Examining Upstream to Understand Downstream: Use of Telehealth and Other Health Equity Measures for Addressing Health Disparities

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Background

The modern public health enterprise is rooted in the premise that the efficient elimination of health disparities requires addressing their upstream root causes, the health inequities. The paradigm shift to Public Health 3.0 capitalizes on understanding health disparities as an outcome of the intertwined concepts of health inequities, Social Determinants of Health (SDoH). The “upstream” unfair and avoidable differences concerning social, cultural, economic, and political power shape “downstream” poor health outcomes for vulnerable groups. A recent manifestation of such inequitable health outcomes was witnessed during the COVID-19 pandemic. The pandemic highlighted the underlying inequities and disparities in health across populations. The socioeconomic determinants of health, identified before the global health crisis, led to discrepancies in transmission, hospitalization, and death rates. These “upstream” SDoH played a fundamental causal role in poor “downstream” health outcomes.

Health equity approaches, including telehealth as an equalizer of healthcare access, aim to eliminate the “upstream” disparities to achieve the “downstream” optimal health and well-being for everyone. Public health literature has documented studies that address both upstream and downstream aspects of the problems. Some focus on the fundamental “upstream” determinants, while others address the “downstream” outcomes. A better understanding of how the upstream affects the downstream can serve as a tool to mediate or moderate those effects.

Telehealth embraces the delivery of health care, health education, and health information services via remote technologies. During the COVID-19 pandemic and the need for social distancing, public health, and clinical care practices rapidly transitioned from in-person visits to virtual visits (via telehealth), particularly to assure continuity of care for chronic conditions. Even post-pandemic, the use of telehealth remains a major mode of care delivery for many patients, especially for those patients who have access to telehealth facilities and tools. As the utility of telehealth becomes increasingly evident, so do its challenges regarding serving the needs of vulnerable populations globally. Two main areas that remain particularly challenging are differential connectivity to the internet and access to quality healthcare services.

This Research Topic aims to showcase the research studies exemplifying how upstream health inequities in SDoH and healthcare can be addressed through telehealth and other approaches to eliminate or reduce health disparities in population health or healthcare outcomes. Submissions will provide strong evidence of a link between upstream and downstream promising leverage points for improving individual and population health outcomes. This collection welcomes research manuscripts, analytical essays, and reviews, including but not limited to the themes listed below:

● Measurement approaches and methodologies for telehealth, health disparities, and health equity;

● Social and structural determinants of telehealth use as a health equity tool concerning specific health areas (e.g., MCH, cancer, heart disease, other chronic conditions, infectious disease, mental and behavioral health, etc.);

● Perceptions of public health and healthcare workforce about the use of telehealth as a health equity tool to reduce or eliminate health disparities during COVID-19;

● Investing in telehealth infrastructure (access to broadband internet, technology or peripherals, access to technical support staff, and training of non-tech staff)) as a health equity measure;

● Programs/initiatives to support telehealth for eliminating unfair and avoidable differences in health outcomes for underserved communities (e.g., rural, low-income, elderly, disabled, immigrants);

● Targeted approaches (e.g., predictive analytics) to identify individuals who will benefit from support for telehealth appointments and ongoing care through telehealth;

● Promoting community and corporate partnerships to promote telehealth (e.g., through improved broadband connectivity) for improved accessibility to quality healthcare among vulnerable populations;

● Assessing digital technologies’ interoperability across clinical portals, telehealth platforms, and patient data outside of patient visits using allied health professionals or artificial intelligence;

● Telehealth as an equalizer of healthcare access: Patients’ digital literacy and engagement in telehealth across underserved and vulnerable populations;

● Satisfaction of patients and health providers (public health and healthcare organizations) with the use of eHealth and telehealth tools.

Keywords: health equity, telehealth, social determinants of health, socioeconomic determinants, upstream and downstream root causes

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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