Developing and Validating a Global Digital Health Resilience Index to Predict Cross-National Health Outcomes During Public Health Shocks

Developing and Validating a Global Digital Health Resilience Index to Predict Cross-National Health Outcomes During Public Health Shocks

Isma Khalid1, Maheen Qutab2*, Fatima Sikander3, Nizia Shahid4

1Sughra Shafi Medical Complex, Narowal, Pakistan

2Queens Medical College, Kasur, Pakistan

3Akhtar Saeed Medical and Dental College, Lahore, Pakistan

4Blacktown and Mount Druitt Hospitals, Western Sydney Local Health District Network, Australia

*Corresponding address: Queens Medical College, Kasur, Pakistan

Email: qutab.maheen@gmail.com

 Received: 09 March 2026 / Revised: 12 May 2026 / Accepted: 24 May 2026 / Available Online: 26 June 2026

DOI: https://doi.org/10.63137/jsteam.241906

ABSTRACT

Objectives: To develop and validate a composite Global Digital Health Resilience Index (GDHRI) constructed from pre-shock baseline indicators and to assess its predictive capacity for cross-national variation in health outcomes during a public health shock.

Methods: A cross-national ecological study using publicly available, aggregate country-level datasets. The GDHRI was constructed exclusively from pre-shock baseline indicators (2015–2019), capturing digital engagement capacity, information ecosystem integrity, and structural health system readiness. No shock-period variables were used in index development. Principal component analysis and confirmatory factor analysis were applied to establish construct validity. Predictive validity was evaluated against shock-period outcomes (2020–2022), including excess mortality, vaccination coverage, health service disruption, and case-fatality ratio, using multivariable cross-sectional regression, fixed-effects panel models, and machine learning robustness checks.

Results: A total of 162 countries were included. Factor analysis supported a three-domain structure, explaining 72.6% of the variance, with acceptable model fit indices. Higher baseline GDHRI scores were significantly associated with lower excess mortality, lower case-fatality ratios, reduced service disruption, and higher vaccination coverage during 2020–2022, independent of macroeconomic and demographic covariates. Associations remained stable across panel specifications, alternative weighting schemes, and sensitivity analyses.

Conclusion: The GDHRI operationalizes pre-existing digital and structural capacity as measurable components of systemic resilience. Baseline digital ecosystem strength was independently associated with cross-national variation in health outcomes during a public health shock. Integrating digital ecosystem metrics into resilience assessment frameworks may enhance the measurement of global preparedness.

Keywords: Delivery of health care; Health status indicators; Internet; Public health surveillance; Vaccination

Data Availability: The data supporting this study are available from the corresponding author upon reasonable request.

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How to Cite: Khalid I, Qutab M, Sikander F, Shahid N. Developing and Validating a Global Digital Health Resilience Index to Predict Cross-National Health Outcomes During Public Health Shocks. J Sci Technol Educ Art Med. 2026;3(1):3-14