Strengthening public health data governance: A Co-regulatory framework for integrating wearable health data into...

This perspective article addresses systemic governance gaps in the integration of wearable health technologies into public health infrastructures. While high-frequency physiological data offer potential for chronic disease management and epidemiological surveillance, they remain largely siloed due to fragmented regulatory frameworks and limited data trustworthiness. Recent empirical evidence underscores the magnitude of this gap: a global meta-analysis of 141,193 participants reports a 77.2% willingness to share health data, while only 26.5% of U.S. wearable users actually share their data with clinicians despite a 78.4% stated willingness.^1,2 We propose the Good Data Service Practice (GDSP) as a conceptual co-regulatory governance framework designed to bridge the limitations of existing regimes such as the European Union (EU) General Data Protection Regulation (GDPR) and the United States (U.S.) Health Insurance Portability and Accountability Act (HIPAA) in handling continuous, dynamic data streams. Using a transparent, replicable comparative public-health policy analysis with pre-specified document inclusion/exclusion criteria and a structured coding protocol, we examined three purposively selected jurisdictions-the EU, the U.S., and Taiwan-across five operationally defined governance dimensions (consent architecture, accountability allocation, interoperability requirements, oversight capacity, and public-health usability). Drawing on design-science research principles,3 the GDSP framework was iteratively derived from the identified gaps through an explicit gap-to-principle mapping. We theoretically propose-rather than empirically demonstrate-that GDSP creates the institutional preconditions under which wearable data could, in principle, support clinical decision-making and public-health surveillance. No empirical validation, stakeholder consultation, or pilot implementation was conducted; subsequent Delphi consensus, expert panel review, and pilot evaluation are required before policy adoption. This framework offers a policy-relevant governance roadmap for strengthening digital health infrastructures and supporting equitable public health data use.