| Summary: | Digital exclusion from essential services is conventionally framed as a user deficiency requiring digital literacy training. We challenge this perspective, arguing that exclusion results from structural interface design failures rather than individual incapacity. This analysis positions interface design as a social determinant of health, examining how design decisions create systematic barriers to healthcare, social services, and civic participation. We synthesize evidence from multiple global contexts examining the persistence of the Windows, Icons, Menus, Pointer (WIMP) paradigm developed in the 1970s, structural bias in contemporary design processes, and health consequences of compulsory digitization. The WIMP paradigm persists despite five decades of demographic change, embedding assumptions about visual acuity, motor control, and technical literacy that systematically exclude older adults and other populations. Homogeneous design workforces reproduce these exclusionary patterns. Compulsory digitization transforms design failures into barriers to fundamental rights: 38% of U.S. adults aged 65+ were unprepared for telehealth during COVID-19; digital-only healthcare scheduling excludes patients lacking smartphone proficiency; interface complexity correlates with functional dependence and accelerated cognitive decline in older populations. Addressing interface design as a social determinant of health requires comprehensive intervention: regulatory frameworks mandating accessibility across essential services, genuine co-design with excluded populations, cultural adaptation, workforce diversification, exploration of post-WIMP paradigms, and policy commitments recognizing accessible design as a fundamental right rather than accommodation.
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