Research work · 2026
Digital Health as Public Health Infrastructure: Reimagining Public Health Surveillance (Preprint)
John O'Donoghue, Kayode Philip Fadahunsi
JMIR Publications Inc.
Abstract
UNSTRUCTURED Public health surveillance systems were largely developed for an era in which healthcare delivery occurred predominantly within hospitals, clinics, and other institutional settings. However, population aging, rising chronic disease prevalence, workforce constraints, and policy reforms are accelerating a shift toward home- and community-based care. Despite this transition, public health information infrastructures remain largely institution-centric. Data generated through home-care services, remote monitoring systems, social care organisations, community services, and informal caregiving networks often remain fragmented or poorly integrated into public health decision-making. This creates blind spots in population health intelligence and limits the ability of public health agencies to monitor outcomes, identify inequities, evaluate interventions, and support evidence-informed policymaking. We argue that digital health should be conceptualised not merely as a collection of technologies but as a form of public health infrastructure. Reframing digital health in this way shifts attention from technology adoption to the development of equitable, trustworthy, and interoperable data ecosystems capable of supporting surveillance. As care increasingly occurs in homes and communities, building data ecosystems that make home-based care visible is both a digital health priority and a public health imperative.