According to John Locke (1764), “The state of nature has a law of nature to govern it”, which mandates that no individual can injure others’ lives and health as our innate natural rights. By extension, healthcare, as both a critical determinant of health and effective action to promote it, should be protected as a civil and political right. All World Health Organization (WHO) Member States have endorsed the human rights treaty that incorporates “the right to the highest attainable standard of health” (WHO, 2023). To ensure the accessibility of such standard, WHO not only requires states to implement laws and policies to guarantee universal access to quality healthcare services, but also addresses the root causes of the entrenched social disparities. It further demonstrates a motive to consolidate healthcare as part of our human rights on the basis of equality. However, health outcomes are significantly sensitive to social circumstances (Wilkinson & Marmot, 2003). The concept of “the highest attainable standard of health” is also influenced by individual biological factors, socioeconomic conditions, and the country’s available resources (Committee on Economic, Social and Cultural Rights, 2000). Today, while technological development has elevated the ceiling of the “highest attainable standard of health”, it has also widened the gaps in individuals’ actual access to healthcare services due to preexisting disparities, such as socioeconomic status, and newly emerged barriers of technology-driven gatekeeping. This has resulted in the further exclusion of marginalized groups from the facilities, services, and conditions necessary to achieve the “highest attainable standard of health,” posing an alarming and pressing question: Has healthcare been transformed into a privilege contingent upon wealth, social standing, and digital literacy in its technological evolution?
Cost Barriers for Accessing Advanced Treatment
Technological innovations have introduced more possibilities for healthcare with cutting-edge treatment methods and advanced medical equipment, but economic conditions determine who can access and benefit from these developments. Increasingly high costs, along with a limited and lagging insurance system, have led to a stratified pattern in the actual healthcare that people can receive. In principle, the right to health requires that healthcare costs should be based on the principle of equity to ensure it’s “affordable for all”. This means that poorer families should not bear a disproportionate economic burden compared to wealthier families (Committee on Economic, Social and Cultural Rights, 2000).
However, the reality is that many high-tech healthcare technologies, such as gene therapy and advanced prosthetics, are expensive, even unaffordable for low-income groups. For example, gene therapy treatment Zolgensma comes with a staggering price of up to $2,100,000, while state-of-the-art prosthetic limbs with bionic models can cost between $5,000 and over $10,000 (Boateng, 2024). Although these technologies have offered transformative benefits, their exorbitant costs put them out of reach for low-income populations. The high prices of these healthcare technologies stem not only from R&D costs, but also from market scarcity and corporate profit-seeking behaviors. The pricing of pharmaceuticals has testified to this issue: From 2011 to 2016, Mylan, as the sole supplier of epinephrine auto-injectors in the market, raised the price of EpiPen by nearly 400% (U.S. Department of Justice, 2017). Such inflated prices do not fully reflect production costs, but are the result of deliberate price-raising mechanisms for companies to maximize profits (Browne, 2022). This suggests that there will consistently be cutting-edge healthcare technologies available at a prohibitively expensive price, unaffordable for the general populace.
To tackle the problem of economic inaccessibility, the existence of healthcare insurance provides a safety net that bridges the financial disparity leading to healthcare inequality. However, due to its substantial cost, cutting-edge treatment such as gene therapy is often not covered in self-insured employers’ healthcare insurance in the United States, effectively restricting access for ordinary individuals, while the wealthy can pay out of their pocket to obtain the “highest attainable” treatment (Quantile Health, n.d.). Even if these treatments are gradually included in healthcare insurance in the future as newer technologies are introduced and costs fall, it will be difficult to avoid lags in insurance coverage. The repercussions of this delay are grave and severe, as economically disadvantaged patients will face fatal consequences when excluded from accessing life-saving treatment during coverage gaps. This is why the issue of healthcare disparity being amplified by technological progress warrants urgent attention. Behind the privilege induced by cost barriers lies the well-being and survival of countless marginalized individuals.
Data Biases That Further Exclude the Marginalized
With the integration of artificial intelligence and big data into the healthcare field, the disparities widened by technology consist not only of economic barriers but also of algorithmic bias caused by the data underrepresentation of the marginalized groups. As sociologist Ruha Benjamin (2016) points out, despite the potential of digital health technologies, they can become “one of the many conduits by which past forms of inequality are upgraded”. While AI is often framed as an objective tool, it has been found to be biased towards certain patient groups, leading to differences in diagnostic accuracy and actual clinical outcomes (Cross et al., 2024). This stems from the fact that the datasets AI systems learn from are shaped by human decision-making, including historical health records, clinical treatment decisions, and patient demographic patterns. When these datasets underrepresent certain ethnic or gender groups, medical technology based on such data consequently absorbs and reflects these biases (James, 2024).
For instance, pulse oximeters typically overestimate the Sao2 of dark-skinned hypoxic subjects, as they have been calibrated using individuals with light skin tones, leading to the misdiagnosis or delayed treatment for patients of color (Feiner et al., 2007). Furthermore, algorithm design can also embed bias in healthcare. In another example, the U.S. healthcare system relies on a commercial algorithm to inform health decisions, which uses healthcare costs as a proxy for illness severity. Less money spent on black patients, due to systemic discrimination and financial constraints, is thus incorrectly interpreted as better health, resulting in a more than half reduction of black patients identified as needing additional care. (Obermeyer, 2019).
The issue of marginalized groups being unable to obtain accurate healthcare due to data gaps and algorithmic bias actually reflects a systemic crisis: in the age of high-tech healthcare, the absence of data means unrecognized and unmet health needs. And such a problem has become increasingly acute in today’s advanced treatment methods, such as gene therapy and precision medicine, which rely heavily on databases like the Human Genome Project (HGP). However, the HGP repository is almost entirely composed of European genomic data, excluding underrepresented groups from the big-data facilitated medical progress (Gordon, 2024). This demonstrates how AI and big data are shaping a data privilege, where some populations are represented in the data and some are not (Wang et al., 2020). And such inequality contradicts WHO’s emphasis on how every human being should have access to “the highest attainable standard of physical and mental health” (WHO, 2023) by privileging those included and erasing the underrepresented in the training datasets for new medical progress. In this sense, digital technology exacerbates healthcare inequality in a novel and alarming way: by fundamentally reshaping the filtering mechanism of “who is assumed to count as ‘human’” (Ferryman, 2022). Such implicit gatekeeping of human rights recognition further systematically excludes the already marginalized group from the scope of rights entitlement.
The Digital Literacy Gap in Information Accessibility
In the internet-enabled era, the use of digital health technologies has become increasingly vital for healthcare services. WHO (2023) thus emphasizes that the right to health includes information accessibility. At the individual level, one key determinant of such accessibility is one’s digital literacy or health literacy, defined as the ability to “access, understand, appraise, and use information and services in ways that promote and maintain good health and well-being” (WHO, 2024). Proficiency in digital health literacy is found to be consistently related to positive health outcomes across diverse health domains (Ji et al., 2024). However, in reality, the gap in digital reality can also result in inequality. Research highlights that most digital healthcare tools are not tailored to vulnerable groups, including the elderly, the undereducated, and other populations with limited digital literacy (Toscos et al., 2019), indicating how technology introduces a new skill-based gatekeeping from the outset of design.
During the COVID-19 pandemic, mobile smart devices emerged as the most effective way for people to access healthcare. However, in China, elderly people may not be able to use mobile devices to register for health codes or make appointments for healthcare services online, due to their limited digital literacy and low willingness to use such technology. (Yao et al., 2022). Many elderly people find themselves struggling with the complex digital processes, while concerns over making mistakes or damaging the equipment further discourage them from trying. Additionally, many older adults tend to hold a skeptical attitude towards the accuracy of online consultations and the efficacy of digital health devices because they lack the authenticity and personal connection of face-to-face interactions (Shao et al., 2025).
To address the issue of the digital literary gap, policy-level implementations, such as ensuring access to health information services for the socially disadvantaged groups, streamlining internet-based services, and investing in educational programs on digital and health literacy, can be more effective than individual-level interventions (Yao et al., 2022). However, a WHO European Region (2023) report reveals that only 17 out of 48 European countries have action plans, policies, and strategies in place for digital health education. This lack of interventions leaves older people, migrants, individuals with disabilities, and those living in rural areas underserved, lacking access to and training on digital solutions. It thus cautions us that pursuing new technological advancement in healthcare alone is not sufficient; it’s equally important to ensure that progress can actually be enjoyed by those who need it and prevent new barriers restricting their access to the “highest attainable standard of health”.
Toward Inclusive Healthcare for All in the Digital Age
While equal access to the highest attainable healthcare should be recognized and protected as a universal and fundamental human right, technological advancements have aggravated the real-world inequalities, widening the existing access disparities caused by the economic divide and introducing new barriers to perpetuate exclusion, including data underrepresentation and the digital literacy gap. However, this does not mean we should stop the pursuit of technological innovation, as its potential to revolutionize the healthcare field is undeniable. What we need to avoid is a future like the one described in dystopian novels and films, marked by extreme stratification, where the fruits of technological progress are monopolized as a privilege by the economically and socially advantaged. Therefore, domestic and international policymakers need to keep pace with technological advancement to update their methods to ensure universal accessibility to the highest attainable standard of healthcare services. This entails addressing the deep-rooted and emerging inequality with coordinated approaches, including but not limited to: regulating market pricing or adopting value-based pricing and spending cap, shifting to a human right-based approach for disaggregated and inclusive data collection to ensure equitable representation (Office of the High Commissioner for Human Rights, 2018), and promoting the initiatives aimed to mitigate the skill divide in digital and health literacy. Only through such systemic efforts can we ensure that healthcare progress brought about by technological development remains a human right enjoyed by all, rather than a privilege reserved for a select few.
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