Equity across the regulation, implementation and evaluation of digital health: scoping review

Overview

Digital health has the potential to improve health-care delivery and population health outcomes. To ensure equitable benefits, its development and implementation must address potential health inequities arising from biased technologies and systemic factors. A scoping review used a sociotechnical lens to examine how equity is considered in digital health regulation, implementation and evaluation within the WHO European Region. Equity is increasingly acknowledged in digital health, but its integration into practice remains inconsistent. Regulatory frameworks primarily emphasize safety, privacy and performance, with limited focus on inclusion of underserved populations or adaptability to low-resource settings. Implementation strategies often overlook structural barriers. Standardized equity metrics and robust bias auditing for artificial intelligence-driven technologies are lacking. The review highlighted the need for an equity-by-design approach to embed equity throughout the digital health life cycle. Advancing equity requires inclusive governance, participatory design and cross-sectoral collaboration. Recommendations include establishing a shared understanding of equitable digital health, integrating equity metrics into maturity models, and reinforcing regulation, governance and sustainable financing. The Region is positioned to lead harmonization efforts and support Member States to embed equity within digital health policies and practices, ensuring that digital health contributes to improved health outcomes, stronger health systems and reduced health inequities.