Sustainable development

Data and artificial intelligence

The response to COVID-19 reinforced the centrality of data and AI for the health sector and WHO’s activities. Data and AI policies are covered by the following instruments:

• Data policy: Guideline on data integrity
• Data standardization: Resolution WHA66.24: eHealth Standardization and Interoperability (May 2013)
• Data sharing during health emergencies: Policy Statement on Data Sharing by WHO in the Context of Public Health Emergencies (as of 13 April 2013) (May 2016) | Best Practices for Sharing Information through Data Platforms: Establishing the Principles (April 2016)
• Data and member states: Text for Inclusion in Data Collection Forms in all Data Collection Tools (Paper-based, Electronic, or Other) used by WHO to Collect data from Member States
• Data sharing: FAQs on WHO Data Sharing Policy in Non-Emergency Contexts | Policy on the Use and Sharing of Data Collected in Member States by WHO Outside the Context of Public Health Emergencies (August 2017) | WHO Statement on Public Disclosure of Clinical Trial Results (April 2015).

Digital standards

• Integration of Health Information Exchange (HIE): WHO collaborates with health information exchange standardisation bodies and organisations, such as HIE and Health Level Seven International (HL7®), to promote sustainable investment in interoperable digital health technologies and systems. Digital health technologies, standards, and protocols enable health systems to integrate the exchange of health data within the health system. Coupled with data governance, ethics, and public health data standards, digital health and innovation enable the generation of new evidence and knowledge through research and innovation and inform health policy through public health analysis. Promoting Better Integration of Health Information Systems: Best Practices and Challenges (2015).
• SMART Guidelines – Digital Adaptation Kits: Implementation Research and Technical Support: Digital adaptation kits (DAKs) are software-neutral, operational, and structured documentation based on WHO clinical, health system, and data use recommendations to systematically inform the design of digital systems. DAKs include the package of business process workflows, core data needs, decision support algorithms, linkages to indicators, and functional requirements for a health domain area, which can then be incorporated more easily in a digital system. In creating these operational tools derived from WHO guidelines, DAKs provide a unique way to reinforce recommendations and ensure adherence to clinical guidelines and standards within digital systems for improved service delivery.
• WHO Guideline: Recommendations on Digital Interventions for Health System Strengthening: Recommendations based on a critical evaluation of the evidence on emerging digital health interventions that are contributing to health system improvements, based on an assessment of the benefits, harms, acceptability, feasibility, resource use, and equity considerations.
• Classification of Digital Health Interventions v2.0 – A Shared Language to Describe the Uses of Digital Technology for Health: The classification of digital health interventions categorises the different ways in which digital and mobile technologies are being used to support health system needs. A shared and standardised vocabulary was recognised as necessary to identify gaps and duplication, evaluate effectiveness, and facilitate alignment across different digital health implementations.
• Electromagnetic Field and Health Protection: As the digital reality moves from ‘cable’ to wireless traffic (Wi-Fi and mobile), a growing number of concerns are emerging on the impact of electromagnetic fields on human health. This technology has become part of the wider public debate and has given rise to conspiracy theories such as those that claim 5G spreads COVID-19. These concerns increase the importance of WHO’s research and policymaking within a broader evidence-based discussion on the impact of Wi-Fi and mobile devices on health. Model Legislation for Electromagnetic Field Protection (2006); Institute of Electrical and Electronics Engineers’ (IEEE) Standard for Safety Levels with Respect to Human Exposure to Radio Frequency Electromagnetic Fields, 3 kHz to 300 GHz.

Online gaming: Since 2018, gaming disorder has been included in WHO’s International Classification of Diseases (ICD). While the negative impacts of online gaming on health are being increasingly addressed by national health policies, it has been recognized by some authorities, such as the US Food and Drug Administration (FDA), that some game-based devices could have a therapeutic effect. Given the fast growth of online gaming and its benefits and disadvantages, the implications on health are expected to become more relevant.

The health top-level domain name: Health-related generic top-level domain (gTLD) names, in all languages, including ‘.health’, ‘.doctor’, and ‘.surgery’, should be operated in a way that protects public health and includes the prevention of further development of illicit markets of medicines, medical devices, and unauthorized health products and services. Resolution WHA66.24: eHealth Standardization and Interoperability (2013).

Net neutrality

The issue of net neutrality (the equal treatment of internet traffic) could affect bandwidth and the stability of digital connections, especially for high-risk activities such as online surgical interventions. Thus, health organizations may be granted exceptional provisions, as the EU has already done, where health and specialized services enjoy exceptions regarding the principle of net neutrality. Resolution WHA66.24: eHealth Standardization and Interoperability (2013).

WHO has dedicated cybersecurity focal points, who work with legal and licensing colleagues to provide frameworks for the organization to not only protect WHO data from various cyber-risks, but also provide technical advice to WHO and member states on the secure collection, storage, and dissemination of data. Health facilities and health data have always been the target of cybercriminals; however, the COVID-19 crisis has brought into sharp focus the cybersecurity aspects of digital health.

Ransomware attacks threaten the proper functioning of hospitals and other healthcare providers. The global Wannacry ransomware attack in May 2017 was the first major attack on hospitals and disrupted a significant part of the UK’s National Health System (NHS). Ransomware attacks on hospitals and health research facilities accelerated during the COVID-19 crisis.

Considering that data is often the main target of cyberattacks, it should come as no surprise that most cybersecurity concerns regarding healthcare are centred on the protection of data. Encryption is thus crucial for the safety of health data: It both protects data from prying eyes and helps assuage the fears patients and consumers may have about sharing or storing sensitive information through the internet.

Data governance

The 2021 Health Data Governance Summit brought together experts to review best practices in data governance, sharing, and use. The result was a call to action to tackle the legal and ethical challenges of sharing data, ensure data is shared during both emergency and non-emergency situations, and encourage data and research stewardship that promotes tangible impact. Key WHO resources include WHO’s Data Sharing Policies, the UN Joint Statement on Data Protection and Privacy in the COVID-19 Response, and GATHER (Guidelines for Accurate and Transparent Health Estimates Reporting).

WHO’s SCORE technical package (Survey, Count, Optimize, Review, and Enable) identifies data gaps and provides countries with tools to precisely address them. SCORE has been developed in partnership with the Bloomberg Data for Health Initiative. As part of SCORE, WHO completed the first ever global assessment of health information systems capacity in 133 countries, covering 87% of the world’s population.

The project Strengthening National Nutrition Information Systems1 is running in five countries in Africa and Asia – Côte d’Ivoire, Ethiopia, Laos, Uganda, and Zambia – for a period of four years (2020–2024). Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS) and national nutrition surveys are the major sources of nutrition data for many countries, but they are complex and expensive undertakings that cannot be implemented with the required frequency. It is, therefore, critical to strengthen or establish integrated nutrition information systems (NIS) of countries to enhance the availability and use of routine nutrition data to better support policy development, programme design and monitoring.

• Data and digital health in the WHO European Region in 2022: a year in review
• How can digital technologies be used to enhance health financing? Claims management in Estonia
• Digital Health in the European Region: the ongoing journey to commitment and transformation

Data-driven delivery approach

A data-driven delivery approach sharpens WHO’s focus to address gaps, close inequalities, and accelerate progress towards national and regional priorities from WHO regions. The WHO Regional Office for the Americas is working to create open data platforms for evidence-based decisions and policymaking. The Core Indicators Portal provides a dataset of around 200 health indicators for 49 countries across the region from 1995 to 2021. The WHO Regional Office for the Eastern Mediterranean is conducting harmonized health facility assessments and tracking 75 indicators through the Regional Health Observatory (RHO). The WHO Regional Office for Africa has prioritized investments in civil registration and vital statistics (CRVS) and digital health. Its integrated African Health Observatory (iAHO) offers high-quality national and regional health data on a single platform and District Health Information Software (DHIS2) is now implemented in all but four African countries. The WHO Regional Office for South-East Asia is focused on promoting health equity through workshops that introduce member states to WHO’s Health Equity Assessment Toolkit (HEAT). High-quality data on health indicators is available on the Health Information Platform (HIP). The WHO Regional Office for Europe is prioritizing support for countries’ national health information systems (HIS) through more robust data governance frameworks. Member states also have access to the European Health Information Gateway, a one-stop shop for health information and data visualization. The WHO Regional Office for the Western Pacific has released a progress report on each member state’s journey to achieving universal health coverage (UHC). Additionally, the Western Pacific Health Data Platform provides a single destination where countries can easily monitor and compare their progress towards national and global health objectives.

Access

WHO is working with Facebook and Praekelt.Org to provide  WHO’s  COVID-19  information to the world’s most vulnerable people through Discover and Free Basics in a mobile-friendly format. Though over 85% of the world’s population lives in areas with existing cellular coverage, many people can’t afford to purchase mobile data consistently and others have not yet adopted the internet. This initiative enables underserved communities to access life-saving COVID-19 health information through participating operators in more than 55 countries.

Sustainable development

Good Health and Well-being (SDG 3): To achieve a healthier population, improvements have been made in access to clean fuels, safe water, sanitation (WASH), and tobacco control. Greater focus is being placed on leading indicators for premature mortality and morbidity, such as tobacco, air pollution, road injuries, and obesity. Due to COVID-19, 94% of countries experienced disruption to essential health services. while 92 countries experienced little change or worsening trends in financial protection– exacerbated by the continuing pandemic. Emphasis on primary health care is essential to equitable recovery.

Climate change (SDG 13): The 10 recommendations in the COP26 Special Report on Climate Change and Health propose a set of priority actions from the global health community to governments and policymakers, calling on them to act with urgency on the current climate and health crises. The 2021 Global Conference on Health & Climate Change, with a special focus on Climate Justice and the Healthy and Green Recovery from COVID-19, convened on the margins of the COP26 UN climate change conference.

The SIDS Summit for Health in 2021 brought together small island developing states (SIDS) heads of states, ministers of health, and others to discuss the urgent health challenges and needs they face. It helped amplify SIDS voices, promote collaborative action, and strengthen health and development partnerships and financing. It included steps to advance ongoing health initiatives, and to help drive results at the UN Food Systems Summit in September 2021, the 26th Climate Change Conference (COP26) in November 2021, and the Nutrition for Growth Summits in December 2021 and the years following.

Strengthening Health Information Systems for Refugee- and Migrant-Sensitive Healthcare: Health information and research findings can provide a platform for understanding and responding to the health needs of refugees and migrants and for aligning the efforts of other sectors and sources of international assistance. However, the systematic national data and evidence comparable across countries and over time available for policy- and decision-making on health of refugees and migrants from around the world are inadequate. The WHO Health and Migration Programme (PHM) supports the strengthening of member-state information systems, providing specialized technical assistance, response, and capacity-building.

Human rights principles

Improving access to assistive technology: Assistive technology enables and promotes inclusion and participation, especially of persons with disability, ageing populations, and people with non-communicable diseases. The primary purpose of assistive products is to maintain or improve an individual’s functioning and independence, thereby promoting their well-being. Despite a growing number of people in need of assistive products in every country, only 5%–15%, or one in 10 people has access to assistive products. WHO coordinates the Global Cooperation on Assistive Technology (GATE) as a step towards realizing the SDGs and the Convention on the Rights of Persons with Disabilities (UNCRPD), and implementing resolution WHA71.8 on assistive technology. The GATE initiative has the goal to support countries in addressing challenges and improving access to assistive products within their context. To achieve this, the GATE initiative is focusing on five interlinked areas (5Ps): people, policy, products, provision, and personnel.

Data and privacy protection

WHO supports the adoption of the Joint Statement on Data Protection and Privacy in the COVID-19 Response in line with the UN Personal Data Protection and Privacy Principles adopted by the UN System Organizations to support its use of data and technology in the COVID-19 response in a way that respects the right to privacy and other human rights and promotes economic and social development. Organizations in their operations should, at a minimum:

• Be lawful, limited in scope and time, and necessary and proportionate to specified and legitimate purposes in response to the COVID-19 pandemic.
• Ensure appropriate confidentiality, security, time-bound retention, and proper destruction or deletion of data in accordance with the aforementioned purposes.
• Ensure that any data exchange adheres to applicable international law, data protection and privacy principles, and is evaluated based on proper due diligence and risks assessments.
• Be subject to any applicable mechanisms and procedures to ensure that measures taken with regard to data use are justified by and in accordance with the aforementioned principles and purposes, and cease as soon as the need for such measures is no longer present,
• Be transparent in order to build trust in the deployment of current and future efforts alike.

Content policy: Infodemics

An infodemic is an overflow of information, including misinformation, that prevents people from accessing reliable information; in the context of the COVID-19 pandemic, it hampers the ability of people to know how to protect themselves. Our current infodemic cannot be eliminated, but it can be managed by producing engaging reliable content and using digital, traditional media, and offline tools to disseminate it; engaging key stakeholder groups in cooperative content-creation and dissemination; empowering communities to protect themselves; and promoting community and individual resilience against misinformation. Digital health technologies and data science can support these activities by analyzing the information landscape and social dynamics in digital and analogue environments; delivering messages; supporting fact-checking and countering misinformation; promoting digital health, media, and health literacy; and optimizing the effectiveness of messages and their delivery through real time monitoring and evaluation (M&E), among others.

At the Munich Security Conference 2020, WHO Director-General Tedros Adhanom Ghebreyesus stated: ‘We’re not just fighting an epidemic; we’re fighting an infodemic.’ This translated into many WHO initiatives to counter the infodemic, such as working with the public and the scientific community to develop a framework for managing infodemics; bringing the scientific community together for the 1st WHO Infodemiology Conference;

Interdisciplinary

Public health challenges are complex and cannot be effectively addressed by one sector alone. A holistic, multi-sectoral, multidisciplinary approach is needed for addressing gaps and advancing coordination for health emergency preparedness and health security and is essential for the implementation of the International Health Regulations (IHR) 2005.

• WHO Classifications and Terminologies: operates a one-stop shop for WHO classifications and terminologies and delivers and scales use of terminologies and classifications. WHO maintains a portfolio of digital tools and methods for emergency preparedness and response, for example:
• Go.Data is an outbreak investigation tool for field data collection during public health emergencies. The tool includes functionality for case investigation, contact follow-up, and visualisation of chains of transmission including secure data exchange and is designed for flexibility in the field, to adapt to the wide range of outbreak scenarios. The tool is targeted at any outbreak responder.
• Epidemic Intelligence from Open Sources (EIOS) is a unique collaboration between various public health stakeholders around the globe. It brings together new and existing initiatives, networks, and systems to create a unified all-hazards, One Health approach to early detection, verification, assessment, and communication of public health threats using publicly available information. Creating a community of practice for public health intelligence (PHI) that includes member states, international organizations,  research institutes, and other partners and collaborators is at the heart of the initiative; saving lives through early detection of threats and subsequent intervention is its ultimate goal. Since January 2022, the lead of the EIOS initiative is hosted within the new WHO Hub for Pandemic and Epidemic Intelligence. As one of the Hub’s flagship initiatives, EIOS is one of the main vehicles for building a strong PHI community of practice, as well as a multidisciplinary network supporting it.
• Digital proximity tracking technologies have been identified as a potential tool to support contact tracing for COVID-19. However, these technologies raise ethical and privacy concerns. This document
• Ethical Considerations to Guide the Use of Digital Proximity Tracking Technologies for COVID-19 Contact Tracing – provides policymakers and other stakeholders with guidance as to the ethical and appropriate use of digital proximity tracking technologies for COVID-19.
• WHO Digital and Innovation for Health Online Community to Fight COVID-19 is a platform for discussion and sharing experiences and innovative responses related to the COVID-19 pandemic.
• The new Survey Count Optimize Review Enable (SCORE) for Health Data Technical Package was published during one of the most data-strained public health crisis responses ever – that of the COVID-19 pandemic. SCORE can guide countries to take action by providing a one-stop shop for best technical practices that strengthen health information systems, using universally accepted standards and tools.
• WHO Hub for Pandemic and Epidemic Intelligence supports countries, and regional and global actors in addressing future pandemic and epidemic risks with better access to data, better analytical capacities, and better tools and insights for decision-making.
• Digitalized health workforce education: an elicitation of research gaps and selection of case studies.
  The report outlines research gaps in utilising digital technology for healthcare worker education, employing a conceptual framework. It presents 63 research questions across six domains for guiding future studies and identifies evidence gaps in the literature for further research.

Health data

• WHO Health Data Hub (WHDH) is a single repository of health data in WHO and establishes a data governance mechanism for member states.
• Civil Registration and Vital Statistics (CRVS) registers all births and deaths, issues birth and death certificates, and compiles and disseminates vital statistics, including cause of death information. It may also record marriages and divorces.
• The open-access WHO Snakebite Envenoming Information and Data Platform is already working to shorten the time between a snakebite and receiving antivenom. It does this by mapping the distribution of venomous snakes, known antivenoms, and the proximity to health facilities that stock them.

Health facilities data

• Harmonized Health Facility Assessment (HHFA) is a comprehensive, external review tool for assessing whether health facilities have the appropriate systems in place to deliver services at required standards of quality.
• District Health Information Software and Toolkit for Analysis and Use of Routine Health Facility Data are open source, web-based health management information system (HMIS) platforms. The toolkit provides standards and guidance for the analysis of Routine Health Information Surveys (RHIS) data for individual health programmes, as well as integrated analysis for general health service management.
• RHIS provides frequent, up-to-date information on service performance at all levels of the health system, enabling regular analysis of progress and timely identification of problems.

Digital health solutions

• The Digital Health Atlas is a global registry of implemented digital health solutions. It is open and available to anyone to register and contribute information about digital implementations. The registry provides a consistent way to document digital solutions, and offers functionalities in a web platform to assist technologists, implementers, governments, and donors for inventory, planning, coordinating, and using digital systems for health. The Digital Health Atlas includes a special focus on listing digital technologies related to the COVID-19 pandemic. The repository of information is open to all users to register projects, download project information, and connect with digital health practitioners globally.
• Be He@lthy, Be Mobile (BHBM) helps users access the right information when they need it. In support of national governments, BHBM is helping millions of people quit tobacco, and control diabetes and cervical cancer. It helps people at risk of asthma and chronic obstructive pulmonary disease (COPD), and those who care for older people.
• WHO features a new in-game character on Goodville named Florence, along with exciting expeditions and in-game events to help players better understand themselves by providing advice for achieving and maintaining physical and emotional well-being.
• WHO has launched a women’s health chatbot with messaging on breast cancer. The new chatbot uses the Viber platform to deliver health information directly to subscribers’ mobile phones. People subscribing to the new chatbot will find information on how to reduce the risk of breast cancer, symptoms and treatment options.

Resources

Resolutions and deliberations on eHealth

• Resolution WHA58.28 eHealth
• Resolution WHA71.7 (2018): The resolution urges member states to prioritize the development and greater use of digital technologies in health as a means of promoting Universal Health Coverage and advancing the SDGs.
• Report EB 142/20 (2018): The Executive Board in January 2018 considered the updated report ‘mHealth: Use of appropriate digital technologies for public health’. This updated version of the report also includes the use of other digital technologies for public health.
• Report EB139/8 (2016): The Executive Board considered ‘mHealth: Use of mobile wireless technologies for public health,’ reflecting the increasing importance of this resource for health services delivery and public health, given their ease of use, broad reach and wide acceptance.
• Resolution WHA66.24 (2013): The World Health Assembly recognized the need for health data standardization to be part of eHealth systems and services, and the importance of proper governance and operation of health-related global top-level Internet domain names, including ‘.health’.
• Resolution WHA58.28 (2005): The World Health Assembly in 2005 recognized the potential of eHealth to strengthen health systems and improve quality, safety, and access to care, and encouraged member states to take action to incorporate eHealth into health systems and services.
• Resolution EB101.R3 (1998): WHO recognized the increasing importance of the internet and its potential to impact health through the advertising and promotion of medical products, in its resolution on ‘Cross-border Advertising, Promotion and Sale of Medical Products through the Internet’.
• Joint Statement on Data Protection and Privacy in the COVID-19 Response (2020) is developed by the UN Privacy Policy Group, an inter-agency group on data privacy and data protection, to support the privacy protective use of data and technology by the UN in fighting the current pandemic.
• The purpose of a Global Strategy on Digital Health (2020-2025) is to promote healthy lives and well- being for everyone, everywhere, at all ages. To deliver its potential, national or regional digital health initiatives must be guided by a robust strategy that integrates financial, organzsational, human, and technological resources.

Relevant policy documents to data and digital health in the WHO European Region

Digital health and data

For detailed coverage of WHO resources, tools, and programmes visit dig.watch/actors and giplatform.org/actor/world-health-organization.

• Regional digital health action plan for the WHO European Region 2023–2030
• ion: leveraging digital transformation for better health in Europe
• Measurement framework for the European Programme of Work, 2020–2025: approach,
  targets, indicators and milestones
• Resolution: the measurement framework for the European Programme of Work, 2020–2025
• Development of the measurement framework for the European Programme of Work,
  2020–2025

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