The digital rainbow: Digital determinants of health inequities

Abstract

The widely used socioecological rainbow model from Dahlgren and Whitehead specifies determinants of health inequity on multiple hierarchical levels and suggests that these determinants may interact both within and between levels. At the time of its inception, digital determinants only played a minor role in tackling inequities in public health and were therefore not specifically considered. This has dramatically changed: From today's perspective, health inequities increasingly depend on digital determinants. In this article, we suggest adapting the Dahlgren-Whitehead model to reflect these developments. We propose a model that allows formulating testable hypotheses, interpreting research findings, and developing policy implications against the background of the global spread of digital technologies. This may facilitate the development of a new line of research and logic models for public health interventions in the digital age. Using the COVID-19 pandemic as a case study, we illustrate how the digitization of all aspects of life affects the different levels of determinants of health inequities in the Dahlgren–Whitehead model. In doing so, we deliberately argue for not introducing a separate digital sphere in its own right, but for understanding digitization as a phenomenon that permeates all levels of determinants of health inequities. As a result, we present a digital rainbow model that integrates Dahlgren and Whitehead's 1991 model with digital environments to identify current health promotion and research issues without changing the rainbow model's initial structure.

Effectiveness of gamified digital interventions in mental health prevention and health promotion among adults: A systematic review

“…Thus, high-income earners were 2.34 times more likely than low-income earners to comply with the programme. These effects -as already described by Dahlgren and Whitehead [41] -was taken up in a model on digital determinants of health equities [42]. Beyond that, it might be interesting to examine a person's individual characteristics in the context of gami cation and serious games.…”

Digital determinants of health as a way to address multilevel complex causal model in the promotion of Digital health equity and the prevention of digital health inequities: A scoping review

“…19 When a definition is proposed, there are some differences in the sorted perspective: Lawrence claimed "is a term that describes the unique elements of people's experiences with the digital health ecosystem that impact on their experience of health and healthcare" 12 ; Richardson and colleagues focused on the effects of DDoH, they "are condition in the digital environment that affect a wide range of health, functioning and quality of life outcomes and risks" and described some example (access to technological tools, digital literacy, community broadband availability) 24 ; the same authors and other authors focused also on their impact on digital health equity. [22][23][24] Moreover, some papers described their multiple and hierarchical structure 22 and on the cross over interactions between levels or layers and within them. 20,22,24…”

“…The sorted papers focused on Digital Determinants of Health in the framework of the promotion of Digital Health equity and/or context of the prevention of digital health inequities, according to two general approaches: firstly, some authors proposed to integrate or modify the "Rainbow model" with Digital Determinants of Health 5,20,22 ; secondly, some other authors proposed to define Digital Determinants of Health according to/or within other models, like the Digital Health equity framework 21,23,24 or the Social Determinants of Health model of the WHO. 12 Even when the "Rainbow model" is proposed, the authors used different approaches: Rice and Sara 20 proposed to integrate the model with a new level/layer, the so-called "virtual environment" and they proposed the "Rainbow model 2.0" with the aim to distinguish it from the previous version; Jahnel et al 22 proposed an adaptation of the model where the digital environments influence each layer and the interaction between layers and within each layer.…”

Care Transition Interventions to Improve Stroke Outcomes: Evidence Gaps in Underserved and Minority Populations

“…However, a concern remains as to whether the use of eHealth interventions could exacerbate the digital divide in underserved or disadvantaged groups, resulting in more rather than less health inequities. 114 The lack of access to or familiarity with digital technology could result in minority populations having less access to relevant information, resources, or strategies necessary to facilitate care transitions, recovery and risk factor control. 115,116 More research focused on community reintegration is also needed.…”