Challenges and opportunities for policy development on digital health equity in four Canadian jurisdictions

Digital health equity is an increasingly important topic, understood here as an aspirational state where everyone has access to the health-related digital technologies that support them in meeting their health-related needs. Despite strong emerging evidence regarding policy options to promote digital health equity, little policy action has been taken internationally to implement these options. The purpose of this paper is to report on a qualitative research project that explores the challenges and opportunities for policy development and implementation on digital health equity in four Canadian jurisdictions: Alberta, Saskatchewan, Ontario, and Quebec. We completed an Intersectionality-Based Policy Analysis, involving in-depth qualitative interviews with 23 participants, including both policy actors (i.e., those in positions to develop and/or implement digital health equity policy) and community leaders (i.e., those in positions advocating for the needs of structurally marginalized communities). Our findings illustrate a set of foundational policy options and more tailored policy programs for digital health equity, including the development of equity-focused accountability processes in new funding for digital health innovation. We also found challenges related to the political structure of Canada as a federation, and novel challenges related to the development of policy for digital health equity specifically. In our discussion, we explore three policy development challenges in detail: conflicting views on the priority status of health equity, challenges in building long-term partnerships with community for policy development, and conflicting views on the role of technology vendors in public policy for health care.