Digital transformation of public health systems: strengthening to take rights seriously

Abstract   The expansion of digital public health, with the use of data in digital systems for planning and operation of public health policy, presents itself as strategic for the public and digital future of Public Health Systems, such as Brazilian Sistema Único de Saúde/SUS, as well as for the effectiveness of the right to healthcare and expansion of the access to public health services (with the experience of COVID-19 highlighting the importance of digital health, as well as fostering its accelerated expansion). Such digital expansion will increasingly stress the fundamental right to the protection of personal data, and it is therefore important to strengthen the regulatory and care response of SUS in the field of digital public health, both for the preservation of its regulatory capacity in digital public health (facing market private interests of Big Tech for example), but also to guarantee the protection of fundamental rights, such as the protection of personal data. The theory of fundamental rights and the dogmatics on personal data protection offer support to solve the tensions to the right to data protection arising from the expansion of digital health, with consideration between the rights of patients-data subjects and the needs of managing and planning public health policy Key messages • The intense use of data and digital systems in public health policy is strategic to strengthen public health systems. • The enhancement of Public Health Systems’ regulatory capacity in digital transformation is important to protect right to health and data protection.

Medical rehabilitation is a valuable component to restore physical and mental health, to prevent social isolation and to ensure a return to work. Due to the demographic change and the still increasing number of Post-Covid-19 patients, the demand for rehabilitation is still increasing. Latest, the COVID-19 pandemic elucidated that especially people from lower socio-economic backgrounds are disproportionally affected by health crisis. The aim of this study was to determine the influence of socio-demographic and socioeconomic factors on quantitative exercise therapy in medical rehabilitation and to clarify the divergence of existing research findings. In our study we used data from 824.606 rehabilitation cases (German Federal Pension Insurance) and investigated the role of age and gender, marital status, social status and location towards inequalities in access to medical rehabilitation. Multiple linear regression and effect size calculation were used to show associations and to discuss the relation to clinical relevance. We were able to show a highly significant difference (P < 0.001) in access to exercise therapy in our study group. Patients aged 65+, women, single or widowed people, rehabilitants of low socioeconomic status or people located in the new federal states in Germany received shorter and less frequent exercise therapy. There are differences of up to 3.5 hours of treatment duration and 4.25 treatments per week, when disadvantaged social factors accumulate. However, despite the presented differences, the received treatments for the disadvantaged groups are still in the range of suggested minimum therapeutic requirements by the German Federal Pension Insurance. We could show a significant difference in rehabilitative therapy, which is solely based on social factors. There is an urgent need to draw special attention to the here discussed inequalities in access to medical rehabilitation for socially disadvantaged population and the overarching impact on society. Key messages: The social inequality in medical rehabilitation to the detriment of the socially disadvantaged population that we have identified must give rise to clear changes in order to establish social justice. Equal opportunities and health quality assurance that address the individual needs of each patient should be the focus of socio-medical, policy development.

Background:
A Primary Care Model Programme had been implemented in Hungary between 2013-2017 in which group practices were established that employed -among others -nonprofessional health workers (health mediators, similar to community health workers) to facilitate access for the most disadvantaged population groups. The health of mediators, themselves mostly disadvantaged ethnic Roma, was monitored every odd year of the Programme.

Methods:
A repeated cross-sectional health interview survey had been implemented inviting all health mediators who were employed at the time of the survey. The same questionnaire was used in all 3 surveys with items from the European Health Interview Survey 2009 and validated versions of other scales.

Results:
Positive changes occurred in the health status of mediators during 5 years of follow-up. Significant improvement in mental health occurred among those who completed on-thejob vocational training. By 2017, significant increase in sense of coherence was observed among those who obtained vocational qualification as opposed to those who did not. The proportion of highly stressed mediators showed a significant increase among those with no vocational training. Improvement was detected in all mediators in health awareness, dysfunctional attitudes, psychological stress and smoking prevalence.

Conclusions:
Significant improvement in mental status among those who obtained on-the-job vocational qualification were observed during follow-up of ethnic Roma health mediators in the programme in which they were equal members of the primary health care team. Employment of health mediators in primary care teams not only contributed to improving access to care for