As AI, social media, surveillance, and digital infrastructure reshape daily life, this paper argues that technology is not just a tool, but a powerful determinant of who benefits, who is harmed, and how health equity is built.
Perspective: A global call to action on the digital determinants of health. Image Credit: elenabsl / Shutterstock
The modern world is deeply penetrated by digital technology, producing profound impacts on health through direct and indirect mechanisms. According to a Perspective paper published in the journal npj Digital Medicine, digital systems should be understood as active mediators of health-related conditions, rather than merely technical tools. The authors call for international collaboration on governance and research in this field to ensure that human and planetary health are benefited rather than harmed by digital systems.
What are the digital determinants of health?
The authors summarize how the literature has defined digital determinants of health and outline the levels at which digital transformations affect human health. They argue that these should be understood as digital determinants of health, alongside and interacting with social, political, and commercial determinants.
Digital technologies shape people’s understanding and involvement with their own health. More broadly, they also affect social interactions and reliance on public and private health organizations.
The accelerated rate at which digital technology is evolving, including the emergence of artificial intelligence (AI), is matched by similarly high rates of data acquisition and digital transformation. The term ‘digital transformation’ refers to the integration of digital technology into all areas of life.
Digital transformation has not been approached uniformly worldwide, with different countries adopting varying levels of oversight for their development, use, and marketing.
Perspectives on the health impact of digital technology
The authors synthesized existing literature reviews, highly cited primary sources, and recent searches of digital technologies in relation to health. They identified four distinct perspectives on this relationship: digital technologies as healthcare tools, as a standalone determinant of health, as producing complex and widespread effects on multiple health determinants, and as a collective entity that transforms social, political, and economic life, thus impacting health.
The Lancet and Financial Times Commission on Governing Health Futures 2030 approaches this question from the fourth perspective, treating digital technologies as drivers of digital transformations that arise from, and work within, this broader sociopolitical and economic context of public and individual health.
Positive and negative digital determinants
The authors explain that digital technologies affecting health are not restricted to medical apps or electronic health records (EHRs). They include AI, the internet, social media, and digital surveillance. They are designed based on assumptions about how people engage with the material world, “the social, environmental, commercial, economic, and political circumstances that are produced by longstanding inequities.” In turn, they modify daily institutional processes that determine how health is achieved.
This cascade includes algorithm design, which may be influenced by scientists’ biases and assumptions about material reality and people’s lives, health, and well-being; online misinformation; control over social media platforms; and corporate control of digital infrastructure.
When these technologies enhance the positive effects of the context in which people live, they are positive determinants of health. Conversely, they are negative determinants when they worsen health outcomes by affecting life circumstances. In this framework, digital technologies are not merely separate risk factors but mediators that can amplify or attenuate the effects of existing social, political, commercial, and economic conditions.
Levels of health impacts
The authors classify these effects into three levels:
Primary mechanisms
These have direct impacts on individuals and communities, such as:
- access to online health information
- exposure to misinformation
- social media effects on mental health
- potentially reducing healthcare access and health among disadvantaged populations, especially when technologies amplify existing inequalities and inequities
Secondary mechanisms
Digital transformations of processes, institutions, and systems are presented as means to increase their efficiency or reduce inequality. The impacts of such transformations include:
- Data handling in healthcare organizations, schools, and workplaces
- Digitalization costs and algorithmic bias
Tertiary mechanisms
These include the broader impact of digital transformation on global political and economic forces, such as:
- concentration of power in technology corporations that influence government policy, outsource labor internationally, build high-risk technologies like generative AI, and acquire and use data from poorer countries for use in developing new applications without proportional benefit
- diversion of scarce resources to regulate and protect against digital technology harms
- reinforcing the unequal digital infrastructure between countries
- the digital industry is shaping geopolitical power and governance dynamics
For instance, historically exploited groups or those lacking connectivity and digital literacy may be especially vulnerable to harm from the rapid spread of digital technology.
The authors comment, “Digital technologies and industries are built on top of pre-existing inequities that arise from generations of concentration of wealth and power and the exploitation of some communities for the gain of others. Such inequities represent root causes of health inequities, which are being coded into digital technologies and the business practices through which they spread across the globe.”
The way forward
Based on this framework, the authors call for international multidisciplinary collaboration and research investment to understand how digital technologies affect health. They recommend a critical approach to examining how these are currently being built and marketed.
Researchers should focus on identifying opportunities to prevent or reduce harm to health and improve benefits. They also propose that, where possible, people in positions of power move more slowly through digital transformations, given a limited understanding of the health-related impacts and risks, so that these risks can be better understood, anticipated, and mitigated.
Overall, the paper calls for action in these areas to ensure that global digital transformation promotes health and supports long-term health equity.
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