The concept of determinants of health has evolved significantly over time. The Industrial Revolution marked a shift in thinking about health determinants, moving from a focus on individual factors to a broader recognition of how social, economic, and environmental conditions shape population health. The Digital Revolution and the growing role of artificial intelligence (AI) are broadening our understanding of health determinants further, raising new questions about what influences health and well-being in the modern world.
The health promotion community has always been at the forefront of efforts to address the determinants of health, advocating for multisectoral action and policy responses that tackle structural inequalities and challenge the practices of health-harming industries. In the face of new opportunities and problems presented by digital transformations, the health promotion community has now been called on to lead the charge in addressing the digital determinants of health (Kickbusch and Holly 2023).
DIGITAL DETERMINANTS OF HEALTH: A BRIEF HISTORY
Health promoters have been considering the significance of internet access and digital technologies as determinants of health for over a decade. (Baum et al. 2014, Clyburn 2016) Schamroth and Razzaki noted that ‘if we accept that digital technology is affecting our behaviour and social interactions, decades of public health research tell us it also plays a role in determining our health’. (Schamroth and Razzaki 2019).
The influence of digitalization on the social determinants of health emerged as an area of particular interest for researchers, with some even proposing digital connectivity and digital literacy to be ‘super social determinants’ (Sheon 2018). Several attempts have been made to incorporate the digital domain into well-established models on the social determinants of health. (Rice and Sara 2019, Dyar et al. 2022). Similarly, digital influences on political and commercial determinants of health have come under closer examination (Buchanan et al. 2018, Storeng et al. 2021).
After considering the multiple direct and indirect ways in which digital technologies, data and AI are transforming health and healthcare, a Lancet and Financial Times Commission went further by calling for policymakers, health professionals and the academic community to recognize the emergence of a whole new set of health determinants: the digital determinants of health (DDoH) (Kickbusch et al., 2021).
RAPID ADOPTION OF A NEW CONCEPT
The concept of DDoH has been readily adopted by academics, policymakers, and international organizations, indicating its usefulness in encapsulating the various opportunities and challenges for health presented by digital transformations. In June 2023, Health Promotion International became the first journal to create a special collection on DDoH, bringing together relevant publications from as far back as 2011 (‘Collection: Digital Determinants of Health’ n.d.).
Whilst the new terminology has quickly been taken up by the global health community, DDoH is often interpreted narrowly. For example, in guidance developed for policymakers and health professionals, DDoH is used to refer only to technological factors that shape health systems and health care, especially the divides in digital connectivity and digital literacy that limit the expansion of digital health solutions. (World Health Organization 2021, OECD 2023, World Bank 2023) The health impacts of digital transformations expand far beyond health systems: the digital world is an increasingly important setting in which health is created. A more holistic interpretation of DDoH needs to consider all the characteristics, features, uses, and governance of digital technologies and digital ecosystems that influence health-related behaviours, health outcomes, and healthcare delivery.
Digital determinants can impact health directly and also through their interaction with other social, political, and commercial determinants. A recent study and expert consultation led by the WHO Regional Office for Europe and the London School of Economics identified 127 health determinants that have arisen or been changed in the digital age, including 37 digital determinants. (van Kessel et al. 2025) The findings from this project reinforce the formation of digital determinants as a separate category and highlight the need for further research into the evolving interlinkages between different determinants of health.
THE NEED TO ADDRESS DIGITAL AND OTHER DETERMINANTS TOGETHER
Deepening our understanding of the relationship between digital and other determinants of health is the objective of Health Promotion International’s special issue on DDoH. Contributors were invited to explore how different determinants are influencing people’s ability to benefit from digital transformations in healthcare and health promotion, and how digital determinants—such as internet access, digital literacy, digital platforms, online information environments, digital marketing, and digital policies—are positively or negatively impacting other determinants of health.
The special issue adds to a growing body of evidence on the strong intersection between digital, commercial, and political determinants of health. Corporate entities continue to find new and creative ways to use digital platforms, algorithms, and data to market a range of health-harming products, including to children. (McKerchar et al. 2023, Thomas et al. 2023, Raskin et al. 2024) This issue is published at a point in time when the Big Tech companies are wielding considerable power and political influence on the global stage. By leveraging their vast resources, data, and technological capabilities, such companies have the potential to significantly reshape the healthcare landscape and society as a whole. (Lupton 2015) The political and digital determinants of health must be addressed in tandem so that governance systems are strengthened to prioritize public health over the interests of a few powerful actors.
Intersections between social, political, and digital determinants of health become apparent when considering how to overcome divides in digital health literacy and digital health solutions. (Yelton et al. 2024) Access to digital health services is an increasingly important determinant of health, particularly in times of crisis and in settings where health systems are severely strained. However, even where digital tools for health care and health promotion are available, a range of socio-economic and gender-related barriers can prevent people from benefiting them. (George et al. 2018, Ferretti et al. 2024) To build trust and ensure equity in digital health, governments must demonstrate political will by enacting transparent legislation that tackles misinformation, controls the use of personal health data, and addresses algorithmic bias.
BALANCING THE POSITIVE AND NEGATIVE SIDES OF DIGITAL DETERMINANTS OF HEALTH
The diverse contributions to the special issue reinforce the synchronous health benefits and risks of the digital world. The challenge for health promoters is how to strike the right balance between expanding the positive aspects of digitalization whilst preventing digital harms and widening health inequities. Addressing the negative impacts of digital determinants on health and well-being, particularly for children, is a current priority in many parts of the world. For example, several countries are introducing new policies and regulations to restrict young people’s access to smartphones and social media platforms to reduce their exposure to harmful information and content. (Holly 2024)
Such proposals have been met with criticism because they risk excluding young people and marginalized groups from essential health information and services. Social media platforms can also play a positive role in promoting health among underserved communities, overcoming health disparities, and mitigating the negative impact of some other determinants. (O’Reilly et al. 2019, Bert et al. 2023) Young people actively use digital tools to connect with each other and advocate for their health and well-being. Tremendous movements have developed online, for example in response to the climate crisis, with social media offering inclusive spaces for young people to organize and support each other. (Arnot et al. 2024)
MOVING FORWARD
Addressing the multifaceted relationship between digital determinants and other determinants of health requires bold action across multiple fronts. The health sector must embrace a broad and holistic interpretation of the DDoH and actively shape policies and legislation to create safe and healthy digital environments whilst also expanding access to effective digital health interventions (Castro Lopes et al. 2025).
The health promotion community can play a vital role by continuing to challenge commercial practices online that are detrimental to health and the power imbalances in the digital ecosystem that threaten to undermine health equity and human rights. Drawing on other health promotion strategies, a range of interventions can be developed and tested to empower people to use digital technologies in healthy ways whilst protecting them from digital harms (Holly et al. 2024).
Despite being a new area of interest, a strong body of scholarship is emerging on the DDoH. Continued research is essential to better understand the nuances of different digital determinants and the pathways by which they positively or negatively shape health and well-being. More evidence is also needed to evaluate the impact of digital health solutions and enable positive digital innovations to reach all sectors of society. As with other determinants, it is important that more research and recommendations for action come from low and middle-income countries and reflect the diverse experiences of different communities. (Thomas et al. 2024) Health Promotion International will continue to encourage contributions to DDoH, an important aspect of health promotion that is inevitably set to shape health in significant, and perhaps unpredictable, ways.
Discover more about DTH-Lab:
DTH-Lab is a global consortium of partners working to drive implementation of The Lancet and Financial Times Commission on Governing Health Futures 2030’s recommendations for value-based digital transformations for health co-created with young people.
