The Lancet Series on the digital determinants of health: (What only three papers?)

Published: October 4, 2026

Executive summary

Digital technologies have become embedded within the systems and environments that shape health and wellbeing. They influence how people access information, communicate, learn, work, access health care, participate in society, and make decisions about their lives. Understanding and governing these determinants has therefore become a critical public health priority. This three-paper Series proposes a new approach for conceptualising and responding to the digital determinants of health, and sets a bold agenda for future research, practice, and governance.

https://www.thelancet.com/series-do/digital-determinants-of-health

My source: 'Unnecessary Services in Clinical Medicine & Public Health' group. 

Whether it is a journal, a clinic, community disciplinary team, a government committee, or an APPG - all-party parliamentary group, a university course (outside 'general studies') ... we are dealing with knowledge silos. Even more so, in the case of a journal series, special issue, or most conferences. 

There is always a case for expertise, in-depth perspectives and evidence-based understanding. Finding cures for cancer, diseases, the future of AI as relates to humanity's continuity are prime examples. When we speak of integrated care, if that care begins with education and self-care, then we need to consider all the determinants. Not only that, we need to conduct this investigative task concurrently with all the literacies. Otherwise, theory, practice, management, policy and ongoing research may struggle to cohere. Integration is essential, to facilitate sustainability, measurement and subsequent reporting. Hodges' model can assist.

Julian Tudor-Hart 'The Inverse Care Law' - c/o The Lancet

On the bottom of my notes re. Giarchi and 'distance decay' I'd written:

'Inverse Care law - p.60. - Giarchi. "those who suffer more ill health are less likely to be assisted."

It made me wonder about the origin of this law having posted about it in 2020.

The Lancet has an editorial and an associated podcast:

50 years of the inverse care law. The Lancet, Volume 397, Issue 10276, 767. February 27, 2021.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00505-5/fulltext

'“The availability of good medical care tends to vary with the need for it in the population served. This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.”

These understated opening lines of Julian Tudor Hart's paper, The Inverse Care Law, are as relevant now (50 years to the day since publication) as in 1971. The paper is one of the landmark publications in The Lancet's near 200-year history, and the resonance of Tudor Hart's definition of the inverse care law has global and timeless importance. Simply expressed, Tudor Hart observed that disadvantaged populations need more health care than advantaged populations, but receive less.

Tudor Hart's life and career took him from highly privileged beginnings in London and Cambridge to decades spent in the deprived and deeply socialist Welsh valleys. His experience and work has inspired a generation of influential health-care leaders including Andrew Haines, Allyson Pollock, Cesar Victora, and Graham Watt. Today's anniversary issue of The Lancet explores both the global reach of the inverse care law and primary care initiatives in deprived areas around the UK.

Although inequality in health and its many causes are widely understood, inequity in health-care service provision is enduring and fundamental: an intractable concept that lies at the heart of the inverse care law. The inverse care law is primarily about inequity (injustice) in health care that results in unfair social inequalities (imbalances) in health. Since the inverse care law was published, the UK's National Health Service (NHS) has strived to reduce inequity with mixed success. Notably, long-lasting progress was achieved through the 1970s resource allocation formula, which reduced geographical inequality in hospital and institutional expenditure. In the early 2000s, the NHS strengthened primary care provision in disadvantaged areas, leading to a temporary reduction in social inequality, although this progress has reversed following shifts in funding, a slowing of spending, and years of living with austerity.'

See also: 

https://en.wikipedia.org/wiki/Julian_Tudor-Hart

https://www.chpi.org.uk/blog/julian-tudor-hart-and-the-essence-of-primary-care/

Nursing models of care: "There is another"!

It seems Star Wars forums continue to debate the meaning of Yoda's response to Obi-Wan that "There is another". 

The lack of practice-based debate in nursing and health education about 'nursing theory' and 'models of care, confirms that these academia sagas did indeed take place in a galaxy far, far away.

There is, as ever, positive and negative news too. The bibliography in the sidebar keeps growing. I'm hoping for news of additions dropping into the inbox before the end of the year. Not just prospective papers I know about (yes, there is another prospect!), but other work. In a way the latter is even more special. As these sporadics reveal that there are research heroes out there, on their own path and journey of discovery. Finding Hodges' model, they have applied it to their respective field.

Yesterday, searching for 'Activities of Daily Living' (first published in 1980) while writing the DASH post, on BMJ Careers I came across:

'What models do nurses use to guide their care?'

Is that 'models' plural?

Perhaps the response to the question says something about:

• nurse academia;
• how our medical colleagues view nursing;
• and more importantly - their understanding of nursing, the nursing profession, ongoing aspirations and relevance to self , health and social care in the 21st century?

In January, frustrated at the effort that is getting published (a shared experience then) and lack of attention to theory I posted:

Are you planning a health* study in 2025?

The literature trail for Hodges' model is not voluminous, but it is there:

• as a model of care, conceptual framework;
• person-centredness;
• integrated and holistic care;
• holistic bandwidth
• SDGs
• life chances, health career, prevention, life-style and literacies
• socio-technical approach
• global health;
• reflection and reflective practice;
• critical thinking
• mind-mapping;
• concepts, conceptual spaces, threshold concepts

- with much more to do, even in the above.

Please, call this a gentle nudge. Thank you.

Image: http://www.quickmeme.com/

FINAL CALL: Have your say about evidence-based implementation! c/o HIFA

PARTICIPATE TO WIN PRIZES

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LAST CHANCE TO INPUT - CLOSING ON 27TH JUNE!

Do you work on improving health and equity in low-and middle-income countries (LMICs)?

Have YOUR chance to: -Democratise research and evidence for implementation! -Ensure your setting is represented! -Win a £50 voucher in the prize draw!

Palestine, Uganda, and Peru shared the most replies so far!

BETTER HEALTH WORLDWIDE!

Complete this 10 minute survey about evidence-based implementation

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English Do you work on improving health outcomes around the world?

Have your say! Why? To accelerate evidence-based implementation, with equity, for better health worldwide.

Who? People involved in any aspect of health service implementation and strengthening at any level of the system (e.g. health care provider, data analyst, policy maker).

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Evidence-based Implementation: Many life-saving interventions are not implemented effectively, with wide gaps between what is known and what is done, especially in low- and middle-income countries.

We are keen to hear perspectives and realities from implementers in all low- and middle-income contexts. 

We are seeking your insights to help close the gap from evidence to implementation!

We hope you will take a few minutes to complete this brief survey.<https://newborntoolkit.us5.list-manage.com/track/click?u=7a4ba8643fabeb1b06801b973&id=422f1a8283&e=f1722a9293>

Answers can be anonymous and there is no requirement to provide identifying information.

This survey is being conducted as part of the Lancet Commission on Evidence-Based Implementation in Global Health<https://newborntoolkit.us5.list-manage.com/track/click?u=7a4ba8643fabeb1b06801b973&id=ef480cd254&e=f1722a9293>. This study was funded by the Children’s Investment Fund Foundation.

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[content removed as not supported by HIFA - and my source.]

From Harriet Ruysen - Harriet.Ruysen AT lshtm.ac.uk

"No safety without emotional safety" by Veale, et al. (2022)

 INDIVIDUAL
|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

psychological needs (risk) inc. threat processing - treatment of interpersonal violence 'therapeutic emotional safety (re-traumatisation) control behaviour severe panic with flashbacks, dissociation, and visual hallucinations	physical needs (RISK) 'low intensity touch' environment' ... tepee - in room my safe space physical safety (safe room) to increase physical safety privacy, lighting, doors, window
lived experience family - relationship experience (touch) 'atmosphere'? change in culture, positive risk-taking person-centredness, family orientation in 'team' Leadership 'therapeutic community' Open Dialogue	CONTROL: 'take away' - autonomy, responsibility policies - abuse risk, 'protect' patients and staff regulatory reform in-patient care, pets - policy parity of esteem Access (still) to therapies, CBT Institutional risk Alternative protocols

David Veale, Eleanor Robins, Alex B Thomson, Paul Gilbert, No safety without emotional safety, The Lancet Psychiatry, 2022, ISSN 2215-0366, https://doi.org/10.1016/S2215-0366(22)00373-X. (https://www.sciencedirect.com/science/article/pii/S221503662200373X)

My source:
https://twitter.com/tadhg50/status/1596901626765529091?s=20&t=FJe9qpYUrxHN2yxWEWLUdQ

The purposes of Hodges' model is to identify the concepts that have salience clinically, to the person, be they - patient, carer, student ... and then to integrate care, to draw the care domains together into a 'whole'.

Four original purposes of Hodges' model: 

1. Reflection, reflective practice, critical thinking
2. Person-centred care
3. Holistic - integrated care
4. Bridge the Theory - Practice gap

May 10th Lecture: "Planetary Law for the Anthropocene"

Dear followers of H-net Environment,

Planetar denken

the Panel on Planetary Thinking of the Justus Liebig University Giessen, Germany, cordially invites you to join our kick-off event of our Planetary Lecture Series which may be of interest to many of you:

On May 10th, at 6:15 CET, Prof. Dr. Dr. Louis Kotzé (North-West University, South-Africa), will be giving a lecture on "Planetary Law for the Anthropocene" . Prof. Kotzé currently holds a fellowship at the Institute for Advanced Sustainability Studies in Potsdam, Germany, and is a Senior Professorial Fellow in Earth System Law at the University of Lincoln, UK. Prof. Dr. Thilo Marauhn (Chair of Public and International Law, JLU) will open the discussion with a response. The lecture will take place in a hybrid format, allowing you both digital and analog participation.

Feel free to spread the word to interested colleagues and friends. You can register at panel AT planet.uni-giessen.de or join us spontaneously in our BigBlueButton Conference Room.

Warm regards,

Liza Bauer

(on behalf of the Panel on Planetary Thinking).

[c/o HIFA] Lancet Planetary Health: An argument for the naturalistic study of collective intelligence

Citation, extracts and a comment from me below. Full text here: https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00077-2/

CITATION: An argument for the naturalistic study of collective intelligence Jonathan Nattel, David Akullian
Comment| volume 5, issue 5, e247-e248, may 01, 2021
Published:May, 2021 DOI:https://doi.org/10.1016/S2542-5196(21)00077-2 

SELECTED EXTRACTS 

Over the past decade, corporate-owned digital media—minimally regulated, geared towards profit, and willing to engage a broad range of psychological techniques to command an expansive swath of human attention5—have increasingly caused information to flow around, rather than through, the structures of professional journalism as it makes its way from politicians to the public at large.

The circumvention of professional journalism as a means for filtering, organising, and distributing information has led to multiple distortions of collective perception, including the decontextualisation of information, propagation of false information, and the manipulation of public opinion by agents with a broad variety of interests. 

 the overall result has been an increase in polarisation, fragmented collective perceptions of reality, and the ensuing failures of collective discourse and decision making. All in all, ideal conditions for the emergence of populist, fascist, or dictatorial leadership. 

A study of how information is channelled within a society to support collective wellbeing and decision making might allow us to ask crucial questions, such as when a new technology for communication arrives, in what way is it healthy? In what way is it unhealthy? And in what ways must it be contained?... Given the critical juncture at which humanity currently finds itself, the timing of such a project could hardly be more crucial.

 --

Comment (NPW): 'The circumvention of professional journalism... has led to multiple distortions'. The same could be said for the circumvention of processes required for reliable and actionalble healthcare information to be made available to end users (whether the public, health workers, or policymakers). 

Neil Pakenham-Walsh, 

HIFA Coordinator, neil AT hifa.org www.hifa.org

HIFA: Healthcare Information For All: www.hifa.org 

I  have related concepts from this short work to Hodges' model, followed by a reference that reflects the naturalistic scale of the study suggested here:

individual
|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

[ Multi- ] Context - Situated [ model ] HEALTH WORKERS individual perception & intelligence - literacy Individual values Individual sense making	WELL-BEING of NATURAL WORLD HEALTH WORKERS Physical PROCESSES: Time [Is there an 'Over-arching theory of health communication'?] Channels of information - tech / forms
WELL-BEING of SOCIETY Intergenerational coherence (*amid change*) PUBLIC Social processes: Diffusion, Sharing SOCIO-tech? societies: channels of information? collective perception & intelligence (wisdom of crowds?)	Channels of information - control Journalism Populist, fascist, or dictatorial leadership POLICYMAKERS Digital & other divides? Political processes Electoral Politics

 

 

Jones, P. (1996) An overarching theory of health communication? Health Informatics Journal,2,1,28-34.

Four windows on reducing the global burden of Malaria

SELF - individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - POPULATION

education awareness	Insect screen: photo https://centor.com
New research on the effect of window screening in #Tanzania is “strong enough to reduce the global burden of #malaria”, expert says. https://t.co/5xu5dkLJLM pic.twitter.com/iYos8ezwBx — SciDev.Net (@SciDevNet) April 5, 2019	policy SDH funding - further studies reduction in the global burden of malaria

Modelling Scale: Self, Families, Communities, Organisations - a Planet's Health...

Dear HIFA colleagues,

I would like to wish you all a happy new year and to share with you a powerful quote on the front cover of the current print issue of The Lancet:

"Achieving planetary health will require a renaissance in how we define our place in the world. A new narrative will reject the one streaming into our homes — that happiness comes from relentlessly acquiring more things — and embrace what we know: that what truly makes us happy is time spent with those we love, connection to place and community, feeling connected to something greater than ourselves, taking care of each other."

The quote is from a lecture by Samuel Myers, Planetary Health Alliance at Harvard University, USA. The citation is below and the full text is freely available here:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32846-5/fulltext

CITATION: Planetary health: protecting human health on a rapidly changing planet

Dr Samuel S Myers

Volume 390, No. 10114, p2860–2868, 23 December 2017

DOI: http://dx.doi.org/10.1016/S0140-6736(17)32846-5

Best wishes, Neil

Let's build a future where people are no longer dying for lack of healthcare information - Join HIFA: www.hifa.org

<->

My additions:

I am always fascinated by the need for such expansive perspectives, the need to simultaneously factor in scale; how for example, do we warn future generations of environmental hazards?

Such questions are also crucial to "how we define our place in the world"?

individual

|

INTERPERSONAL : SCIENCES

humanistic --------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

	The Far Future - BBC Radio 4 The Long Now
	Political planning NHS workforce planning NHS preparedness for (a?) the (this?) Winter

Source: HIFA Dr Neil Pakenham-Walsh with thanks.

THE LANCET From public to planetary health: a manifesto

A new vision for planetary health

This manifesto for transforming public health calls for a social movement to support collective public health action at all levels of society. Our aim is to respond to the threats we face: threats to human health and wellbeing, threats to the sustainability of our civilisation, and threats to the natural and human-made systems that support us.

Our vision is for a planet that nourishes and sustains the diversity of life with which we co-exist and on which we depend. Our goal is to create a movement for planetary health.

If you agree with the broad thrust of the manifesto (not necessarily every detail), please register your agreement here ...

c/o HIFA2015 Press Release: BMJ Editorial calls on funding agencies to commit to Healthcare Information For All

Dear HIFA2015 colleagues,

Please find the Press Release below. The subject of the press release is an Editorial in the BMJ, calling for major funding agencies to commit to Healthcare Information For All by 2015.

The Editorial is freely available at: http://bit.ly/hifa2015-10

Please be sure to read the Editorial online and submit *your* comment to the BMJ (click on Rapid Response on the left side of the page). Your Rapid Response will be displayed on the BMJ website (after approval by the editors) and may be selected for publication in the print version of the BMJ. Thank you for your support.

We are informed that the Editorial itself will be in the print BMJ within the next few weeks.

Please distribute this message/press release widely to your contacts and networks!

Many thanks,
Neil Pakenham-Walsh
Coordinator, HIFA2015

PRESS RELEASE: FOR IMMEDIATE RELEASE

BMJ Editorial calls on major funding agencies to commit to 'Healthcare Information For All by 2015'

London, UK, 5 July 2011 - Every day, tens of thousands of people die needlessly, particularly in low and middle income countries, often for the simple reason that the parent, carer or health worker lacks the information and knowledge they need to save them. An Editorial in the British Medical Journal by Richard Smith [1] and Tracey Pérez Koehlmoos [2,3] asks why a major funding agency has not yet come forward to support Healthcare Information For All by 2015 (HIFA2015) [4].

HIFA2015 ( www.hifa2015.org) is a global campaign and discussion forum. Its members range from senior executives at the World Health Organization in Geneva to community health workers in rural Uganda. Together they are working for the HIFA2015 goal: 'By 2015 every person worldwide will have access to an informed healthcare provider - lack of relevant, reliable healthcare information will no longer be a major contributor to avoidable death and suffering.' [5]. But progress has been constrained by lack of funding.

The Editorial states: "Funders are much keener to put money into drugs, vaccines, and bed nets than they are into something as nebulous as information access. Yet information and the capacity to act on that information is the first building block of an effective health system".

The Editorial concludes, "the best way forward would be for a major funder to recognise that improved health information is fundamental to global health improvement and development and offer substantial support, not just funds, to HIFA2015.".

HIFA2015 Coordinator, Dr Neil Pakenham-Walsh, welcomes the editorial saying "When we launched HIFA2015 in 2006, we knew our goal was ambitious, but we also knew it could be achieved if all stakeholders work together. All stakeholder groups are now working together and our work is expanding rapidly - what is needed now is financial support from a major funding agency. We repeat the call to the Gates Foundation and others made by international health leaders in The Lancet in 2006: "The challenge is to ensure that everyone in the world can have access to clean, clear, knowledge - a basic human right, and a public health need as important as access to clean, clear, water, and much more easily achievable."[6].

In keeping with the sentiments of the editorial, the BMJ has made this editorial freely available online. To access the full text simply visit
http://www.bmj.com/content/342/bmj.d4151.full?sid=55d7a166-946d-416c-bc47-8c294d5fb57d 

For further information or interview, please contact:

Neil Pakenham-Walsh, Coordinator HIFA2015, Co-director, Global Healthcare Information Network
neil.pakenham-walsh AT ghi-net.org

The authors of the Editorial have also kindly made themselves available for interview:

Richard Smith, Director, UnitedHealth Chronic Disease Initiative, UK
richardswsmith AT yahoo.co.uk

Tracey Koehlmoos, International Centre for Diarrhoeal Disease Research, Bangladesh
Tracey AT icddrb.org

Notes for Editors:

1. Richard Smith is the former editor of the British Medical Journal and is now director of the UnitedHealth Chronic Disease Initiative.
2. Tracey Koehlmoos is Head of the Health & Family Planning Systems Programme, ICDDR,B, Bangladesh & Adjunct Professor, Department of Health Administration and Policy, College of Health and Human Services, George Mason University, USA.
3. Further to discussion on the HIFA2015 forum, Richard Smith and Tracey Koehlmoos published an editorial in The Lancet (22 January 2011) which led to a reversal of Elsevier's decision to withdraw free access to medical journals in Bangladesh.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60067-6/fulltext
4. Healthcare Information for All by 2015 is the flagship project of Global Healthcare Information Network - a non-profit organisation based in the UK. HIFA2015 is a global campaign and discussion forum that brings together more than 5000 health professionals, information technologists, publishers, librarians, researchers and policymakers from over 2000 organisations in 158 countries worldwide. HIFA2015 is supported by organisations such as the British Medical Association, Royal College of Midwives and Royal College of Nursing.
5. To achieve its goal, HIFA2015 has developed a three pronged strategy based on communication (bringing together a critical mass of interested parties in five global e-mail forums), understanding (of information needs and how to meet them set out in a database of evidence), and advocacy (persuading governments, funding agencies, and others to invest in cost effective health information services). For further details, see http://www.hifa2015.org
6. Tikki Pang (WHO), Muir Gray (NHS, UK), and Tim Evans (WHO): A 15^th grand challenge for global public health. The Lancet 2006; 367:284-286.
http://www.thelancet.com/journals/lancet/article/PIIS0140673606680501/fulltext