The concept of a health equity audit (HEA), as part of guidance issued by Public Health England (PHE) in the context of their Health Equity Assessment Tool, updated in May 2021, helps to articulate a clear framework to address health inequalities and has potential to be extended to the broader field of digital health [1]. Specifically, the PHE guidance defined how the objective of HEAs is to evaluate whether resources are distributed equitably with respect to the health needs of different population groups; they systematically examine health inequalities and access to services for particular groups or areas. Audits also ensure that actions to address health inequalities are incorporated into planning decisions, prioritizing actions to address health inequalities, and addressing how they can evaluate the impact of the actions on reducing inequalities.

These tools, despite having been widely used in the United Kingdom since the 2000s and subsequently neglected due to organizational changes in the British health care system, are currently recommended by PHE, which following the inequalities evidenced during the COVID-19 pandemic, renewed interest in adopting the tool for health care purposes; the tool could also be adapted for various applications of digital health technologies [2,3].

As the field of health disparities has matured to reach a crucial element of health care management and quality, we have simultaneously witnessed the effects of digital transformation on health status as well as health care [4-7]. This necessitates the need for a reexamination of the utility of HEAs in the design, implementation, and evaluation of digital health technologies. These inequalities have amplified during the COVID-19 pandemic, especially due to the misinformation caused by the infodemic, which pushed the World Health Organization to call a conference on the topic. Importantly, the convergence of factors such as volume and speed of information, misinformation, and disinformation flow, combined with political polarization, requires the forging of a community for the evidence-based practice of infodemic management [8].

According to the National Institutes of Health, digital health refers to the use of information and communication technologies in medicine and other health professions to manage diseases and health risks and promote well-being [9]. For the European Union, digital health and care refers to tools and services that use information and communication technologies to improve the prevention, diagnosis, treatment, monitoring, and management of health-related problems, and to monitor and manage lifestyle habits that affect health. Digital health and care facilitates the use of emerging and innovative technologies, and has the potential to improve access and the quality of care, as well as increase the overall efficiency of the health care sector [10].

The World Health Organization [11] has three key objectives to promote the adoption and expansion of digital health and innovation:

Access to digital technologies in health, including the internet, technological tools, digital agendas and systems, digital literacy, etc, has also become an increasingly important determinant of health and has a special relationship with social determinants of health. Emerging evidence from the scientific literature recognizes that access to digital technologies is now a determinant of health outcomes [12,13]. As digital determinants of health (DDoH) become increasingly recognized [14,15], a framework for digital health equity audits (DHEAs), including the evaluation of key DDoH, is needed.

In this editorial, we propose an approach to extend HEA tools to address shared international objectives of synergistically promoting both health equity and digital health adoption and access, framed as a DHEA. This strategy is rooted in the World Health Organization’s objectives of equity and digitalization as described above and involves the synthesis of a tool that combines HEA concepts with stated goals of digital health equity, as published in other academic literature, and modeled based on proposals by the Agency for Healthcare Research and Quality in a comprehensive framework [16]. We support the implementation of a similar approach also focusing on improving the health status of the population in relation to the use of technologies and the context of health technology assessments. However, we must consider that new digital “approaches have the potential to address some of the structural challenges for marginalized populations.... Yet the digitalization of health care can also harm health equity if this digitally enabled ecosystem moves forward without proactive engagement, planning, and implementation” [5]. As discussed in the recent literature, the evidence linking inequality in health care to misinformation exposure and mitigating strategies is a complex area where further research is needed [17-19].

The DHEA model is an integrated model that takes into account social, epidemiological, health, and technological variables. The integration of knowledge and resources, together with the involvement at the institutional and the population levels, should produce a health gain for the majority of the population, reducing health inequities thanks to new technologies and strengthening trust in government institutions and health care. The systematic adoption of integrated and digitized tools for reading the system could certainly contribute to the evaluation of the effectiveness of interventions [20]. However, the digitization of health services in 2025 is increasingly important and its massive implementation is expected in the following years. The large amount of data that we will have to manage—fueled by the continuous flow of information—is converging and will converge with artificial intelligence all over the world, leading to a rapid and proportionally difficult-to-control diffusion of infodemiology. The increased convenience, accessibility, and penetration of internet services have significantly transformed how people obtain information on health-related issues. The rapid proliferation of information and communication technology tools has led to an era of unprecedented accessibility to vast repositories of information, especially through online communication channels and social media platforms [21]. In summary, we could therefore affirm that new technologies can be the cause of inequalities or the solution to health inequalities. We would like the DHEA tool to help increase equity at all levels so that one day everyone can benefit from the advantages of technologies and, through them, be in control of their health and well-being. Facilitators include building trust (eg, providing evidence for health messages), while barriers include user reluctance to accept support. The main recommendations are adopting a collaborative working approach (involving users, developers, health care professionals, policy makers, etc, often through co-design) and using effective advertising to raise awareness of available support.

Being aware of the great advantages of the widespread, adequate, and fair use of continuous technological and digital innovations available to science, we must never forget that they are the tool and not the goal.