Mitigating digital harms for the structurally vulnerable – a service provider perspective

Denmark is one of the most highly digitized countries offering a range of critical services (e.g., health services) that require certain digital skills and online accessibility to access. 

During her AIAS-SHAPE fellowship project, ‘A street-level examination of digital service journeys among socially marginalized people,’ Associate Professor Maj Nygaard-Christensen conducted research based on ethnographic fieldwork among unstably housed people who use drugs and service providers in Denmark. Her findings are now published in the paper: ‘‘That’s when we start being analogue’: Mitigating digital harms through street-level service provision’ in the International Journal of Drug Policy.

Harm production - Four types of digital harms

In the study, Maj Nygaard-Christensen and collaborators examine how the digitalization of public sector services in Denmark can serve as a source of harm production for structurally vulnerable people who use drugs by requiring a particular form of ‘digital citizenship.’ This digitalization necessitates additional forms of care work by service providers as they seek to mitigate these ‘digital harms’ faced by people who use drugs. 

The study identifies four overall forms of ‘digital harms’ that were articulated by service providers: 

• ‘material-infrastructural harms’ which emerge at the intersection between risk environments and digital infrastructures
• ‘digital-organizational harms’ which describe digital impacts on service providers’ everyday work organization
• ‘standardization-related harms’ that highlight the narrowed space for the complexity and lived experience of people who use drugs in digital services
• ‘rights-related harms’ that may potentially lead to exclusion or refusal of services.

Digitalization a new determinant of health inequities

A key finding in the study by Maj Nygaard-Christensen and colleagues shows how digitalization is emerging as a new determinant of health for structurally vulnerable people who use drugs. It also amplifies already existing barriers across interconnected services, including banking, transportation, social services, and health care. 

The shift to digitalized health and social care has profoundly reshaped the everyday work of harm reduction service providers in low-threshold and outreach services. The mitigation of digital harms is emerging as a new administrative burden for outreach service providers as they seek to bridge clients with digitalized services in the welfare system.

Policy attention and a need for interventions 

“The ad hoc nature of digital harm reduction by service providers underscores the need for policy attention to vulnerable populations. There is also a need for developing and integrating structural and inclusive interventions that counter digital harms experienced by structurally vulnerable people who use drugs into municipal and regional planning,” Maj Nygaard-Christensen explains.

Next steps: user perspectives

This recent study focused on service providers’ perspectives. However, the need for additional accounts that draw on the lived experiences of people who use drugs are needed to show how they navigate digitalized public and private services. A forthcoming study that examines these digital experiences among people who use drugs is in preparation by Maj Nygaard-Christensen and colleagues.

Funding

The study received funding by Helsefonden and the AIAS-SHAPE Fellowship funded by AIAS and Aarhus University Research Foundation.

Access the full scientific article here

‘‘That’s when we start being analogue’: Mitigating digital harms through street-level service provision’ in: International Journal of Drug Policy by Maj Nygaard-Christensen, Alexandra B. Collins and Venus A. V. Fabricius:
https://doi.org/10.1016/j.drugpo.2026.105524

Contact

Maj Nygaard-Christensen, 2024-2025 AIAS-SHAPE Fellow & Associate Prof.
E-mail: mnc.crf@psy.au.dk 

Department of Psychology and Behavioural Sciences,
Centre for Alcohol and Drug Research, 
Aarhus University
Denmark