A smartphone is a civil right

Apparently, we all have the information we need regarding our health in the palm of our hand. Except if you don’t.

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The day after the Australian Institute of Digital Health’s HIC 2026: Innovation to Impact – the major digital health conference focusing on turning groundbreaking ideas into practical solutions that transform healthcare – I unexpectedly encountered a young man I’d known for many years.

This man was not well; he appeared to be either homeless or in unstable accommodation. He was distressingly unwell, malnourished and in obvious need of medical attention. There was a lengthy history of addiction and untreated mental illness.

The only time he received medical care was in prison; it was where he was first diagnosed and treated. Unsurprisingly, prison is the only place he gets fed, housed and properly medicated. Unsurprisingly, it’s also where he has readily available access to dangerous drugs.

Then he’s discharged from prison without the most essential of survival tools – a smartphone.

I reckon there are many like him, on the streets, cycling in and out of custodial facilities and criminal justice systems with untreated complex comorbidities, receiving inconsistent and episodic healthcare.

Maslow’s hierarchy of needs lists safety as: security, employment, resources, property and health.

The smartphone belongs in Maslow’s pyramid.

Our health system has transformed such that we are now almost completely reliant on apps for services, information, appointments and treatment. HIC2026 highlighted the incredible ways interoperability, AI and digital health will connect us with individualised healthcare; but there’s a caveat – you’ll need a digital device to access the health system.

I pose a fundamental premise: if access to a workable smartphone is essential to individual health, then we must consider the mobile phone as a civil right.

If you’re not digitally connected then you’re excluded and disenfranchised from healthcare.

Medicare, Australia’s universal health insurance scheme, “guarantees all Australians (and some overseas visitors) access to a wide range of health and hospital services at low or no cost”. That is the exact wording on the government’s website.

Providing universal healthcare and access is also an identified outcome of the government’s Strengthening Medicare taskforce.

Digital health technologies potentially overcome health access inequities in Australia. Telehealth provides remote areas access to medical consultation, while health apps and online health resources such as My Health Record empower individuals to take charge of their own health.

The benefits of digital health are mind-boggling, however, for digital health to fulfil its promises, we need to look at what happens to those locked out, and more importantly what can be done about it.  

The “digital divide” is as real as it was when the term was coined in the 1990s. It applies to those unable to afford, access or use the smartphones needed to fully participate in society, including managing their healthcare.

The UN High Commissioner told the Human Rights Council in 2023 that “it may be time to reinforce Universal Access to the Internet as a Human Right, not just a privilege”.

Governments are not obligated to provide mobile devices (and in most countries, internet access is not a right either). Phone ownership and usage is considered an individual choice; and yet the widespread availability of a “work” phone provided as an essential tool for employees indicates a recognition that one must be “connected” and accessible to properly function and engage.

The Commonwealth government’s Data and Digital Government Strategy has a 2030 Vision that:

“The Australian Government will deliver simple, secure and connected public services for all people and business through world class data and digital capabilities.”

The Strategy includes “embed inclusion and accessibility” among its “missions” – a goal that emphasises the principles of “inclusion and accessibility requirements, so that no one is left behind when accessing government’s digital services”.

But too many are left behind.

“Data poverty” describes those lacking the financial or other means to access the internet and/or mobile data; and the knowledge, skills and supports to properly use them.

Some cannot afford costly smartphones, laptops, or other communication devices or afford to repair damaged devices.

As with human poverty, data poverty is often hidden from public view.

A landmark UK study, Local communities and the internet ecosystem: Scaling solutions to data poverty in the UK (2022), showed data poverty excludes people from accessing essential services and from participating in society; and disproportionately affects those already experiencing social inequalities, creating deeper divides and exacerbating disadvantage.

Although Australia is seen as a world leader in early adoption and use of digital devices, according to the Australian Institute of Family Studies, more than 2.5 million Australians are not using the internet, leading to “digital exclusion now [becoming] a greater driver of inequality than ever before”.

The AIFS describes digital inclusion as having: 

1. Access to available, good quality and flexible internet connections, with appropriate hardware and sufficient data.
2. The resources to cover the costs associated with access.
3. Havingthe knowledge, abilities and attitude to use online technologies with confidence.

The young man I referred to earlier only met category 3; but for understandable reasons he is unable to maintain a phone for more than a few days.

First developed in 2015, the Australian Digital Inclusion Index (AUDII) uses data from the Australian Internet Usage Survey to measure digital inclusion across three dimensions:

• Access – is there internet available in the area where people live through broadband or mobile networks;
• Affordability – can people afford the devices and data plans to access the internet; and
• Digital Ability – do people have the literacy and ability to access the internet. 

The pandemic hastened our reliance on digital technologies, including digital health, however it also brought to the fore the impact of digital exclusion.

The Digital Inclusion and Participation Program at QUT Digital Media Research Centre (DMRC) reported that covid “accelerated the need for internet access to do just about everything, but the sudden transition to services online left many families more digitally excluded than ever”.

The Advancing Digital Inclusion in Low Income Australian Families report found that:

Australians who have adequate, affordable access to digital technologies and the knowledge and skills to use them, have better outcomes across life spheres including education, work, finance, health, and wellbeing.

Access to digital technologies is one indicator of data poverty, another is the ability to afford repairs, upgrades and replacements. The report cited above confirmed that many are using devices that are broken or not functioning, or there may be no available money for repairs or replacement.

My young friend definitely can’t afford repairs or replacements; he likely steals or buys stolen devices.

While there is a decline in the number of “digitally excluded” Australian residents, there are groups lacking the necessary supports and resources to fully participate in civic life: Aboriginal and Torres Strait Islander people, those on low incomes, and older people.

I’d add homeless and itinerant people, those awaiting citizenship or residency visas, people in (and out of) custodial facilities, and those unable to access regular financial and other supports.

Those in custodial facilities, which includes prisoners on remand who are supposed to be considered innocent until proven guilty, have almost no access to digital health services or supports. Phone calls from prison are prohibitive and this has been raised as a barrier to health and social welfare.

The Australian Medical Association (AMA) said it’s “appalling and an affront to Australia’s human rights status that prisoners in this country aren’t allowed to receive the same quality of healthcare as the wider community”, according to their submission to the Pharmaceutical Benefits Advisory Committee.

The AMA raised “serious concerns about inequitable healthcare for Australians in custody”, noting that “people in custodial settings are not able to receive treatment under the country’s universal health insurance scheme, Medicare, nor are they allowed to receive medicines subsidised by the PBS.”

The National Disability Insurance Scheme (NDIS) has ruled that mobile phone ownership or access is a personal responsibility and there is no role for government in ensuring those needing health services can access them.

The NDIS position is that:

“We won’t typically fund a mobile phone as it’s a day-to-day living cost. A mobile phone is unlikely to be an extra living cost due solely and directly as a result of your disability needs.  If you need a mobile phone because of another funded support, for example you need to talk to your NDIS support provider, it’s likely you would already be paying for phone calls as a day-to-day living cost anyway.

“If you need a smartphone to use the internet, this is also a day to day living cost.

“Mobile phones and smartphones are a general household item. Most Australians have them, and most of the community uses them. We can’t fund things that every Australian expects to pay for themselves as a day-to-day living cost.

“Options like a personal computer, would achieve the same benefit. Computers are also a day-to-day living cost. We would ordinarily expect every Australian to pay for their own smartphone or personal computer.”

Paradoxically, the National Disability Insurance Agency (NDIA) is heavily investing in the development and roll out of purpose-built digital tools that are supposed to help participants and their providers digitally manage their plans, confirm invoices, and other activities to empower participants and rein in fraudulent activity

In July 2024, the government, through the Australian Digital Health Agency (ADHA) released Transforming Australia’s Digital Health Infrastructure, a major undertaking to transform our national infrastructure and “move to a contemporary, structured data-rich ecosystem capable of connecting systems across settings and supporting real-time access to information for the patient and the broader care team – anywhere, anytime”. 

Apparently, we all have the information we need regarding our health in the palm of our hand.

Except if you don’t.

Ensuring digital healthcare is accessible, affordable and understood by all citizens and residents should be considered within the design and delivery of health policies and funding, not as a separate issue.

Digital health and AI are already embedded in Australia’s health system.

If those most needing healthcare cannot use or access health information, services and data critical to their survival, then they are being doubly excluded.

It should be a civil right to be connected to the health system.

Simon Tatz was director of communications for Mental Health Australia, director of policy for Mental Health Victoria and co-author of The Sealed Box of Suicide: The Contexts of Self-Death. He is currently the AIDH’s general manager of policy, advocacy and workforce advancement.