What ethical implications does Digital Public Health have, according to Marckmann?

Four: the ambivalence of technology (care can become surveillance), companies as innovation drivers (risk of confusing ends and means), justice (digital offers can widen health inequalities via the digital divide), and privacy and data protection.

Digital Public Health uses digital tools to improve the health of the whole population: disease surveillance, apps promoting exercise and diet, cardiovascular coaching, electronic vaccination records and reminder chatbots, workplace health, big data in disaster management. The first question for any such intervention is its goal: it should serve public health, not profit.

1. Ambivalence of technological innovation. Intended benefits come with unwanted side effects even when used correctly: care vs. surveillance, efficiency vs. empathy. Automated processing of mass data can prevent heart disease and also allow control of the population's health behaviour. But giving up an ambivalent technology entirely is not automatically the best solution.
2. Companies as innovation drivers. Global tech firms (GAFAM: Google, Amazon, Facebook, Apple, Microsoft) sell directly to consumers rather than through health professionals: easy access to health information, but uncontrollable quality and possible misinterpretation, and a strong interest in using the collected data for their own goals. The risk is an ends-means inversion (Zweck-Mittel-Vertauschung): the firm's real interest is selling the tool, not improving health. Public funding should therefore be tied to clearly defined public-health goals.
3. Justice. Interventions should reduce health inequalities, but they require ICT infrastructure and skills, and those who need them most may use them least (digital divide).
4. Privacy and data protection. Better surveillance through automated data collection vs. risks to privacy, and the question of whether individuals can still decide sovereignly about their data.

Go deeper:

• Marckmann (2020): Ethische Fragen von Digital Public Health — the open-access article (German).
• Wikipedia: Digital divide — why digital offers can widen inequality.