The Next WHO Global Digital Health Strategy Must Address Digital Exclusion and Online Abuse [Guest Essay]
Newsletter Edition #288 [The Files In-Depth]
Hi,
More often than not, digital health attracts unblemished optimism in global health. However, the implications for vulnerable groups from such a transition is complex and difficult.
In today’s guest essay, scholars from the Digital Health and Rights Project (DHRP), an international consortium of social scientists, rights advocates and community-led networks, discuss how digital health inequities deepen exclusion, and how Technology-Facilitated Abuse is being normalized.
They call for the next digital health strategy from WHO, to address these issues.
“Global digital platforms and artificial intelligence (AI) continue to evolve faster than regulatory frameworks, and young adults in the digital age are increasingly paying the costs of connection to online health information and services,” they say.
We hope you find this contribution useful.
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I. GUEST ESSAY
The Next WHO Global Digital Health Strategy Must Address Digital Exclusion and Online Abuse
By Tara Imalingat and Sara (Meg) Davis
Authors Affiliation: Digital Health and Rights Project (DHRP), an international consortium of social scientists, rights advocates and community-led networks hosted by The University of Warwick. Contact: sara.davis@warwick.ac.uk
The World Health Assembly (WHA)’s recent decision to extend the Global Strategy on Digital Health 2020-2025 until 2027, and to launch efforts to plan the next Global Strategy on Digital Health, marked an important commitment to improving health for all by accelerating the development and governance of digital health.
However, our new research report - one of the most extensive qualitative studies on this topic - finds that some of the young people who most need to be reached with digital health solutions in low- and middle-income countries (LMIC) are left behind, and face risks of misinformation, online abuse and discrimination. WHO and member states must use these findings to inform their work on governance, planning and prioritisation, or risk driving deeper health inequities and harms for those digital health most needs to reach.
Our new research report, Paying the Costs of Connection: Human rights of young adults in the digital age in Colombia, Ghana, Kenya and Vietnam from the Digital Health and Rights Project (DHRP), an international consortium of social scientists, rights advocates and community-led networks hosted by The University of Warwick, demonstrates some difficult realities below the surface of global health techno-optimism.
While the digital transformation is revolutionising health systems and access to health information globally, socio-economic, gender and other inequalities are leaving diverse young adults in LMIC without access to basic health information and services, and increasingly normalising online harms, ranging from misinformation to abuse. Global digital platforms and artificial intelligence (AI) continue to evolve faster than regulatory frameworks, and young adults in the digital age are increasingly paying the costs of connection to online health information and services.
Focusing on Colombia, Ghana, Kenya and Vietnam, this study is one of the largest international studies of digital human rights in health to date with over 300 young adults ages 18 to 30 participating in focus group discussions and in-depth interviews in rural, urban and peri-urban areas.
Researchers at national civil society organisations and universities also interviewed 41 experts from UN bodies, government agencies, and community organizations, contributing to over 4000 pages of qualitative data in six languages. Because many of the researchers came from the communities in question, including young adults living with HIV, sex workers, and LGBTQ+ communities, they were able to elicit sensitive disclosures and frank views.
Working collaboratively across borders, our multidisciplinary team jointly designed the study, analysed the data, and validated findings with study participants. The resulting insights are grounded in the lived experiences and voices of young, marginalized communities from four contextually diverse digital health ecosystems. Community participants also led drafting of the report recommendations, informed by national and international experts.
The resulting report starkly documents overlapping forms of digital exclusion and harm. It must inform future governance and strategy plans, and implementation of the 2024 Global Digital Compact. It also emerges amid a rapidly devolving global health governance landscape, where shifting political priorities and sweeping cuts in overseas development assistance (ODA) funding will pose significant challenges to addressing these critical issues.
Overlapping digital health inequities deepen exclusion
Young adults who are living with HIV, sex workers, LGBTQI+ people living in urban, peri-urban and rural areas described the range of obstacles preventing them from receiving health information online: the cost of smartphones and internet access, gaps in digital literacy, restrictive cultural norms and fears of stigma were cited as persistent barriers––barriers which often intersect to widen digital divides. In Kenya and Ghana, many young adults told us they are forced to choose between staying connected and buying food. In Colombia, women in a rural village said that if their husbands did not pay for internet access, women could not make medical appointments for themselves or their children.
The digital gender divide was especially pronounced in Colombia, Ghana and Kenya, given overlapping gender, economic and educational inequalities that limit women’s access to lifesaving health information online. In Vietnam, interestingly, we heard fewer reports of gender-based digital health inequality, due in part to more widespread access to smartphones and wifi, and greater familiarity with navigating online; there, one of the greatest barriers was fear of being outed online as living with HIV or as LGBTQ+, as well as worries about navigating online health misinformation.
The report finds that these overlapping forms of digital exclusion are a particularly pressing issue among socially and economically marginalised young populations as the shift towards digital technologies is putting those already left behind at greater risk.
The normalisation of “Technology-Facilitated Abuse”
Three-quarters of young adults across all four countries reported online abuse against themselves or their peers, including cyberbullying, stalking, blackmail and the non-consensual sharing of intimate images. Many young people said that due to socioeconomic or family pressures, they shared phones with parents, partners or friends; leaving them vulnerable to intimate surveillance and exposure of HIV status and criminalised or stigmatised sexual activity. Being outed can have serious and potentially devastating consequences: For one young woman, it meant being evicted from her family home after her father discovered her HIV status through a well-intentioned text message from her doctor. Some accounts shared by young women, people living with HIV and LGBTQ+ people were so distressing that participants reported symptoms of depression and, in some cases, thoughts of self-harm.
Young HIV advocates sharing messages of hope on social media said they were often targeted by hate speech, though many remained optimistic about the positive impact their online visibility could have on peers.
We found that technology-facilitated abuse sometimes moved from online to offline spaces, and back again across all four countries, avenues for redress were insufficient. While a few participants mentioned successfully reporting technology-facilitated abuse to social media platforms or the police, many more expressed concerns that reporting could exacerbate risks of harm. In Ghana, where same-sex sexual activity is criminalised, one participant recounted how a friend who sought help from the police was instead threated with arrest. A transgender woman in Colombia, who described harrowing virtual stalking and physical abuse, shared that in her personal experience, reporting abuse felt pointless, as police failed to take it seriously. Similarly, a transgender participant in Vietnam, who was outed as living with HIV, noted that by the time abuse is reported to the authorities, the damage is usually already done.
Instead, many young adults felt that they themselves bore the main responsibility for keeping themselves safe online; while we agree that digital self-defense is important, the rest of us have an important role to play.
While recent media has drawn attention to worries about young perpetrators of harm, we emphasize the need for actions that counter technology-facilitated abuse to be rooted in a survivor-centred approach: one that upholds autonomy, confidentiality and human rights of survivors of harm, while ensuring access to mental health care and access to justice. Governments must urgently develop robust laws and polices shaped in partnership with those who have lived experience, placing them at the heart of all decision-making processes. Technology companies must also take meaningful action to protect users, moving beyond profit-driven algorithms that amplify controversy, and instead creating safer, more accountable digital spaces.
Digital empowerment, human rights and the next Global Strategy on Digital Health
Despite all the issues they shared, many young adults in the study displayed a strong desire to acquire digital literacy skills to enable them to fully benefit from the digital transformation of health. DHRP coined the term “digital empowerment” to describe the knowledge, skills and competencies people need to advocate for their rights in the digital age. It includes knowledge on legal rights, advocacy skills and digital security. Some found courage through trusted spaces within the HIV movement, including online support groups. In Vietnam, community-led groups became a vital source of inspiration and resilience, when HIV activists mobilised our study’s community advisory committee to counter online abuse.
A young non-binary adult from Accra, Ghana put it well:
“One key thing is digital rights education. Because some of us, we use technology, but we don’t know our rights when it comes to accessing information online. And then it makes people…abuse us because we don’t have the digital knowledge to mitigate some of these things.”
Despite their concerns, young adults expressed hope for a future marked by more digital rights awareness, robust regulatory frameworks and increased transparency and accountability for harms.
But here, the Global Strategy on Digital Health and national digital health strategies must do better: our reviews have found that many national digital health strategies fail to address human rights and gender equality. Our 2024 review of twenty national digital health strategies, conducted in collaboration with WHO, found that none explicitly addressed gender inequality, and few addressed human rights or recognised the specific digital health needs of diverse populations. This oversight reflects systemic weaknesses in global health governance: while digital health is being adopted with enthusiasm, the excitement about technology’s potential are rarely matched by equitable and accountable policies or implementation.
Slow but important national efforts to strengthen health data governance must also be expedited; many young adults expressed concerns over data breaches, unauthorized data sharing by private companies, government surveillance and monitoring by family members or community groups. In her 2023 report to the UN Human Rights Council on digital innovation and the right to health, Dr. Tlaleng Mofokeng highlighted how weak data protection increases risks of online harassment, intimidation and violence. Our findings echo this truth.
As we look ahead to the next Global Strategy on Digital Health, governments, technology companies, civil society and international actors must work together to address the digital inequities revealed in this report and implement its recommendations. “Tech for good” can only deliver on its promise if it protects and empowers those most at risk, ensuring that no one is left to pay the costs of connectivity without support.
Also see: Towards People-centred Digital Health Strategies: Gender, Equity, Rights and Inclusion (Narrative Report, 2024)
II. PODCAST CORNER
AI for equity: bridging global health gaps
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Garry Aslanyan is the host and moderator of the Global Health Matters podcast. You can contact him at: aslanyang@who.int
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