Digital equity a priority for health

FEATURE – Industry Innovation Article – Spark Health

In the 1960s, philosopher Marshall McLuhan coined the phrase ‘the medium is the message,’ meaning the channel delivering the information has as much influence over the scale and form of human association and action as the message being shared. Fast forward 60 years, and this statement still rings true as the integration of digital technologies into our lives is starting to replicate the gaps that we see in our offline society.

When the COVID-19 pandemic reached our shores, people were forced to turn to digital methods of communication – for every aspect of life— from work to school, play and even for health and wellbeing. This rapid disconnection from other channels and methods of communicating, brought into focus the digital divide across New Zealand.  Being completely restricted from participating in society particularly in a time of need and confusion can have dramatic impacts on the health and wellbeing of our communities, which is why the creation of an environment of digital equity should be on the priority list of all health providers.  

Exactly how big is the Digital Divide?

Data gathered from a recent Department of Internal Affairs survey determined that one in five New Zealanders face digital inclusion issues.

Census data also revealed 11% of households do not have any internet access which includes those living in low-income areas and social housing, rural areas, elderly, those with disabilities and Māori and Pasifika communities.

Accentuating the divide even further; 31% of social housing tenants are unable to use the internet from home or work, severely restricting their access to basic information that many of us now take for granted such as, IRD forms and information, bank accounts and social services information.

In addition to access there is the challenge of ability.  A recent OECD survey revealed that 45% of Kiwis only have basic internet skills – this is insufficient for a world moving towards nearly every aspect of life being online.

Unsurprisingly, this data draws a similar picture to that of those that face inequalities in accessing healthcare.

What is Digital Equity?

A number of terms are used to describe the differing levels of access and engagement with digital tools.  Digital equity, digital inclusion, digital exclusion, and digital empowerment are often used interchangeably.

In a recent HiNZ webinar, Digital Equity – bridging the divide, Kim-Connolly-Stone, Policy Director of Internet NZ summarises their working definition; “Digital equity is more about the end state —all New Zealanders making the most of an increasingly digital world. We determine digital inclusion as the things that need to happen to get there.”

The report Digital New Zealanders: The Pulse of Our Nation produced by the Ministry of Business Innovation and Employment in 2017, developed a useful working definition:

“A digitally included person is someone who has access to affordable and accessible digital devices and services at a time and place convenient to them, as well as the motivation, skills, and trust to use the internet to pursue and realise meaningful social and economic outcomes.”

How do we get there?

Like all societal issues there is no one quick fix to achieve equity.  Reaching this goal spans traditional boundaries and requires creative and collaborative thinking.

Matt Shepherd, Senior Psychology Lecturer at Massey University believes participation, partnership and protection are key to achieving true digital equity.  From his experience working with Rangatahi, inclusion should start at the design phase.

“We’re not the end users of these tools, we need to involve them as part of the process from early on,” he said in the webinar.

In terms of whether culture presents a challenge for design he sees it as a strength. “Having young people use their own cultural identity as a way of learning can be a key way of developing engagement.”

The need to involve and consider the person that is using the website or application through real dialogue— not just by making assumptions of those needs— is equally important for those navigating the world with a physical disability or diverse sexual orientation.

Jonathan Godfrey, President of Blind Citizens NZ summarised his experience as part of the webinar. “I’m a person, a partner a parent and advocate. My needs aren’t just contained in ophthalmology, they span the entire system.”

Mr Godfrey, also encourages dialogue with the end users and warns developers from concluding the tools, applications or systems they create work in the way they are intended to.

“There’s equipment required on top of a standard computer to make it work, but access to this equipment is not good. Theoretical access doesn’t always translate to practical usefulness.  This creates a reliance on another person to turn inaccessible content into something useful.”

Jason Myers, CEO of the New Zealand AIDS Foundation shared his concerns over the dangers of making assumptions and compartmentalising the challenges of those with diverse needs in his experience working with those from the Rainbow community.

“Digital spaces provide great opportunity particularly when people may not feel comfortable presenting to a clinic in person and digital spaces can often be the first space people with diverse sexual orientation can feel really seen and heard.”

But there are challenges.  “It might be easy to reach the white middle-aged male living in Ponsonby but it’s much harder to reach the 65-year-old Māori male living in rural New Zealand,” he said.

The plan to achieve digital equity for all New Zealanders

Internet New Zealand have shaped a five-point action plan to guide government action to move toward digital inclusion — developed in collaboration with 60 organisations from across New Zealand.
These points are:

1. Affordable connectivity 
2. Getting devices to people that can’t afford them
3. Wrap around support for newly connected – businesses and people
4. Digital skills for displaced workers and small businesses
5. Internet resilience 

In shaping this plan, Internet NZ connected with a lot of private organisations interested in digital equity and being better coordinated with other organisations to achieve these shared goals.  From these conversations, the Digital Coalition Aotearoa was formed.  Currently being developed, this coalition brings the digital ecosystem together to share information, develop goals, prioritise initiatives, and drive and fund collaborative action.

Spark is committed to this coalition and are playing an active role in funding the initiatives through its Spark Foundation.

Spark Health, a vertical brand established within Spark to provide digital services to the health sector, is hoping to foster this collaborative approach working with the Spark Foundation to achieve their vision to create a positive digital future for all of New Zealand.

Some joint initiatives prior to and during the COVID response have already observed some successes.

Dr. Will Reedy, CEO of Spark Health explained in the webinar; “We have worked with Ministry of Health and the Department of Internal Affairs alongside our colleagues at Vodafone and 2 Degrees to offer sponsored data. This means those on pay monthly or pre-paid data plan can access GP Portals, Mental Health websites and more recently the COVID-19 information sites, at no cost.

“What we have found from this project, is those that were already using those digital tools, spend more time on them; for example more time reading more information on depression and mental health, accessing records on GP portals.  We also saw new consumers of those digital services – as the barrier of cost of data was removed.”

Today, they continue this journey, working closely with mana whenua and Bay of Plenty DHB following their development of a Māori Health and wellness strategy referencing digital tools as a core component to address some of the risks in their rohe.

Spark Health are supporting the DHB and iwi to lead the motivation aspect of the five-point plan to encourage trust in the capacity of digital tools to achieve health outcomes.  Through the foundation, devices are also provided with ‘how to use’ information being translated into Te Reo by Te Wananga o Aotearoa.

In parallel, Spark and Spark Health are working with Te Puna Kokiri to prioritise connectivity to the marae in the Eastern Bay of Plenty, supported by offering Skinny Jump modems into individual households.

Returning to the learnings of Marshall McLuhan, the social implications of the medium need to be considered. This is particularly important for health providers entrusted with the wellbeing of the people using them.

Jason Meyers summarises, “There is great opportunity as healthcare providers, but we also have to be careful to create programs, services and content that makes the experience a positive one”.

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