Mapping Inequities in Digital Health Technology Within the World Health Organization's European Region Using PROGRESS PLUS: Scoping Review.

BACKGROUND: The use of digital technologies within health care rapidly increased as services transferred to web-based platforms during the COVID-19 pandemic. Inequalities in digital health across the domains of equity are not routinely examined; yet, the long-term integration of digitally delivered services needs to consider such inequalities to ensure equitable benefits. OBJECTIVE: This scoping review aimed to map inequities in access, use, and engagement with digital health technologies across equity domains. METHODS: We searched 4 electronic databases (MEDLINE, ASSIA, PsycINFO, and Scopus) for quantitative and mixed methods reviews and meta-analyses published between January 2016 and May 2022. Reviews were limited to those that included studies from the World Health Organization's European region. Extracted data were mapped against Cochrane's PROGRESS PLUS (place of residence, race, ethnicity, culture, and language, occupation, gender and sex, religion, education, socioeconomic status, social capital, and other characteristics) dimensions of equity. RESULTS: In total, 404 unique citations were identified from the searches, and 2 citations were identified from other sources. After eligibility assessment, 22 reviews were included. Consistent evidence was found showing higher access to digital health technologies among patients who were of White ethnicity, were English speaking, and had no disability. There were no reviews that explored differences in access to digital health care by age, gender and sex, occupation, education, or homeless or substance misuse. Higher use of digital health technologies was observed among populations that were White, English speaking, younger, with a higher level of education, of higher economic status, and residents in urban areas. No clear evidence of differences in the use of digital technologies by occupation, gender and sex, disability, or homeless or substance misuse was found, nor was clear evidence found in the included reviews on inequalities in the engagement with digital technologies. Finally, no reviews were identified that explored differences by place of residence. CONCLUSIONS: Despite awareness of the potential impact of inequalities in digital health, there are important evidence gaps across multiple equity domains. The development of a common framework for evaluating digital health equity in new health initiatives and consistency in reporting findings is needed.

Inequalities in colorectal cancer screening uptake in Wales: an examination of the impact of the temporary suspension of the screening programme during the COVID-19 pandemic.

BACKGROUND: Response to the early stages of the COVID-19 pandemic resulted in the temporary disruption of cancer screening in the UK, and strong public messaging to stay safe and to protect NHS capacity. Following reintroduction in services, we explored the impact on inequalities in uptake of the Bowel Screening Wales (BSW) programme to identify groups who may benefit from tailored interventions. METHODS: Records within the BSW were linked to electronic health records (EHR) and administrative data within the Secured Anonymised Information Linkage (SAIL) Databank. Ethnic group was obtained from a linked data method available within SAIL. We examined uptake for the first 3 months of invitations (August to October) following the reintroduction of BSW programme in 2020, compared to the same period in the preceding 3 years. Uptake was measured across a 6 month follow-up period. Logistic models were conducted to analyse variations in uptake by sex, age group, income deprivation quintile, urban/rural location, ethnic group, and clinically extremely vulnerable (CEV) status in each period; and to compare uptake within sociodemographic groups between different periods. RESULTS: Uptake during August to October 2020 (period 2020/21; 60.4%) declined compared to the same period in 2019/20 (62.7%) but remained above the 60% Welsh standard. Variation by sex, age, income deprivation, and ethnic groups was observed in all periods studied. Compared to the pre-pandemic period in 2019/20, uptake declined for most demographic groups, except for older individuals (70-74 years) and those in the most income deprived group. Uptake continues to be lower in males, younger individuals, people living in the most income deprived areas and those of Asian and unknown ethnic backgrounds. CONCLUSION: Our findings are encouraging with overall uptake achieving the 60% Welsh standard during the first three months after the programme restarted in 2020 despite the disruption. Inequalities did not worsen after the programme resumed activities but variations in CRC screening in Wales associated with sex, age, deprivation and ethnic group remain. This needs to be considered in targeting strategies to improve uptake and informed choice in CRC screening to avoid exacerbating disparities in CRC outcomes as screening services recover from the pandemic.

Challenges to self-isolation among contacts of cases of COVID-19: a national telephone survey in Wales.

BACKGROUND: Self-isolation is challenging and adherence is dependent on a range of psychological, social and economic factors. We aimed to identify the challenges experienced by contacts of coronavirus disease 2019 (COVID-19) cases to better target support and minimize the harms of self-isolation. METHODS: The Contact Adherence Behavioural Insights Study (CABINS) was a 15-minute telephone survey conducted with confirmed contacts of COVID-19 (N = 2027), identified through the NHS Wales Test Trace Protect (TTP) database. RESULTS: Younger people (aged 18-29 years) were three times more likely to report mental health concerns (adjusted odds ratio [aOR]: 3.16, 95% confidence interval [CI]: 2.05-4.86) and two times more likely to report loneliness (aOR: 1.96, CI: 1.37-2.81) compared to people aged over 60 years. Women were 1.5 times more likely to experience mental health concerns (aOR: 1.51, 95% CI: 1.20-1.92) compared to men. People with high levels of income precarity were eight times more likely to report financial challenges (aOR: 7.73, CI: 5.10-11.74) and three times more likely to report mental health concerns than their more financially secure counterparts (aOR: 3.08, CI: 2.22-4.28). CONCLUSION: Self-isolation is particularly challenging for younger people, women and those with precarious incomes. Providing enhanced support is required to minimize the harms of self-isolation.

Seeking good work in the COVID-19 recovery: shifting priorities and employment choices among workers.

OBJECTIVE: Disruption to working lives spurred by the COVID-19 pandemic may shape people's preferences for future employment. We aimed to identify the components of work prioritised by a UK sample, and the employment changes they had considered since the start of the COVID-19 pandemic. METHODS: A nationally-representative longitudinal household survey was conducted in Wales at two time-points between 2020 and 2021. RESULTS: Those in poorer health prioritised flexibility, and were more likely to consider retiring. Those with limiting pre-existing conditions or low mental well-being were more likely to consider becoming self-employed. Those experiencing financial insecurity (including those with high wage precarity or those furloughed) were more likely to consider retraining, becoming self-employed, or securing permanent employment. CONCLUSIONS: Ensuring flexible, secure and autonomous work is accessible for individuals facing greater employment-related insecurity may be key.

Mental health of the nursing and midwifery workforce in Wales during the COVID-19 pandemic: a cross-sectional analysis.

BACKGROUND: The mental health of the nursing and midwifery workforce in the UK became a public health concern before the COVID-19 pandemic. Poor mental health is a known factor for those considering leaving the profession, and workforce retention of younger members is crucial for the future of the sector. The aim of this study was to provide up-to-date estimates of mental wellbeing in this workforce in Wales during the COVID-19 pandemic. METHODS: We did a cross-sectional analysis of demographics, work-related information, and health data from respondents to a national online survey of registered and student nurses and midwives and health-care support workers in Wales. The survey was open between June 23 and Aug 9, 2021, and 2910 people responded (approximately 7% of the workforce). Mental wellbeing was calculated using the Short Warwick Edinburgh Mental Wellbeing Score (SWEMWBS). We measured probable clinical depression (SWEMWBS <18) and possible mild depression (SWEMWBS 18-20). We used χ2 analysis and multinomial logistic regression (adjusted for sex and staff grouping) to examine associations between age groups and mental wellbeing. FINDINGS: We analysed data from 2781 (95·6%) of 2910 respondents (129 respondents did not answer all seven SWEMWBS questions). Overall, 1622 (58·3%) of 2781 respondents had SWEMWBSs indicative of either probable clinical depression (863 [31·0%] of 2781) or possible mild depression (759 [27·3%] of 2781). Probable clinical depression was highest among those aged 18-29 years (180 [33·8%] of 532), 30-39 years (250 [35·6%] of 703), and 40-49 years (233 [33·5%] of 696). Respondents in these age groups were twice as likely to report SWEMWBSs indicative of probable clinical depression than respondents aged 60 years and older (18-29 years adjusted odds ratio [aOR] 2·38 [95% CI 1·43-3·97], p=0·0009; 30-39 years aOR 2·86 [1·77-4·64], p<0·0001; 40-49 years aOR 2·49 [1·54-4·02], p=0·0002). INTERPRETATION: This study highlights the substantial burden of poor mental wellbeing among the nursing and midwifery workforce in Wales, especially in those aged 49 years and younger. These figures, higher than previous estimates, could reflect the mental health effect of responding to the pandemic and could have long-term implications on workforce retention. FUNDING: None.

Impact of the temporary suspension of the Bowel Screening Wales programme on inequalities during the COVID-19 pandemic: a retrospective register-based study.

BACKGROUND: Response to the COVID-19 pandemic resulted in the temporary disruption of routine services in the UK National Health Service, including cancer screening. Following the reintroduction of services, we explored the impact on inequalities in uptake of the Bowel Screening Wales (BSW) programme to identify groups who might benefit from tailored intervention. METHODS: BSW records were linked to electronic health record and administrative data within the Secured Anonymised Information Linkage (SAIL) Databank Trusted Research Environment. We examined uptake in the first 3 months (from August to October, 2020) of invitations following the reintroduction of the BSW programme compared with the same period in the preceding 3 years. We analysed inequalities in uptake by sex, age group, income deprivation quintile, urban and rural location, ethnic group, and uptake between different periods using logistic regression models. FINDINGS: Overall uptake remained above the 60% Welsh standard during the COVID-19 pandemic period of 2020-21 but declined compared with the pre-pandemic period of 2019-20 (60·4% vs 62·7%; p<0·001). During the COVID-19 pandemic period of 2020-21, uptake declined for most demographic groups, except for older individuals (70-74 years) and those in the most deprived quintile. Variation by sex, age, income deprivation, and ethnic groups was observed in all periods studied. Among low-uptake groups, including males, younger individuals (60-64 years), those living in most deprived areas, and ethnic minorities, uptake remains below the 60% Welsh standard. INTERPRETATION: Despite the disruption, uptake remained above the Welsh standard and inequalities did not worsen after the programme resumed activities. However, variations associated with sex, age, deprivation, and ethnicity remain. These findings need to be considered in targeting strategies to improve uptake and informed choice in colorectal cancer screening such as co-producing information products with low-uptake groups and upscaling the use of GP-endorsed invitations and reminder letters for bowel screening. FUNDING: Health Data Research UK, UK Medical Research Council, Administrative Data Research UK, and Health and Care Research Wales.

Shifting priorities and employment choices among workers in Wales during the COVID-19 pandemic: a longitudinal analysis.

BACKGROUND: Employment is a determinant of health. The COVID-19 pandemic disrupted working lives, forcing individuals to adapt to new ways of working. These shifts might shape people's priorities and their consideration of changes for future work. We examined how these outcomes differed depending on self-reported health status. METHODS: In this longitudinal analysis, we used data from the COVID-19 Employment and Health in Wales Study; a nationally-representative household survey of workers aged 18-64 years. Timepoint 1 (T1) data were collected between May 27, 2020, and June 22, 2020, and timepoint 2 (T2) data between Nov 30, 2020, and Jan 29, 2021. Participants who responded at both timepoints were eligible. Respondents selected five employment priorities at both timepoints, and the employment changes they considered during the COVID-19 pandemic at T2 only. We used multivariable logistic regressions (including sociodemographics, current employment factors, and self-reported health) and examined associations with health firstly for employment priorities, and secondly for the consideration of employment changes. Health measures were self-reported general health, limiting pre-existing health conditions (both using National Survey for Wales validated questions), and mental wellbeing (using the shortened Warwick Edinburgh Mental Well-being Scale). FINDINGS: We analysed data from 592 respondents (382 [65%] women). 766 (56%) of 1358 T1 respondents were excluded as no T2 responses were provided. Those who self-reported poor general health were consistently more likely to prioritise flexible working arrangements than those rating fair or above (T1 adjusted odds ratio [aOR] 2·06 [95% CI 1·10-3·88], p=0·033; T2 aOR 1·87 [95% CI 1·05-3·33], p=0·034). Those with low (as opposed to average) mental wellbeing were more likely to consider securing a permanent contract (aOR 5·49 [95% CI 1·32-22·81], p=0·023, and those with limiting pre-existing conditions were four times more likely to consider becoming self-employed (aOR 4·00 [95% CI 1·35-11·84], p=0·011) than those without. INTERPRETATION: Promoting the adoption of flexible working policies and supporting those in poor health to obtain flexible employment could benefit people in Wales. Those with low mental wellbeing might seek the security of permanent employment, and those with limiting pre-existing conditions might value the autonomy of self-employment. FUNDING: None.

Exploring the Health Impacts and Inequalities of the New Way of Working: Findings From a Cross-Sectional Study.

OBJECTIVE: The aim of the study is to provide insights into the working Welsh adult population's perceptions of the health impacts of working from home (WFH), their ability to WFH, and their WFH preferences. METHODS: Data were collected from 615 working adults in Wales between November 2020 and January 2021 in a household survey. RESULTS: More than 45% of those able to WFH reported worsened mental well-being and loneliness. Working from home worsened the diets, physical activity, smoking, and alcohol use of those in poorer health. Approximately 50% were able to WFH, although individuals living in more deprived areas, in atypical employment or with precarious income, were less able to WFH. Nearly 60% wanted to WFH to some capacity. CONCLUSIONS: The new way of working introduces new challenges to preserving workforce mental well-being, regulating health behaviors, and tackling inequalities. Hybrid models and targeted health support could make WFH healthier and more equitable.

Individuals with lived experience of homelessness and their COVID-19 outcomes in Wales: a data linkage study

Background Homelessness as a complex and persistent public health challenge is an extreme form of social exclusion. Our understanding on the health of homeless populations is largely informed by research on the more visible street homelessness, highlighting ill health, substance dependencies, and reduced life expectancy. These estimates are likely to underestimate individual's health-care needs, alongside barriers to accessing care. We aimed to adopt a broad definition of homelessness to understand COVID-19-related health outcomes for this population. Methods Our definition includes street homelessness and precarious or insecure housing, thus including those known as hidden homeless who are not in government homelessness statistics. We generated an e-cohort of individuals with recorded lived experience of homelessness in Wales, by combining information across four routine health-care datasets (primary care, inpatient care, emergency department, and substance misuse service. A population comparison group was randomly selected from the Welsh Demographic Service database. We linked the e-cohort and comparison group with COVID-19 NHS Wales Test Trace and Protect, annual district death extract, and the patient episode database to examine the COVID-19 outcomes. This study is exempt from consent due to the anonymised nature of the databank. The independent Information Governance Review Panel approved this study. Findings The e-cohort includes 15 472 individuals aged 16 years and older who visited the four health-care services in Wales since Jan 1, 2014, until July 31, 2020, including 1717 currently homeless during the pandemic in 2020 (69·2% were male and 42·0% were younger than 35 years). Of those people currently homeless during COVID-19, 54 (3·2%;95% CI 2·4–4·1) tested positive for the virus, 16 (0·9%;0·5–1·5) had COVID-19-related hospital admissions, and five (0·3%;0·1–0·7) died, involving COVID-19. Compared with the general population comparison group (n=15 472), where 340 (2·20%;1·97–2·44) tested positive, 11 (0·07%;0·04–0·13) had COVID-19 related hospital admissions, and nine (0·06%;0·03–0·11) died, involving COVID-19 (mentioned on death certificate). Interpretation These findings suggest that COVID-19-related outcomes were worse for individuals who were homeless during the pandemic compared with the general population. The complex health needs and pre-existing vulnerabilities people who are homeless warrant further exploration. This study is likely to underestimate the population size and health needs due to relying on people seeking health care and disclosing their homeless or housing status, to which there are recognised barriers. Accurate and standardised coding of housing status in practise is an area that needs urgent improvement. Funding Public Health Wales.

Precarious employment and self-reported health: a cross-sectional analysis

Background Associations between precarious employment and poorer health outcomes are well documented. However, which components of this multidimensional construct are associated with adverse health is unknown. The primary aim of this study was to examine associations between the different domains of precarious employment and self-reported health. Methods We used data from 1016 respondents (634 women and 382) to the COVID-19 Employment and Health in Wales Study, a nationally representative household survey of the so-called working-age population (18–64 years). The study was done on May 25 and June 22, 2020, using a push-to-web approach (letter invitation to an online survey;response rate: 6·9%). Respondents provided details of their main job in February, 2020, including information on their contract type and different domains of employment precariousness as assessed by the Employment Precariousness Scale. These domains were: temporariness (length of time working under temporary arrangements);disempowerment (control over work schedule);vulnerability (perceived treatment at work);wages (pay and ability to afford basic and unexpected expenses);and rights. Health measures were self-reported pre-existing health conditions, general health, and mental wellbeing (calculated with the Short Warwick Edinburgh Mental Wellbeing Score). To examine associations between domains of precarious employment and health, chi-squared analysis and multinomial logistic regression (adjusted for sex, age, deprivation, contract type, and self-reported health) were done. The Health Research Authority approved this study (Integrated Research Application System reference: 282223). Findings The domains of precarious employment that showed the strongest associations with poor health, independently of contract type, were high vulnerability precariousness (associated with pre-existing condition: adjusted odds ratio 2·44 [95% CI 1·32–4·49], p=0·004;poor general health: 2·35 [1·23–4·51], p=0·010;low mental wellbeing: 2·74 [1·30–5·75], p=0·008);high wage precariousness (associated with pre-existing condition: 1·66 [1·08–2·57], p=0·022;poor general health: 2·21 [1·33–3·69], p=0·002;low mental wellbeing: 3·16 [1·54–6·45], p=0·002);and moderate wage precariousness (associated with pre-existing condition: 1·68 [1·20–2·36], p=0·003;and low mental wellbeing: 2·25 [1·19–4·29], p=0·013). Interpretation Before the COVID-19 pandemic, tackling poverty in those in work and perceived fair treatment in the workplace appear to have been important in improving the health of the working-age population of the UK. Longitudinal analyses are required to establish the effect of the pandemic on employment conditions and on whether these domains remain adversely associated with health. Funding No funding to declare.

Challenges of self-isolation among contacts of cases of COVID-19: a national telephone survey in Wales

Background Self-isolation is known to be challenging and adherence is dependent on a range of psychological, social, and economic factors. We aimed to identify the specific challenges experienced by contacts of COVID-19 cases to better target support and minimise the harms of self-isolation. Methods The Contact Adherence Behavioural Insights Study (CABINS) was a 15 min telephone survey of contacts of COVID-19 cases, identified through NHS Wales Test Trace Protect (TTP). Quota sampling by age, gender (interlocked), and Welsh Index of Multiple Deprivation (WIMD) was used to ensure a representative sample of those in the TTP database. Logistic regression models adjusted for age, gender, living alone, time period, WIMD, and income precarity (financial insecurity) established which subgroups were more likely to experience challenges. Ethical approval was gained from the NHS Research Ethics Committee and the Public Health Wales Research and Development Office. Informed consent was gained from participants at the beginning of the telephone call. Findings We identified 47 072 eligible contacts (24 825 female, 23 090 male, and 10 542 did not say) who were informed to self-isolate over two periods (period 1 [regional lockdowns in place;no financial support available]: Sept 13, 2020, to Oct 23, 2020 [n=18 568];period 2 [during a national lockdown;self-isolation support payments available]: Dec 13, 2020, to Jan 16, 2021 [n=28 504]). 10 801 were invited to participate (5092 from period 1, 5709 from period 2);2027 (18·8%) completed the survey. People with high income precarity were almost eight times more likely to report financial challenges (adjusted odds ratio 7·73;95% CI 5·10–11·74) and three times more likely to report mental health concerns (3·08;2·22–4·28) than their more financially secure counterparts. Younger people (18–29 years) were twice as likely to report loneliness (1·96;1·37–2·81) and three times more likely to report mental health concerns (3·16;2·05–4·86) than individuals aged 60 years and older. Women were nearly twice as likely to experience mental health difficulties as men (1·51;1·20–1·92). No effects of WIMD were found. Findings were similar between the two periods. Interpretation Financial challenges of self-isolation were particularly acute among those individuals with high income precarity, and younger people and women had considerable mental health challenges. During the pandemic, Welsh Government and local TTP teams used this insight to target financial and mental health support to those with greatest need. Despite easing of self-isolation requirements for contacts of COVID-19 cases, identifying these groups remains important for future pandemics and the provision of financial and social support. Funding Project funded internally by Public Health Wales.

Factors influencing initiation of health behaviour conversations with patients: Cross-sectional study of nurses, midwives, and healthcare support workers in Wales.

AIM: To identify factors influencing healthcare professionals' engagement in health behaviour conversations with patients. DESIGN: Cross-sectional survey. METHODS: Between April and June 2019, an online survey of 1338 nurses, midwives and healthcare support workers was conducted. The survey assessed whether staff felt comfortable initiating health behaviour conversations with patients about five behaviours (reducing alcohol intake; stop smoking; being more active; reducing their weight; and improving their diet) and barriers to conversation initiation. Health professionals' own health-related behaviours, self-rated health and mental wellbeing, and socio-demographic characteristics were recorded. Logistic regression models were built to assess factors associated with feeling comfortable initiating health behaviour conversations for each topic. RESULT: Less than 50% of respondents reported feeling comfortable initiating health behaviour conversations with patients. Female staff, young professionals (18 to 29 years), those in lower staff grades and those with poorer health and low mental wellbeing were less likely to report feeling comfortable having health behaviour conversations across all topics. Those who did not adhere to physical activity and dietary guidelines were less likely to initiate a conversation about being more active and having a healthy diet, respectively. Not having time to discuss the topic, suitable space to hold a conversation, and feeling worried about offending/upsetting patients were the main barriers reported. CONCLUSION: Around 6 in 10 members of the nursing, midwifery and healthcare support workforce in Wales potentially do not feel comfortable to initiate a health behaviour conversation with patients about health and wellbeing. Feeling less comfortable to initiate a conversation was associated with staff demographics and organizational factors. IMPACT: We identified those less likely to initiate health behaviour conversations as well as personal and organizational barriers to initiation. This will help to target and tailor interventions to ensure staff are equipped and enabled to hold health behaviour conversations with patients.

Characteristics of those most vulnerable to employment changes during the COVID-19 pandemic: a nationally representative cross-sectional study in Wales.

BACKGROUND: The public health response to the SARS-CoV-2 (COVID-19) pandemic has had a detrimental impact on employment and there are concerns the impact may be greatest among the most vulnerable. We examined the characteristics of those who experienced changes in employment status during the early months of the pandemic. METHODS: Data were collected from a cross-sectional, nationally representative household survey of the working age population (18-64 years) in Wales in May/June 2020 (n=1379). We looked at changes in employment and being placed on furlough since February 2020 across demographics, contract type, job skill level, health status and household factors. χ2 or Fisher's exact test and multinomial logistic regression models examined associations between demographics, subgroups and employment outcomes. RESULTS: Of our respondents, 91.0% remained in the same job in May/June 2020 as they were in February 2020, 5.7% were now in a new job and 3.3% experienced unemployment. In addition, 24% of our respondents reported being placed on furlough. Non-permanent contract types, individuals who reported low mental well-being and household financial difficulties were all significant factors in experiencing unemployment. Being placed on 'furlough' was more likely in younger (18-29 years) and older (60-64 years) workers, those in lower skilled jobs and from households with less financial security. CONCLUSION: A number of vulnerable population groups were observed to experience detrimental employment outcomes during the initial stage of the COVID-19 pandemic. Targeted support is needed to mitigate against both the direct impacts on employment, and indirect impacts on financial insecurity and health.

Creating an e-cohort of individuals with lived experience of homelessness and subsequent mortality in Wales, UK.

BACKGROUND: Homelessness is an extreme form of social exclusion, with homeless people experiencing considerable social and health inequities. Estimates of morbidity and mortality amongst homeless populations is limited due to the lack of recording of housing status across health datasets. The aim of this study is to: (i) identify a homelessness e-cohort by linking routine health data in Wales, and (ii) explore whether a period of reported past homelessness, places this population at greater risk of morbidity and mortality. METHODS: Homelessness identified through linkage across primary, secondary care and substance misuse datasets in the Secure Anonymised Information Linkage (SAIL) Databank. Mortality was examined through linkage to the Office for National Statistics mortality data. RESULTS: E-cohort of 15 472 individuals with lived experience of homelessness identified. Of those, 21 individuals died between February and July 2020 involving coronavirus disease of 2019 (COVID-19). Those with lived experience of homelessness had increased mortality from many causes including accidents, liver diseases and suicides. CONCLUSION: Linking multiple routine datasets provides a more comprehensive dataset of a marginalized population, including individuals who are not included in government homeless statistics. Application of the cohort demonstrated that individuals with lived experience of homelessness have increased mortality involving COVID-19 and other causes. The underlying reasons, health needs and causes of death warrant further exploration.

Addressing the Digital Inverse Care Law in the Time of COVID-19: Potential for Digital Technology to Exacerbate or Mitigate Health Inequalities.

Digital technologies have been transforming methods of health care delivery and have been embraced within the health, social, and public response to the COVID-19 pandemic. However, this has directed attention to the "inverse information law" (also called "digital inverse care law") and digital inequalities, as people who are most in need of support (in particular, older people and those experiencing social deprivation) are often least likely to engage with digital platforms. The response to the COVID-19 pandemic represents a sustained shift to the adoption of digital approaches to working and engaging with populations, which will continue beyond the COVID-19 pandemic. Therefore, it is important to understand the underlying factors contributing to digital inequalities and act immediately to avoid digital inequality contributing to health inequalities in the future. The response to COVID-19 represents a sustained shift to adopting digital approaches to working and engaging with populations which will continue beyond this pandemic. Therefore it is important that we understand the underlying factors contributing to digital inequalities, and act now to protect against digital inequality contributing to health inequalities in the future.