Assessing the Promise and Efficacy of Digital Health Tool | IGF 2023 WS #83

Audience

The need to enhance digital health systems in preparation for future pandemics has become increasingly evident. Accurate and reliable medical advice and treatment should be accessible without individuals having to physically visit healthcare facilities. This is crucial to ensure the safety and well-being of patients and to reduce overcrowding in healthcare facilities, especially among the elderly who are more susceptible to complications from infectious diseases.

The COVID-19 pandemic has highlighted the limitations of traditional healthcare delivery models that heavily rely on in-person consultations and hospital visits. This has caused strain on healthcare systems and increased the risk of transmission in crowded facilities. Therefore, there is an urgent call for the development and improvement of digital health solutions.

One supporting fact behind the argument for digital health improvements is the surge in healthcare demand during pandemics like COVID-19. The rapid spread of the virus has emphasized the need for scalable and efficient healthcare services that can cater to a large number of patients. By implementing digital health solutions such as telemedicine and remote monitoring, the burden on physical healthcare facilities can be alleviated, and healthcare providers can reach a wider patient population.

Another important consideration is the age and vulnerability of certain populations, particularly the elderly. Concerns have been raised about the increased risk they face when visiting crowded healthcare facilities. Digital health technologies can provide them with access to healthcare services from the safety of their own homes, reducing their exposure to potentially infectious environments.

The analysis also highlights the relevance of the United Nations’ Sustainable Development Goals (SDGs), particularly SDG 3: Good Health and Well-being, and SDG 9: Industry, Innovation and Infrastructure. Improving digital health aligns with these goals by promoting accessible and quality healthcare for all, as well as fostering innovative solutions to address healthcare challenges during crises.

In conclusion, the need for digital health improvements in anticipation of future pandemics is supported by various compelling arguments. These include the necessity for accurate and timely medical advice without physical visits to healthcare facilities, concerns about overcrowding, increased healthcare demand during pandemics, and considerations for the vulnerable and elderly populations. Embracing digital health solutions can enhance societies’ capacity to respond effectively to future health crises, ensuring comprehensive and accessible healthcare services for all.

Geralyn Miller

During a panel discussion, speakers elaborate on various facets of Microsoft’s initiatives related to health outcomes, health equity, and digital health literacy. One significant topic highlighted is the crucial understanding of social determinants of health. The speakers underscore that these non-medical factors have a substantial impact on health outcomes, accounting for 30-55% of them. It is emphasised that addressing these determinants is vital for tackling health disparities.

Another key point discussed is the importance of addressing systemic problems, including social determinants of health, to enhance health equity. Microsoft’s multidisciplinary research on issues such as carbon accounting, carbon removal, and environmental resilience is commended. The company’s involvement in humanitarian action programs to effectively respond to disasters is also highlighted. By focusing on these systemic problems, Microsoft aims to create a more equitable healthcare system.

The role of technology and data in improving health outcomes and promoting health equity is emphasised. Microsoft’s development of a health equity dashboard, which enables visualisation and understanding of the problem, is lauded. The dashboard employs public data sets to provide different perspectives on health outcomes. Additionally, Microsoft’s LinkedIn ‘Data for Impact’ program, through which professional data is made available to partner entities, aims to enhance digital health literacy by equipping students and job seekers with the necessary skills.

Responsible AI is another significant aspect underscored by the speakers. Microsoft’s commitment to principles such as fairness, transparency, accountability, reliability, privacy & security, and inclusion in its approach to AI is highlighted. The need for implementing policies and practices to ensure safety, security, and accountability in AI is stressed. Measures such as implementing safety brakes in critical scenarios, classifying high-risk systems, and monitoring to ensure human control are deemed crucial. Moreover, the licensing infrastructure for the deployment of critical systems is considered essential.

The panel also addresses the issue of potential bias in AI models and the need to understand and inspect the data guiding these models. Microsoft actively works towards understanding the distribution and composition of the data to prevent bias. The goal is to ensure fairness and reduce inequalities by ensuring that bias does not occur due to the data employed in AI models.

The value of cross-sector partnerships, especially during the pandemic, is emphasised. Collaborations between the public, private, and academic sectors in research and drug discovery are cited as successful examples. These partnerships, including government-sponsored consortia, privately-funded consortia, and community-driven groups, have been instrumental in advancing healthcare during the pandemic. The continuation of such partnerships to drive positive change is advocated.

Additionally, the panel underscores the importance of maintaining good standards work, particularly during crises such as the pandemic. The use of smart health cards to digitally represent clinical information and support emergency services is discussed. The work of the International Patient Summary Group, aiming to represent a minimum set of clinical information, is commended, and the need to continue this good standards work is stressed.

The challenge of keeping up with the accelerating pace of innovation is acknowledged. As innovation progresses rapidly, individuals and organizations must strive to stay current and adapt. The significance of dialogue and information sharing as opportunities to expand knowledge and foster collaboration is also highlighted. Panels and training sessions are seen as valuable starting points for initiating these discussions and sharing insights.

Furthermore, the panel emphasises the need for training in both tech providers and the academic system. They assert that training in digital health should be integrated into the academic curriculum to ensure that everyone in healthcare is equipped with the necessary knowledge and skills. This approach is considered essential for advancing digital health literacy and ensuring its scalability.

Lastly, responsible implementation of generative AI is discussed, advocating for open policy discussions to ensure inclusivity and address ethical concerns. The importance of discussing responsible AI is underscored for its successful and inclusive implementation.

In conclusion, the panel discussion provides an encompassing overview of Microsoft’s initiatives pertaining to health outcomes, health equity, and digital health literacy. It underscores the importance of understanding social determinants of health, addressing systemic problems, and leveraging technology and data to improve health outcomes. Microsoft’s various initiatives, such as the health equity dashboard, LinkedIn ‘Data for Impact’ program, and Microsoft Learn platform, are commended. Additionally, the panel highlights the significance of responsible AI, cross-sector partnerships, maintaining good standards work, and promoting dialogue and information sharing. The importance of training in both tech providers and the academic system, as well as responsible implementation of generative AI through open policy discussions, is emphasised.

Ravindra Gupta

Digital health has achieved technical maturity, with the necessary technology and infrastructure in place for its implementation. However, it lacks organizational maturity, as highlighted by Debbie, a panelist at an event, who pointed out the shortage of trained individuals who can effectively leverage available healthcare technology. This expertise gap poses a significant challenge to successful digital health implementation.

To address this issue, comprehensive understanding and implementation of digital health are needed. This includes educating healthcare professionals, technologists, and patients about digital health’s integration into healthcare systems. The International Patients Union is one example of an organization dedicated to training patients in effectively using digital health technology.

Another area that requires attention is government policies on digital health, which currently lack focus on capacity building. Governments should prioritize capacity building initiatives to equip healthcare professionals with the necessary skills to leverage technology effectively. Pressure should be exerted on bodies like the World Health Organization (WHO) to provide faster normative guidance for digital health policy development, facilitating effective national policies.

Private and non-profit organizations are developing innovative and affordable strategies for digital health literacy. The Digital Health Academy, for example, offers an online global course for healthcare professionals, and plans are underway to provide low-cost training courses for frontline health workers. These efforts bridge the digital health literacy gap and ensure healthcare professionals are proficient in digital tools and technologies.

Governments must play a pivotal role in funding digital health initiatives, as seen in the Indian government’s investment in the national digital health mission. This funding is crucial, especially considering the evolving business model of digital health, which has led to the withdrawal of many large companies. Government support is essential for sustaining digital health initiatives and ensuring successful implementation.

Digital health has proven its readiness during the COVID-19 pandemic. Fast-track vaccine development involved global researchers, and AI was used in repurposing drug use. Additionally, 2.2 billion doses were digitally delivered through COVID apps, highlighting the efficiency and effectiveness of technology in healthcare. This underlines the need to continue utilizing technology beyond the pandemic.

Digital health literacy is crucial for healthcare professionals and workers in the sector. Failing to adapt and learn digital health skills may render individuals professionally irrelevant. Patients’ increasing access to health information necessitates healthcare providers’ awareness of advancements to provide accurate and quality care.

Upskilling and cross-skilling in digital health are essential for scalability, as scalability relies on healthcare professionals having the necessary competencies to leverage digital tools effectively. Moreover, healthcare providers should stay ahead of patients in terms of health knowledge to provide accurate care.

In summary, digital health has achieved technical maturity but lacks organizational maturity. Comprehensive understanding and implementation, capacity building, and literacy initiatives are necessary. Government support, funding, and upskilling efforts are key to successful digital health implementation. Digital health literacy is important for both healthcare professionals and patients, and upskilling is necessary for scalability. Healthcare providers need to stay informed to provide quality care. By addressing these challenges and investing in digital health, we can achieve better healthcare outcomes for all.

Moderator

The panel speakers engaged in a comprehensive discussion on the topic of digital health literacy and equitable access to digital health resources. They acknowledged the existence of disparities in access to healthcare and emphasized the potential of digital health to advance healthcare outcomes if accessed equitably. The need to enhance digital health literacy and promote equitable access was a recurring theme throughout the discussion.

Collaboration among various stakeholders, including healthcare providers, educational institutions, and technology companies, was identified as crucial for enhancing digital health literacy. The panel highlighted the importance of developing comprehensive frameworks and assessment tools to gain a holistic understanding of individuals’ abilities in navigating digital health. This would enable tailored interventions and support for those who need it most.

The role of social determinants of health in influencing health outcomes was also emphasized. The panel noted that 30 to 55 percent of health outcomes are dependent on social determinants of health. To visualize this problem, the Microsoft AI for Good team has built a health equity dashboard. This highlights the significance of addressing social determinants, such as economic policy, social norms, racism, climate change, and political systems, to achieve health equity.

Furthermore, the speakers advocated for digital health literacy and digital skills to be viewed as part of the social determinants of health. Microsoft’s initiatives, including a multidisciplinary research initiative on climate change, partnership with humanitarian open street map team for disaster mitigation, and a free online learning platform, were highlighted as examples of addressing social determinants. Microsoft-owned LinkedIn also promotes economic development and digital skilling through their economic graph and data for impact program.

Sub-Saharan Africa was identified as a region facing high health inequality, with a high disease burden and a shortage of health workers. The panel called for focused efforts to address health inequality in this region. They highlighted the positive impact of digital technologies, especially mobile, in addressing health issues. Reach Digital Health, for example, uses mobile technology to improve health literacy and encourage healthy behaviors. The Department of Health in South Africa also implemented a maternal health program that reached around 60% of mothers who have given birth in the public health system over the past eight years.

The panel stressed the importance of incorporating a human-centered design approach in the development of digital interventions. They noted that design considerations should include an understanding of the bigger context and the needs of the end-users. This approach ensures that digital health solutions are simple, easy to use, accessible, and free, with appropriate literacy levels.

The moderators expressed their interest in hearing insights and key policy recommendations from the panel. They highlighted the importance of enhancing digital health literacy, especially among marginalized populations. The panel agreed that governments and international organizations should prioritize policy interventions and investments to achieve this goal.

Capacity building in digital health was identified as a significant ongoing challenge in the healthcare sector. The need for policymakers to focus on capacity building and provide training for healthcare professionals and frontline workers was emphasized. The speakers emphasized the importance of continuous upskilling, considering the rapid pace of technological innovation, and highlighted the need for a practical implementation focus before policy development.

The importance of equitable access to digital health resources was another key point discussed. The Digital Health Academy was highlighted as an organization focusing on affordable training, providing $1 trainings for frontline health workers to ensure affordability. The responsible development and deployment of digital health technologies were emphasized, with a focus on upholding digital rights, privacy, and security. The speakers stressed the importance of involving various stakeholders for responsible innovation.

The speakers also touched on the concept of the digital divide and its impact on health equity. They highlighted the need to bridge this divide through initiatives such as Facebook Free Basics, which provides essential information for free, improving people’s literacy and data usage. Aligning priorities between mobile network operators and health organizations was seen as crucial for improving health equity.

Youth-led initiatives and community involvement were identified as crucial for bridging the digital divide in health. The panel emphasized the need for culturally sensitive initiatives that consider the specific needs of the population. They highlighted the importance of empowering young advocates to actively shape internet governance policies to ensure equitable access to digital health resources.

Lastly, the panel discussed the role of governments in investing in digital health. The Indian government, for example, has set up a national digital health mission and provided free consultations to citizens through the e-Sanjeevani program. Implementing free telemedicine consultations through health helplines was seen as a way to bridge the digital divide and address healthcare inequities.

In conclusion, the panel highlighted the need for collaborative efforts, policy interventions, and investments to enhance digital health literacy and achieve health equity. They emphasized the importance of addressing social determinants, building digital health capacity, and promoting equitable access to digital health resources. The responsible development and deployment of digital health technologies, as well as the involvement of youth and community in shaping policies, were identified as crucial. Overall, the panel provided valuable insights and recommendations for advancing digital health literacy and equitable access to digital health resources.

Yawri Carr

The emergence of the Responsible Research and Innovation (RRI) Framework in AI healthcare is seen as a positive development in the field. This framework focuses on transparency, accountability, and ethical principles, ensuring that innovation in AI does not compromise ethical standards. It places an emphasis on safeguarding digital rights and privacy and holds AI systems accountable for their decisions.

Stakeholder involvement is highlighted as essential in the RRI process. Societal actors, innovators, scientists, business partners, research funders, and policymakers should all be involved in the responsible research and innovation process. It is important for these discussions to be open, inclusive, and timely, working towards ensuring desirable research outcomes.

Youth-led initiatives are recognized for their role in promoting responsible AI. Universities, education centres, and mentorship programs have crucial roles in inspiring young people to innovate in health technology. Community-based research projects are also highlighted as a means to promote cultural sensitivity and address specific community needs.

However, there are challenges in applying ethical considerations in profit-driven AI innovations. There is often a clash between ethical considerations and profit-driven motives. Power imbalances, particularly financial, often hinder the work of ethicists. Therefore, regulatory frameworks, certification processes, or voluntary initiatives are needed to enforce ethics in AI.

Young advocates are viewed as influential in shaping internet governance policies and ensuring equitable access to digital health resources. Their participation in policy discussions at forums like the Internet Governance Forum (IGF) and the formation of youth coalitions can amplify the collective voice for accessibility and inclusivity. Engagement with multi-stakeholder processes can ensure a diverse contribution to the policies.

Youth-led research and innovation hubs are seen as valuable in addressing digital health challenges. These hubs provide a platform for young innovators, healthcare professionals, and policymakers to collaborate and find innovative solutions.

Technologies such as telemedicine and the use of robots are praised for their usefulness in pandemic situations. Robots can restrict direct human contact, reducing the risk of virus spread. Telemedicine enables remote treatment, ensuring health services while maintaining social distance.

The importance of technology and AI in healthcare is emphasized, particularly in protecting nurses and healthcare workers. Assistive technologies like robots can help safeguard these frontline workers.

Open sharing of data and research related to the pandemic is encouraged. This open sharing can lead to greater cooperation and more effective responses to emergencies.

Digital health leaders are urged to prioritize equity and ensure that healthcare is not a privilege but a right for all. Technical skills are not the only important aspect; a commitment to equity is also vital. Healthcare and digital health care should be accessible to everyone.

The valuable role of nurses and ethicists in evolving technology is highlighted. The work of nurses remains critical in healthcare, and ethicists play a crucial role in contributing to the mission of responsible AI.

In conclusion, youth-led initiatives, stakeholder involvement, and the emergence of the RRI Framework in AI healthcare are viewed as positive developments. Challenges exist in applying ethical considerations in profit-driven AI innovations, emphasizing the need for regulatory frameworks and certification processes. The importance of technology, telemedicine, robotics, and the open sharing of data and research are recognized. Digital health leaders are urged to prioritize equity, and the crucial role of nurses and ethicists in evolving technology is emphasized. Ultimately, youth play a fundamental role in advancing digital health and ensuring its accessibility.

Deborah Rogers

The speakers in the discussion highlighted several key points about digital health in Africa and how it can potentially address health inequality and overburdened health systems. They emphasised the increased access to mobile technology in Africa, which has seen significant growth over the years. In Africa, where 10% of the world’s population represents 24% of the disease burden, access to mobile technology has the potential to bridge the gap and improve healthcare outcomes.

One of the main arguments put forth was the effectiveness of low-tech but highly scalable technology in disseminating health information and services. The speakers stressed the success of programmes that utilise SMS and WhatsApp in improving health behaviours and service access. For example, a maternal health programme in South Africa has reached 4.5 million mothers since 2014, resulting in improved health outcomes.

The discussions also highlighted the role of digital technology in improving health literacy. Through the use of digital technology, a maternal health programme in South Africa has witnessed increased uptake of breastfeeding and family planning. However, the speakers emphasised the importance of implementing digital health initiatives in a human-centred manner and being cognisant of the larger health system they are a part of.

Furthermore, the speakers addressed the issue of health equity and the digital divide. They presented an example of the Facebook Free Basics model, which provided free access to essential health information and led to increased profit for mobile network operators. This approach demonstrated that reducing message sending costs for end-users does not inhibit profit for operators, thus showing the potential for mobile network operators to improve health equity.

The discussion also delved into the importance of a human-centred approach in developing digital health interventions. The speakers emphasised that digital health should be easy to use and accessible, designed with users in mind. They also noted that access to a mobile device itself is less of a problem than the cost of data, which needs to be addressed for wider adoption of digital health services. Overall, digital health was seen as an integral part of the health infrastructure, rather than a side project.

One noteworthy aspect that was brought up in the discussions was the potential bias and lack of diversity in the development of digital health services. The speakers emphasised that the makeup of the development team often does not represent the actual users of the services, leading to the introduction of biases. This can perpetuate health inequities and hinder the effectiveness of digital health interventions. Therefore, there was a call for more diverse and inclusive development teams to ensure the services are designed to meet the needs of all users.

During the discussion, the speakers also highlighted the role of digital health in the COVID-19 pandemic. Large-scale networks were used to quickly disseminate information, and digital health platforms played a vital role in screening symptoms and gathering data. The burden on healthcare professionals was reduced, showcasing the potential of digital health to alleviate the strain on the healthcare system.

Furthermore, the importance of sharing medical knowledge and not hoarding information was emphasised. The speakers noted that the lack of knowledge during the early stages of the COVID-19 pandemic had a significant impact on everyone. Therefore, the dispersal of information on a large scale can greatly contribute to improving patient health outcomes.

The discussions also emphasised the need for investment in digital health infrastructure for future pandemics. The COVID-19 pandemic highlighted the importance of having digital health platforms in place. Building and investing in such infrastructure before the next pandemic occurs would enable a quicker response and avoid starting from scratch.

Additionally, the potential of technology to decrease health and digital literacy inequities was discussed. Technology was hailed as a great enabler in addressing these inequities and improving access to healthcare and education.

In conclusion, the discussions on digital health in Africa highlighted its potential to address health inequality and overburdened health systems. The increased access to mobile technology and the success of low-tech interventions have provided evidence of the positive impact of digital health. However, the speakers emphasised the need for a human-centred approach, diversity in development teams, and investment in infrastructure to fully capitalise on the potential of digital health. There was optimism about the future of digital health, and the involvement of youth in its evolution was seen as crucial.

Moderator:
in turn creating disparities in access to care. So in this session we will discuss strategies to enhance digital health literacy and identify measures to promote equitable digital health access. Our goal is to find innovative policy solutions that bridge the digital divide and ensure that digital health truly advances healthcare outcomes for all. Thank you all for joining us on this important journey and let’s get started. We have three key policy questions that will guide our discussion today. How can comprehensive frameworks and assessment tools be developed to capture and assess different dimensions of digital health literacy, ensuring holistic understanding of individuals’ abilities in navigating digital health information and services? What strategies towards health equity can be adopted to ensure digital health literacy programs effectively address unique needs and challenges faced by marginalized communities, promote inclusivity and equitable access to digital health resources? And also how can partnerships between key stakeholders including healthcare providers, educational institutions, technology companies and governments be leveraged to enhance digital health literacy skills, foster collaboration and knowledge sharing to advance health equity? Our panelists will be addressing these issues today so if you would like to ask a question towards the panel we will have a Q&A session at the end for on-site participants and online participants may use the Zoom chat to type and send in your questions and my online moderator Valerie will be helping me with them. So without further ado to kick off our discussion I would like to introduce our esteemed panelists who will share their insights on these matters. First joining us online we have Ms. Gerilyn Miller, an innovation leader driving change in healthcare and life sciences through AI. She is a senior director at Microsoft in product incubations, Microsoft health and life sciences cloud, data and AI and she’s also the co-founder and head of AI for health which is Microsoft AI for good research lab. And then we have Professor Rahindra Gupta joining us on site here today, a leading public policy expert with vast experience in policy making and he’s been involved in major global initiatives on digital health and holds several key positions in the digital health arena. He’s also the founder and behind many path-breaking initiatives like his Project Create and organizations working for digital health. And next we have Ms. Debbie Rogers joining us on site as well. She’s an experienced leader in the design and management of national digital mobile health programs and the CEO of Reach Digital Health aiming to harness existing technologies to improve healthcare and create societal impact. And last but definitely not least we have Ms. Jari Carr joining us online. She’s an internet governance scholar, youth activist and AI advocate and she’s also a digital youth envoy for the ITU like me and a global shaper with the World Economic Forum with her work centering on responsible AI and data science for social good. Now let’s begin section one of today’s workshop on low digital health literacy and strategies and I would like Ms. Gerilyn to take the floor first. So what research and development initiatives for example including the creation of comprehensive frameworks and assessment tools is Microsoft pursuing to address the multifaceted challenges of low digital health literacy? And additionally can you highlight your thoughts and innovative strategies and partnerships that Microsoft is employing or supporting to enhance digital health literacy among marginalized populations with a focus on inclusivity and equitable access especially in low-income and rural areas? Ms. Gerilyn over to you. Yeah great thanks and thank you for inviting me today to

Geralyn Miller:
participate in this. So the lens I’m going to take from this is really based on something that is known as social determinants of health. So I want to start by defining and sanity checking that social determinant of health is a non-medical factor that influences health outcomes. So this is the conditions that people are born work and live in and the wider set of forces that shape conditions of our daily lives right. So this includes things like economic policy and development agendas, social norms, social policies, racism, even climate change and political systems and this affects about from research we know that this is about 30 to 55 percent of health outcomes are actually really dependent on social determinants of health. So when you want to think about health equity in digital literacy it’s really important to for two things. First to understand the problem based on data and I’ll share a little bit about what Microsoft research is doing in that area and the second is to open your mind and have a willingness to address the underlying often systemic problems that felt that affect health outcomes and that includes social determinants of health. So Microsoft has some things that we’re doing to understand the problem with data including the Microsoft AI for Good team has built something that we call a health equity dashboard that is essentially a Power BI dashboard that takes a number of public data sets and allows one to look at them from a geography perspective, slice and dice the data by rural, suburban and urban populations and then also examine different health outcomes including things like life expectancy. So that’s the first thing right is really being able to understand and visualize the problem itself. So I invite you to actually have a look at that information. There’s a number of other things that from a Microsoft perspective we’re doing to look at on the social determinants of health side. So I’ll point for example to some of the work we’re doing on climate change. We announced a climate change research initiative that we call MCRI which is really a multidisciplinary research initiative that is focusing on things like carbon accounting, carbon removal and environmental resilience. We also have our Microsoft AI for Good research lab and our humanitarian action program. They have for example worked with a group called humanitarian open street map team or HOT which partnered with Bing maps to map areas vulnerable to natural disaster and poverty. So that’s an example of some of the work out of the research lab and the humanitarian action program coming together to help give relief teams information to respond better after disasters. There’s also a lot of work that we have happening from a Microsoft perspective that ties more directly to economic development and digital skilling. So we have some work on a LinkedIn, something called the economic graph which is a perspective or a view based on data of more than 950 million professionals and 50 million companies. LinkedIn which is a Microsoft company also has a data for impact program and this program makes this type of professional data available to partner entities including entities like the World Bank Group, the European Bank and others. So it’s data on more than 180 countries and regions and this is at no cost to the partner organizations. An example of the impact of this type of data, this data for impact information was able to advise and inform a 1.7 billion dollar World Bank strategy for the country of Argentina. And then there’s also the Microsoft learn program which is a free online learning platform enabling students and job seekers to expand their skills. So role-based learning for things like AI engineers, data scientists and software developers, hundreds of learning paths and thousands of modules localized in 23 different languages. So in summarizing I just want to say that we look at this as from a holistic broad perspective as digital health literacy and digital skills as part of the social determinants of health and the work that we’re doing to support those.

Moderator:
Thank you very much Ms. Miller. And now moving on to Ms. Debbie. As an experienced leader in the design and management of national mHealth programs and the CEO of Reach Digital Health, can you share your thoughts on digital health literacy, digital divide and health equity, effective strategies for enhancing digital health literacy among marginalized populations particularly in resource constrained settings and additionally how can partnerships between non-profit organizations like Reach and private sector mobile operators be strengthened to promote digital health literacy among women and marginalized communities addressing gender-based barriers and limited resources while contributing to bridging the digital divide?

Deborah Rogers:
Thanks very much. So I think the first thing just to talk about is a little bit of the context. So we work primarily in Africa. To give you an idea around inequality and health in sub-Saharan Africa we have 10 percent of the world’s population, 24 percent of the disease burden and only three percent of the health workers. And so we really do have the odds stacked against us in a time when we’re supposed to be going towards universal health care, which quite honestly is a pipe dream if you look at where things are at the moment. While we’ve made some progress in addressing maternal and child health and addressing infectious diseases such as HIV, we are getting an increased burden when it comes to non-communicable diseases. So the burden is just increasing, not decreasing. And so really if we follow the same patterns over and over again and we keep just training more and more health workers and not addressing the systemic issues or relieving the burden from the health system, then there’s absolutely no way that we’re going to be able to improve these stats. We’re going to go backwards and not forwards. And so I think I’m fairly optimistic actually because I think that digital and particularly mobile has the opportunity to really address some of these issues in a way that many other interventions don’t. Reach Digital Health was founded in 2007 with the idea that the massive increase in access to mobile technology in Africa, at the time more people in Africa had access percentage-wise to mobile technology than in the so-called global north or western countries, was a way for us to leapfrog some of the challenges that we’ve had in the global south and to actually address some of these issues. And we really have been able to see that. We have been able to see how the access to information and services through a small device that’s in the palm of many people’s hands has been able to improve health, both from a personal behavior change perspective but also health systems as a whole. And so what we primarily focus on is using really, really low tech but highly scalable technology, so things like SMS, WhatsApp. These are the things that everybody uses every day to communicate to their family and friends. And we use that to empower them in their health, help them to practice healthy behaviors, to stop unhealthy behaviors, and to access the right services at the right time. And with the fairly ubiquitous nature of mobile technology in Africa, we’ve been able to reach people at a massive scale. So for example, we have a maternal health program with the Department of Health in South Africa. It’s been running since 2014. We’ve reached 4.5 million mothers on that platform. But that represents about 60% of the mothers who have given birth in the public health system over the last eight years, which percentage-wise is huge. And we’ve been able to see that this has had impacts such as improved uptake of breastfeeding, improved uptake of family planning, and really has seen not just an individual change but a more systemic change with the ability to understand what is the quality of care on a national scale for the Department of Health in South Africa. And so we really do believe that if you harness the power of the simplest technology, if you design for scale with scale in mind, if you design with understanding the context, then you can actually use digital to be able to increase health literacy. And so it’s not all doom and gloom. It’s not just about the fact that digital is always excluding other people. It can be an enabler, but only, of course, if we consider the wider context and we don’t go blindly into things and ignore the fact that this could be something that increases it. And so I think I’ll talk a little bit later more about some of the strategies that can be used, but I think two things to remember is design with the human, not patient. I don’t like the word patient, but in digital health we tend to use that word. With the human at the center of what you’re trying to do, and design understanding that you are part of a bigger system. And this is not something that exists by itself. And if you do those two things, not only will you be able to improve health literacy, but you’ll be able to do so in a way

Moderator:
that doesn’t widen the divide that many technologies already put in place. Thank you very much, Ms. Debbie. Now moving on to Professor Gupta. With your extensive experience in policy development, digital health education, and founding the world’s first digital health university, can you share your thoughts and offer key policy recommendations that governments and international organizations should prioritize to comprehensively enhance digital health literacy, especially amongst marginalized populations? Additionally, can you share insights into successful and scalable educational strategies and approaches that have effectively improved digital health literacy, with a focus on adapting these methods globally to meet healthcare scaling needs for digital health? Thanks, Connie. Firstly, I congratulate you for picking up this

Ravindra Gupta:
very important topic. And secondly, I’m a little worried for such a long question, because after 5 p.m., I’m half asleep. It’s been an engaging session throughout the day. But yes, it’s a very important topic. It keeps me awake. But pardon me for my incoherence. But let me give you a little backdrop of why this topic is important. There is an international society called International Society of Telemedicine and eHealth. It’s been around for a quarter of a century and has memberships in 117 countries. So way back in 2018, I said that digital health has two opportunities and two challenges. But the two challenges are like, we have reached the stage of technical maturity. Give me a challenge, I’ll give you 100 solutions. But where we lack is organizational maturity. People are not trained enough to leverage technology that’s available. So I said, let’s look at capacity building. I think the issue that you brought up. So 2019, they formed the Capacity Building Working Group, which I chair. And post that, we have done two papers on capacity building. One is listing the kind of people we need to train across digital health. And second, we have done a deep dive. We released that in partnership with World Health Organization. So there is, for those who are looking at what kind of capacity we need, the ISFDH website has a list, two papers written on this topic. And then 2019, WHO set up their Capacity Building Department, which is a very recent thing. So I think there is a lot of focus. And now coming back to what my experience was. So having pushed various organizations to do that, but I still relied, we were just doing policy papers and, you know, policies take time to translate. I mean, people like Debbie would need people to help her, you know, in technology. I mean, a policy paper can’t help her. She needs people trained in digital health. So in 2019, I set up the Digital Health Academy, which now is now the Academy of Digital Health Sciences. We have started a course for doctors and for people in healthcare. It’s a global course, fully online as digital course should be. But to your point, that also would not solve my biggest overall challenge. I am training doctors, you know, it is so shocking. And I’ll put a context to that, that we had a half page advertisement in a leading newspaper in India. A very senior doctor called me and asked, Rajendra, what’s digital health? So I was shocked that even doctors need to be first surprised that what does word digital health mean? I’ll give you another example. There’s a company that works exclusively in data domain. So I called the founder who is a doctor and asked, do you do digital health? He said, no Raj, we don’t do digital health. I said, do you use data? He said, we only use data. So I said, you only do digital health. So the challenge is first people should know the definition of digital health. That is the level we have to get in and which is needed across the ecosystem. So right from the bureaucracies and the ministers and the ministries of health, they need to understand what is digital health because they come for a fixed tenure or they get transferred. If that level they are sensitized, then the things flow down the line because government makes policies which get implemented as programs. So that’s one level of competencies that I have told WHO to look at because my experience in WHO meetings is that bureaucrats come, they spend two, three days in Geneva or New York and then they go back and forget it. So there has to be a course for policymakers at the highest level, which probably WHO or any organization could do. The second level is what we need to do is the courses for doctors and health professionals. And third and the most important, which we are launching in next two months is frontline health workers. But understand the challenge that frontline health workers are either doing voluntary service, like you have the ASHA workers in India, which is a million workers. They are our first line or first responders. Don’t expect them to pay you $1,000 or $100. So we had to actually innovate and convince one of the Institute of National Importance that we need to bring out $1 trainings. So we should train people for as low as $1. And this we’re doing globally. So frontline health workers, if I’m able to train, I think I would have addressed the biggest challenge for healthcare. Now, one of the government’s agency has approached us to work with us. So as such, on the capacity building, I think governments just focus on the program minus capacity building, which is a serious lapse. And I think this is across the board. I think that we would agree on that is that we are very focused on saying maternal health, mobile application, child health, mobile application, rural health, telemedicine, but who will do it? We don’t know. But people are going to use don’t even know how to use a mobile phone. They do not know how to log in on the account. So we need basic training. And I think this is what private organizations, not-for-profits, and then government step in very late, let me tell you that. So they are not the ones who would initiate. So once you go with the program, talk to them, they will partner. So as a policy, I’m glad, Connie, that you put a session on this, something that our Digital Health Dynamic Coalition should have done, but they only allow one session for a dynamic coalition. So we had our session, which we are doing tomorrow. But now that you have taken it up, it puts the spotlight on this important topic. At ISFDA, there are policy papers. They have been given to WHO. WHO set up the capacity building department, but honestly, nothing much has moved between 19 and 23, four years. We are still to look at, and they’re still forming a committee. So I think it’s mostly going to be the civil society organizations and private sector that will take the lead. On policy side, I have not seen documents that talk about it so far, so we will have to wait for a normative guidance from WHO, which will be still, I think, a few years away. It takes time to build a document in WHO. How this will happen fast is like this. In India, we have a digital health mission, which has rolled out 460 million health IDs. In this year, we will roll out 1 billion health IDs. Our health consultations, teleconsultations have crossed 120 million. So I think that is the first point. So I’m inverting the process from policy to let’s first have implementation. So when the government rolls out at such level and scale, automatically you will start feeling the need of trained people in this. So I think this is one thing, but more than structured courses, it will be more of continuous upskilling that everyone will need to do because technology is also changing. Till last year, no one talked about generative AI. Now people have started talking about generative AI. So I think we need to keep that trainings as feud and make it more as a continuous upskilling program for people across healthcare. We are not waiting for government policies, we are rolling out as Academy of Digital Health Sciences and these are global programs. We are making it really affordable as $1 trainings for front-end health workers, for doctors and for the industries, the postgraduate program. And we will announce undergraduate programs as well because I think this is where we need to build capacity. So for now, I think policy interventions will happen. I think overall a part of the health policy, everyone should put capacity building and digital health is now an integral part of health. So digital upskilling is required for digital scaling. So I think this is something that governments have to look at and WHO should take a frontal role. So I would say more to WHO and organizations like the one that Debbie runs, organization like the ones that I run with my team. And more importantly, there are two people sitting in this room, Priya and Saptarshi. They run patients union, International Patients Union. Even if you train doctors, industry and the frontline health workers, if patients are not trained, who will use digital? At the end of the day, they have to open an app, use it. They need to know what’s privacy, what’s security. So it’s on us on people like them, to go and train patients for how to use digital technology. So it’s a multidimensional topic and I’m happy that there’s a session dedicated to this. Unless we address this in a complete ecosystem perspective, we’re not done justice to this topic, thank you.

Moderator:
Thank you very much, Professor Gupta. And now to Jari. As someone with expertise in responsible AI, digital rights and a passion for the intersection of technology and society, how can policymakers craft regulations to ensure the responsible development and deployment of digital health technologies, especially for marginalized communities? And also, what role do you see for youth-led initiatives in enhancing digital health literacy, bridging the digital divide and engaging with policymakers to drive policies that support equitable access to digital health resources? Over to you. Hello, everyone, dear organizers, participants and guests.

Yawri Carr:
Thank you very much, Connie, for the organization and thank you for inviting me. Well, so in a world where technology and healthcare are more intertwined than ever, the responsible development and deployment of digital health technologies are paramount importance. This is especially true when considering marginalized communities where equitable access to healthcare is not just a goal, but a moral imperative. So in this case, I would like to mention the Responsible Research and Innovation Framework as one of the guiding philosophies that serve as a roadmap for navigating the intricate terrain of AI in healthcare. At its core, RRI is a commitment to harmonizing technological process with ethical principles. It places a premium on transparency and accountability, recognizing them as pivotal elements in the responsible development and deployment of AI technologies. In the realm of healthcare AI, RRI advocates for policies that do not only uphold digital rights, safeguarding privacy and security, but also establishing mechanisms to hold AI systems answerable for their decisions. It is a holistic approach that seeks to ensure that benefits of innovation are realized with a compromise in ethical standards or jeopardizing individual rights. So who should be involved in a process of responsible research and innovation? Societal actors and innovators, scientists, business partners, research funders and policymakers, all stakeholders involved in research innovation practice, funders, researchers, stakeholders and the public, large community of people, early stages of R&I processes, and the process as a whole. And when? Through the entire innovations life cycle. And to do what? So it is important to anticipate risks and benefits to reflect on prevailing conceptions, values and beliefs, to engage the stakeholders and members of the wider public, to respond the stakeholders, public values and also the changing circumstances that are present in these kinds of processes, to describe and analyze potential impacts, reflecting on underlying purposes, motivations, uncertainties, risks, assumptions and questions, and a huge amount of dilemmas that could also emerge in this kind of circumstances, and open to reflections and to have a collective deliberation and a process of reflexivity and to integrate measures throughout the whole innovation process. So these are also in which ways should we do this? Working together, becoming mutually responsive to each other, and of course in an open, inclusive and in a timely matter. And to what ends, what this framework proposes is that it’s allowing appropriate embedding of scientific and technological advances in society to better align their processes and outcomes with values, needs and expectations of society to take care of the future, to ensure desirable and acceptable research outcomes, solve a set of moral problems, and will also protect the environment and consider impacts on social and economic dimensions, also promote creativity and opportunities for science and innovation that are socially desirable and are taking the public interest. And how these can be applied specifically in a context of healthcare technologies. For example, there are academic projects and also societal projects. One example of an academic project is one from the Technical University of Munich in which I am now studying. Well, we have a project that’s an AI-driven innovation, including a robotic arm of exoprothesis and an advanced version of bimanual mobile service robot. So to ensure the responsible and ethical integration of these technologies into broader healthcare applications, the developers from the Machine Intelligence Institute have collaborated with the Institute of History and Ethics of Medicine, as well as the Munich Center for Technology and Society. And these teams are employing embedded ethics, incorporating ethics, social scientists and legal experts into the development processes. So they have initial onboarding workshops where these experts have become integral members of the development team. They have been actively participating in regular virtual meetings to discuss technological advancements, algorithmic development and product design collaboratively and interdisciplinary. And when ethical challenges are raised, they are addressed as part of the regular development process leading to adjustments in product design. An example involves the planning of model flats for a smart city where initial designs focus on open play layouts. Embedded ethics is highlighted in this case, potential challenges for elderly population and accustomed to such arrangements, promoting every consideration of the layout. Also taking into consideration that these kinds of projects in this specific case had a target population of the elderly population. So this is why it is very important to look at this target population and actually see if they are prepared and if they could be adapted to these kinds of technologies. So insights from this discussion influence the design process, emphasizing the importance of directly seeking future inhabitant perspectives in layout planning. And simultaneously, the project also involves interviews with various stakeholders, including developers, programmers, healthcare providers, and patients. Well, workshops, participant observations of development work, and collaborative reflection and case studies contribute also to active ethical consideration. And well, the project is also aiming to develop a toolbox to facilitate implementation of embedded ethics in diverse settings in the future. But there are also several unresolved issues that remain and that are also like with cultural setting and with corporate and organizational structures. Because even in research setting funded by public resources, the development of AI is predominantly situated in a fairly competitive landscape with prioritization of efficiency, speed, and also profit. So, and also in the case of health, so ethical considerations might be normally isolated or like are normally like not so taken into an importance when they directly clash with profit-driven motives. So taking ethical concerns seriously often creates a tension with industry objectives and the needs of the community. And this is the risk of being assimilated into broader corporate commitments to concepts like technological solutionism, micro-fundamentalism, that at the end prevents ethicists to actually do their work and to do a responsible healthcare technology. Normally, embedded ethicists may find themselves working within contexts that are characterized by pronounced power imbalances, particularly those of a financial nature. And it is probable that some form of enforcement measures will become very necessary in such environments. So not just for the development of the technical aspects, but also like for the work of the persons that are working on the responsible development and deployment. So that may be regulatory framework certification processes or even voluntary initiatives into the organization can make an awareness of these kind of issues that are arising in these situations. And well, okay, I also needed to talk about youth-led initiatives, right? If I still have time. Okay, so, well, there are also like a lot of ways in which youth-led initiatives and also marginalized community could also engage with responsible research and innovation. So for example, youth-led initiatives could connect or could try to participate in events such as this one, but also like try to, that universities or centers of education could inspire the youth so that they can also learn about telemedicine, how can they develop telemedicine initiatives in countries and also in a special rural areas as the professor was mentioning about in India, that these kinds of populations don’t have the same access. Also, for example, community-based participatory research projects that are involved in communities in their research process, ensuring that interventions are culturally sensitive and address the specific needs of a population. Also detail health literacy programs. And also like innovation challenges could be motivated between students and youth so that they can also engage. And I also consider the mentorship that these students or youth can also gain from experienced people is also very important because they need a guidance and also like foundations and also examples of how can they develop their ideas. So thank you.

Moderator:
Thank you very much, Jeri. So while low digital health literacy is a challenge for all populations, it’s also particularly harmful for marginalized communities. So in this section, we’ll discuss strategies for addressing health equity and the digital divide in the context of digital health. So let’s start this off with Ms. Gerilyn again. So in light of the session’s focus on health equity and the digital divide, could you share your thoughts and elaborate on specific policy measures and initiatives that Microsoft is advocating for or actively participating in to bridge the digital divide and promote equitable digital health access? And also how is Microsoft addressing barriers faced by diverse populations and how are these efforts contributing to advancing health equity? Over to you.

Geralyn Miller:
Yeah, thank you very much for the question. So I want to respond to, in this context to some of the comments that Dr. Gupta and Ms. Carr mentioned and really shine a light on the concept of artificial intelligence, generative AI, and what we at Microsoft call responsible AI as an example of policy. So one of my favorite quotes in this area is a quote by our Chief Legal Officer and President, Brad Smith. And I’m gonna paraphrase a quote I don’t have exactly, but Brad has a quote that basically says that when you bring a technology into the world and your technology changes the world, you bear a responsibility as a person that created that technology to help address the world that the technology helps create. And so from a Microsoft perspective, we look at this under the lens of something that we call responsible AI. Our responsible AI initiatives date back far before the birth of the chat GPT and generative AI and large foundation models and large language models, really back to about 2018, 2019. And we have a set of principles that we’ve established that are around how you design solutions that are worthy of people’s trust. So these are our principles, what we call our responsible AI principles. There are many people who have different principles around responsible AI. I’ll share with you ours. I would just offer that it’s something worthy of thought. And very often when I work with academic medical centers or healthcare providers who are starting to use AI or build and deploy AI models, I also offer to them, hey, you should have a position on responsible AI, right? Do your thought work, do your homework. You should have something that is consistent with your own values, your own entity’s values. And, but going back to, from a Microsoft perspective, what we believe those principles are. The principles are really based on fairness. So treating all stakeholders equitably and not making sure that the models themselves don’t reinforce any undesirable stereotypes or biases. Transparency. So this is all about AI systems and their outputs being understandable to relevant stakeholders. And relevant stakeholders in the context of healthcare means not only patients who may be receiving the output of this, but also clinicians who may be using these as decision support tools or to do some type of prediction. Accountability. And so people who design and deploy AI systems have to be accountable for how the systems operate. And I’m gonna do a click down on accountability in a second. Reliability. So systems should be designed to perform safely, even in the worst case scenarios. Privacy and security, of course, that goes, those are underpinnings behind any technology and AI systems as well should protect data from misuse and ensure privacy rights. And then inclusion. And this is all about designing systems that empower everyone, regardless of ability, and engaging people in the feedback channel and in the creation of these tools. And there are some things I will drill down a little bit on the inclusion front as well. So when you, an example, as I mentioned of the accountability, I’d like to share some things that are, President Brad Smith was offering when he testified before this, the U.S. Senate Judiciary Subcommittee. This was back in the beginning of September, around September 12th, on a hearing entitled The Oversight of AI, Legislating and Artificial Intelligent. So Brad highlighted a few areas that he is suggesting help shape and drive policy. One is really about accountability in AI development and deployment. Things like ensuring that the products are safe before they’re offered to the public. Building systems that put security first. Earning trust. So this is things like provenance, technology, and watermarks so people know when they’re looking at the output of an AI system. Disclosure of model limitations, including effects on fairness and bias. And then also really channeling research, energy, and funding into things that are looking at societal risk associated with AI. He also suggested that we need something called, what he terms safety brakes for AI, that manages any type of critical infrastructure or critical scenarios, including health. And when you think today, we have collision avoidance systems in airlines, we have circuit breakers in buildings that help prevent a fire due to, for example, power surges, right? AI systems should have safety brakes as well. So this involves classifying systems so you know which ones are high risk. Requiring these safety brakes. Testing and monitoring to make sure that the human always remains in control. And then licensing infrastructure for the deployment of critical systems. And then from a policy perspective, ensuring that the regulatory framework actually maps to how these systems are designed so that the two flow together and work together. So that’s an example of the policy in action side of things. And from a Microsoft perspective, we put our responsible AI principles that I mentioned into action through our commitments at a policy level. Our voluntary alignment, for example, here in the US out of some of the things coming out of the White House. So voluntary alignment with commitments around safety, security, and trustworthiness of AI. And on one last point, I did wanna go back to the responsible AI principle and talk about inclusion. And so we’re doing some work from a Microsoft perspective in the health AI team that I am a product manager on to really look at how, when we have data that guides models, and this is either custom AI models or when we’re grounding large foundation models or large language models with data, how do we make sure that we understand the distribution and makeup of that data to ensure that their bias doesn’t creep in from the data perspective? And we’re also doing work, for example, on the deployment of models. How do you understand if models are performing

Moderator:
as they intended?

Geralyn Miller:
How do you monitor for something called model drift? So when models start to perform in a manner that isn’t how you think, right? When the accuracy starts to decline, and then what do you do when the models don’t perform that way? And this last part, the model monitoring and drift is some of the things that we have happening out of our research organization. So thank you. Thank you very much, Ms. Cherilyn.

Moderator:
So now I want to move back to Ms. Debbie. Drawing from your experience in developing the digital strategy for a major telco in South Africa, how can telecommunication companies play a more significant role in advancing health equity and bridging the digital divide through innovative approaches and digital solutions? And also, what lessons can be learned from your work in South Africa that can be applied globally to improve digital health access? Thanks.

Deborah Rogers:
I think one of the most interesting examples of how mobile network operators have really had a big impact on in decreasing any inequities around health is the Facebook Free Basics model. You may not know what that was, but Facebook basically put together simple information through what looked like a little Mobi site. And this was essential information that they felt everybody should have access to. And they work with mobile network operators to zero rate access to only that portion of Facebook, just that portion, not to everything, but just that portion. And they were able to show that by providing essential information that is free to access, they were able to improve people’s literacy and use of data. So they then went on to use more data and to use the internet more often and therefore become more valuable customers to the MNOs. So by doing something like providing free access to essential information, there was also an increase in profit for the mobile network operators. And I think that’s a really interesting model to look at. I think very often we forget that it’s just as important for mobile network operators to be reaching as many people as possible as it is for those of us who are trying to improve health through something like digital health. And so if there are aligned priorities, then there are very good ways that you can work together. One of the ways that we’ve worked with mobile network operators in South Africa has been to reduce the cost of sending messages out to citizens of the country. And that’s been done not in a way that prohibits the mobile network operators from making a profit, but what it does do is it makes it completely free for the end user. So if it’s completely free for the end user, you’re reducing the barriers for them to be able to access this kind of information. But the reduced cost is then something that can be brought to the table because of the increased size of access. So the more we scale out these programs, the more we’re able to see economies of scale, and the more worthwhile it then becomes for mobile network operators to engage with us. And so one of the very interesting models that’s been used was to reduce churn. So if people can only access information, say using a MTN SIM card, they’re less likely to switch to other SIM cards if that’s the case. And so being able to align the health, the desires of a health, digital health organization or government with those of mobile network operators is incredibly important for being able to ensure that you’re working towards the same goal, but without anyone asking for any handouts because that’s not going to work. I think when it comes to strategies for decreasing inequity, I think the one that we really need to talk about more is about being human-centered. And that doesn’t just mean designing for people and occasionally having them attend a focus group. It means designing with them and ensuring that the service is actually something that they want to use, something that they love using. Make it easy and intuitive for them to use. No one starts a course on how to use Facebook before they use Facebook. We shouldn’t create services that need so much upscaling. We should create services that are simple and easy for people to use. You need to use appropriate language and literacy levels. And this is something that the medical fraternity often forgets about because it is a very patriarchal society. Make it something that is at least close to free for people to access. We find that access to a mobile device is less of a problem than the cost of data, for example. So just because somebody has access to a device doesn’t mean that they’re going to be able to go and look up information because they may not have data on their phones. So you can work very closely to reduce the cost or make it zero cost. And that’s really going to ensure that you reduce the barrier to access. And then you really have to try and think about the system that you’re in. By creating a digital health solution, are you overburdening the health system that already exists, for example, or are you reducing the burden on it? Are you creating feedback mechanisms that mean that you can understand what the impact is that you’re having on the system itself rather than working within a vacuum? Are you making sure that where a digital health solution may not be accessible to somebody, there is an alternative in place that does not rely on the digital health solution? We can’t just operate within silos. We have to think about the fact that digital health is just as much a part of health infrastructure as the physical facilities, for example. Until digital health is seen as just as much of an infrastructure, it’s going to be a fun project on the side and not something that’s going to have some systemic change. And so it’s really important for us to think about that system. And then recognizing biases, I think Geraldine mentioned this, very often the people who are creating digital health services are not the people that are using the digital health services. So this goes back to why human-centered design is so important, but it’s also important to understand that you will be introducing biases if the people who are building the system are not the people who are using the system. And so you have to look more systemically. Look at the makeup of your team. How diverse is the makeup of your team? I would assume, having been an electrical engineer myself, that it’s probably not particularly representative from a gender or race perspective. So look at the team that you have. How are you working to make your team more representative and therefore address some of the biases that are going to be put in place by having a non-representative team building up the systems? So there’s a bunch of things in there, but I guess in summary, build for the end user in mind, make it human-centered, make it easy to use, appropriate, and intuitive. Design with the understanding that you work within a system and make sure that you don’t have unintended consequences and that you’re always feeding back to understand what the impact on the broader system is. And ensure that you think about the biases that are going to be inherent in the fact that the people building the system are not necessarily the people using the system.

Moderator:
Thank you very much, Ms. Debbie. And now moving on to Professor Gupta. So based on your background in advising the Health Minister of India and drafting national policies, how can governments play a pivotal role in addressing the intersection of health equity and the digital divide, particularly in the context of healthcare access for marginalized communities, and also what policy measures should be prioritized to ensure equitable digital health access?

Ravindra Gupta:
Thank you, Connie. Thank you, Connie. This depends on the economic status of the country. So when you have a LMIC country like India, so I’ll give you example was what was done. So we understand that there is a sizable population which is underprivileged, which is marginalized. So there was a scheme that was launched for 550 million people, and you have to understand that countries are at different phases of development and they require investments on infrastructure, they require investments on health and education, and it’s not possible to give the amount that the sectors actually deserve. So what was done very carefully since I was in drafting the health policy, I played a role in that. So we carefully treaded the path of saying, let’s first make primary care a comprehensive primary care. So first guarantee primary care. So that’s comprehensive, that includes chronic disease management to all the things. Then let’s convert the sub-centers and primary centers into health and wellness centers and put telemedicine as a part of it. So what happens is 160,000 health and wellness centers now across the country offer you telemedicine. Then we created a e-Sanjeevani program, which is a telemedicine program, which is you can get a doctor consultation for free. So that is across specialties. That’s why it’s at 120 million consultations. And now what’s going to happen is we’re putting in AI and NLP in that. So given that India has 36 states and people talk different languages, their dialects are different. So a person’s talking from a southern state to a doctor in northern state will hear like his language when he speaks and the doctor will hear in his language when he listens to the patient’s problem. So I think India has planned its strategy for addressing the vulnerable and the underprivileged sections as it charts its course of development. One is that integrate technology in the care delivery right from the primary care. So that has proven, as I said, 460 million health records, 550 million people given insurance, which is of a very decent amount, I would say, which a typically middle class would afford. So on the policy side on digital health, India has, as we speak, is probably the largest implementation of digital health in the country that is happening. And I would bring here one point that the government has not only to take the stewardship, but also the ownership of investing in digital health. Debbie would understand it very well that digital health is still figuring out the business model. That’s why you see the largest companies have withdrawn digital health and as much they can give talks on the forum, but their investments are on futuristic technologies, which are probabilistic technologies. But the companies that forayed into it years ago don’t exist on the map. So I think governments have to play a frontal role on investing like Indian government has done. They set up a national digital health mission, rolling it across states, ensuring that everyone has what you call the Ayushman Bharat Health Account number, ABHA number. And we actually will be probably the first country to work towards what I have championed that let’s work to make digital health for all by 2028. And this for those who work in healthcare and more so in public health. 45 years back in Almaty, we promised health for all by 2000. It’s 23 years after the deadline that we are still not close to that. At least we can champion digital health for all by 2028. If that is one objective we pursue as governments across the world, I think a lot of issues will get addressed because there is a whole lot of planning that will go into doing that. And it’s doable. That’s the only way you can address the issue of health equity. Because the practical part is that doctors who study in urban areas do not want to go to rural areas. They will not. I mean, even if you push them to do, they will find a way to scuttle that. But the only way you can do is you can get technology into their hands with the mobile phones. I think now the systems are fairly advanced. Tomorrow we are hosting a session on generate the conversational AI in low resource setting. So you can have chatbots interacting with people, addressing their basic problems. And 80% of the problems are routine, acute problems. So I think we need to leverage technology not only as a policy, but as a program. And there are best practices available. I think India has, parts of Africa have, but these are like islands of excellence. I think forums like these are good to discuss if they can be mainstreamed into islands of excellence to center of excellence. And we can replicate them and scale those programs. So I think India probably would have a good story as we speak about scale up of digital health program. But again, the key point is that the federal government has to be the funder for the program. And where do you start is health helpline. If you really want to address the inequities, start a health helpline, which people can pick the phone, talk to a doctor or a paramedic and get a consultation free of cost. Get into projects like East and GV, which I think the country is offering to other countries as a goodwill gesture, is where you connect to district hospitals and tell doctors to allocate time for doing digital consultations. So these programs actually help you bridge the digital divide. And health and wellness centers, a phenomenal experience of under $60,000 health and wellness centers which have telemedicine facility. So I think picking up the queue, I would say it’s time for implementation. For policy-wise, I think we all know that. I think that we very clearly said it’s getting integrated. And in fact, I go a further line and say, if you’re not into digital health, you’re not into healthcare. Don’t talk healthcare. That’s the truth, actually.

Moderator:
Thank you. Thank you very much, Professor Gupta. And finally, Tijari, drawing from your experiences in speaking about youth in cyberspace and internet governance, how can young advocates actively participate in shaping internet governance policies to ensure that digital health resources are accessible and equitable for all, regardless of socioeconomic status or geographic location? And also, what are some successful examples of youth-driven initiatives in this context? Over to you.

Yawri Carr:
Thank you very much. Well, in the realm of youth in cyberspace and internet governance, empowering young advocates to actively shape internet governance policies is crucial for ensuring equitable access to digital health resources. So young advocates can play a transformative role in policy discussions by engaging in many ways, such as participating in the IGF, because with this active participation, we start to break the ice in how to discuss, how to have dialogues, how to ask questions, and all of these activities, even though they are seen as very daily for experienced people, for youth, this is, yeah, ways to break the ice and to gain confidence in how to participate in public debates. And they also get insights into current challenges and opportunities in digital health governance. Second, for a formation of youth coalitions, young advocates can form coalitions or networks dedicated to digital health equity. And these coalitions can amplify the collective voice of young people advocating for policies that prioritize accessibility and inclusibility in digital health. For example, we have the Inter-Society Youth Group, or we have regionally different youth initiatives, and a chapter about digital health could also be open so that coalitions in this specific topic can deepen into these kinds of topics. Also, third, it would be engagement with multi-stakeholder processes. So not just the IGF, but also in other kinds of processes that are led by governments, NGO, or industry stakeholders. And their participation ensures that diverse voices contribute to shaping policies that consider the needs of all. And it is also important that in this circumstance, so public sector and industries and NGOs can also open this kind of opportunity for youth and that they actively seek for youth that could participate into their processes as well. Because if they don’t do it in such a direct way, so youth, as I mentioned before, they could feel intimidated and think that they are not experienced enough to participate. The fourth, youth-lead policy research. Young advocates can initiate research projects to understand the specific challenges faced by marginalized communities in accessing digital health resources. Because evidence-based research can be a powerful tool for advocating target policy changes. And I think this is something that it is a situation, it is a possibility in many countries that have the resources for research, but it is still very behind in countries, for example, in Latin America, where we don’t have so much support from public foundations or from the government to do research. And we also don’t have like so big research focus in our university. So I think maybe one professor can bring this kind of perspective that can inspire the students to make a research group for example, universities in Brazil, they have like student groups in which they meet some day of the week or some day monthly, and they discuss specific topics. So I think this is a good practice so that youth can start to create, that they can start to discuss and that they can start to bring this university and to other colleagues and classmates. Of course, it would be great if some countries could also start to help other global South countries in order that they can have more research and that the students can participate more in these kinds of initiatives in their own countries. Also innovation hubs for digital health. So for example, in which hubs in which young innovators, healthcare professionals and policy makers can create solutions together. In this sense, it would be also good to have a funding from an organization or a company that can also collaborate so that these kinds of innovations at the end can also maybe have like starting a month of financial resource so that they can start with this kind of innovation and that youth can feel that they are able to become innovators in this kind of field. But also I think that this kind of innovation address gaps in digital health accessibility. And some kind of examples of youth driven initiatives are for example, digital health task forces because in several regions, youth led task forces focus on creating policy recommendations for integrating digital health into broader intergovernance frameworks. Also youth led data privacy campaigns in which youth can also for example, create dialogues in various communities and they can provide awareness about the importance of robust data privacy measures in digital health technologies that people and common patients can also understand why it’s important to protect their privacy when they access some kind of digital health tool. And global youth hackathons for health in which there are health challenges that can develop on innovative apps and platform addressing specific healthcare needs that are specifically related in the communities of these youth. And I also consider another action. It’s this movement also of paid internships that students can also have access to internships that are paid so that they can equally participate in a practical application of what they are learning at university or what they are studying. So, well, I think that by actively participating in these initiatives, young advocates contribute with fresh perspectives, innovative solutions and commitment to digital health equity in internet governance policies because they are digital natives and they also could. I consider they could understand rapidly how the technologies can help them, but also their challenges, their issues, and they can also become more active as they are not just the future, but also the present. So, thank you. Thank you very much, Jari.

Moderator:
And also, thank you once again to the panel for their responses. And so now we’ll move on to the Q&A session. So, if any on-site participants would like to raise their questions, please feel free to walk up to the mic. Okay. Hello, I’m Nicole. I’m a Year 2 student in Hong Kong.

Audience:
In case of another pandemic like COVID-19 nowadays, how do you think the current digital health can be developed and improved and contribute to the society in recovering and ensuring each individual can receive the accurate and same medical advice and treatment without physically visiting a healthcare facility as it will be crowded with a lot of people or elderly. Thank you.

Deborah Rogers:
Thanks. I think actually looking at some of the work that was done during COVID-19 is a really good example of how we can use digital health to address issues that come up during a pandemic. I think one of the things that has really been a challenge in the work that we do is that we speak directly to citizens and empower them in their own health. Given that the medical fraternity is quite patriarchal, that’s not usually a priority. What we found is that when an issue is something that happens to somebody else, then it isn’t seen as a need to provide people with the right information. But when COVID-19 happened, everybody was affected. Nobody had the information. It didn’t matter if you were the president of the country or if you were a student at a high school. No one had the information about the pandemic that was needed. So we were able to use really large-scale networks, things that were already there like Facebook, like WhatsApp, like SMS platforms, to be able to get information to people extremely quickly. In a time when the information was changing on a daily basis, this wasn’t something where you could take a lot of time, think through things and put up a website and think about how things are going to be talked about. This was happening in real time. So you continually had to be updating things. People continually had to get the latest information. And without that, many more people would have died than did already in the pandemic. I think what’s important, though, is for us not to forget the lessons of COVID-19. We very quickly forget, as human beings, when things go back to so-called normal, we very quickly forget the lessons that we learned. And so I think one of the really important things that needs to continue from COVID-19 is an understanding that knowledge is power in the patient or citizen’s hands. And this isn’t something that needs to be hoarded by the medical fraternity, that by giving information to people at a really large scale, you can improve their health and you actually make your life easier at a time when you are most needed. Digital health can’t replace a healthcare professional, but it certainly can reduce the burden for healthcare professionals. And so that’s a really important thing that we need to continue to consider as we move on from COVID-19. I think the other thing to remember is that we built up platforms, digital health platforms, that solved problems during COVID-19. Screening for symptoms, for example, gathering data that could be used for decision-making, sending out large-scale pieces of information to people. Many, many people in the digital health space reacted very quickly and created incredible platforms that could be used to solve the problems during COVID-19. Many of those no longer exist today. And so we need to remember that there needs to be an investment in digital health infrastructure in the long term so that we don’t have to spin up new solutions every time there is a new pandemic, because there will be another one. It’s not something that is going anywhere. So how are we preparing so that when the next pandemic comes, we’re not having to start from scratch all over again? And I think that’s something that we very quickly have forgotten.

Moderator:
I want to take a minute and address that as well, if you don’t mind.

Geralyn Miller:
A couple of things, I think, from the pandemic, and that’s a really great question, because as a society, we want to learn from the past. There’s two areas where I think are worthy to bring forward from the pandemic. First is that there is an incredible value in these cross-sector partnerships. So in public, private, and academic partnerships, we seek to light up research on understanding the virus to do things like drug discovery. Some of this was governance-sponsored consortium. Other were more privately-funded consortium. And then third class was kind of just similar groups of people coming together, what I would say almost community-driven groups. So really this cross-sector collaboration, that’s the first thing. Second thing is there is some good standards work that I think was done during the pandemic that could be brought forward. So we saw the advent of something called smart health cards during the pandemic. Smart health cards are a digital representation of relevant clinical information. During the pandemic, it was used to represent vaccine status. So think of it as information about your vaccine status encoded in a QR code. There has been an extension of that, something called smart health links, where you can encode a link to a source that would have a minimum set of clinical information. And it’s literally encoded in a QR code that can be put on a mobile device or printed on a card for somebody to take if they don’t have access to a mobile device. Smart health cards also reinforces the concept of some of the work being done by the IPS, or International Patient Summary Group. It is a group that is trying to drive a standard around representing a minimal set of clinical information that could be used in emergency services. And so some of those things that happened in the standards bodies I think were very powerful during the COVID-19 pandemic and I would love to see more momentum around driving those use cases forward and also expanding them. Thank you.

Moderator:
Thanks. Firstly, another COVID shouldn’t happen. That’s first.

Ravindra Gupta:
Second, I don’t think that technology at any time failed. Actually, it proved that it was ready. So whether you looked at the fast-track development of vaccine, which was collaborating researchers across the globe for technology. Repurpose drug use, artificial intelligence. That’s why we did it. I think almost every country, our country used COVID app. We delivered 2.2 billion vaccinations, totally digital. So I think digital health proved that it was ready. It is ready. Challenges will come, but I think technology is the only one that saved the life. We wouldn’t be sitting in this room, trust me, if technology wasn’t around. The only thing that we should do through forums like this is to keep the momentum going. What we want is to forget the COVID and go back to the old ways. I think there were incentives given by the government. There were flexibilities offered in terms of continuing the telehealth regulations like in the United States. I think that should become permanent. That’s all we should do. So technology has already proved that it’s ready. We were waiting for COVID to be shaken and start using it. So I think technology is ready, will always be ready with us for anything that comes our way. Thank you.

Yawri Carr:
Geri, would you like to provide a response? Yeah. I just wanted to say that I consider that in this situation of a pandemic, telemedicine and also the implementation of robots as the case that I mentioned previously are of a huge importance and could also be very useful taking into consideration that it’s very dangerous for humans to attend or to take care of people because of the contagious possibilities or risks. So I think that in these specific scenarios, the application of telemedicine and robots is particularly useful. Of course, taking into consideration that it’s an emergency, that the robots should not be working alone. They should also be guided by humans, but at least they are protecting also that workers such as nurses that are commonly workforce are not so valued in different societies because the tasks that nurses do, for example, are normally considered as dirty or not of a great importance. So I think, actually, these kind of technologies can protect not just the health of the patients that are infected by COVID or other pandemic, but also the work of the medical professionals such as nurses that are normally very exposed. And in the other side, I also remember the initiative of Open Science that my country, Costa Rica, actually had proposed to the World Health Organization so that the initiatives, the projects, and the research that was done in a context of a pandemic is opened and that also is kept available for every person that’s interested. And the data can also be accessed without having to pay, without having to make a patent of that. And I consider this also of extremely importance because in a case of an emergency, we just don’t have time for that and we should really try to cooperate within each other and to try to respond to the emergency in a holistic and collaborative way. Thank you.

Moderator:
Thank you very much to the panel for your responses. Are there any other on-site questions? If not, then I’ll take the question from the chat. So what are some emerging trends and future directions in digital health literacy? And what do you suggest to individuals to stay informed and up-to-date in this rapidly evolving field and ensuring they have the accurate guidance and outdated information?

Ravindra Gupta:
I’ll take that because of the couple of initiatives we are running. So one is on the technical community side. What we are doing is, within the health parliament that I run with my team, we have created co-labs. We are creating developers for health, working with companies like Google and others because I think what we need to do is to create developers to solve problems. So that’s one initiative where people who are enthusiastic about being part of the technical contributors to digital transformation of health, that’s one. The other thing, in the next three months, we’ll be starting courses for class 8 students on robotics and artificial intelligence, an elementary course. We want to educate them very early on so that they can choose what they want to do. They will be aware on what the opportunities are. And same way, we are doing courses which are very elementary level for people to understand rather than going to deep dive into tech. And everyone who is into health, I would strongly recommend that if you don’t know digital health, you will hit a zone of professional irrelevance. Please update. Whatever you do, whether you do a one-week course, two-week course, just make sure that you know digital health from an ecosystem perspective. Thank you.

Moderator:
Would any other speaker like to take the question?

Geralyn Miller:
Yeah, just a few comments on that. I think it’s always a challenge at the pace of innovation that we’re seeing today to keep current. So I want to call out and acknowledge our panel here today and the people who put the panel together today and gave us this opportunity. This is one way that the dialogue starts and that information is shared. And so more opportunities for people of similar interests to come together, I think will always help advance the state of where we’re at from an understanding perspective. So opportunities like this, training as well. I know, and it’s not just training from tech providers, it is just training infused into the academic system as well. And so I would agree with what Dr. Gupta said there. But again, a call out to the folks who put together this panel because I think this is one way that that starts. Thank you.

Moderator:
Thank you very much, Ms. Geraldine. So we have about five minutes left. So maybe we could go with the closing remarks from each of the speakers. Maybe starting with Ms. Debbie.

Deborah Rogers:
I guess my closing remark would be that technology is a great enabler. It can actually be used to decrease the inequity that we see in health, but also in digital literacy. I am actually very positive about the future that we see with digital health. And I think Dr. Gupta is right, the technology is ready. We’ve seen many case studies where things have been done at a really large scale. This is no longer a fledgling area. This is now a mature and really large scale area of practice. And so I’m really excited to see what happens from this point. And I’m excited to see that we have youth involved in this panel because yes, absolutely, youth will be the people who will be building the next evolution in this space. So really excited to see how that works and to see how things evolve from here.

Ravindra Gupta:
I think I would say that in this age where patients are more informed, if not than anyone, about health conditions, about the treatment options, it is high time doctors know them before patients start telling them. You don’t know about it? Let me tell you this. I saw this. So I think, one, this is that digital health is something that everyone who is into healthcare, whether it is a clinician or a paramedic, needs to learn this. Second, if you’re talking about digital health, scalability, scalability comes first. So I think continuously upscale, cross-scale yourself.

Geralyn Miller:
And lastly, I must say thanks, Connie, for putting up this wonderful panel discussion. Ms. Sterling? Yeah, first off, I want to start by expressing my gratitude for being included in this. It was a wonderful opportunity. I want to echo the sentiment that youth play a huge role in this going forward, and I’m very appreciative that you brought everybody together under this umbrella. The thing from a tech perspective, I agree with the panelists on that, you know, digital health is here now. The one part that I would add to this is that when we’re thinking about things new, evolving technology like generative AI, let’s do this in a responsible way, open the dialogue around policy discussion. A discussion is always healthy, and let’s make sure that this technology that we’re bringing to light, with good intent, benefits everyone. Thanks.

Yawri Carr:
Well, and in my case, well, in conclusion, let us strive to be digital health leaders equipped not only with technical skills, but also with a profound commitment to equity. I consider value the work of nurses is very important, even though the technology evolves. Of course, professionals, humans will be very necessary, and it is a fact that technology can help us to protect them and also the patients in situations of emergency and also value of the work of ethicists when they have something to say that they are not misvalued, that they can take into consideration and also when there are conflicts with, for example, profits, so that ethicists can also have an opinion of that and that they can also try to contribute in the mission of responsible AI, so that they are not just there as a decoration, but they are actually taken into consideration. And also, well, of course, the role of youth is fundamental. As we see, all the youth-led initiatives that could strengthen the mission of digital health literacy nowadays can, in the future, so develop in a very good environment that it’s inclusive, that it’s including marginalized communities and all the population. So I consider that now health care and digital health care should not be more a privilege, but also a right. And yes, I’m very thankful also for the opportunity to be here and to express my opinions and to talk about youth as well. Thank you very much.

Moderator:
Thank you very much once again to the panel for your insightful responses, and the workshop has closed today. Thank you very much for coming, and together we hope we can create a future where digital health resources are accessible, equitable, and can empower individuals to navigate their health journey confidently online. Thank you. Thank you. Thank you. Thank you. Thank you.