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Health charity warns NHS app could exacerbate existing health inequalities

The Health Foundation has warned the existence of digital divides in UK society could create a false sense of security as some segments of society are left in the dark.

The digital divide might not be as obvious in the UK as it is in other places, but that does not mean it is not there. Low income families and the elderly are two segments of society who risk being placed at a higher risk of infection should they not be able to download or consistently run the application, for one reason or another.

To be the most effective, academics have suggested that at least 60% of the population would have to download and operate the application as designed.

“The NHS contact tracing app could play a critical role in the fight against COVID-19, expanding the number of people who are traced and speeding up the process,” said Adam Steventon, Director of Data Analytics at the Health Foundation.

“But there’s a significant risk that many will be left behind. The impact of COVID-19 is already being felt unequally across society and appears to be having a disproportionate impact on people living in more deprived areas, older people, and some ethnic minorities.

“Within that context, it’s especially concerning that people in lower paid jobs and those with less formal education say they are less likely to download and use the app, and of course not everyone has a smartphone.”

A survey commissioned by the Health Foundation and carried out by Ipsos Mori suggests that 62% would be likely to download the application, though when asking routine and manual workers, state pensioners and the unemployed, this figure falls to 50%. 17% of those over the age of 65 do not own a smartphone, neither do 8% of the unemployed.

To validate these results, the UK Consumer Digital Index 2019, a report produced by Lloyds Bank, suggests 13% of UK citizens, some 7.1 million people, cannot open an app.

While it is highly unlikely any Government would be able to produce a COVID-19 which is completely fair, benefiting each and every element of society equally, little attention seems to have been paid to the digital divide.

Interestingly enough, this is a topic which has not been addressed by the telcos. Industry lobby group, the GSMA, has said one thing the industry could do to assist the success of such initiatives would be to zero-rate the applications, meaning none of the data consumed would be held against customer data tariffs. Many NHS websites have been zero rated already, while helplines are generally free to call, but this is an area which it could be extended to.

The consequence of failure to address the digital, or societal, divide is quite clear. Quoted statistics from the Office of National Statistics (ONS), the Health Foundation claims that deaths in the most deprived areas are double than of the least deprived. Those facing greater socio-economic disadvantage living in these areas, are also likely to be the individuals less likely to see the benefits of the contract tracing application mentioned above.

“NHSX must ensure that the benefits of the app are experienced by the communities who need these the most, while ensuring that the potential negative consequences of the app, such as false alerts, do not fall on those least able to withstand them,” Steventon said.

“It is also vital that those who do not have access to the app are protected as a priority by the government’s wider Test and Trace system, and that a more comprehensive strategy to tackle health inequalities is put in place.”

There is plenty which can still go wrong with this application, but as the NHSX, the technology unit of the NHS, is doing little to offer any transparency into development, who knows what is going on.

We suspect this app is going to be a disaster. The NHS has decided against listening to advice from Silicon Valley, the guys who really know about building successful applications, and has offered little insight into the Isle of Wight trials. Going on reports from the island, the app was downloaded 50,000 times, though it failed to function for a material number.

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