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The dawn of digital public health in Europe: Implications for public health policy and practice

  • WHO European Observatory on Health Systems & Policies


The COVID-19 pandemic has highlighted the importance of digital health technologies and the role of effective surveillance systems. While recent events have accelerated progress towards the expansion of digital public health (DPH), there remains significant untapped potential in harnessing, leveraging, and repurposing digital technologies for public health. There is a particularly growing need for comprehensive action to prepare citizens for DPH, to regulate and effectively evaluate DPH, and adopt DPH strategies as part of health policy and services to optimise health systems improvement. As representatives of the European Public Health Association's (EUPHA) Digital Health Section , we reflect on the current state of DPH, share our understanding at the European level, and determine how the application of DPH has developed during the COVID-19 pandemic. We also discuss the opportunities, challenges, and implications of the increasing digitalisation of public health in Europe.
The dawn of digital public health in Europe:
Implications for public health policy and practice
Brian Li Han Wong,
Laura Maaß,
*Alice Vodden,
Robin van Kessel,
Sebastiano Sorbello,
Stefan Buttigieg,
Anna Odone,
on behalf of the European Public Health Association (EUPHA) Digital Health Section
Secretariat, The Lancet and Financial Times Commission on Governing Health Futures 2030: Growing up in a digital world,
Global Health Centre, The Graduate Institute, Geneva, Switzerland
Medical Research Council Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental
Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
Digital Health Section, European Public Health Association (EUPHA), Utrecht, The Netherlands
Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
Leibniz Science Campus Digital Public Health Bremen (LSC), Bremen, Germany
Research Center on Inequality and Social Policy (socium), Bremen, Germany
East London NHS Foundation Trust, London, UK
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht,
Studio Europa, Maastricht University, Maastricht, Netherlands
Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
Ministry for Health, Malta
The COVID-19 pandemic has highlighted the importance of digital health technologies and the role of effective sur-
veillance systems. While recent events have accelerated progress towards the expansion of digital public health
(DPH), there remains significant untapped potential in harnessing, leveraging, and repurposing digital technologies
for public health. There is a particularly growing need for comprehensive action to prepare citizens for DPH, to regu-
late and effectively evaluate DPH, and adopt DPH strategies as part of health policy and services to optimise health
systems improvement. As representatives of the European Public Health Association's (EUPHA) Digital Health Sec-
tion, we reflect on the current state of DPH, share our understanding at the European level, and determine how the
application of DPH has developed during the COVID-19 pandemic. We also discuss the opportunities, challenges,
and implications of the increasing digitalisation of public health in Europe.
Copyright Ó2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND
license (
Keywords: Digital health; Digital public health; Europe; Public health; Digital transformations
The Coronavirus disease 2019 (COVID-19) pandemic
is among the most severe crises facing society this cen-
tury. The rapid speed of transmission has forced coun-
tries to adapt their national healthcare systems at an
unprecedented rate. With remote work, surveillance,
and care delivery as new societal norms, there has
been an ever-increasing spotlight on digital health
COVID-19 has emphasised the impor-
tance of establishing effective surveillance systems for
public health at all levels.
Governments must adopt
digital public health (DPH) strategies in their national
health policy and healthcare to coordinate and manage
those systems.
As representatives of the European
Public Health Association's (EUPHA) Digital Health
Section, we share our understanding of DPH at the
European level. In this viewpoint, we reflect on the
understanding and application of DPH during the
COVID-19 pandemic and in a wider context, as well as
discuss the opportunities, challenges, and implications
Abbreviations: EUPHA, European Public Health Association;
DPH, Digital public health; UHC, Universal health coverage;
ICT, Information and communications technologies; RCT,
Randomised control trial; WHO, World Health Organization;
UNICEF/ERACO, United Nations Children’s Fund/Europe
and Central Asia Regional Office; UK, United Kingdom; NHS,
National Health Service; PHWF, Public health workforce;
GDPR, General Data Protection Regulation; UN, United
E-mail address: (L. Maa).
The Lancet Regional
Health - Europe
2022;14: 100316
Published online xxx
lanepe.2022.100316 Vol 14 Month March, 2022 1
of the increasing digitalisation of public health in
As a discipline, ‘public health’ traces back to the
beginnings of human civilisation when communities
first started promoting health and combating diseases.
Contemporary public health has undergone rapid trans-
formations to respond to modern threats and opportuni-
ties. Among these are the digital transformations of the
health sector, which have led to the establishment of
‘digital health’ with a vital role in strengthening health
systems, increasing equity in access to health services,
and working towards universal health coverage (UHC).
More recently, these digital transformations have given
rise to the concept of ‘digital public health’.
This con-
cept combines the already defined terms of ‘public
health’ and ‘digital health’ (Box 1) and is not considered
a novel field of itself, but the adoption of digital tools to
achieve public health goals, such as preventing disease,
empowering citizens, promoting value-based health-
care, or achieving UHC.
The central aim of DPH is
to improve the health of populations from the individual
to the population level by using information and com-
munications technologies (ICT).
This is one of the
key factors differentiating DPH from 'digital health', the
latter being predominantly focused on individual
Evidence- and needs-based approaches should
characterise interventions.
An inclusive, participa-
tory approach to designing, developing, and implement-
ing digital technologies will improve not only their
acceptance but also their effectiveness.
DPH tech-
nologies must ensure that inequalities are not exacer-
bated due to varied access to and/or competence of a
digital intervention amongst different demographic
Interventions in DPH should collect data for
public health surveillance, whether it be for public
health emergencies or monitoring risk factors for wide-
spread diseases at the population level.
Amidst the ongoing COVID-19 pandemic, we have
seen glimpses of the transformational potential of DPH
to accelerate responses to various public health emer-
gencies (Box 2). The perception of digital health tools
rapidly moved from being seen as “opportunities” to
“necessities”, which kickstarted a sequence of rapid
developments in the healthcare and public health
domains that still retained their pre-digital structures
and were stagnated and eroded:
changes to policy
and regulation facilitated rapid changes to reimburse-
ment, training for health professionals, and unprece-
dented investment in technical infrastructure.
countries and communities have effectively leveraged
pre-pandemic digital investments in public health and
applied them to their pandemic management.
development and adoption of digital technologies made
critical contributions to many public health functions:
epidemiological surveillance, contact tracing, case iden-
tification, mass immunisation service delivery, and pub-
lic communication.
One of the domains of DPH impact is epidemiologi-
cal surveillance. The development of tools for interna-
tional real-time public health data has supported
policymakers in planning and refining containment
strategies. These tools allowed for the evaluation of the
real-time effectiveness of interventions. Concerning
community transmission, the possibility to collect loca-
tion data (GPS) and proximity data (Bluetooth) from
mobile devices pushed several countries to support the
development of digital contact tracing apps. These apps
speed up contact tracing and quarantining contacts.
Another relevant field to pandemic response con-
cerns public education. Digital platforms of health
authorities and national agencies use the Internet to
enable a rapid engagement and education of the popula-
tion through prompt dissemination of trusted and tai-
lored public health information, limiting at the same
time the visibility of news from unreliable sources.
System readiness for digital public health
The conceptualisation of digital health in Box 1 already
alluded to the notion that digital health is part of the
overarching health ecosystem. Over the course of the
COVID-19 pandemic, the health ecosystem has digital-
ised out of a need to survive rather than a desire to inno-
vate; this is indicated by the rapid shift from a
traditional to a digital paradigm and subsequent series
of changes when COVID-19 became a pandemic.
However, this widespread digital transformation also
allowed the risks and benefits of digital health services
to be experienced in an unprecedented manner and
data on the efficacy and efficiency of digital health serv-
ices to be gathered. As a result, the digital health
Term Denition
Health Health is dened as "a state of complete physical,
mental and social well-being and not merely the
absence of disease or inrmity" by the constitu-
tion of the World Health Organization (WHO).
Public Health Public health is conceptualised as "the art and sci-
ence of preventing disease, prolonging life and
promoting health through the organised efforts
of society" by Acheson in 1988.
Digital Health Digital health is framed as the "the convergence of
the digital and genomic revolutions with health,
health care, living, and society" by Paul Sonnier
in his 2017 book The Fourth Wave: Digital
Digital health, as a concept, can refer
to a technology, a user experience, a service, a
product, a process, an ecological system of itself,
and part of the ecological system of health
Box 1: The respective conceptualisations of health, public
health, and digital health.
2 Vol 14 Month March, 2022
literature previously on the scarcer end in terms of
longitudinal articles is slowly growing richer and
more diverse as more health sub-domains experiment
with the capabilities of digital health.
The results of digital health services are slowly
becoming more apparent in various domains. For
instance, in a study of 143 people aged 10-17 with
chronic pain, people using the WebMAP Mobile App
perceived greater improvements post-treatment
(Cohen'sd:0¢54; P <0¢001) and at a 3-month follow-up
(Cohen'sd:0¢44; P = 0¢001). It also emphasised the
importance of patients remaining engaged in their treat-
ment process. Greater engagement was associated with
significantly greater reductions in pain and disability
from pre-treatment to post-treatment (Cohen's
d=0¢57; P <0¢01) and follow-up (Cohen'sd=0¢38,
A non-randomised control trial of 1064 par-
ticipants testing the effectiveness of digital health inter-
ventions in preventing readmission after an acute
myocardial infarction showed that the digital health
intervention group had fewer all-cause 30-day readmis-
sions compared to the control group (6¢5% compared to
16¢8%). After adjustments, the digital health interven-
tion group was found to have a 52% reduced risk of
readmission (hazard ratio: 0¢48; 95% CI: 0¢260¢88).
Finally, a multicenter RCT of 891 participants at moder-
ate to high risk of cardiovascular disease evaluated the
effect of a consumer-focused digital health intervention
on guideline-recommended medication adherence, car-
diovascular risk factor control, and lifestyle behaviors at
one year. Although no difference was observed between
groups in medication adherence (RR: 1¢07; 95% CI:
0¢88-1¢20) and a miniscule improvement in attaining
risk factor targets (RR: 1¢40; 95% CI: 0¢97-2¢03), physi-
cal targets were attained significantly more (87¢0%
intervention vs. 79¢7% control, P = 0¢02) and e-health
literacy developed more as well (72¢6% intervention vs.
64¢0% control, P = 0¢02).
While these examples are more in line with digital
health services at the individual level than at the popula-
tion level, it is important to acknowledge that in order
for new or repurposed DPH tools to be taken up at
larger scale the receiving system needs to be ready to
assimilate the innovation, both in terms of technological
compatibility and restructuring of work processes and
System readiness, in this line of reason-
ing, is fostered by exposure to and awareness of success-
ful innovations in either the same domain elsewhere or
COVID-19 HealthBuddy+: a chatbot created through a joint initiative of the WHO/Europe and the United Nations Childrens Fund Europe and
Central Asia Regional Ofce (UNICEF/ECARO). It is accessible in Europe and Central Asia and its goal is to provide access to up-to-
date and evidence-based information on COVID-19.
Digital epidemiological surveillance: an umbrella term for the so-called 'coronadashboards'that are created by European countries
to provide continually updated information on the state of COVID-19 in the respective country.
Primary care My Health: a personal space of digital health that allows the citizens of Catalonia to interact in a non-contact way with the Health
System of Catalonia. It facilitates its users to consult clinical reports, diagnoses and results of clinical analyses and tests that are
part of its medical history. Users can also access their current Medication Plan to go directly to the pharmacy, request a primary
care visit, or access various non-face-to-face care services (e.g. eConsult: a system that allows health professionals to ask health-
related questions, carry out procedures, and send documents).
AccuRx: a digital healthcare start-up supported by Innovate UK who developed and rolled out video consultation software that
enabled United Kingdom (UK) healthcare providers to communicate remotely with their patients, thus minimising infection risk
from seeing patients with COVID-19. Within a few months, it was used to conduct over one million video consultations and was
used in 6700 GP practices. It protected National Health Service (NHS) professionals and patients and increased NHS efciency,
saving each user approximately 40 minutes per day.
Mental health Now I Can Do Heights: a software application by Oxford VR that seeks to help users with acrophobia overcome their fear of heights.
The application is for adults older than 18 years and designed to be used without a supporting therapist.
In a randomised con-
trol trial (RCT) of 100 participants, Now I Can Do Heights has demonstrated the capability of producing large clinical effects (mean
change of the Heights Interpretation Questionnaire score 24¢5 [SD 13¢1] in the VR group versus 1¢2[7¢3] in the control
GET.ON Mood Enhancer Prevention: a web-based, guided self-help intervention based on psychoeducation, problem-solving ther-
apy, and behavioral activation. In a RCT of 406 participants in Germany, GET.ON produced a hazard ratio of 0¢59 [95% CI: 0¢42-
0¢82] in participants with subthreshold depression. GET.ON could also potentially prevent one clinical case of major depressive
disorder within a 12 month period after 5¢9 sessions.
Obesity Esporti Family: a mobile application whose objective is to treat childhood obesity which allows sharing information among profes-
sionals, patients and families. It teaches kids and their families healthy habits and nutrition through gamication and encourages
them to increase their level of physical activity. A two-month trial of 67 users in Murcia, Spain showed an overall 44¢4% reduction
in fast food consumption, 38% of users increased their weekly physical exercise, and 27% of users increased their sleep hours.
Box 2: Case examples of DPH services in Europe.
Viewpoint Vol 14 Month March, 2022 3
a different domain within the same overarching system
(i.e. healthcare or public health) and can occur at a
national, organisational, community, and individual
Another point to consider is the readiness of the gen-
eral population to structurally adopt digital health serv-
ices. According to a recent analysis of digital skills in
the European Union, there are clear discrepancies in
digital skills across the European regions: the majority
of highly digitally skilled people are found in the North-
ern and North-Western parts of Europe, while South-
Eastern Europe shows less than 20% of individuals
being highly digitally skilled. Certain population groups
also seem to fare more favourable in a digital world: peo-
ple who are younger, higher educated, male, live in
urban regions, are either a student or employed, or are
employed consistently report higher internet access and
digital skills.
These findings suggest that if digital
health services were structurally introduced now only
certain population groups would be able to benefit from
these services. Ironically, population groups that could
potentially benefit most from these innovations are the
ones that would experience the highest barriers to
access, creating a digital health paradox.
Opportunities & Challenges
While recent events have rapidly accelerated progress
towards the expansion of DPH, there remains signifi-
cant untapped potential in harnessing, leveraging, and
repurposing digital technologies (and data) for public
health. International real-world data can boost large-
scale observational studies at the European level (thus
ameliorating current constraints presented by a lack of
high-quality data surrounding digital health and DPH
interventions), tackle cross-border epidemiological
questions, and accelerate the implementation of shared
European public health policies. However, the effective-
ness of the implemented strategies depends on the
active involvement of the population. That said, in order
for the population to become actively involved in DPH
and for DPH to improve the social health experience,
a more horizontal design of DPH needs to be normal-
ised and healthcare pathways need to be reconsidered
in light of existing and emerging technologies.
instance, a DPH initiative using the technology cur-
rently in use to detect information relating to COVID-
19 in social media posts could make use of the habit of
the general population to search for health-related infor-
mation through (social) media networks in order to pro-
vide them with contact details for relevant health
To develop these technologies, public
and private actors should not only ensure their techno-
logical infrastructure is compatible, but also align their
values, vision, and resources.
To fully embrace the potential of DPH, social deter-
minants also need to be considered to ensure access to
DPH for all population segments and overcome geo-
graphic and socioeconomic barriers to achieving good
health and well-being.
Digital connectivity is a
major prerequisite for accessing DPH and vast digital
divides in the European region continue to exist.
grating DPH into curricula and training remains of par-
amount importance to develop the capacity to support
the sustainable development of DPH systems and infra-
structure. Whether this is through the inclusion of
DPH modules within existing academic courses or
implementing additional educational initiatives, such a
focus is vital to identifying potential areas for future dig-
ital health uptake and the continual strengthening of
digital health systems.
Young professionals namely, youth constitute
an untapped resource within the public health work-
force (PHWF) and present a great opportunity for
strengthening both the digital health capacity and digi-
tal readiness of (public) health systems in which they
are employed.
Additionally the involvement and
engagement of youth via multidisciplinary public-pri-
vate partnerships between academia, governments, civil
society, and other relevant stakeholder groups can fur-
ther strengthen governance processes related to DPH.
However, youth must be enfranchised to structurally
contribute to the promotion and adoption of DPH tech-
nologies (e.g. by means of digital health literacy initia-
tives) so that existing health inequalities and digital
divides are not exacerbated.
Only by harnessing the
digital potential of the current and future generation of
the PHWF can DPH interventions achieve maximum
uptake and spread across Europe.
A key challenge to the effective implementation of
European DPH strategies is the concept of interopera-
bility (Box 3).
Interoperability requires a shared tech-
nical, legal and organisational framework and is a
prerequisite for using digital tools and data-driven tech-
nologies to their full potential in the public health land-
The COVID-19 pandemic has highlighted the
Interoperability refers to the ability of two or more systems or com-
ponents to exchange information and to use the information that
has been exchanged.
It can be construed as a wicked problem
as it can be dened in multiple dimensions:
Technical interoperability: the basic data exchange capabilities
between systems.
Structural or syntactic interoperability: two or more systems have
data formats that are compatible.
Semantic interoperability: two or more systems use a shared lan-
guage and terminology and can therefore understand, process,
and interpret each others data.
Organisational interoperability: the legal, political, and organisa-
tional facilitators of data exchange of two or more systems are
Box 3: The denition and dimensions of interoperability.
4 Vol 14 Month March, 2022
importance of timely access to health data in ensuring
the rapid development of digital tools (e.g. mobile
health apps, wearable sensors) to collect large volumes
of data. However, due to unstructured data and isolated
data infrastructures, it is challenging to combine data-
sets and run comprehensive analysis, severely limiting
the ultimate potential of these technologies from a pub-
lic health perspective.
Pursuing interoperability especially cross-country
requires data protection to be considered. The Gen-
eral Data Protection Regulation (GDPR) established
requirements that data operators have to comply with,
which are more stringent when dealing with personal
As such, interoperability must be in compliance
with the current legal system, while digital health systems
should be designed prospectively to guarantee adherence
to data protection legislation.
That being said, with the
GDPR, the EU has set a precedent to legislate in the field
of health data, which could enable them to create more tar-
geted legislation related to data protection and interopera-
bility. The recommendation of the European Commission
to adopt a standard format in their electronic health
records is a first step in this process.
Implications for Policy & Practice
The extraordinary momentum and progress witnessed
worldwide regarding DPH led us to acknowledge the
broader implications for policy and practice extending
beyond the current public health emergency.
The COVID-19 pandemic has led us to recognise the
pivotal role of surveillance in deepening our under-
standing of infection transmission and identifying risk
factors for the disease to guide effective interventions.
Strengthening digital epidemiological surveillance
through digital tools to support operations (e.g. case
identification, contact tracing, and other strategies for
pandemic control) represent perhaps the most crucial
area of DPH in the future epidemic preparedness and
more widely. Increased recognition of the role of non-
health data in providing novel insights for public health
remains a significant step to ensuring DPH interven-
tions reflect the field’s interdisciplinary nature.
contains developing ways of systematically integrating
data sources, including social media data, mobility data,
and survey data, into DPH surveillance and monitoring
From a top-down perspective, the effectiveness of
DPH interventions fundamentally rests upon their abil-
ity to be communicated to individuals.
Guiding indi-
vidual decisions and behaviour towards effective public
health practices through timely and targeted communi-
cation strategies remains a pivotal role of DPH. This
will enable the success of digital interventions and in
the broader public health field more generally.
interventions would limit existing divergences and
accelerate the path towards two critical goals of DPH
technologies: (1) optimisation of healthcare services pro-
vision and patients'accessibility to health data (primary
use of health data) and (2) implementation of research,
policymaking, and regulatory activities (secondary use
of health data). In contrast, DPH interventions should
be designed with the individual at the centre of the
design process, meaning a comprehensive focus on
understanding the factors that support people (profes-
sionals and patients) to use technology should be
included and the importance of cultural and organisa-
tional change recognised.
As the generation which stands to gain or lose
the most from digital transformations in health, youth
must be enfranchised (e.g. through digital literacy initia-
tives) to contribute to policymaking processes. Youth
can simultaneously play a key role in enabling and
enriching policy initiatives by helping to increase the
uptake and spread of digital transformations across
demographics. One such example is the work of the
recently adopted United Nations (UN) Convention on
the Rights of the Child general comment No. 25 (2021)
setting out children’s rights in the digital world, in
which children and young people were consulted at
every stage.
Another example is the work of The
Lancet and Financial Times Commission on Governing
health futures 2030: growing up in a digital world (here-
after “GHFutures2030”), which set a new benchmark
for meaningfully including youth in the design, devel-
opment, implementation, and evaluation of digital
health policies, programmes, and services.
There is a growing need for coordinated, multidisciplin-
ary approaches and strategies for regulating, evaluating,
and using digital technologies, particularly in the con-
text of public health emergencies.
Moreover, there are
broader implications for applying DPH measures,
which extend beyond the epidemiological management
of COVID-19 (e.g. other concurrent public health crises
like domestic violence).
Such applications can help
improve the efficiency and effectiveness of public health
prevention, surveillance, and responses. To safeguard
health futures for generations to come, governments,
stakeholders, and experts need a concerted effort to
establish an appropriate technical, legal, and gover-
nance framework, as proposed by the GHFutures2030
This will lead to interoperable systems
and accessible health information by accessing and
exchanging health data. We call upon all stakeholders to
show political commitments, set up a normative and
regulatory framework supported by technical infrastruc-
ture and sustainable financial investments. To trans-
form this journey into a sustainable and long-term
reality we also believe that academic and private institu-
tions need to invest in training, education, research,
and collaboration with national and regional authorities
Viewpoint Vol 14 Month March, 2022 5
to establish robust monitoring and evaluation to sup-
port continuous improvement efforts.
Declaration of interests
All authors have completed the ICMJE uniform disclo-
sure form at and
declare: no support from any organisation for the sub-
mitted work (except the research grants listed in fund-
ing); no financial relationships with any organisations
that might have an interest in the submitted work in the
previous three years; no other relationships or activities
that could appear to have influenced the submitted
Author contributions
The corresponding author confirms that all listed
authors meet authorship criteria and that no others
meeting the criteria have been omitted. The contribu-
tions of all authors are outlined using the CRediT state-
ment. BLHW: Conceptualisation, Investigation, Formal
Analysis, Writing - Original Draft, Writing - Review &
Editing, Supervision. LM: Investigation, Formal Analy-
sis, Writing - Original Draft. AV: Investigation, Formal
Analysis, Writing - Original Draft. RVK: Investigation,
Formal Analysis, Visualisation, Writing - Review & Edit-
ing. SS: Investigation, Formal Analysis, Writing - Origi-
nal Draft. SB: Investigation, Formal Analysis, Writing -
Original Draft. AO: Investigation, Formal Analysis,
Writing - Original Draft.
1Peek N, Sujan M, Scott P. Digital health and care in pandemic
times: impact of COVID-19. BMJ Health Care Inform. 2020;27:
2Murray CJL, Alamro NMS, Hwang H, Lee U. Digital public health
and COVID-19. Lancet Public Health. 2020;5:e469–e470.
3Whitelaw S, Mamas MA, Topol E, Spall HGCV. Applications of
digital technology in COVID-19 pandemic planning and response.
Lancet Digit Health. 2020;2:e435–e440.
4 World Health Organization. Digital health. 2021. https://www.
Accessed 14 December 2021.
5Odone A, Buttigieg S, Ricciardi W, Azzopardi-Muscat N, Staines A.
Public health digitalization in Europe. Eur J Public Health.
6Wienert J, Jahnel T, Maa L. What are Digital Public Health Inter-
ventions? First Steps Towards a Definition and an Intervention
Classification Framework. JMIR. 2022. 04/01/2022:31921 (forth-
coming/in press).
7 Rosalia RA, Wahba K, Milevska-Kostova N. How digital transfor-
mation can help achieve value-based healthcare: Balkans as a case
in point. Lancet Reg Health
Eur. 2021;4.
8Wilson D, Sheikh A, G
orgens M, Ward K. Technology and Universal
Health Coverage: Examining the role of digital health. 2021;11:12.
9Darmann-Finck I, Rothgang H, Zeeb H. Digitalisierung und
Gesundheitswissenschaften White Paper Digital Public Health.
Gesundheitswesen. 2020;82:620–622.
10 Zeeb H, Pigeot I, Sch
uz B. Leibniz-WissenschaftsCampus Digital
Public Health Bremen. Digital Public Health ein
Uberblick. Bun-
desgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz.
11 Jahnel T, Sch
uz B. Partizipative Entwicklung von Digital-Public-
Health-Anwendungen: spannungsfeld zwischen Nutzer*innenper-
spektive und Evidenzbasierung. Bundesgesundheitsblatt - Gesund-
heitsforschung - Gesundheitsschutz. 2020;63:153–159.
12 van Kessel R, Hrzic R, O’Nuallain E, et al. The digital health para-
dox: international policy perspectives to address the increased
health inequalities for people living with disabilities. J Med Internet
Res. 2022. doi:10.2196/33819.
13 Aiello AE, Renson A, Zivich PN. Social Mediaand Internet-Based
Disease Surveillance for Public Health. Annu Rev Public Health.
14 Shakeri Hossein Abad Z, Kline A, Sultana M, et al. Digital public
health surveillance: a systematic scoping review. Npj Digit Med.
15 World Health Organization. Constitution of the World Health Orga-
nization. New York. 1948.
16 Rechel B, McKee M. Facets of Public Health in Europe. European
Observatory on Health Systems and Policies Series. Maidenhead, UK:
Open University Press; 2014.
17 Sonnier P. The fourth wave: Digital health - a new era of human prog-
ress. 2017. San Diego, California.
18 Wong BLH, Delgrange M, Nathan NL, et al. The Association of
Schools of Public Health in the European Region Statement on the
Erosion of Public Health Systems. Public Health Rev. 2021. https://
19 Fahy N, Williams GA. COVID-19 Health System Response Monitor
Network. Use of digital health tools in Europe: before, during and after
COVID-19. Copenhagen: European Observatory on Health Systems
and Policies; 2021.
20 WHO/Europe. HealthBuddy+. 2020.
index. Accessed 12 December 2021.
21 Budd J, Miller BS, Manning EM, et al. Digital technologies in the
public-health response to COVID-19. Nat Med. 2020;26:1183–1192.
22 Catalan Department of Health. eConsult. 2020. https://catsalut. Accessed 12 Decem-
ber 2021.
23 UK Research and Innovation. Over one million GP consultations
using new app. 2020; published online Oct 28. https://www.ukri.
app/. Accessed 14 December 2021.
24 Negreiro M. The rise of digital health technologies during the pandemic.
Brussels: European Parliament; 2021.
25 Freeman D, Haselton P, Freeman J, et al. Automated psychological
therapy using immersive virtual reality for treatment of fear of
heights: a single-blind, parallel-group, randomised controlled trial.
Lancet Psychiatry. 2018;5:625–632.
26 Buntrock C, Ebert DD, Lehr D, et al. Effect of a Web-Based Guided
Self-help Intervention for Prevention of Major Depression in
Adults With Subthreshold Depression: a Randomized Clinical
Trial. JAMA. 2016;315:1854–1863.
27 inDemand. MENUDO: mobile digital technologies to treat child-
hood obesity through education, motivation and adherence. 2020
INDEMANDSTORIES_MENUDO-1.pdf. Accessed 12 December
28 Ming LC, Untong N, Aliudin NA, et al. Mobile health apps on
COVID-19 launched in the early days of the pandemic: content
analysis and review. JMIR MHealth UHealth. 2020;8:e19796.
29 Jahnel T, Kernebeck S, B
obel S, et al. Contact-Tracing-Apps als
utzende Manahme bei der Kontaktpersonennachverfolgung
von COVID-19. Gesundheitswesen Bundesverb Arzte Offentlichen
Gesundheitsdienstes Ger. 2020;82:664–669.
30 Hern
ıa I, Gim
ulvez T. Assessment of Health
Information About COVID-19 Prevention on the Internet: Infode-
miological Study. JMIR Public Health Surveill. 2020;6:e18717.
31 Palermo TM, de la Vega R, Murray C, Law E, Zhou C. A digital
health psychological intervention (WebMAP Mobile) for children
and adolescents with chronic pain: results of a hybrid effectiveness-
implementation stepped-wedge cluster randomized trial. PAIN.
32 Marvel FA, Spaulding EM, Lee MA, et al. Digital Health Interven-
tion in Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes.
6 Vol 14 Month March, 2022
33 Redfern J, Coorey G, Mulley J, et al. A digital health intervention
for cardiovascular disease management in primary care (CON-
NECT) randomized controlled trial. Npj Digit Med. 2020;3:1–9.
34 Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Dif-
fusion of innovations in service organizations: systematic review
and recommendations. Milbank Q. 2004;82:581–629.
35 Greenhalgh T, Wherton J, Papoutsi C, et al. Beyond adoption: a
new framework for theorizing and evaluating nonadoption, aban-
donment, and challenges to the scale-Up, spread, and sustainability
of health and care technologies. J Med Internet Res. 2017;19:e8775.
36 Ross J, Stevenson F, Lau R, Murray E. Factors that influence the
implementation of e-health: a systematic review of systematic
reviews (an update). Implement Sci. 2016;11:146.
37 Sbayou M, Zacharewicz G, Bouanan Y, Vallespir B. BPMN coordi-
nation and devs network architecture for healthcare organizations.
Int J Priv Health Inf Manag. 2019;7:103–115.
38 van Kessel R, Wong BLH, Rubini
c I, O’Nuallain E, Czabanowska
K. Is Europe prepared to go digital? Making the case for developing
digital capacity: an exploratory analysis of Eurostat survey data.
PLOS Digit Health. 2022.
pdig.0000013. published online Forthcoming.
39 Lefebvre RC, Bornkessel AS. Digital Social Networks and Health.
Circulation. 2013;127:1829–1836.
40 Swiatek B. Social Networking: the Future of Digital Healthcare.
10Clouds; 2018. published online April 23;
blog/web/digital-healthcare-social-networking/. Accessed 8 Janu-
ary 2022.
41 Mazzucato M. Mission Economy: A Moonshot Guide to Changing
Capitalism. 1st edn Allen Lane; 2021.
42 Honeyman M, Maguire D, Evans H, Davies A. Digital technology
and health inequalities: a scoping review. Cardiff: Public Health Wales
NHS Trust; 2020.
43 Wong BLH, Khurana MP, Smith RD, et al. Harnessing the digital
potential of the next generation of health professionals. Hum
Resour Health. 2021;19:50.
44 Wong BLH, Siepmann I, Chen TT, et al. Rebuilding to shape a bet-
ter future: the role of young professionals in the public health
workforce. Hum Resour Health. 2021;19:82.
45 Wong BLH, Smith RD, Siepmann I, Hasse A, Tandon S. Youth
engagement in digital health: a critical perspective towards mean-
ingful youth agency in governance. MMS Bull. 2021;157. https://
46 IEEE Standard Computer Dictionary: A Compilation of IEEE Stan-
dard Computer Glossaries. IEEE Std. 1991;610:1–217.
47 Lehne M, Sass J, Essenwanger A, Schepers J, Thun S. Why
digital medicine depends on interoperability. Npj Digit Med.
48 Kolasa K, Kozinski G. How to value digital health interventions? a
systematic literature review. Int J Environ Res Public Health.
49 European Commission. General Data Protection Regulation. 2016
LEX:32016R0679. Accessed 14 December 2021.
50 Bincoletto G. Data protection issues in cross-border interoperability
of Electronic Health Record systems within the European Union.
Data Policy. 2020;2:e3.
51 Hutchings R, Scobie S, Edwards N. Fit for the future: what can the
NHS learn about digital health care from other European countries?
London: Nuffield Trust; 2021..
files/2021-11/international-digital-policy-review-web.pdf. Accessed
10 December 2021.
52 United nations committee on the rights of the child. General com-
ment on children’s rights in relation to the digital environment.
drensRightsRelationDigitalEnvironment.aspx. Accessed 19 Decem-
ber 2021.
53 Terre des hommes. #CovidUnder19. 2021.
projects/covidunder19. Accessed 19 December 2021.
54 Wong BLH, Gray W, Holly L. The future of health governance
needs youth voices at the forefront. The Lancet. 2021:1–2.
55 Wong BLH, Gray W, Georges Stevens EA, et al. The lancet-financial
times commission governing health futures 2030: growing up in a digital
world youth statement + call for action. Geneva, Switzerland: The
Lancet and Financial Times Commission on Governing health
futures 2030: Growing up in a digital world; 2021. https://els-jbs-
56 Jeyaraman D, Chandan JS. Digital public health: a hopeful strategy
to tackle the surge in domestic violence. Lancet Public Health.
57 Kickbusch I, Piselli D, Agrawal A, et al. The Lancet and Financial
Times Commission on governing health futures 2030: growing up
in a digital world. The Lancet. 2021;398:1727–1776.
Viewpoint Vol 14 Month March, 2022 7
... The resulting lack of data on the comparative effectiveness and cost-effectiveness of digital therapeutics can limit market access for innovative technologies [13,15] and present challenges for policy makers and providers when establishing reimbursement mechanisms. There are also factors that influence uptake at the patient level, including digital infrastructure and literacy [2,[15][16][17][18], and at the health professional level, including lack of training, uncertainties surrounding accountability, and shifts in professional workflow [13,19]. Although the COVID-19 pandemic boosted the implementation of digital health across the health ecosystem [17,18,20], the uptake was not sustainable, as patients reverted back to traditional health services over time [21]. ...
... There are also factors that influence uptake at the patient level, including digital infrastructure and literacy [2,[15][16][17][18], and at the health professional level, including lack of training, uncertainties surrounding accountability, and shifts in professional workflow [13,19]. Although the COVID-19 pandemic boosted the implementation of digital health across the health ecosystem [17,18,20], the uptake was not sustainable, as patients reverted back to traditional health services over time [21]. ...
... Uptake, in this context, refers to both the integration of digital therapeutics into the health system and the acceptability and practical use of digital therapeutics by patients and health professionals. Publications from 2000 onward were considered, as this year marks the start of digitalization in health [1,17,21]. Only publications in English were considered. ...
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Background: Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products. Objective: In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals. Methods: A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis. Results: We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure. Conclusions: The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system's readiness for digital therapeutics.
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The European Union has implemented various strategies and policies to mitigate the effects of the coronavirus-19 pandemic and promote recovery. This article reviews the European Union's response and management decisions, examines the public health measures implemented to contain the virus, and explores the Union's economic recovery and support initiatives. These include the "NextGenerationEU" recovery fund, the "European Support" instrument to mitigate "Unemployment Risks in an Emergency" (SURE) program, and the Multiannual Financial Framework recognizing the EU's efforts to promote social welfare and inclusion during the pandemic. The challenges and lessons learned from the EU's experience are analyzed, highlighting the importance of solidarity, cooperation, and resilience in crisis management. Drawing from the pandemic, this study explores the prospects and conclusions drawn from the pandemic, the need for building more resilient healthcare systems, fostering environmentally sustainable initiatives, strengthening social protection and inclusion, enhancing crisis preparedness and response, and promoting global health and equity.
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Background The COVID-19 pandemic highlighted pre-existing weaknesses in health and care systems and services and shortages of health and care workers (HCWs). As a result, policymakers needed to adopt measures to improve the health and care workforce (HCWF) capacity. This review aims to identify countries’ range of policies and management interventions implemented to improve HCWs’ capacity to address the COVID-19 pandemic response, synthesize their evidence on effectiveness, and identify gaps in the evidence. Methods The literature was searched in PubMed, Embase, Scopus, LILACS–BVS, WHO’s COVID-19 Research Database and the ILO, OECD and HSRM websites for literature and documents published between January 2020 and March 2022. Eligibility criteria were HCWs as participants and policy and management interventions aiming to improve HCWF capacity to address the COVID-19 pandemic response. Risk of bias was assessed with Joanna Briggs Institute (JBI) Critical Appraisal Tools (CAT) and certainty of the evidence in presented outcomes with GRADE. Results The searches retrieved 3378 documents. A total of 69 were included, but only 8 presented outcomes of interventions implemented. Most of the selected documents described at least one intervention implemented by countries at the organizational environment level to increase the flexibility and capacity of the HCWF to respond to the pandemic, followed by interventions to attract and retain HCWs in safe and decent working environments. There was a lack of studies addressing social protection, human resources for health information systems, and regarding the role of community health workers and other community-based providers. Regarding the risk of bias, most of documents were rated as medium or high quality (JBI’s CAT), while the evidence presented for the outcomes of interventions was classified as mostly low-certainty evidence (GRADE). Conclusions Countries have implemented various interventions, some innovative, in response to the pandemic, and others had their processes started earlier and accelerated by the pandemic. The evidence regarding the impact and efficacy of the strategies used by countries during the pandemic still requires further research.
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Background The adoption of digital health care within health systems is determined by various factors, including pricing and reimbursement. The reimbursement landscape for digital health in Europe remains underresearched. Although various emergency reimbursement decisions were made during the COVID-19 pandemic to enable health care delivery through videoconferencing and asynchronous care (eg, digital apps), research so far has primarily focused on the policy innovations that facilitated this outside of Europe. Objective This study examines the digital health reimbursement strategies in 8 European countries (Belgium, France, Germany, Italy, the Netherlands, Poland, Sweden, and the United Kingdom) and Israel. Methods We mapped available digital health reimbursement strategies using a scoping review and policy mapping framework. We reviewed the literature on the MEDLINE, Embase, Global Health, and Web of Science databases. Supplementary records were identified through Google Scholar and country experts. Results Our search strategy yielded a total of 1559 records, of which 40 (2.57%) were ultimately included in this study. As of August 2023, digital health solutions are reimbursable to some extent in all studied countries except Poland, although the mechanism of reimbursement differs significantly across countries. At the time of writing, the pricing of digital health solutions was mostly determined through discussions between national or regional committees and the manufacturers of digital health solutions in the absence of value-based assessment mechanisms. Financing digital health solutions outside traditional reimbursement schemes was possible in all studied countries except Poland and typically occurs via health innovation or digital health–specific funding schemes. European countries have value-based pricing frameworks that range from nonexistent to embryonic. Conclusions Studied countries show divergent approaches to the reimbursement of digital health solutions. These differences may complicate the ability of patients to seek cross-country health care in another country, even if a digital health app is available in both countries. Furthermore, the fragmented environment will present challenges for developers of such solutions, as they look to expand their impact across countries and health systems. An increased emphasis on developing a clear conceptualization of digital health, as well as value-based pricing and reimbursement mechanisms, is needed for the sustainable integration of digital health. This study can therein serve as a basis for further, more detailed research as the field of digital health reimbursement evolves.
Introduction Nigeria recently used electronic surveillance tools for epidemic diseases, one such tool is the Surveillance Outbreak Response Management and Analysis System (SORMAS); no readily available study has assessed the use of SORMAS in Nigeria. The title of this study is the usability of SORMAS for coronavirus disease among epidemiological officers in Delta State; it explored the ease of use, the effectiveness of SORMAS, its applicability, and the challenges with its use. Materials and Methods This descriptive qualitative study involved disease surveillance and notification officers (DSNOs) and their assistants DSNOs in the year 2022; 25 of them were interviewed using two audio tape recorders after consent was obtained. Ethical clearance was obtained from the appropriate body. Thematic content analysis, with the help of Analysis of Qualitative Data software, was used to analyze data. Results The findings showed that SORMAS was difficult to use for 100% of the respondents, particularly at the initial time, and subsequent use was relatively easy. About 100% of users found SORMAS to be effective for coronavirus disease 2019 surveillance and claimed it could be applied to other health diseases. About 100% of the respondents had challenges which included network problems, unavailability of adequate airtime, low technological know-how, software glitch, and hardware issues, among others. Conclusion This study helped to outline the factors affecting SORMAS use, demonstrated that SORMAS was relatively easy to use after repeated training, was deemed effective by all respondents; applied to other health diseases, and its use was affected by several challenges.
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The health care sector experiences 76% of cybersecurity breaches due to basic web application attacks, miscellaneous errors, and system intrusions, resulting in compromised health data or disrupted health services. The European Commission proposed the European Health Data Space (EHDS) in 2022 to enhance care delivery and improve patients' lives by offering all European Union (EU) citizens control over their personal health data in a private and secure environment. The EU has taken an important step in homogenizing the health data environment of the European health ecosystem, although more attention needs to be paid to keeping the health data of EU citizens safe and secure within the EHDS. The pooling of health data across countries can have tremendous benefits, but it may also become a target for cybercriminals or state-sponsored hackers. State-of-the-art security measures are essential, and the current EHDS proposal lacks sufficient measures to warrant a cybersecure and resilient environment.
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Digital public health is an emerging field in population-based research and practice. The fast development of digital technologies provides a fundamentally new understanding of improving public health by using digitalization, especially in prevention and health promotion. The first step toward a better understanding of digital public health is to conceptualize the subject of the assessment by defining what digital public health interventions are. This is important, as one cannot evaluate tools if one does not know what precisely an intervention in this field can be. Therefore, this study aims to provide the first definition of digital public health interventions. We will merge leading models for public health functions by the World Health Organization, a framework for digital health technologies by the National Institute for Health and Care Excellence, and a user-centered approach to intervention development. Together, they provide an overview of the functions and areas of use for digital public health interventions. Nevertheless, one must keep in mind that public health functions can differ among different health care systems, limiting our new framework’s universal validity. We conclude that a digital public health intervention should address essential public health functions through digital means. Furthermore, it should include members of the target group in the development process to improve social acceptance and achieve a population health impact.
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Digital divides are globally recognised as a wicked problem that threatens to become the new face of inequality. They are formed by discrepancies in Internet access, digital skills, and tangible outcomes (e.g. health, economic) between populations. Previous studies indicate that Europe has an average Internet access rate of 90%, yet rarely specify for different demographics and do not report on the presence of digital skills. This exploratory analysis used the 2019 community survey on ICT usage in households and by individuals from Eurostat, which is a sample of 147,531 households and 197,631 individuals aged 16-74. The cross-country comparative analysis includes EEA and Switzerland. Data were collected between January and August 2019 and analysed between April and May 2021. Large differences in Internet access were observed (75-98%), especially between North-Western (94-98%) and South-Eastern Europe (75-87%). Young populations, high education levels, employment, and living in an urban environment appear to positively influence the development of higher digital skills. The cross-country analysis exhibits a positive correlation between high capital stock and income/earnings, and the digital skills development while showing that the internet-access price bears marginal influence over digital literacy levels. The findings suggest Europe is currently unable to host a sustainable digital society without exacerbating cross-country inequalities due to substantial differences in internet access and digital literacy. Investment in building digital capacity in the general population should be the primary objective of European countries to ensure they can benefit optimally, equitably, and sustainably from the advancements of the Digital Era.
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While there is tremendous promise to leverage technology for UHC, it will require smart, context-specific policies and programming with ample flexibility to adapt as needs and opportunities change - and with robust safeguards to protect privacy, data security, and equity. The health sector, by its very nature of being data intensive, lends itself to the use of technology for analytics to improve health outcomes, respond to public health crises, and efficiently and equitably allocate resources. The first imperative in considering the use of digital health to expand UHC is to remember that digital health is a means to an end, and only one of the available means. Efforts leveraging digital health to move along that path to universality have taken many forms: to increase the number of people reached, to provide enhanced service coverage, and to reduce the financial burdens on individuals in need of health care. Making use of digital health interventions is an evolving process, not a one-time decision point. It is context specific and needs a clear vision to move from pilot interventions to scaled implementation. Technology can be a key tool in achieving UHC but its use has to be strategic, judicious, and cognizant of issues around privacy and patient rights.
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The COVID-19 pandemic accelerated the uptake of digital health worldwide and highlighted many benefits of these innovations. However, it also stressed the magnitude of inequalities regarding accessing digital health. Using a scoping review, this article explores the potential benefits of digital technologies for the global population, with particular reference to people living with disabilities, using the autism community as a case study. We ultimately explore policies in Sweden, Australia, Canada, Estonia, the United Kingdom, and the United States to learn how policies can lay an inclusive foundation for digital health systems. We conclude that digital health ecosystems should be designed with health equity at the forefront to avoid deepening existing health inequalities. We call for a more sophisticated understanding of digital health literacy to better assess the readiness to adopt digital health innovations. Finally, people living with disabilities should be positioned at the center of digital health policy and innovations to ensure they are not left behind.
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Background Thirty-day readmissions among patients with acute myocardial infarction (AMI) contribute to the US health care burden of preventable complications and costs. Digital health interventions (DHIs) may improve patient health care self-management and outcomes. We aimed to determine if patients with AMI using a DHI have lower 30-day unplanned all-cause readmissions than a historical control. Methods This nonrandomized controlled trial with a historical control, conducted at 4 US hospitals from 2015 to 2019, included 1064 patients with AMI (DHI n=200, control n=864). The DHI integrated a smartphone application, smartwatch, and blood pressure monitor to support guideline-directed care during hospitalization and through 30-days post-discharge via (1) medication reminders, (2) vital sign and activity tracking, (3) education, and (4) outpatient care coordination. The Patient Activation Measure assessed patient knowledge, skills, and confidence for health care self-management. All-cause 30-day readmissions were measured through administrative databases. Propensity score–adjusted Cox proportional hazard models estimated hazard ratios of readmission for the DHI group relative to the control group. Results Following propensity score adjustment, baseline characteristics were well-balanced between the DHI versus control patients (standardized differences <0.07), including a mean age of 59.3 versus 60.1 years, 30% versus 29% Women, 70% versus 70% White, 54% versus 54% with private insurance, 61% versus 60% patients with a non ST-elevation myocardial infarction, and 15% versus 15% with high comorbidity burden. DHI patients were predominantly in the highest levels of patient activation for health care self-management (mean score 71.7±16.6 at 30 days). The DHI group had fewer all-cause 30-day readmissions than the control group (6.5% versus 16.8%, respectively). Adjusting for hospital site and a propensity score inclusive of age, sex, race, AMI type, comorbidities, and 6 additional confounding factors, the DHI group had a 52% lower risk for all-cause 30-day readmissions (hazard ratio, 0.48 [95% CI, 0.26–0.88]). Similar results were obtained in a sensitivity analysis employing propensity matching. Conclusions Our results suggest that in patients with AMI, the DHI may be associated with high patient activation for health care self-management and lower risk of all-cause unplanned 30-day readmissions. REGISTRATION URL: ; Unique identifier: NCT03760796.
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The COVID-19 pandemic has made clear the extreme needs of the public health workforce. As societies discuss how to build up the capacity and infrastructure of their systems, it is crucial that young professionals are involved. Previous attempts to incorporate young professionals into the public health workforce have wrestled with inaccessibility, tokenisation, and a lack of mentorship, leading to a loss of potential workforce members and a non-representative workforce that reinforces systemic societal exclusion of diverse young people. These barriers must be addressed through robust mentorship structures, intentional recruitment and continuous support, as well as genuine recognition of the contributions of young professionals to build the sustainable, interdisciplinary, unified public health that is necessary for the future.
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Over the past few decades, public health systems have been slowly but steadily eroding, culminating in national governments’ inability to swiftly respond to the COVID-19 pandemic. This structural erosion has not only led to a lack of preparedness, but also a decreased the ability of governments to generate sufficient human, physical, financial and knowledge resources. However, key lessons can be learned from governments’ responses to the pandemic and in identifying factors contributing to failure or success. In light of historical trends and national case studies, the Association of Schools of Public Health in the European Region (ASPHER) highlights essentials for the strengthening and “building back better” of our public health systems moving forward as well as calls upon key stakeholders to take action.
Digital transformations are well underway in all areas of life. These have brought about substantial and wide-reaching changes, in many areas, including health. But large gaps remain in our understanding of the interface between digital technologies and health, particularly for young people. The Lancet and Financial Times Commission on governing health futures 2030: growing up in a digital world argues digital transformations should be considered as a key determinant of health. But the Commission also presses for a radical rethink on digital technologies, highlighting that without a precautionary, mission-oriented, and value-based approach to its governance, digital transformations will fail to bring about improvements in health for all.