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Digitalization: Potentials and pitfalls from a public health perspective

DOI:10.1093/eurpub/ckz169
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Natasha Azzopardi- Muscat at University of Malta
Natasha Azzopardi- Muscat
Walter Ricciardi
Walter Ricciardi
Walter Ricciardi
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Anna Odone
Anna Odone
Anna Odone
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Stefan Buttigieg at Ministry for Health, Malta
Stefan Buttigieg
  • Ministry for Health, Malta
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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/
4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
doi:10.1093/eurpub/ckz169
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Editorial
.........................................................................................................
Digitalization: potentials and pitfalls from a public
health perspective
Natasha Azzopardi-Muscat
1,2
, Walter Ricciardi
3
, Anna Odone
4
, Stefan Buttigieg
5
,
Dineke Zeegers Paget
2
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
`Pubblica, Universita
`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.
1
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.
2
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.
3
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.
4
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
inequalities.
5
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.
6
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.
7
This
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.
8
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’.
9
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.
References
1 Jakab Z. Speech––Opening address at eHealth Week. 10 May 2017, Malta. Available at:
http://www.euro.who.int/en/about-us/regional-director/speeches-and-presentations-by-
year/2017/speech-opening-address-at-ehealth-week (28 August 2019, date last accessed).
2 The Lancet Digital Health. A digital (r)evolution: introducing The Lancet Digital
Health, 2019.
3 McKee M, van Schalkwyk MCI, Stuckler D. The second information revolution:
digitalization brings opportunities and concerns for public health. Eur J Public
Health 2019;29(Suppl 3):3–6.
4 Ricciardi W, Barros P, Bourek A, et al. How to govern the digital transformation of
health services? Eur J Public Health 2019;29(Suppl 3):7–12.
5 Azzopardi-Muscat N, Sørensen K. Towards an equitable digital public health era:
promoting equity through a health literacy perspective. Eur J Public Health
2019;29(Suppl 3):13–17.
6 Brall C, Schro
¨der-Ba
¨ck P, Maeckelberghe E. Ethical aspects of digital
health from a justice point of view. Eur J Public Health 2019;(Suppl 3):
18–22.
7 Pastorino R, De Vito C, Migliara G, et al. Benefits and challenges of Big Data
in healthcare: an overview of the European initiatives. Eur J Public Health
2019;(Suppl 3):23–27.
8 Odone A, Buttigieg S, Ricciardi W, et al. Public health digitalization in Europe –
EUPHA vision, action and role in digital public health. Eur J Public Health
2019;(Suppl 3):28–35.
9 Adhanom Ghebreyesus T. World Health Organization April 2019. Available at:
https://www.who.int/news-room/detail/17-04-2019-who-releases-first-guideline-
on-digital-health-interventions (28 August 2019, date last accessed).
2European Journal of Public Health
... Since health and social care systems are often disconnected, integrated approaches, including enhanced continuity of care will be necessary to optimize outcomes [10]. To meet these challenges, digital health technology (DHT) [11] in the form of telemedicine (TM) may be of benefit. ...
... Its modus operandi is to align digital innovation with public health system goals [14,20,30]. Supporting these initiatives, research will be necessary to explore digital health interventions' impact, efficacy, and cost-effectivenessalways considering the solid need for a Health Technology Assessment (HTA) [11]. ...
Telemedicine as a Means to an End, Not an End in Itself
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Telemedicine (TM)—the management of disease at a distance—has potential usefulness for patients with advanced respiratory disease. Underscoring this potential is the dramatic expansion of its applications in clinical medicine. However, since clinical studies testing this intervention often provide heterogeneous results, its role in the medical management of respiratory disorders remains inconclusive. A major problem in establishing TM’s effectiveness is that it is not a single intervention; rather, it includes a number of divergent diagnostic and therapeutic modalities—and each must be tested separately. Reflecting the discord between the need for further documentation of its approaches and effectiveness and its rapid utilization without this needed information, a major challenge is the lack of international guidelines for its integration, regulation, operational plans, and guidance for professionals. Tailored TM, with increased flexibility to address differing healthcare contexts, has the potential to improve access to and quality of services while reducing costs and direct input by health professionals. We should view TM as a tool to aid healthcare professionals in managing their patients with respiratory diseases rather than as a stand-alone substitute to traditional medical care. As such, TM is a means rather than an end.
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... All 11 articles, to varying extents, clarified the roles of digitization, digitalization, and digital transformation in relation to public health. has substantial impact ization extends be- [5] and Az-on health systems and yond platforms and zopardi-will fundamentally al-mechanisms, through Muscat et al [23] ter the future of health. ...
... Conceptualizing digital public health in relation to digitalization supposes that digital technologies play a supportive role or serve as tools available to public health practitioners to achieve existing public health goals [23,28]. This conceptualization aims to integrate digital technologies to meet public health needs more efficiently while firmly maintaining focus on public health goals rather than on technologies and how they alter public health functions [28]. ...
Defining Digital Public Health and the Role of Digitization, Digitalization, and Digital Transformation: Scoping Review
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  • May 2021
Background The recent proliferation and application of digital technologies in public health has spurred interest in digital public health. However, as yet, there appears to be a lack of conceptual clarity and consensus on its definition. Objective In this scoping review, we seek to assess formal and informal definitions of digital public health in the literature and to understand how these definitions have been conceptualized in relation to digitization, digitalization, and digital transformation. Methods We conducted a scoping literature search in Ovid MEDLINE, Embase, Google Scholar, and 14 government and intergovernmental agency websites encompassing 6 geographic regions. Among a total of 409 full articles identified, we reviewed 11 publications that either formally defined digital public health or informally described the integration of digital technologies into public health in relation to digitization, digitalization, and digital transformation, and we conducted a thematic analysis of the identified definitions. Results Two explicit definitions of digital public health were identified, each with divergent meanings. The first definition suggested digital public health was a reimagination of public health using new ways of working, blending established public health wisdom with new digital concepts and tools. The second definition highlighted digital public health as an asset to achieve existing public health goals. In relation to public health, digitization was used to refer to the technical process of converting analog records to digital data, digitalization referred to the integration of digital technologies into public health operations, and digital transformation was used to describe a cultural shift that pervasively integrates digital technologies and reorganizes services on the basis of the health needs of the public. Conclusions The definition of digital public health remains contested in the literature. Public health researchers and practitioners need to clarify these conceptual definitions to harness opportunities to integrate digital technologies into public health in a way that maximizes their potential to improve public health outcomes. International Registered Report Identifier (IRRID) RR2-10.2196/preprints.27686
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... Scientists have highlighted that ICT positively affects the population's health: easy access to services in a shorter time ensures prompt medical care in time. Digitalization of the education sector also regulates the work of the entire healthcare system, which is a lagging sector of the economy, which is gradually introducing ICT into its activities [3] [5] [13] [16] [26]. At the same time, scientists have found a negative impact of digitalization on people's health: cyberattacks, privacy violations, false information, and some others [23]. ...
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... In recent years many studies have focused on the digitization of health sector with the vast majority of them referring to the public health sector (Iyamu et al, 2021;Azzopardi-Muscat et al, 2019). They focus on the complexity of digitalisation in public health , on the service delivery model they offer (Fitzpatrick et al, 2020), the use and preservation of personal data (Mohamed, 2020;Karampela et al, 2019) and to the needs of users (van Poelgeest et al, 2019;Steinhubl & Topol, 2015). ...
Health digitalisation and innovative entrepreneurship status. A qualitative exploration of private sector in Greece and synthesis of main issues
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  • Sep 2022
This primary research aims to examine to what extent Greek health entrepreneurs, as they looking for options to grow their businesses, have realized the opportunities offered to them by the new technologies. Furthermore, to which level they have implemented innovative practices, based on the potential of digitalisation, to improve the operation of their entrepreneurial activities in providing treatment services to the citizens as well as to cooperate with other structures and other organisations. The research explores the views of the entrepreneurs on using digital practices at their services and their impact regards to the reduction of operating costs, the control of materials and the change of the patient-doctor cooperation grid. A qualitative study was conducted with semi-structured interviews in twelve healthcare companies from various regions of Greece. The selection of the sample was made with the Convenience Sampling strategy. The interviews were conducted in Greek with the owners or managers of these healthcare units and the duration was 45 minutes. The content of the semi-structured interviews was classified into three thematic categories. The first section dealt with innovative digital interventions in relation to suppliers, materials, wares, supplies and payments. The second section is concerned with innovative digital interventions compared to the public services and self-administrative authorities, insurance funds and public health structures. The third section is concerned with the innovative digital interventions in relation to the quality care of the patient, his treatment and upgrading the offered health services. The research showed that there were discrepancies in the development of innovative digital activities among the examined companies. Innovative digital interventions were developed by health enterprises, especially in the field of their internal operation and in the service of their patients. On the contrary, many digital interventions could not be completed since there has been an incompatibility with public services and public health structures where the digital transition has not progressed in the same level. Entrepreneurs who preferred traditional forms of operating and offering services to their patients, they did so by fearing that innovative digital activities required more financial capitals and new qualified staff that would surely increase their operating costs.
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... For them, the cornerstones are already valid enough. Late adopters, on the other hand, are incidentally those that would need the most protection but often lack equipment (20,51,52) and understanding of technology (43) Interventions are speculative but transparent communication, education-level-adjusted (34), aimed at explaining the technology and the boundaries on data usage is fundamental (12). Also, in the future basic technological literacy will be a prerequisite for healthcare, regardless of pandemic mitigation measures. ...
Characteristics and determinants of population acceptance of COVID-19 digital contact tracing: a systematic review
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Full-text available
  • Dec 2021
Background and aim: As recently outlined in the WHO-ECDC Indicator framework (1) to evaluate the public health effectiveness of digital proximity tracing solutions, one of the main barriers to digital contact tracing (DCT) is population acceptance, which, in turns, is influenced by digital literacy, attitudes and practice. DCT came to public prominence during the COVID-19 pandemic but evidence on its population acceptance have not been comprehensively analyzed. Methods: We carried out a systematic review (PROSPERO: CRD42021253668) following the PRISMA guidelines to collect, systematize and critically appraise the available evidence on population DCT acceptance. Original studies reporting on different measures of population DCT acceptance were included. Conclusions: The systematic review was based on 41 articles meeting our a priori defined inclusion criteria, comprising aa total of 186144 surveyed subjects, 50000 tweets, 5025 Reddit posts and 714 written comments. Data extraction and synthesis required a qualitative outcome grouping, performed ex-post, in 14 different benchmarks components. They constitute a narrative analysis of actionable points for public health policy. Population acceptance is a key component of DCT effective adoption and infection control during infectious diseases outbreaks. Assessing DCT acceptance's determinants in different settings, populations an cultural contexts it is of fundamental importance to inform the planning, implementation and monitoring of public health interventions. The results of our in-depth qualitative and quantitative analysis will provide context for prospective improvements and actionable items and should guide future research aimed at exploring how digitalization can serve people-centred care.
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... The results of this systematic review show that COVID-19 pandemic has induced a process of implementation of already existing digital tools through the definition of varied and heterogeneous apps that allow user data to be shared using GPS or Bluetooth technologies (22)(23)(24)(25); however any implementation of DCT should include national or international legislation to protect personal data and privacy of users also in order to increase perceived security. Hopefully this would boost the download percentages, as well as effectiveness, according with WHO definitions (7). ...
Public health effectiveness of digital contact tracing in the COVID-19 pandemic: A systematic review of available data
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Full-text available
  • Dec 2021
Background and aim Contact tracing is a key element of epidemiologic investigation and active surveillance during communicable infectious diseases outbreaks. Digital contact tracing (DCT) are new technologies that have been increasingly adopted in different countries to support conventional contact tracing efforts to control the COVID-19 pandemic. However, scant evidence is available on its effectiveness. We applied the Indicator Framework issued in 2021 jointly by the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) to assess the available evidence on DCT adoption and impact in the context of the COVID-19 pandemic. Methods We carried out a systematic review following the PRISMA guidelines (Prospero registration number: CRD42021253662) to retrieve, pool, and critically appraise studies published in English from November 2019 to April 2021. We excluded mathematical models of effectiveness. Only studies representative of the general population or specific populations were included. In line with the WHO-ECDC indicator framework, outcomes of interest were grouped in indicators of: i) DCT use, ii) DCT success, and iii) DCT performance. Results We identified 1.201 citations searching PubMed, Embase, Web of Science and The Cochrane Library. After screening, 10 studies were included. All included studies reported measures of DCT use, varying widely by study population and setting (percentage of DCT apps download from 0.01% to 58.3% in included studies). Only one reported measures of DCT success (ratio of exposure notifications received to positive test results entered), while no studies were retrieved reporting measures of DCT performance. Conclusions DCT is a promising technology in the field of epidemics control. Its adoption is hindered by several normative, technical and acceptance barriers in different regions and countries. Our review shows that while some evidence is available on its adoption and use in selected settings, very scant data is available on its effectiveness in the fight against COVID-19. As digitalization provides new tools for infection control at the population level, solid research is needed to quantify the public health effects of their application. (www.actabiomedica.it)
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... A preliminary review of literature in the field suggests that the conceptualization of "digital public health" is relatively recent [10,[18][19][20]. Therefore, this scoping review will be more broadly focused on how "digital health" and closely related domains (eg, virtual health, mobile health [mHealth], eHealth) have been conceptualized and characterized within public health research and practice discussions. ...
Defining Digital Public Health and the Role of Digitization, Digitalization, and Digital Transformation: Scoping Review
Preprint
  • May 2021
BACKGROUND Despite increasing interest in digital public health, there appears to be a lack of clarity and consensus on its definition. OBJECTIVE In this scoping review, we assessed formal and informal definitions of digital public health in the literature. METHODS We conducted a scoping literature search in OVID Medline, Embase, Google Scholar and on 14 government and intergovernmental agency websites encompassing six geographical regions. Among a total of 409 full articles identified, we reviewed 12 publications that formally defined digital public health and/or informally described the integration of digital technologies in public health in relation to digitization, digitalization, and digital transformation, and conducted a thematic analysis of the identified definitions. RESULTS We identified two explicit definitions of digital public health with divergent meanings. While one definition is predicated on digitalization, and involves the integration of digital technologies to achieve existing public health goals, the other implies transformation of public health services and goals, leveraging digital technology to improve health outcomes. Further, we found that when described in relation to public health, digitization refers to the conversion of analog records to digital information, digitalization involves the integration of digital technologies into public health operations, and digital transformation involves a cultural shift that pervasively integrates digital technologies and reorganizes service based on the health needs of the public. CONCLUSIONS The definition of digital public health remains contested in the literature. Public health researchers and practitioners need to clarify these conceptual definitions to harness opportunities to integrate digital technologies in public health in a way that maximizes their potential to improve public health outcomes. INTERNATIONAL REGISTERED REPORT RR2-10.2196/preprints.27686
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Digital cognitive testing using a tablet-based app in patients with brain tumors: a single-center feasibility study comparing the app to the gold standard
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Full-text available
OBJECTIVE Healthcare digitization has led to increasing tablet-based apps to improve diagnostics, self-discipline, and well-being in patients. Moreover, patient-reported outcome measures are crucial for optimized treatment, with superior applicability if independent from patient visits. Whereas most uses cover health maintenance, only a few studies have focused on cognitive testing in neurosurgical patients despite its nature as one of the most integrative outcome measures in neurooncology. METHODS The authors performed a prospective single-center feasibility study including neurosurgical patients affected by intraaxial tumors and healthy subjects, testing cognitive function by using a digitized app-based approach and conventional paper-and-pencil (PP) tests. Healthy subjects underwent follow-up testing for retest reliability. RESULTS The authors included 24 patients with brain tumor and 10 healthy subjects, all of whom completed both tests. Equivalent mean performance results were found in the tablet-based digital app and PP counterparts; whereas the digital approach had shorter test duration in patients (29.9 minutes for PP vs 21.9 minutes for app, p = 0.019) and in the healthy cohort (23.2 minutes for PP vs 16.4 minutes for app, p = 0.003), patients with brain tumor scored lower when both test strategies were applied. Results were consistent in healthy subjects after a median of 3 months. CONCLUSIONS Cognitive function assessment is feasible using a digitized tablet-based app, with equivalent results to those of PP tests in healthy subjects and patients with brain tumor. Thus, this approach allows much closer follow-up independent of patient visits and might provide a viable option to improve patient follow-ups.
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“Top-Three”health reforms in 31 high-income countries in 2018 and 2019: an expert informed overview
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Background: High-income countries continuously reform their healthcare systems. Often, similar reforms are introduced concomitantly across countries. Although national policymakers would benefit from con- sidering reform experiences abroad, exchange is limited. This paper provides an overview of health re- form trends in 31 high-income countries in 2018 and 2019, i.e., before Covid-19. Methods: Information was collected from national experts from the Health Systems and Policy Monitor network. Experts were asked to report on the three “top”national health reforms 2018 and 2019. In 2019, they provided an update of 2018 reforms. Reforms were assigned to one of 11 clusters and identified as one of seven different reform types. Results: 81 reforms were reported in 28 countries in 2018. 44/81 went to four clusters: ‘insurance cover- age & resource generation’, ‘governance’, ‘healthcare purchasing & payment’, and ‘organisation of hospital care’. In 2019, 86 reforms in 30 countries were reported. 48/86 fell under ‘organisation of primary & ambulatory care’, ‘governance’, ‘care coordination & specialised care’, and ‘organisation of hospital care’. Most 2018 reforms were reported ongoing in 2019; 27 implemented; seven abandoned. Health agency-led reforms were implemented most frequently, followed by central government-legislated reforms. Conclusions: Policymakers can leverage international experience of distinct reform approaches addressing similar challenges and similar approaches to address distinct problems. Such knowledge may help inspire or support future successful health reform processes.
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Public health digitalization in Europe
Article
Full-text available
Background: As digitalization is progressively permeating all aspects of society, how can be it fruitfully employed to sustain the public health goals of quality, accessibility, efficiency and equity in health care and prevention? In this paper, we reflect on the potential of applying digital tools to public health and discuss some key challenges. Methods: We first define 'digitalization' in its broader sense, as well as applied to public health. We then build a conceptual framework where key public health domains are associated to available digital technologies in a matrix that help to identify digital features that bolster public health action. We also provide illustrative data and evidence on the application of digital solutions on selected public health areas. In the second part, we identify the strategic pillars for a successful European strategy for public health digitalization and we outline how the approach being pursued by the European Public Health Association (EUPHA) applies to digital health. Results: From a public health perspective, digitalization is being touted as providing several potential benefits and advantages, including support for the transition from cure to prevention, helping to put people and patients at the center of care delivery, supporting patient empowerment and making healthcare system more efficient, safer and cheaper. These benefits are enabled through the following features of digital technologies: (i) Personalization and precision; (ii) Automation; (iii) Prediction; (iv) Data analytics and (v) Interaction. Conclusion: A successful European strategy for public health digitalization should integrate the following pillars: political commitment, normative frameworks, technical infrastructure, targeted economic investments, education, research, monitoring and evaluation. EUPHA acknowledges digitalization is an asset for public health and is working both to promote the culture of "public health digitalization", as well as to enable its planning, implementation and evaluation at the research, practice and policy level.
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Towards an equitable digital public health era: Promoting equity through a health literacy perspective
Article
Full-text available
Digital technologies shape the way in which individuals and health systems interact to promote health and treat illness. Their propensity to exacerbate inequalities is increasingly being highlighted as a concern for public health. Personal, contextual and technological factors all interact and determine uptake and consequent use of digital technologies for health. This article reviews evidence on the impact of digital technologies on health equity. Health literacy is presented as a lens through which to approach research and policy on access, uptake and use of digital technologies. In the short term, based on our review of published literature, we conclude that it is likely that digital technologies will increase health inequities associated with increased age, lower level of educational attainment and lower socio-economic status. Geographical inequity may increase as a result of poor infrastructure but may decrease if digital technologies can be effectively widely deployed to compensate for health workforce and health system deficiencies. Programmes to enhance health and digital literacy and monitoring of access, utilization and impact across all groups in society can help to ensure that digital technologies act to reduce rather than reproduce or exacerbate existent health inequalities.
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The second information revolution: Digitalization brings opportunities and concerns for public health
Article
Full-text available
The spread of the written word, facilitated by the introduction of the printing press, was an information revolution with profound implications for European society. Now, a second information revolution is underway, a digital transformation that is shaping the way Europeans live and interact with each other and the world around them. We are confronted with an unprecedented expansion in ways to share and access information and experiences, to express ourselves and communicate. Yet while these changes have undoubtedly provided many benefits for health, from information sharing to improved surveillance and diagnostics, they also open up many potential threats. These come in many forms. Here we review some the pressing issues of concern; discrimination; breaches of privacy; iatrogenesis; disinformation and misinformation or 'fake news' and cyber-attacks. These have the potential to impact negatively on the health and wellbeing of individuals as well as entire communities and nations. We call for a concerted European response to maximize the benefits of the digital revolution while minimizing the harms, arguably one of the greatest challenges facing the public health community today.
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How to govern the digital transformation of health services
Article
Full-text available
The impact of digitalization of health services has been profound and is expected to be even more profound in the future. It is important to evaluate whether digital health services contribute to health system goals in an optimal way. This should be done at the level of the service, not the ‘digital transformation’. Decisions to adopt new digital health services, at different levels of the health care system, are ideally based on evidence regarding their performance in light of health system goals. In order to evaluate this, a broad perspective should be taken in evaluations of digital health services. Attainment of the broad health system goals, including quality, efficiency and equity, are objectives against which to judge new digital health services. These goals in a broad sense are unaltered by the process of digitalization. Governance should be designed and tailored in such a way to capture all relevant changes in an adequate way. When evaluating digital health services many specific aspects need to be considered. Like for other innovations and (new) technologies, such promises may or may not materialize and potential benefits may also be accompanied by unintended and/or negative (side) effects in the short or long term. Hence, the introduction, implementation, use and funding of digital health technologies should be carefully evaluated and monitored. Governments should play a more active role in the further optimization both of the process of decision making (both at the central and decentral level) and the related outcomes. They need to find a balance between centralized and decentralized activity. Moreover, the broader preparation of the health care system to be able to deal with digitalization, from education, through financial and regulatory preconditions, to implementation of monitoring systems to monitor its effects on health system performance remains important.
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Ethical aspects of digital health from a justice point of view
Article
Full-text available
Digital health is transforming healthcare systems worldwide. It promises benefits for population health but might also lead to health inequities. From an ethical perspective, it is hence much needed to adopt a fair approach. This article aims at outlining chances and challenges from an ethical perspective, focusing especially on the dimension of justice-a value, which has been described as the core value for public health. Analysed through the lenses of a standard approach for health justice-Norman Daniels' account of just health and accountability for reasonableness-most recent and relevant literature was reviewed and challenges from a justice point of view were identified. Among them are challenges with regard to digital illiteracy, resulting inequities in access to healthcare, truthful information sharing to end users demanding fully informed consent, dignity and fairness in storage, access, sharing and ownership of data. All stakeholders involved bear responsibilities to shape digital health in an ethical and fair way. When all stakeholders, especially digital health providers and regulators, ensure that digital health interventions are designed and set up in an ethical and fair way and foster health equity for all population groups, there is a chance for this transformation resulting in a fair approach to digital health.
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Benefits and challenges of Big Data in healthcare: an overview of the European initiatives
Article
Full-text available
Healthcare systems around the world are facing incredible challenges due to the ageing population and the related disability, and the increasing use of technologies and citizen's expectations. Improving health outcomes while containing costs acts as a stumbling block. In this context, Big Data can help healthcare providers meet these goals in unprecedented ways. The potential of Big Data in healthcare relies on the ability to detect patterns and to turn high volumes of data into actionable knowledge for precision medicine and decision makers. In several contexts, the use of Big Data in healthcare is already offering solutions for the improvement of patient care and the generation of value in healthcare organizations. This approach requires, however, that all the relevant stakeholders collaborate and adapt the design and performance of their systems. They must build the technological infrastructure to house and converge the massive volume of healthcare data, and to invest in the human capital to guide citizens into this new frontier of human health and well-being. The present work reports an overview of best practice initiatives in Europe related to Big Data analytics in public health and oncology sectors, aimed to generate new knowledge, improve clinical care and streamline public health surveillance.
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Speech--Opening address at eHealth Week
  • May 2017
  • Z Jakab
Jakab Z. Speech--Opening address at eHealth Week. 10 May 2017, Malta. Available at: http://www.euro.who.int/en/about-us/regional-director/speeches-and-presentations-byyear/2017/speech-opening-address-at-ehealth-week (28 August 2019, date last accessed).