From access to capability: digital literacy and health inequality in contemporary China

As digital environments become part of everyday life, digital inequality may be increasingly associated with health differences. Using data from the Chinese Social Survey 2023 (CSS2023), this study examines whether digital literacy is associated with self-rated physical health and self-rated psychological health, whether these associations persist beyond traditional socioeconomic status, and how digital literacy among internet users relates to health alongside the broader access divide in the full sample. Ordinary least squares (OLS) models indicate that digital literacy is positively associated with both outcomes after adjustment for age, gender, marriage, hukou (household registration), education, income, and subjective social status. The association is more pronounced for self-rated psychological health than for self-rated physical health. Supplementary models show that internet access is also associated with health in the full sample, while digital literacy captures capability differences among respondents already online. Because these analyses are based on different samples and differently measured variables, the access-literacy comparison is interpreted descriptively rather than as a formal test of relative importance. Heterogeneity analyses suggest that the association with self-rated psychological health is stronger among older respondents and those with lower educational attainment. These findings are consistent with the view that health-related digital inequality extends beyond access and also involves capability differences among internet users. Digital literacy may therefore be understood as a capability-based health-related resource and a dimension of contemporary health inequality, although the cross-sectional design precludes causal inference.