Health technologies: The digital divide and health disparities in China

Despite the nearly ubiquitous nature of smart phones, tablets and smart home devices, there is still a gap in access to these technologies. Commonly called the digital divide, this gap has been the subject of much research and has been found to have a correlation with health outcomes. Much of the research on the digital divide and health disparities has focused on Western nations, but a new study led by Alicia Hong, PhD, associate professor in the Department of Health Promotion and Community Health Sciences in the Texas A&M School of Public Health, turns attention toward the population in China.

Factors thought to contribute to both the digital divide and health disparities include older age, lower education and lower income. Research has focused on these individual socioeconomic factors but has paid little attention to community-level aspects, such as community resources and neighborhood characteristics. There is also a shortage of work looking at older adults, who are more likely to experience health disparities and can sometimes be slow to adopt newer technology. Hong and her colleagues aimed to fill in some of these weak points with their study, published in the Journal of Medical Internet Research. They relied on respondents from the China Health and Retirement Longitudinal Study to find out about use of the internet and mobile phones among people 45 years of age and older, individual and community factors that predict internet use and mobile phone ownership and the relationship between access to these technologies and health outcomes.

The survey measured internet use and cell phone ownership by asking respondents whether they had accessed the internet in the past month and if they owned a cell phone. Hong’s team then dug into the data, using per capita household expenditures to represent income and analyzing types of community resources such as drinking water sources and waste disposal facilities, hospitals and health centers and playgrounds, activity centers and organizations for helping the elderly and people with disabilities. They also looked into self-reported health and disability status of respondents as well as ability to perform activities of daily living such as bathing, dressing and preparing meals.

“We built four statistical models to see how internet access and phone ownership might correlate with health outcomes, while carefully controlling for individual and community factors and geography,” Hong said.

What they found was that 6.5 percent of the over-45 population in China used the internet and 83 percent owned a mobile phone. Internet access was associated with good self-reported health, but there appeared to be no correlation with disability. Mobile phone ownership, on the other hand, showed a significant association with not having a disability. Both internet and mobile phone use were correlated with socioeconomic factors as in previous research.

These findings point to both individual and community socioeconomic factors being important to health, thus building community resources and improving access to technology could be ways to improve health outcomes. The fact that the over-45 population in China has such a high rate of mobile phone ownership also suggests a way to reach parts of the population with health disparities and limited access to health-related online tools.

“Mobile phone subscription vouchers for elderly people and those with disabilities could improve that access and reduce health disparities in these vulnerable populations,” Hong said. “This could be especially important as older adults are a rapidly growing demographic group in China.”

This study serves as a starting point for further research that will be needed to gain a clearer understanding of health disparities and the digital divide in China. Hong and her colleagues said that future research should examine the use of mobile tools, as this study did not have data on smart phone use. In addition, future research will benefit from a more in-depth study of specific health outcomes.