Lancet Series Paper Proposes a Framework for the Digital Determinants of Health

Digital transformations increasingly influence the lives of people worldwide, affecting health and wellbeing in both beneficial and harmful ways among people with varying levels of digital access and engagement, according to a Series paper published in The Lancet. James Shaw and colleagues wrote that the scale of this influence on human and planetary health makes attention to the digital determinants of health (DDoH) urgent. It is the first of three Series papers.

The authors define the DDoH as structural conditions that shape health and wellbeing through digitally mediated infrastructures, business models, design choices, and information environments. They describe a prevailing "digital sociotechnological order" as the structural source of the DDoH, comprising dominant assumptions that motivate digital practices operating through four features: political norms, economic logics, infrastructures, and personal and social practices.

They identify seven such practices, including technological solutionism, datafication, and algorithmic decision making. They also note unequal exposure: a 2025 survey of more than 10,000 US adults reported an average of more than 6 hours per day using smartphone applications, whereas the International Telecommunication Union found that 2.2 billion people had no internet access in 2025. Using social media as an example, the authors wrote that platforms have amplified views associated with vaccine skepticism and contributed to misinformation, and that online self-presentation has led to adverse mental health effects, especially among young people.

While acknowledging contributions such as telemedicine and COVID-19 dashboards, the authors stated that current approaches to governing this order are "deeply insufficient" to protect public health. Their eight recommendations for future research include avoiding industry conflicts of interest, auditing technology companies' harmful practices, and developing public health interventions that do not place responsibility on individuals.

The authors note that the assumptions underlying the current order are not inevitable and that different assumptions could inform different approaches to digital innovation.

Source: Shaw J, Gross N, Saldaña-Tejeda A, et al. The digital determinants of health: a new era for global public health. Lancet. Published online October 4, 2026. doi:10.1016/S0140-6736(26)01292-4