Digital Health Divides: Telehealth Equity in a Global Context-A Narrative Review with an Israeli Case Study

Area of Science:

• Digital Health
• Health Equity
• Public Health Policy

Background:

• The COVID-19 pandemic accelerated global telehealth adoption, highlighting its potential for healthcare access.
• However, digital health technologies have also exacerbated existing healthcare disparities.
• Distinguishing between health equity and health equality is crucial for targeted policy responses.

Purpose of the Study:

• To synthesize global evidence on equity challenges in telehealth implementation.
• To identify key barriers hindering equitable access to telehealth services.
• To analyze strategies for promoting inclusive digital health delivery, using Israel as a case study.

Main Methods:

• A narrative review methodology was employed.
• Searches were conducted in PubMed/MEDLINE and Google Scholar (January 2020-June 2025).
• Boolean search strings combined telehealth, equity, access, and barrier keywords, leading to the analysis of 49 high-quality studies.

Main Results:

• Significant global disparities in telehealth utilization persist across age, race/ethnicity, geography, and language.
• Technology access alone is insufficient; cultural barriers, digital literacy, provider readiness, and policy failures create digital disadvantage.
• Israel's case study revealed persistent Arab-Jewish and center-periphery disparities despite high technological penetration.

Conclusions:

• Achieving telehealth equity necessitates multi-layered interventions targeting digital divides, cultural/linguistic barriers, and systemic inequalities.
• Strategies include equity-first design, multi-modal service delivery, comprehensive provider training, infrastructure investment, and continuous monitoring of disparate impacts.
• Addressing these factors is essential for inclusive digital health delivery.