Health, the digital divide and rural dwellers

A timber barn in a rural setting. Looks like it is on a farm. Health and digital divide. In the land of access and inclusion, the focus is usually on the built environment and services. But there is also virtual access and inclusion to consider. The pandemic has highlighted a lack of equitable access to the internet and therefore access to health services. This is particularly the case for rural dwellers. The issues of health, the digital divide and rural dwellers is discussed in a report from the US.

The context of the report is the social determinants of health and the digital divide. Broadband access and digital literacy are key for connecting to services such as employment, education and health services. While broadband infrastructure and computer hardware are necessary, true equitable access also requires focus on digital literacy and proficiency. However, there are other issues related to poor health outcomes. 

According to the report, rural residents are subject to additional social determinants including physician shortages, persistent poverty, and food insecurity. Excessive travel times, inadequate transportation options, environmental exposures are also problematic. And broadband internet services that are often poor quality, unaffordable, or unavailable. 

“Super-determinants” of health are poor transportation, lack of broadband access, and living with a disability. That’s because they cause disadvantage across other areas of life. 

The title of the report is Underfunded Infrastructure Impact on Health Equity. The study focuses on north America, but Australian rural dwellers share many of the same issues.

People are looking at bright orange pumpkins piled in rows in a field on a farmThe report recommends engagement and involvement by community members. Community health workers live and work in vulnerable communities, and they understand the real lives of people. Consequently, community health workers should lead community involvement in coming up with solutions. 

The report explains the social determinants of health, the cost of inequity, and the need for digital literacy training. 

Four key findings in the report

      1. Households with consistent broadband have increased health literacy, greater access to clinical and social services, make better informed healthcare choices, and stay closer connected to support systems of friends and family.
      2. A holistic approach led by health advocates from the local community has the best chance of improving health outcomes and successfully overcoming barriers caused by social determinants.
      3. Strategies for reaching vulnerable populations should center on community health workers (CHWs) who are trusted and respected members of that population. CHWs have an ability to better understand the reality of
        how people live and the obstacles that keep them from success.
      4. Program leadership should include meaningful representation from local community organizations with valuable experience in health equity and extensive community networks.

Microsoft renews commitment to accessibility

Microsoft icons for wheelchair users, cognition, signing and mobility. Microsoft commitment to accessibility.The ‘disability divide’ is only set to get wider. So it’s good news that Microsoft plans to to be more accessible and inclusive. That includes their workforce culture as well as accessible technologies described in their Inclusive Design Toolkit. Microsoft’s commitment to accessibility includes people with disability in their action plans.

According to an article in an IT industry magazine, Microsoft plans to increase training and recruitment of people with disability. It plans to use industry collaboration and recruitment across GitHub, LinkedIn and Microsoft Learn communities. Suppliers are another group they are targeting for creating a culture of accessibility.

A black and white graphic of stick people in various states of being.In 2019 Microsoft produced an Inclusive Design Toolkit.  Their key advice is to recognise exclusion, solve for one and extend to many, and learn from diversity. You can download the toolkit in sections. it has case studies and videos.

The magazine article is titled, Microsoft pledges to bridge ‘disability divide’ with renewed commitment to disability, has more detail about the use of AI in software. 

Good that companies that promote inclusive products and services are realising they need an inclusive workforce. 

Digital transitioning requires mainstream accessibility

Front cover of the ICT report.COVID has revealed our reliance communicating online and via social media. That’s why European countries are getting together to improve the accessibility of all digital services. The digital world has to be accessible to all. It is also part of the Sustainable Development Goals and “leave no-one behind”. That’s why digital transitioning requires mainstream accessibility.

The International Telecommunication Union has launched its ICT accessibility assessment for the Europe region. The COVID-19 pandemic has reinforced the importance of ICT accessibility. The report is designed to provide ITU members and stakeholders from the ITU Europe region with a holistic view of ICT accessibility requirements, the implementation status of ICT accessibility laws, regulations, policies and institutional frameworks, and with good practices and recommendations. Accessibility for all, including ICT is now a top priority.

A magazine article in Mirage titled, Accessible Europe 2021: Making ICTs accessible to all, provides an overview of the assessment report. By 2023 the ITU wants 90% of digital services to have the “seal of usability and accessibility”. This is part of the Accessible Europe project. 


Older people and internet use

A pair of hands belonging to an older man hold a mobile phone.2020 has been a year of digital connectedness. Many of us relied on the internet to keep working and stay connected to family and friends. Access to virtual health services turned out to be important too. But access to the internet and digital connection wasn’t available to everyone. It’s assumed that older people are unable or unwilling to use digital communications. The assumptions by others about the capabilities of older people doesn’t help. It reinforces a negative mindset in both older people and their younger family members. 

Understanding older people’s relationship with the internet was the subject of a survey in rural Queensland. 1500 households were surveyed and asked about the general adoption of internet use. Within this survey, respondents were asked to indicate their understanding of older people’s relationship with the internet. Researchers found three general assumptions: older people aren’t interested in the internet, and they generally can’t use it. However, family members did believe the internet would be useful for older people.

If family members act on these assumptions they are unlikely to assist older members of the family to use the internet to communicate with others. If society continues to assume older people incapable or disinterested in internet communications it will lead to reinforcing the digital divide.

The researchers conclude that distinctions should be drawn between older people in rural areas and the tendency to apply urban norms to this population. 

The title of the article is, Perceptions of older age and digital participation in rural Queensland. It is academically dense in parts but the issue is clear. Older people will be unable to join with younger cohorts in independently using internet technology if we continue to apply these assumptions.


Participation is thought to build and sustain individual and community resilience. What constitutes participation today significantly involves networked digital communications. With Australia’s ageing population set to increase exponentially, and with a growing concentration of older people living outside of larger cities and towns, a need exists to address how participation in later life is understood and facilitated. Coupled with the need for regional communities to find relevant change processes that build resilience, this multidisciplinary paper highlights variations in perception about older people’s digital abilities in regional Queensland. Following the general increase in appeal of digital devices to older people, defined here as those aged over 65, the paper suggests that how older people’s digital connectedness progresses is foundationally influenced by the speculative, antithetical and potentially ambivalent perceptions of others. In doing so, we seek to understand rural connectedness in later life through a suite of literacies informing digital participation.

There’s a related article from 2015, Internet use: Perceptions and experiences of visually impaired older adults. Published in the Journal of Social Inclusion, it provides some excellent qualitative research – the comments from older people with vision loss are especially revealing.

Ambient Technology: Assistive or Intrusive?

A graphic of a blue body with different labels around it. For example, telehealth, patient monitoring, assisted living.Designing and creating electronic devices for older people so they can stay home in their later years is a good thing. But are they actually what older people want? It’s a balancing act between assistance for independence versus privacy intrusions. Where do you draw the line? And will the older person have a say in where that line is drawn? These are tricky questions and the answers are likely to be individual. And what happens to any data that are collected both deliberately and as a by-product?

A conference paper from Germany discusses some of these issues as we are increasingly looking to technology to solve our problems. The issues raised in could benefit from a universal design perspective. Taking this view, one would ask, “How can we make ambient technology more universal and general and less specialised so that people don’t feel stigmatised? As Eva-Maria Schomakers and Martina Ziefle say, privacy concerns include the feeling of constant surveillance, misuse of personal information by third parties, as well as the invasion of personal space, obtrusiveness and stigmatising design of these technologies.

The title of the article is Privacy Perceptions in Ambient Assisted Living 

Ambient Assisted Living is a growing field of research. A related paper on ResearchGate “Enabling Technologies for the Internet of Health Things”, might be a place to start. It contains some useful diagrams.

UD, ID, DfA, UX, UA: A terminology muddle

A hand holding a coloured pen is poised over a green post it note. There are drawings on the table and a smartphone. It indicates UX design.  UD, ID, DfA, UX, UA muddle.The aims of universal design (UD), inclusive design (ID), design for all (DfA), user experience (UX) and universal accessibility (UA), are basically the same – inclusion. So why should we have a terminology muddle? Most designers and practitioners who understand the underpinning principle of inclusion, say it’s not a big deal.  But shouldn’t the key issue be about implementation rather than discussing the nuances of terms? Even if we had one term, would that alter designer and practitioner attitudes towards inclusion?

Nevertheless, researchers find it frustrating not having one term to cover the concepts. That’s because it makes it difficult to know if people are talking about the same thing when sharing research findings. The debate among academics has resulted in many papers on this topic. Some putting forth arguments that they are all different things. Others lamenting the problems of not having a consistent terminology. A few delve into philosophical arguments.

A paper from 2014 is still relevant today because the arguments are still current. This paper discusses historical, methodological and philosophical aspects. It’s a long paper, probably best suited to academics. It covers just about every aspect of the issues. It also draws in the ICF (International Classification of Functioning, Disability and Health) and international standards which is quite useful. 

The title of the paper downloadable from ResearchGate says it all, Universal design, inclusive design, accessible design, design for all: different concepts—one goal? On the concept of accessibility—historical, methodological and philosophical aspects.

Editor’s Note: I also wrote on the topic of terminology in relation to housing design, Calling a Spade a Shovel: Universal, accessible, adaptable, disabled – aren’t they all the same? 


Accessibility and equal opportunities for all in the digital age have become increasingly important over the last decade. In one form or another, the concept of accessibility is being considered to a greater or smaller extent in most projects that develop interactive systems. However, the concept varies among different professions, cultures and interest groups.

Design for all, universal access and inclusive design are all different names of approaches that largely focus on increasing the accessibility of the interactive system for the widest possible range of use. But, in what way do all these concepts differ and what is the underlying philosophy in all of these concepts?

This paper aims at investigating the various concepts used for accessibility, its methodological and historical development and some philosophical aspects of the concept. It can be concluded that there is little or no consensus regarding the definition and use of the concept, and consequently, there is a risk of bringing less accessibility to the target audience. Particularly in international standardization the lack of consensus is striking.

Based on this discussion, the authors argue for a much more thorough definition of the concept and discuss what effects it may have on measurability, conformance with standards and the overall usability for the widest possible range of target users.

Digital Accessibility: It’s not an add-on

A graphic showing a laptop with a green screen and several smart phones around it also with green screens. It is indicating that they are all connected.Beware digital consultants who offer a range of services “plus Accessibility services”. If they list it as a separate service then it is likely they don’t truly know what it is. Why? Because accessibility should be built-in regardless. It’s not an added extra. But it is specialised.

As Sheri Byrne-Haber says,
“Just because you are good at one does not make you good at the other”. If you say you are good at both it implies you don’t understand the business drivers for either.

In her article Byrne-Haber lists some other mistakes commonly made by consultants:
1. They assume that you can wave a magic wand over people and turn them into accessibility testers.
2. They rarely employ people with disability, but outsource to disability services and pay them a pittance for their knowledge.
3. They tell people they can do every type of accessibility testing in their contact messages.

Byrne-Haber also points out that digital accessibility specialists will be in demand as disability discrimination legislation gets tighter. Big tech companies are already on board with an increasingly diverse workforce. But you do need to know what questions to ask. The list of questions to ask is in her article, Vetting Accessibility Vendors.  


Artificial Intelligence: A framework

Infographic of the proportion of 272 different stakeholder groups.A discussion paper was released on 5 April 2019 to encourage conversations about AI ethics in Australia. This paper included a set of draft AI ethics principles. 130 submissions were received from a wide range of stakeholders, including one from CUDA. The Australian AI Principles are ready for testing and are:

    • Human, social and environmental wellbeing
    • Human-centred values
    • Fairness
    • Privacy protection and security
    • Reliability and safety
    • Transparency and explainability
    • Contestability
    • Accountability

You can find out more detail in a list of insights from the consultations. You can ask a question or give feedback via an online form at the bottom of the Department of Industry website on this topic.

It is good to see human-centred values and human, social and environmental wellbeing now included. A closer look shows that older people, people with disability, people from diverse backgrounds and children are included in these principles by virtue of including human rights. The Fairness Principle includes mentions of Inclusion and Accessibility. 

Smart Cities for All Toolkit

cover of Smart Cities for All Toolkit.How smart can a smart city be? ‘Smart’ is everything from the footpath to the website. So not so smart if it doesn’t include everyone and join the dots between all the factors that make a city a city.  With digital transformations happening worldwide, the aim of the Smart Cities for All Toolkit is to eliminate the digital divide and improve urban environments for everyone. 

The main part of the toolkit, the Inclusive Innovation Playbook, is detailed and aimed at a policy and planning level. Stakeholder participation and inclusion is an essential theme. Case studies assist with understanding. There is a helpful checklist at the end of the Playbook. There’s a lot to digest, but this means it isn’t a cursory overview with simplistic solutions. It goes much deeper than a digital accessibility checklist. This is about joining the dots across city assets and leveraging them for everyone’s benefit. Other sections of the toolkit cover: 

    • Toolkit Overview
    • Guide to adopting an ICT accessibility procurement policy
    • Implementing priority ICT accessibility standards
    • Communicating the case for stronger commitment to digital inclusion in cities
    • Database of solutions for digital inclusion in cities

“The toolkit supports a range of organizations and roles related to Smart Cities, including government managers, policy makers, IT professionals, disability advocates, procurement officials, technology suppliers, and developers who design Smart City apps and solutions.

Each of the tools addresses a priority challenge identified by global experts as a barrier to the digital inclusion of persons with disabilities and older persons in Smart Cities.”  See also Smart Cities for All: A Vision

James Thurston of 3Gict discusses the issues in the video below.  

Connect me to my car

Self driving vehicle on the road.Gerard Goggin has written a thoughtful piece on the issue of automated vehicles and how they might, or might not, be a boon for people with disability. The value of automated vehicles for people with disability is often mentioned in articles related to this technology, but will that value be realised? The article raises some important points about the depiction of disability and how it is communicated and how that plays out into the world of technological development. Goggin covers “blind driving”, developments by Google and Waymo and more. Mentioning the inclusion of older people and people with disability as good news stories is insufficient to put these users at the centre of designs. Written in academic style but important thinking going on here. The title of the article is, Disability, Connected Cars, and Communication.

Introduction: In this article, I take up a highly visible theme in discourses, experimentation, and manufacture of connected cars and autonomous vehicles: disability. I analyze the leading ways in which this new kind of technology is imagined for particular users with disability, as in the highly publicized case of Google’s pilot driverless vehicle promoted as a boon for blind people and those with vision impairments. Then, I try to stand this kind of framing of connected-cars-as-good-for-disability on its head, and discuss the implications for questions of emerging social technology, equality, diversity, and design. Reflecting on this analysis, I look at what disability tells us about connected cars, and, indeed, how we might rethink communication and technology.

Note: Gerard Goggin co-authored a book, “Disability in Australia: exposing a social apartheid”. Written in 2005, it is still relevant today. It can be bought online or accessed through the National Library of Australia.