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Primary care
Digital health interventions and inequalities: the case for a new paradigm
  1. Amitava Banerjee
  1. Institute of Health Informatics, University College London, London NW1 2DA, UK
  1. Correspondence to Dr Amitava Banerjee, Institute of Health Informatics, University College London, London NW1 2DA, UK; ami.banerjee{at}ucl.ac.uk

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Ischaemic heart disease, cerebrovascular disease (the most common cardiovascular diseases, CVD) and diabetes mellitus (DM) represent the 2nd, 3rd and 11th leading causes of disease burden1 in England. Both CVD and DM2 are targeted in high-level prevention policies, but variations in risk factors, diseases3 and outcomes,4 as well as treatment and access to services, persist on the basis of ethnicity, which has long been recognised as one of the ‘causes of the causes’ of health inequalities.5 Consideration of ethnicity in health policy has contributed to improved outcomes in ischaemic heart disease in South Asians in the last two decades in the UK,6 showing the benefits of targeted interventions. The NHS Outcomes Framework includes 11 metrics for health inequalities,7 but although ethnicity is mentioned, it is variably recorded in routine data, limiting the scope for measurement and analysis of healthcare use in black and minority ethnic (BME) individuals.

Digital health interventions (DHIs), ‘interventions delivered via digital technologies such as smartphones, website, text messaging’,8 could improve healthcare nationally and internationally, facilitating healthcare’s ‘triple aim’ of better care, better health outcomes and reduced costs.9 Systematic reviews support DHIs for improving outcomes in DM10 and CVD,11 and they are actively promoted in national policies (eg, diabetes prevention programme digital stream, heart age calculator in the cardiovascular disease …

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