European Journal of Public Health, Vol. 29, Supplement 3, 1–2
ßThe Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/
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Digitalization: potentials and pitfalls from a public
, Walter Ricciardi
, Anna Odone
, Stefan Buttigieg
Dineke Zeegers Paget
1 Department of Health Services Management, Faculty of Health Science University of Malta, Villetta, Malta
2 European Public Health Association, Utrecht, The Netherlands
3 Sezione di Igiene, Istituto di Sanita
`Cattolica del Sacro Cuore, Rome, Italy
4 School of Medicine, University Vita-Salute San Raffaele, Milan, Italy
5 Digital Health Malta, Villetta, Malta
The ehealth conference organized under the auspices of the
Maltese Council Presidency of the European Union in May
2017 will remain memorable for the plea made by Zsusanna Jakab
for all experts and stakeholders to work for a ‘Beautiful Marriage’
between the worlds of digital health and public health.
This supplement may be viewed as an outcome of the public
health’s community response to this plea. Digitalization has
become a driving force for transformation in all spheres of life.
Health and health systems are not excluded from the influence of
these developments. Yet, the health sector can be considered to be
somewhat of a laggard when compared to other sectors and digital
technologies have not yet impacted on health in the same way that
they have impacted on other industries.
Indeed, we still talk about
‘ehealth’ and ‘digital health’ when other industries that function
almost exclusively through digitally enabled platforms have
abandoned this prefix years ago.
The first article in this series by McKee et al.
reminds us that this
second information revolution is well underway. Whilst the benefits
associated with digitalization include the power of information
sharing amongst disparate communities as well as improved surveil-
lance and diagnostics, the impact of other aspects of digital
technology such as wearable devices on human health, may have
been largely oversold. On the other hand, McKee et al. highlight
five factors that should pose a serious cause for concern by the
public health community and which merit further research. These
are discrimination; breaches of privacy; iatrogenesis; disinformation
and misinformation or ‘fake news;’ and cyber-attacks.
The harmful impacts of digitalization can be avoided if we have
effective and appropriate governance mechanisms that are able to
align digital innovation with public health system goals. Ricciardi et
al. emphasize the onus on governments to create the policy environ-
ment and incentives that steer the industry towards the development,
adoption and use of technologies that contribute to health system
goals going beyond the confines of health technology assessment in
evaluating specific technologies to see whether they should be funded.
Azzopardi-Muscat and Sorensen highlight the importance of con-
sidering equity in the impact assessment of technologies, as well as in
the type of policy and regulatory environment that digital
technologies operate within. They propose the health literacy
approach as one of the possible avenues to ensure that digital
technologies work to reduce rather that reproduce health
Brall et al. build argue that it is imperative for digital
health providers and regulators, to ensure that digital health inter-
ventions are designed and set up in an ethical and fair way if we wish
to ensure a sense of ‘justice’ in the application of digital technologies
in the health sector.
Pastorino et al. document several initiatives that are advancing
knowledge on the role of using big data for health. They call for new
approaches to be found for translating the big data into meaningful
information that health care professionals can use to impact on health
outcomes and highlight the need for Europeanactiononinternational
technical standards embracing a paradigm for openness in data.
will of course also require that health professionals are trained to
discover the uses of such data to make a difference to their patients.
The final paper of this supplement by Odone et al. maps the
potential of digital technologies to improve public health research,
policy and practice. They show the importance and relevance of
digital health to the various domains of public health practice.
They also link the strategic objectives of the European Public
Health Association to digital health action in areas including
advocacy, evidence-generation, agenda-setting, capacity and
knowledge building, training and leadership innovation.
Our analysis and review supports the statement by the WHO
Director General that ‘Ultimately, digital technologies are not ends in
themselves; they are vital tools to promote health, keep the world safe
and serve the vulnerable’.
The public health community has a duty to
engage with innovation but equally to uphold that the ethics and values
which characterize the underpinning philosophical principles of our
discipline are at the forefront of our endeavors. Only in this way, can
we truly seek to exploit the potential for digitalization to enhance health
and well-being whilst striving to avoid the pitfalls along the way.
Conflicts of interest: None declared.
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2European Journal of Public Health