The Syndemic of Inequity and COVID-19 in Virtual Care

Abstract

The critical intersections of structural inequities and vulnerabilities of marginalized populations, particularly those engaging the social gradient of minority ethnic communities, are revealed in the syndemic approach to COVID-19. Although proposals for cultural interventions to improve virtual care provide relevant measures, they may not address the root cause of the disparate impacts of a pandemic on population subgroups. The common misperception of equality as synonymous with equity further impedes the efficacy of digital health in quality-of-care initiatives, as it systemically fails to acknowledge the disparate realities of marginalized populations, while intending to benefit all. This commentary suggests that an alignment of the health care system with Canada’s pluralist principles would support a paradigm shift in transforming virtual care into an equitable standard as envisioned by Pham and colleagues in their paper, “The Future of Virtual Care for Older Ethnic Adults Beyond the COVID-19 Pandemic.”

Telemedicine, e-Health, and Digital Health Equity: A Scoping Review

“…The selected articles have been published in the last five years, mainly in the last 3 years, and only one article has been published in 2018 [ 21 ]. The geographical distribution of the papers has suggested a prevalence of interest in the USA [ 14 , 17 , 22 - 37 ], Canada [ 15 , 21 , 38 - 40 ], and in Australia [ 9 , 41 , 42 ]; one paper has been from Korea [ 43 ], and only some authors from Europe have addressed the topic [ 44 , 45 ]. The papers have been mainly editorials [ 21 , 22 ], commentaries [ 27 , 36 , 38 , 46 ], or viewpoint papers [ 14 , 23 , 29 , 39 ], and only a few research articles have focused on the themes of this scoping review [ 12 , 17 , 24 , 25 , 41 , 44 ].…”

“…The geographical distribution of the papers has suggested a prevalence of interest in the USA [ 14 , 17 , 22 - 37 ], Canada [ 15 , 21 , 38 - 40 ], and in Australia [ 9 , 41 , 42 ]; one paper has been from Korea [ 43 ], and only some authors from Europe have addressed the topic [ 44 , 45 ]. The papers have been mainly editorials [ 21 , 22 ], commentaries [ 27 , 36 , 38 , 46 ], or viewpoint papers [ 14 , 23 , 29 , 39 ], and only a few research articles have focused on the themes of this scoping review [ 12 , 17 , 24 , 25 , 41 , 44 ]. According to the digital e-environments or e-platforms considered, even if all the papers refer to Telemedicine and/or e-Health, some other fields are considered, like Telehealth [ 13 , 14 , 17 , 22 , 24 , 25 , 34 , 36 , 42 ] and mobile health [ 14 , 21 , 26 , 37 ].…”

“…To date, there is no complete agreement on the definition of DHE, although the aforementioned documents of the World Health Organization represent a common thread between the different positions proposed by the authors [ 5 - 7 ]. However, the main shared elements among all the most recent definitions seem to be the promotion of one's health potential through digital tools [ 24 , 35 , 44 ], the reference to a list of risk factors [ 25 , 38 , 42 ] or to single risk factor [ 13 , 27 ] that can lead to some forms of marginalization, and the reference to the description of group/s of people at higher risk of inequalities [ 12 , 13 , 15 , 17 , 21 - 24 , 27 - 30 , 32 , 34 , 35 , 40 - 49 ].…”

“…Regarding the description of group/s of people at higher risk of inequalities, while the World Health Organization’ documents make a general reference to the concept of disadvantage, there is a common reference to a set of people or groups that could incur in forms of marginalization and could meet some barriers in the development of their health potential [ 5 - 7 ]. Those people are sometimes described in a general way as “groups of people with reduced resources” [ 23 , 30 , 36 , 42 ], or as “marginalized group/s or individuals” [ 15 , 21 , 22 , 28 , 38 , 46 ]. Some papers have described in a deeper way the group/s of people that could incur some forms of inequity (people with disability, people living in lower socio-economic areas, cultural ethnical, and economically diverse communities, elderly people, and people who live in rural areas) [ 27 , 40 ].…”

“…Some authors have highlighted the multidimensional nature of DHE (individual level, contexts, social determinants of health, and the enabling environment) and the need to consider different levels to achieve a comprehensive knowledge of it [ 31 , 38 ]. Anaya and colleagues [ 22 ] took a further step forward in defining the multidimensional features of “equity in digital healthcare” in Telemedicine, highlighting its complexity.…”