On the imperative of thinking through the ethical, health equity, and social justice possibilities and limits of digital technologies in public health

Abstract

The COVID-19 pandemic has demonstrated both the positive and negative use, usefulness, and impact of digital technologies in public health. Digitalization can help advance and sustain the core functions of public health, including health promotion and prevention, epidemiological surveillance, and response to emergent health issues. Digital technologies are thus—in some areas of public discourse—presented as being both necessary and inevitable requirements to address routine and emergency public health issues. However, the circumstances, ways, and extent to which they apply remain a subject of critical reflection and empirical investigation. In this commentary, we argue that we must think through the use of digital technologies in public health and that their usefulness must be assessed in relation to their short- and long-term ethical, health equity, and social justice implications. Neither a sense of digital technological optimism and determinism nor the demands of addressing pressing public health issues should override critical assessment before development and implementation. The urgency of addressing public health emergencies such as the ongoing COVID-19 pandemic requires prompt and effective action, including action facilitated by digital technologies. Nevertheless, a sense of urgency cannot be an excuse or a substitute for a critical assessment of the tools employed.

Challenges in the development of digital public health interventions and mapped solutions: Findings from a scoping review

“…The COVID-19 pandemic has fostered an unprecedented level of political commitment to identify strategies to optimally harness the potential of digital technologies in public health. 156 This is a crucial opportunity for policy makers, public health practitioners, and researchers to envision digital public health in a cohesive manner. 157 , 158 Leveraging these key pillars as a central aspect of a digital public health strategy can be an effective starting point to ensure the successful development of the field.…”

Defining Digital Public Health and the Role of Digitization, Digitalization, and Digital Transformation: Scoping Review

“…Health system goals to ensure the quality, accessibility, efficiency, and equity of health services remain unaltered despite acknowledgment that digital technologies must be thoughtfully leveraged in public health efforts [ 28 ]. Perhaps envisioning digital public health in this manner resists the technological determinism that has been characteristic of a more pervasive integration of digital technologies [ 45 , 46 ]. Technological determinism is the assertion that the use of digital technologies inevitably leads to improved processes, services, and outcomes [ 45 ].…”

Digitization and Health in Germany: Cross-sectional Nationwide Survey

“…In the long term, such data could be used for clinical decision-making [ 1 ]. However, rapid technological advancement is associated with several challenges on individual-, social-, and care-related levels, such as the ethical and legal aspects of data acquisition, storage, and application [ 1 , 13 , 15 , 16 ]. Aligned with these challenges, the majority of our participants expressed concern about their personal data and privacy online.…”

“…However, less than 50% of our participants showed interest in smartphone apps for disease prevention and health promotion, the COVID-19 contact-tracing app, or digital technologies for physical activity in late 2020. This is surprising, because during the COVID-19 pandemic, the use of digital technologies for health-related purposes increased rapidly worldwide [ 15 ]. We can only speculate that the results of our study were affected by the timing of data collection that aligned with relaxing of contact restrictions in Germany between the European summer and late November 2020.…”