Digital e-health and welfare services in rural areas: a Danish case study on patterns of digital exclusion

Digitalization has for decades been touted as one of the major solutions for welfare state challenges, due to the potential to provide less cost-extensive, and more sustainable provisions of services to citizens. The COVID-19 pandemic that arrived in Europe in early 2020, served as a catalyst for digitalization, boosting uptake and experiences with digital solutions. However, it also clearly showed the challenges of this development, as some countries, local communities, and citizens where better prepared than others to handle the digital solutions of socially distanced pandemic life, leading to risks of inequality, less social cohesion, and exclusion for vulnerable citizens, specifically in rural areas. Reasons for this are manifold and range from a lack of access to technological hardware to a lack of digital competences or motivation. These patterns have been coined digital exclusion by the research literature, that argues the “dividing lines of digital exclusion are closely aligned to those associated with social exclusion, for example income, age, ethnic minority, location and disability” (Watling, 2012, p. 126) In this paper we focus on patterns of exclusion from digital local health services in the case of a rural municipality in Denmark, and thereby disentangle its dimensions. The aim is not only to contribute to an exploration of the problem but also to find potential for more inclusive digital care services in rural areas.