A recent World Health Organization (WHO) press release has revealed a set of key principles for determining how best to utilise artificial intelligence (AI) within the context of healthcare, along with the challenges it may present.
The report, “Ethics and governance of artificial intelligence for health”, is the result of two years of consultations held by a panel of international experts appointed by WHO. The report notes that “AI holds great promise for improving the delivery of healthcare and medicine worldwide, but only if ethics and human rights are put at the heart of its design, deployment, and use.”
Health Issues India has reported in the past on numerous cases of AI-powered innovations — many of which have been developed domestically. These innovations range from a wearable glove with the ability to detect seizures in those with epilepsy to therapeutic devices to help manage conditions like diabetes. Applications have even been developed wherein AI-powered robots can act as virtual assistants for doctors or even display diagnostic abilities with similar degrees of accuracy as in-person medical professionals.
“Like all new technology, artificial intelligence holds enormous potential for improving the health of millions of people around the world, but like all technology it can also be misused and cause harm,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This important new report provides a valuable guide for countries on how to maximise the benefits of AI, while minimizing its risks and avoiding its pitfalls.”
The WHO has determined six key points as the basis for AI regulation and governance
- Protecting human autonomy. Given that the use of AI could see large amounts of control ceded to computer programmes, it is therefore vital that there is still an element of human control of health-care systems and medical decisions. Privacy and confidentiality should be protected. This also requires that even with in-depth use of AI algorithms and programmes, a consent based system must be used that remains within the confines of national privacy laws
- Promoting human well-being and safety and the public interest. The report states “the designers of AI technologies should satisfy regulatory requirements for safety, accuracy and efficacy for well-defined use cases or indications.” Priority must be placed on safety standards and quality of AI programmes, given the potential for these programmes to be placed into a position of reliance in health systems, it is imperative that all potential shortfalls or oversights of the programmes be properly considered
- Ensuring transparency, explainability and intelligibility. Transparency forms another key issue when implementing AI technology. requires that sufficient information be published or documented before the design or deployment of an AI technology. This information must be publically available and “and facilitate meaningful public consultation and debate on how the technology is designed and how it should or should not be used.”
- Fostering responsibility and accountability. Responsibility and accountability mechanisms and procedures become vital as control of areas of health systems fall under the control of AI algorithms. As the WHO states “effective mechanisms should be available for questioning and for redress for individuals and groups that are adversely affected by decisions based on algorithms.”
- Ensuring inclusiveness and equity. “Inclusiveness requires that AI for health be designed to encourage the widest possible equitable use and access, irrespective of age, sex, gender, income, race, ethnicity, sexual orientation, ability or other characteristics protected under human rights codes.” Given the pragmatic nature of AI tools, attempting to optimise available resources to benefit the maximum number of people, there are dangers that some may fall through the cracks. This issue is already prevalent in India, with the majority of healthcare infrastructure developed within cities. This approach allows each health facility to reach the maximum number of people, though this ignores the fact that the majority of individuals in India live in rural locations, albeit in a less densely populated manner. AI could fall into a similar trap, with vast numbers of people not receiving equitable care
- Promoting AI that is responsive and sustainable. Any programmes developed and put into use must be constantly reassessed to ensure they are appropriate within the current context. It must also be assured that any programme is built from the ground up with sustainability in mind, both for resource usage and environmental impact
The WHO summarised the report in a Twitter thread, stating “Artificial Intelligence (#AI) holds enormous potential for improving the health of millions of people around [the world] but only if ethics & human rights are put at the heart of its design, deployment, & use.”
The use of AI in healthcare may seem like a futuristic concept to some. However, the concept has been proposed in India for a number of years. In 2019, Union Minister for Health and Family Welfare Dr Harsh Vardhan told Lok Sabha MPs that “the potential of AI in public health is being explored in our country. The Ministry of Health and Family Welfare (MoHFW) is working towards using AI in a safe and effective way in public health in India.” The Modi administration has foregrounded digital health as a matter of policy, such as through a blueprint for digital health unveiled by Vardhan in 2019.
AI may well be the future of healthcare. With everyday health monitoring taken over by a computer programme that can analyse risk factors such as weight, smoking or alcohol intake and add in aspects such as family history, the risk of many noncommunicable diseases can be assessed in an individual without intervention by a doctor.
Likewise, epidemiological patterns of infectious diseases can be monitored through AI, coupled with information regarding travel habits, commuter figures and population distribution, this could allow for advanced modelling of potential outbreaks. The result of this is that doctors and medical staff will find more time on their hands for in-person consultation and more in-depth assessment of individuals.
Such a technology could vastly improve health outcomes. However, in order to do so this technology must be made to be accessed equitably, to not do so could see health service disparities widen further. AI must not become a tool to improve services within cities while leaving rural locations with the most basic of infrastructure.
