WHO's First Global Report on AI in Health and Six Guiding Principles for Its Design and Use

According to a report published by the World Health Organization (WHO), "Digital technologies and artificial intelligence (AI), particularly machine learning, are transforming medicine, medical research and public health. Technologies based on AI are now used in health services in countries of the Organization for Economic Co-operation and Development (OECD), and its utility is being assessed in low- and middle-income countries (LMIC)."

The report, Ethics & Governance of Artificial Intelligence for Health, which is the result of two years of consultations held by a panel of international experts appointed by WHO, further says: Whether AI can advance the interests of patients and communities depends on a collective effort to design and implement ethically defensible laws and policies and ethically designed AI technologies. There are also potential serious negative consequences if ethical principles and human rights obligations are not prioritized by those who fund, design, regulate or use AI technologies for health. AI's opportunities and challenges are thus inextricably linked."

To limit the risks and maximize the opportunities intrinsic to the use of AI for health, the WHO provides the following six principles as the basis for AI regulation and governance:

Protecting human autonomy: In the context of health care, this means that humans should remain in control of health-care systems and medical decisions; privacy and confidentiality should be protected, and patients must give valid informed consent through appropriate legal frameworks for data protection.

Promoting human well-being and safety and the public interest. The designers of AI technologies should satisfy regulatory requirements for safety, accuracy and efficacy for well-defined use cases or indications. Measures of quality control in practice and quality improvement in the use of AI must be available.

Ensuring transparency, explainability and intelligibility. Transparency requires that sufficient information be published or documented before the design or deployment of an AI technology. Such information must be easily accessible 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. Although AI technologies perform specific tasks, it is the responsibility of stakeholders to ensure that they are used under appropriate conditions and by appropriately trained people. 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.

Promoting AI that is responsive and sustainable. Designers, developers and users should continuously and transparently assess AI applications during actual use to determine whether AI responds adequately and appropriately to expectations and requirements. AI systems should also be designed to minimize their environmental consequences and increase energy efficiency. Governments and companies should address anticipated disruptions in the workplace, including training for health-care workers to adapt to the use of AI systems, and potential job losses due to use of automated systems.

As the WHO notes: "AI for health has been affected by the COVID-19 pandemic. Although the pandemic is not a focus of this report, it has illustrated the opportunities and challenges associated with AI for health. Numerous new applications have emerged for responding to the pandemic, while other applications have been found to be ineffective. Several applications have raised ethical concerns in relation to surveillance, infringement on the rights of privacy and autonomy, health and social inequity and the conditions necessary for trust and legitimate uses of data-intensive applications."

"While the primary readership of this guidance document is ministries of health, it is also intended for other government agencies, ministries that will regulate AI, those who use AI technologies for health and entities that design and finance AI technologies for health."

The report importantly adds:

Implementation of this guidance will require collective action. Companies and governments should introduce AI technologies only to improve the human condition and not for objectives such as unwarranted surveillance or to increase the sale of unrelated commercial goods and services. Providers should demand appropriate technologies and use them to maximize both the promise of AI and clinicians' expertise. Patients, community organizations and civil society should be able to hold governments and companies to account, to participate in the design of technologies and rules, to develop new standards and approaches and to demand and seek transparency to meet their own needs as well as those of their communities and health systems.

Do you agree with the six principles as the basis for AI regulation and governance? What are you recommendations for how AI can be used for health?

Aaron Rose is a board member, corporate advisor, and co-founder of great companies. He also serves as the editor of GT Perspectives, an online forum focused on turning perspective into opportunity.

Bridging the Digital Divide through Aerial Connectivity

"Access to the internet will no longer be a problem in a few years." This was a claim I made during a during a recent conversation with a representative from Re+connect, a social venture developing a civic technology solution that closes the last-mile disaster relief gaps and builds long-term resilience for underserved communities, and a manager at the Puerto Rico Science, Technology & Research Trust, an organization whose mission is to invest, facilitate and build capacity to continually advance Puerto Rico's economy and its citizens' well-being through innovation-driven enterprises, science and technology and its industrial base. The success of the mobile application Ms. Qin and her colleagues are developing for people living in Puerto Rico's rural and remote areas depends on having uninterrupted access to wireless internet.

Whether designed to help people living in the United States, Afghanistan or somewhere in between, having regular access to the internet is crucial to delivering valuable technology-based services. However, there are large swaths of areas globally where internet service is not available. But recent and continuing advances in satellite broadband will greatly reduce (and hopefully eliminate) the digital divide, which is the gulf between those who have ready access to the internet and those who do not.

According to a report written by Tim Hatt, Head of Research and Consulting at GSMA, a UK-based organization representing the interests of mobile operators worldwide, with support by OneWeb, Intellian and SoftBank, "Satellite broadband continues to undergo a period of reinvention through the low Earth orbit (LEO) constellation model that re-emerged five years ago from OneWeb, SpaceX and a range of other participants. Momentum and industry traction have been underpinned by a reduced cost structure and higher performance capability relative to legacy geostationary satellites that operate at much higher altitudes." The report notes that a "separate mode of aerial connectivity called high-altitude platform stations (HAPS) is also in development, albeit at an earlier stage and further away from commercial deployment."

Segmented into four chapters beginning with "Bridging a large and persistent internet divide," the report explains that "[w]hat is driving the push for satellite and broader aerial connectivity has not changed: the size and persistence of the internet divide and the consequential – but less appreciated – connectivity barriers for businesses in rural areas." Moreover, "Given that internet access is near ubiquitous in most western countries, it can be easy to forget that on a global scale, penetration is only 50%. This leaves around 3.7 billion people (or 3 billion adults) offline; we forecast that continued network expansion and smartphone price declines will help bring this down over the next five years but only to 3 billion, leaving 40% of the world still offline. The vast majority of unconnected individuals live in India, Africa and a handful of populous, lower-income Asian countries such as Pakistan and Indonesia (see Figure 2)."

In the chapter entitled "Connectivity from space: under the hood," the report explains that the "basic model for LEO constellations is to integrate with mobile operator networks: 3G, LTE and eventually 5G. The major change with LEO constellations compared to traditional GEO architectures, which primarily connect to slower-speed 2G and 3G networks, is a lower deployment altitude to drive higher data throughput and lower latencies."

"Providing network coverage and backhaul links to rural areas is foremost a challenge of economics rather than anything to do with technology," the third chapter points out. "Large distances, uneven topography and the presence of impediments such as forests all make rural coverage more difficult than in urban or suburban areas. Low population densities also mean that usage and revenue per mobile cell site (or broadband exchange point) are much lower than in a city or suburban environment."

Outlining the differences between wholesale versus retail business models with satellite and HAPS connectivity is the focus of the report's final chapter. "The first and most common is connectivity provided on a wholesale basis to mobile operators, which continue to own the end-customer relationship. The second is to sell access directly to consumers or enterprise customers."

Addressing the future outlook, I appreciate the report's concluding paragraph:

We expect current market momentum for LEO connectivity to continue as established constellations increase towards their target size. Forming commercial partnerships with operators will be key over the next 2–3 years to test and deploy aerial solutions in practice, providing feedback loops to inform tech and business model iterations. To a certain extent, regulatory issues surrounding spectrum licensing will persist, albeit to a lesser extent given progress over the last five years. Operators will also need to focus on infrastructure deployment logistics in rural areas as part of a wider package of educational support for such communities. Coverage is, after all, one of several barriers to mobile internet and broadband access along with costs, digital literacy and relevance. Tying these together through joined-up efforts is most likely to result in success rather than tackling each in isolation.

Accessing the internet through aerial connectivity is not a new concept. Such connectivity has historically been cost-prohibitive for most enterprises and individuals. Encouragingly, recent reductions in research and development costs leading to advances in satellite – low Earth orbit and geostationary orbit – and the newer high-altitude platform station technology is altering business models that will allow operators to provide reliable low-cost internet service to those living in unconnected or poorly-connected areas. The end result is delivering mobile solutions like those created by Re+connect that closes the last-mile disaster relief gap.

What recommendations do you have for improving internet connectivity to close the digital divide?

Aaron Rose is a board member, corporate advisor, and co-founder of great companies. He also serves as the editor of GT Perspectives, an online forum focused on turning perspective into opportunity.