Why health products must be accessible by default

Most software teams treat accessibility as a quality bar. Text should have enough contrast, buttons should be large enough to tap, and screen readers should be able to make sense of the page. Those things matter in every product.

In healthcare, the stakes are different. A shopping app that is hard to use loses a sale. A health product that is hard to use can leave someone without information they needed, or without a route to a professional at the moment it mattered. Accessibility in health is less about polish and more about who the product serves at all.

That is why we think it has to be the default, built in from the first sketch, not added in the last sprint.

Who gets left out

Start with disability. WHO estimates that 1.3 billion people, or 16% of the world's population, experience a significant disability. The same fact sheet notes that some persons with disabilities die up to 20 years earlier than those without disabilities, and it lists inaccessible health facilities and information among the barriers they face in health systems.

Then there is connectivity. The International Telecommunication Union's Facts and Figures 2025 estimates that 2.2 billion people remain offline. It also finds that access remains unaffordable in around 60% of low and middle-income countries, and that 71% of women are online compared with 77% of men.

The gap also shows up on mobile. The GSMA's Mobile Gender Gap Report 2025 found that women in low and middle-income countries are 14% less likely than men to use mobile internet. Among the top barriers it names are literacy and digital skills, and the cost of internet-enabled handsets.

Put together, these figures describe a large share of the people women's health products most need to reach. A product designed only for fast networks, new phones and confident readers excludes them before they have opened it.

Standards give a floor, not a ceiling

The good news is that much of the groundwork already exists. The W3C publishes the Web Content Accessibility Guidelines, known as WCAG, which set testable requirements for accessible web content. Version 2.2 became a W3C Recommendation in October 2023, and it is organised around four principles. Content should be perceivable, operable, understandable and robust.

Some of its requirements are refreshingly concrete. Normal text should have a contrast ratio of at least 4.5 to 1 against its background. Under the target size criterion, added in version 2.2, pointer targets should generally be at least 24 by 24 CSS pixels.

For a health product, WCAG 2.2 at level AA is a sensible minimum. But a product can pass every success criterion and still be hard to use for someone reading in a second language on a slow connection with a cracked screen. Standards are where accessible design starts, not where it ends.

Accessible health products in practice

For us, being accessible by default comes down to a handful of habits.

• Write for clarity first. Health information should make sense without a glossary. Short sentences, common words and one idea at a time help everyone, and they help most for readers working in a second language or with limited time.
• Offer more than one format. Some people prefer to read. Others take in information better from a short video or a simple illustration. Captions and transcripts make video useful to more people.
• Design for modest devices and connections. Light pages, careful use of images, and features that degrade gracefully when the signal drops are part of the design, not an engineering afterthought.
• Support assistive technology from the start. Proper labels, a logical reading order and full keyboard access are far cheaper to build in than to retrofit.
• Never rely on colour alone. Cycle and pregnancy views often use colour to carry meaning. Pairing it with text or shape keeps that meaning available to people with colour vision deficiency.
• Provide more than one way to get help. Not everyone can or wants to type. Where a product connects people to a professional, the supported ways to communicate should reflect how people actually live.

The NHS service standard puts the underlying principle well. Teams should make sure people with different physical, mental health, social, cultural or learning needs can use the service. That list is broad on purpose.

Accessibility is a team responsibility

Accessible products are rarely the work of one specialist. Content designers decide whether a sentence can be understood. Designers decide whether a control can be seen and reached. Engineers decide whether it works with a screen reader and on an older phone. Clinicians and health educators decide whether simplified language is still accurate.

Health content raises a particular challenge. Making medical information simpler can make it less precise, and a sentence that is easy to read but subtly wrong is worse than one that is hard to read. The answer is not to avoid plain language. It is to have writers and qualified health professionals review simplified content together, so that clarity and accuracy are checked at the same time.

That means accessibility has to be part of every review, not a separate audit at the end. It also means testing with people whose circumstances differ from the team's own. Assumptions about what is obvious rarely survive contact with someone using a different device, language or level of vision.

The question to ask

Every design decision in a health product answers a question about who it is for. A heavy page answers it, and so does an unlabelled button.

We would rather answer that question deliberately. If you are working on digital health services and want to talk about building them to reach more people, we would be glad to hear from you.