Disparities in mobile phone ownership reflect inequities in access to healthcare

Human movement and population connectivity inform infectious disease management. Remote data, particularly mobile phone usage data, are frequently used to track mobility in outbreak response efforts without measuring representation in target populations. Using a detailed interview instrument, we measure population representation in phone ownership, mobility, and access to healthcare in a highly mobile population with low access to health care in Namibia, a middle-income country. We find that 1) phone ownership is both low and biased by gender, 2) phone ownership is correlated with differences in mobility and access to healthcare, and 3) reception is spatially unequal and scarce in non-urban areas. We demonstrate that mobile phone data do not represent the populations and locations that most need public health improvements. Finally, we show that relying on these data to inform public health decisions can be harmful with the potential to magnify health inequities rather than reducing them. To reduce health inequities, it is critical to integrate multiple data streams with measured, non-overlapping biases to ensure data representativeness for vulnerable populations.Author summary: Mobile phone data are increasingly used to inform public health efforts in both high and low-income settings due to convenience and growing phone penetration. However, digital inequities are ubiquitous and more pronounced in areas where mobile phone ownership is low or heterogeneous. The biases introduced by using mobile phone data to represent populations and their health care needs are rarely measured but have the potential to be detrimental to the most vulnerable segments of populations. We conducted detailed interviews measuring mobile phone ownership, mobility, and access to healthcare in mobile and remote populations in Namibia. We found that mobile phone owners represent a small proportion of the population that is highly mobile and has better access to healthcare. This is likely not unique. Due to the nature of their collection, mobile phone data often underrepresent vulnerable populations. This study demonstrates that uncritically using mobile phone data to inform public health decisions can perpetuate health inequities.