A Consideration of Social Determinants of Health and Health Justice in the Design of Technological Public Health Tools: A Case Study of China’s Health Code in the SARS-CoV-2 Pandemic

Abstract

Abstract: In the wake of the SARS-CoV-2 (COVID-19) outbreak, advanced technologies were employed to curb the spread of the disease. Among those is China’s Health Code Apps, an AI-driven surveillance program that assesses individuals’ risk for COVID used in a concerted effort alongside China’s zero-COVID policy. However, there are no formal established guidelines on the design of these AI public health tools. Current definitions of public health are based on utilitarian frameworks which cause tension between individuals v. population and cure v. prevention. This paper maintains that China’s Health Code fails to use a robust framework that ensures health equity and fails to promote health justice as it prioritizes the needs of healthy groups over marginalized groups. Anecdotal evidence from the elderly, disabled, low-income, and rural-living populations suggests that the design of China’s Health Code disregards social determinants of health. These groups endure barriers to using the health tool which consequently, risks not only producing worse public health outcomes but as well as exacerbating health inequity in these vulnerable communities. The paper contends that contemporary governments must reexamine public health measures that are shaped by outdated understandings of public health and recognize the differences and challenges in each subset of its public. In response, the paper offers a definition of public health by applying the WHO’s requisites for health in the Ottawa Charter for Health Promotion. The charter lays the foundation for a more holistic approach to public health promotion by outlining social principles around peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity. The inclusion of these social factors in the design of public health tools will prompt the much-needed balance of utilitarian health approaches with deontological practices that tend to be more patient-centered.