Birgit Babitsch

Background/Objectives: Social determinants of health (SDOHs) are linked to inequities in digital health application (DHA) use and digital health literacy (DHL), a predictor of DHA use, but few studies have examined these inequities intersectionally. This study examined intersectional differences by gender, educational attainment, and generation. Methods: Data were obtained from an online cross-sectional survey (STELLAR; N = 1200) in Germany. Intersectionality was assessed using Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), with the intersections of gender, educational attainment, and generation defining strata for both outcomes. Results: Educational attainment was the strongest predictor of DHL and was associated with DHA use; gender was not significant for either. Generation was associated with DHA use, with higher odds for Generation Y and Z than for Traditionalists, but was not associated with DHL. Predicted DHL was highest among women with higher education from the Traditionalist or Generation Y group and lowest among men with basic education from Generation Z. Predicted DHA use was highest among women with higher education from Generation Z and lowest among men with basic education from the Baby Boomer generation. Additive main effects explained a greater share of the between-stratum variance for DHA use than for DHL, while the proportion of total variance attributable to strata remained limited for both outcomes. Conclusions: MAIHDA can identify population groups at greater risk of second-level digital divide-related inequities in DHL and DHA use, informing population-level measures to strengthen DHL and improve DHA use. Further research should clarify the underlying mechanisms.

The link between health, socio-economic status and the living environment is increasingly moving into the focus of public health research and policy. The aim of the European Union’s Project “Joint Action Health Equity Europe (JAHEE)” is to enable countries to identify and implement needs-based measures to promote health equity. In one of JAHEE’s work packages, focusing on healthy living environments as a strategy to tackle health inequities, a Policy Framework for Action (PFA) has been developed. This article gives an insight into the core contents of the PFA, which are valid beyond the project boundaries for all actors that work at the intersection of community health promotion. The PFA was developed as a consensus document in a participatory process between the members of the work package and an interdisciplinary German team of public health experts. Results from project meetings of the partner countries as well as research findings and recommendations from field experts were incorporated. Reducing health inequalities in public health is a cross-sectional issue that needs to be addressed across all policy areas. The municipality setting is of particular importance in this context, as it offers many starting points and can coordinate between all relevant actors with an overarching strategy.

Zusammenfassung: Im Rahmen des Modellvorhabens „Gesundheitsuntersuchungen in Grundschulen“ ǀ GrundGesund wurde ein neuer Ansatz erprobt, der Elemente der Gesundheitsförderung und Prävention verzahnt. Auf Basis einer schulärztlichen Untersuchung und Elternbefragung wurden Impulse zur Förderung der Gesundheit der Grundschüler*innen sowohl individuell als auch kollektiv abgeleitet und gemeinsam mit den Schulen Aktivitäten der Gesundheitsförderung entwickelt und durchgeführt. Die Konzeption von GrundGesund erwies sich in allen Teilkomponenten als umsetzbar.