Bridging the digital divide between old and young people in China: challenges and opportunities
Authors: Yao Yao, Hao Zhang, Xinran Liu, Xiaoyun Liu, Tao Chu, Yi Zeng
Journal: The Lancet Healthy Longevity (2021)

The digital divide between old and young people in China has been substantially bridged during the COVID-19 pandemic. According to the 47th Chinese Statistical Report on Internet Development by the China Internet Network Information Center (CNNIC), the number of older so-called netizens (ie, internet users) aged 60 years and older has doubled since the beginning of the COVID-19 outbreak and has reached 110·8 million.1China Internet Network Information Center (CNNIC)The 47th statistical report on internet development in China.http://www.cnnic.cn/hlwfzyj/hlwxzbg/hlwtjbg/202102/t20210203_71361.htmDate: Feb 3, 2021Date accessed: February 4, 2021Google Scholar And this number is continuously increasing due to the necessity of using smartphones with an internet connection. For example, health agencies in China rely on Health Code, a colour-based QR code on contact-tracing apps, to determine an individual's exposure risks on the basis of tracking categories such as travel history, time spent in high-risk areas, and close contacts with potential carriers.2Budd J Miller BS Manning EM et al.Digital technologies in the public-health response to COVID-19.Nat Med. 2020; 26: 1183-1192Crossref PubMed Scopus (128) Google Scholar Digital exclusion is an ongoing global issue during the COVID-19 pandemic.3Ramsetty A Adams C Impact of the digital divide in the age of COVID-19.J Am Med Inform Assoc. 2020; 27: 1147-1148Crossref PubMed Scopus (89) Google Scholar Older adults are not only at increased risk of infection with SARS-CoV-2, but are also the population most susceptible to digital exclusion because they are less likely than younger people to take advantage of the modern information and communication technologies such as smartphones and tablets.4Hill R Betts LR Gardner SE Older adults' experiences and perceptions of digital technology: (Dis)empowerment, wellbeing, and inclusion.Comput Human Behav. 2015; 48: 415-423Crossref Scopus (141) Google Scholar Barriers to using technologies among older adults include opting out of using the internet, being unable to afford internet access or relevant devices, or lack of technological literacy and skills to use such technologies. Lack of access to information and communication technologies prevents individuals from seeking health information online and receiving medical services remotely, which might lead to feelings of social exclusion and exacerbate health disparity among older adults.5Gibson A Bardach SH Pope ND COVID-19 and the digital divide: will social workers help bridge the gap?.J Gerontol Soc Work. 2020; 63: 671-673Crossref PubMed Scopus (8) Google Scholar CNNIC did two surveys in March and December, 2020, and found that the proportion of Chinese netizens who were aged 60 years or older increased from 6·7% to 11·2%.1China Internet Network Information Center (CNNIC)The 47th statistical report on internet development in China.http://www.cnnic.cn/hlwfzyj/hlwxzbg/hlwtjbg/202102/t20210203_71361.htmDate: Feb 3, 2021Date accessed: February 4, 2021Google Scholar The net number of older netizens in China has nearly doubled from 60·5 million in March, 2020, to 110·8 million in December, 2020, whereas from June, 2014, to June, 2019, the proportion of netizens who were aged 60 years or older only increased from 2·1% (13·3 million) to 6·7% (59·0 million). The 4·5 percentage point increase between March and December, 2020, is almost equal to that over the past 5 years combined (appendix). Much of the increase in older netizens during March–December, 2020, could be attributed to the national lockdown, online shopping, health-code application, and seeking information on the COVID-19 pandemic and prevention of SARS-CoV-2 transmission online.6Xiaonan W China's seniors shake up e-commerce. China Global Television Network (CGTN), Nov 9, 2020https://news.cgtn.com/news/2020-11-09/China-s-seniors-shake-up-e-commerce--VgWcmPceoE/index.htmlDate accessed: February 5, 2021Google Scholar Most of these older Chinese people gained access to the internet and learned skills to use relevant devices with the help of their children, relatives, and community volunteers.7Liu S Yang L Zhang C et al.Online mental health services in China during the COVID-19 outbreak.Lancet Psychiatry. 2020; 7: e17-e18Summary Full Text Full Text PDF PubMed Scopus (693) Google Scholar Also, the Chinese State Council General Office promoted a plan to effectively address difficulties in accessing technologies among older adults on Nov 24, 2020,8Chinese State Council General OfficeImplementation plan to effectively address the difficulties of using ICT for older adults.http://www.gov.cn/zhengce/content/2020-11/24/content_5563804.htmDate: Nov 24, 2020Date accessed: February 5, 2021Google Scholar which substantially reduced barriers to technologies among older adults during the COVID-19 pandemic. Bridging the digital divide between older and younger adults during the COVID-19 pandemic brings new opportunities from the perspective of health service providers for improving the health of the older population.9Burr C Taddeo M Floridi L The ethics of digital well-being: a thematic review.Sci Eng Ethics. 2020; 26: 2313-2343Crossref PubMed Scopus (28) Google Scholar First, the government can use this opportunity to build a unified electronic medical record system for older Chinese adults to record and track an individual's health status. Using a design similar to the Health Code app, health records from the unified system would be comparable regardless of where the individual seeks health care and what type of health insurance they have. Creating a unified health record system could subsequently reduce health inequities. A unified design of electronic medical records for older adults in China would help to fix the now fragmented methods of care delivery and would help build a more efficient health-care system. The second opportunity is to build a so-called senior-friendly platform for delivering high-quality health information. An authorised platform with high penetration rate for the older populations is crucial for health education and promotion, interventions for chronic conditions, and health management for older adults. Notably, these opportunities are accompanied by several major challenges. One challenge is that the digital divide between older and younger people is still prevalent in China and in other low-income and middle-income countries, especially in rural areas. We need continued efforts to lessen the existing inequities and promote the digital inclusion of older adults. Another main challenge is the privacy and ethical issues associated with the use of digital health data, especially among vulnerable older adults.9Burr C Taddeo M Floridi L The ethics of digital well-being: a thematic review.Sci Eng Ethics. 2020; 26: 2313-2343Crossref PubMed Scopus (28) Google Scholar These concerns require combined efforts from the government, health-care providers, technology providers, and older adults themselves. Telecommunication fraud is also a major problem for older netizens. According to the US Federal Trade Commission, adults aged 60 years and older were five times more likely to be a victim of so-called tech-support scams than were younger adults.10Federal Trade CommissionProtecting older consumers 2018-2019: a report of the Federal Trade Commission.https://www.ftc.gov/reports/protecting-older-consumers-2018-2019-report-federal-trade-commissionDate: Oct 23, 2019Date accessed: February 5, 2021Google Scholar Taken together, creating a safer online environment for older netizens and strengthening regulations on telecommunication fraud should be considered when promoting digital inclusion of older adults during and after the pandemic. During this pandemic, policy makers should endeavour to ensure that no one is left behind or suffers undue inconvenience due to a digital divide. We believe the increase in older internet users in China during the COVID-19 pandemic has inspiring implications for other developing countries with substantial intergenerational digital divides. We declare no competing interests. Download .pdf (.24 MB) Help with pdf files Supplementary appendix