Gulzar H Shah ^1,2* Kristie Cason Waterfield ² Tran Nguyen ³ Sripriya Rajamani ⁴

• ¹ Georgia Southern University, Statesboro, United States
• ² Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, United States
• ³ Department of Health Management, Economics, & Policy, Institute of Public and Preventive Health, Augusta University, Augusta, Georgia, United States
• ⁴ School of Nursing, University of Minnesota, Minneapolis, Minnesota, United States

The methodological rigorous research by Kobashi et al. involved the use of machine learning and historical cohort design to examine hospital visit behaviors of patients after receiving physicians' telehealth-supported advice. The study showed that physician advice shaped patients' adherence to physician-recommended hospital visits, but differences existed based on patient's characteristics. This study offered insights into the need for optimizing telehealth applications and equitable health resource allocation upstream to reduce downstream disparities in adherence to medical advice and access to care. The authors also highlight disadvantages concerning telehealth use for population subgroups such as older adults and those with behavioral health issues. Policy reforms from the Centers for Medicare and Medicaid Services (CMS) may influence telehealth adoption and access for vulnerable populations, particularly CMS 1135 and the CHRONIC Care Act (7)(8). These policies increase telehealth coverage for Traditional Medicare enrollees and enhance access to telehealth for managing chronic conditions. Wang et al. examined the differences in the availability and use of telehealth services among Medicare enrollees based on their status regarding Alzheimer's disease and related dementias (ADRD), as well as their enrollment in Medicare Advantage (MA) versus Traditional Medicare (TM) during the COVID-19 pandemic. The authors found no significant differences in the availability or utilization of telehealth services between Medicare beneficiaries with ADRD and those without. Although telehealth services were more readily available to Medicare enrollees prior to the pandemic, due to heightened demand for these services, this was not the case during the pandemic. Aldekhyyel and colleagues' data-driven research focuses on addressing health equity upstream by understanding health disparities to make a case for investments in telehealth. They examined behavioral intentions and e-health literacy shaping the potential use of telemedicine in the post-COVID-19 pandemic, spreading their positive impact on the adoption of telemedicine. Post-COVID, addressing the rural-urban digital health divide is even more critical to utilizing telehealth as an equalizer to address health inequities. Improving digital health literacy will address the barriers to telemedicine adoption, including complex user interfaces and limited digital skills, and enhance telemedicine participation among older adults and persons with chronic comorbidities. Hernandez et al. also examined the digital divide in telehealth screening for disadvantaged population subgroups. The authors reason that ensuring inclusive access to healthcare and equitable digital screening contributes to health equity. The authors make a case for collaborations among healthcare and community-based organizations and federal agencies such as CMS charged with improved healthcare for disadvantaged populations to incentivize healthcare service providers to ensure inclusion in digital health screening. The authors recommend ensuring inclusive access and equity-centered digital screening through culturally appropriate tools, adapting to patients' digital literacy, and addressing limited internet access. The characteristics of neighborhoods, towns, and cities can significantly influence the health and well-being of their residents through physical, social, and economic factors and impact SDOH. Just before the COVID-19 pandemic, Ortiz et al., from the Valencian Community, Spain, used the Place Standard Tool (PST) to assess how the community perceived their municipality regarding these aspects, exploring the differences between rural and urban contexts. The PST facilitates discussions about SDOH, organized into 14 themes, and serves as a foundation for local health interventions. Their findings validated that PST is valuable for promoting local health due to its versatility and action-oriented approach.To address the disparities in healthcare that negatively affect minority ethnic populations in England, Obita et al. conducted a study examining childhood obesity and related health issues from the perspectives of parents within Black, Asian, and Minority Ethnic (BAME) communities in Northeast England. The authors discovered that the views of these communities on childhood obesity prevention do not align with the preventative services offered by the healthcare system. They emphasized the need for community and family-oriented approaches to prevent obesity, particularly through lifestyle interventions. The study underlines the need for culturally appropriate strategies to prevent obesity and its associated comorbidities in minority ethnic communities living in high-income countries. Continuing to examine the SDoH "upstream" factors that influence health disparities "downstream" is crucial because it allows for a more comprehensive understanding of the root causes of health inequities (1). This allows for more effective and lasting solutions to reduce health disparities across underserved and vulnerable populations. Researchers, policymakers, and practitioners can utilize telehealth to create a more equitable healthcare system by increasing access to early screening and diagnosis, optimizing telehealth resource allocation, examining patient behavioral intentions, measuring e-health literacy, and incentivizing healthcare service providers to deliver more inclusive digital health screenings. Collaboration across sectors and stakeholders is vital and includes data gathering and sharing SDOH "upstream" data, community involvement in technology development and deployment, flexible funding for social needs, and supporting backbone organizations (9).