespread adoption in a variety of specialties until the COVID-19 Pandemic. This increase in utilization allowed patients to seek care when they would otherwise have had to risk exposure or when they would have had to go without. Increased adoption due to the Pandemic also led providers and patients to conclude that telehealth could be used to increase access to care beyond just the COVID-19 Pandemic.

The increased rate of telehealth utilization means that another modality is available for patients seeking care. Telehealth can ease barriers for patients, allowing them to obtain care from providers within their own homes. There are a variety of barriers that may be mitigated – parents and guardians may be able to complete telehealth visits without seeking childcare, employees may be able to attend appointments without taking time off work, and individuals who lack convenient access to transportation do not have to determine how they will get to an appointment.

These benefits can spare those engaging with telehealth financial burdens – this is particularly important for those with chronic conditions that may require regular visits with a provider. That may be compounded even further if patients have the ability to utilize treatment modalities such as store and forward, which allows them to submit information to a provider at their convenience.

The benefit of the increased access that telehealth has the potential to provide cannot be overstated. Not every type of visit to a clinician can be completed with the use of telehealth, but there are many that can without being negatively impacted. By deliberately using telehealth to increase access and lessen barriers, we can provide essential care to those who have long been underserved.

Specialty Care

Telehealth can also provide specialized care to those who would otherwise not be able to obtain it. This allows for greater access to those who might be geographically isolated or those who cannot obtain specialized care locally for whatever reason.

One example of specialty care available through telehealth is teledentistry. According to the American Dental Association, teledentistry is an effective way to provide improved access to oral healthcare and lessen the disparity between rural and urban populations regarding oral health. Studies have projected that teledentistry will be an important part of dental care in the future and will alleviate any access issues brought on by shortages of dentists.

Another example of how telehealth is increasing the reach of specialty care is stroke telehealth or telestroke. Some hospitals, particularly rural hospitals, do not have providers who specialize in stroke care. To ensure that potential stroke patients are still being treated effectively, providers can work with remote neurosurgeons and other specialists to diagnose remotely quickly and accurately. This allows providers to identify stroke patients as soon as possible and provide appropriate treatment.

By encouraging the use of telehealth in providing specialty care, a more comprehensive range of patients can be reached. This will decrease health disparities due to a lack of access to specialized types of care.

Meeting the Challenges

Telehealth can be a powerful tool to promote health equity. However, there are many challenges that we should be aware of. To achieve health equity, we must not only identify these challenges but work to overcome them.

Digital Literacy

Technology makes telehealth possible – without communications technology, we would not be able to provide telehealth. When considering health equity, this evident dependence on technology can have a few drawbacks. It is vital to be aware of the challenges that can arise when working with technology to use telehealth to promote health equity.

Digital literacy, a term that refers to a person's comfort level with technology, is an important concept to consider when working with underserved populations. According to one study, approximately 16 percent of adults in the United States are not digitally literate, meaning they will have difficulties engaging with telehealth. Additionally, underserved populations frequently have higher instances of digital illiteracy. Black adults are twice as likely not to be digitally literate than White adults, while Hispanic adults are three times as likely not to be digitally literate than White adults. Older adults also have lower levels of digital literacy overall – just 67% of adults over 65 report being able to use the internet, while that number falls to 44% among those over 80.

To ensure that all populations can benefit from telehealth, we must work to improve digital literacy among underserved populations and reduce the potential complexity of telehealth devices. Working with community partners to enhance digital literacy is vital to increasing telehealth adoption rates in underserved communities. By engaging with the community and facing digital literacy issues directly, we can make telehealth more accessible for all.

Language Barriers

According to a report by the US Census Bureau, 8.3% of people in the United States have limited English proficiency. These people have a distinct disadvantage when engaging with telehealth, which is primarily offered in English.

Luckily, some steps can be taken to reduce and increase the accessibility of telehealth to those with limited English proficiency. Whenever possible, telehealth platforms should be accessible through multiple languages. Languages should reflect the community's needs – different areas have different language needs. These needs should be carefully considered when utilizing telehealth to ensure access to telehealth is as equitable as possible

Adaptive Equipment

Populations with disabilities and some functional access needs may have additional barriers to engaging with telehealth. According to the US Census Bureau, 13 percent of the United States population has some type of disability. Some procedures may need to be altered or adjusted when serving disabled patients, but the process should be made as simple for these patients as possible.

Some disabled patients may require adaptive equipment – any equipment should be sent and tested beforehand, so the appointment can proceed as planned. Additionally, patients may need resources provided in accessible formats, such as information provided in braille or printed forms. Communicating with disabled patients and ensuring they have the resources that they need to have a successful telehealth visit is an important piece of health equity.

Internet Access

Those with no or limited internet access often cannot engage with telehealth. Though some telehealth technologies, like audio-only appointments and certain types of store and forward, can operate without an internet connection, the vast majority require a stable connection to work. The Federal Communications Commission (FCC) has estimated that 19 million people in the United States do not have access to the internet. This problem is exacerbated for those in rural populations, who are far more likely to lack a stable connection. It is estimated that nearly a quarter of the rural population in the United States is without internet access.

Efforts are ongoing to increase access to the internet – the FCC is leading several initiatives aimed at increasing broadband access. Several communities and government organizations within the UMTRC service area aimed at increasing access – these include the Michigan Moonshot, the Ohio Broadband Strategy, the Indiana Telehealth Network (ITN), and Connect Illinois, as well as many others. Equitable internet access is vital to achieving health equity – by supporting initiatives locally and nationally, we can ensure that all people can obtain care via telehealth.

The Future of Telehealth and Health Equity

As we look at the future of telehealth, we can see that it has the potential to be an incredibly valuable tool in achieving health equity. Though there are challenges to overcome, telehealth has the potential to promote equal access and lead to greater health equity. Telehealth is a valuable tool, but if not utilized deliberately, it can recreate existing health inequities, further disenfranchising underserved populations who could benefit immensely. But if used thoughtfully, telehealth can lead to equitable access to healthcare among populations that, up until now, have lacked access to the care vital to living their healthiest possible lives.