Equi-Tech-ity: Close the gap with digital health literacy | IGF 2023

Man Hei Connie Siu

The speakers at the discussion highlighted the persistent disparities in access to care, despite the progress made in digital health. They argued that digital health has not necessarily improved health equity and mentioned two key factors contributing to this issue: the digital divide and low digital health literacy.

The digital divide refers to the gap between those who have access to digital technology and those who do not. This divide disproportionately affects disadvantaged communities, including low-income individuals, rural populations, and marginalized groups. As digital health relies on technology, those without access are unable to benefit from its potential advantages. This creates a further divide in healthcare, perpetuating existing health inequalities.

Low digital health literacy is another barrier to achieving health equity. Many individuals lack the necessary skills and knowledge to navigate digital health information and services effectively. This can prevent them from accessing healthcare resources, making informed decisions, and actively participating in their own care. Addressing this issue requires comprehensive frameworks and assessment tools that capture and assess various dimensions of digital health literacy. By understanding individuals’ abilities and needs in this area, tailored interventions can be developed to enhance digital health literacy and bridge the gap.

Policy solutions were proposed as a means to bridge the digital divide and ensure that digital health truly advances healthcare outcomes for all. It was emphasised that these solutions should be inclusive and consider the unique needs and challenges faced by marginalized communities. By actively addressing these disparities, policymakers can promote equity and ensure that the benefits of digital health are accessible to all.

Throughout the discussion, the importance of promoting inclusivity and equitable access to digital health resources was stressed. It was highlighted that this not only requires action at the policy level but also requires advocacy for strategies that effectively address the unique needs of marginalized communities. By prioritising inclusivity and equity, digital health initiatives can contribute to reducing health disparities and improving overall healthcare outcomes.

In conclusion, while progress has been made in digital health, disparities in access to care persist. The digital divide and low digital health literacy contribute to these disparities, hindering efforts to improve health equity. Policy solutions, comprehensive frameworks, and tailored strategies are needed to bridge this divide, enhance digital health literacy, and promote equitable access to digital health resources for all individuals and communities. By addressing these issues, digital health has the potential to play a significant role in advancing healthcare outcomes and reducing health inequalities.

Audience

The current state of digital health needs to be improved in order to effectively handle future pandemics, according to experts. With the potential for another pandemic like COVID-19, it is crucial to address the shortcomings of the existing digital health infrastructure. The main concerns revolve around overcrowded healthcare facilities during pandemics, which can lead to increased transmission rates and overwhelmed healthcare systems. To mitigate these challenges, it is essential for individuals to receive accurate and timely medical advice and treatment remotely.

There is a growing need to provide accessible treatment and advice without physical visits, especially for vulnerable populations such as the elderly or those with underlying health conditions, who may face higher risks during a pandemic. The reliance on telemedicine and digital healthcare services has become necessary to ensure their safety and well-being.

The argument for improving digital healthcare in pandemic response is compelling. The current system falls short of meeting the demands and implications of a crisis like COVID-19. Enhancing virtual consultations, remote monitoring, and telehealth services would allow individuals to access medical advice, receive prescriptions, and monitor their health from the comfort of their homes.

Additionally, digital health should aim to provide consistent and accurate medical advice and treatment. The decentralization of healthcare during a pandemic can result in inconsistencies and disparities in the quality of care received by individuals in different locations. By standardizing and improving digital healthcare services, individuals can have confidence in the advice and treatment they receive, regardless of where they are located.

In conclusion, the current state of digital health needs to be improved in order to effectively handle future pandemics. The concerns over overcrowded healthcare facilities, the need for individuals to receive accurate and remote medical advice and treatment, and the importance of providing accessible healthcare for vulnerable populations all highlight the urgency of enhancing digital healthcare services. By integrating telemedicine and digital health into the healthcare system, it is possible to enhance access, ensure consistent care, and improve overall pandemic response capabilities.

Geralyn Miller

The analysis examines the perspectives of various speakers on topics related to health, technology, and social determinants. One key point is the importance of addressing social determinants of health to improve health outcomes. It is emphasized that social determinants, including economic policy, development agendas, and social policies, have a significant impact on health outcomes, contributing to around 30 to 55% of health outcomes. The argument put forward is that tackling these determinants is crucial for achieving better health outcomes.

Another important theme is the use of data and technology to understand and address health disparities. The Microsoft AI for Good team has developed a health equity dashboard that provides insights into disparities and outcomes. Partnerships between Microsoft and other organizations, such as the Humanitarian Action Program and Bing Maps, are highlighted as a way to map vulnerable areas. The argument is that data and technology play a crucial role in addressing health disparities.

The analysis also emphasizes the impact of partnerships on social determinants. LinkedIn’s Data for Impact program is mentioned as an example of a partnership that provides professional data to organizations like the World Bank Group. LinkedIn’s data has informed a $1.7 billion World Bank strategy for Argentina. The argument is that partnerships with various entities can have a significant impact on social determinants.

Additionally, the promotion of digital skilling is highlighted as a way to contribute to health equity. Microsoft’s Learn program offers free online learning resources, including role-based learning paths for AI engineers and data scientists. The argument is that digital skilling is important for advancing health equity.

Microsoft’s responsible AI initiatives are also highlighted, emphasizing their focus on fairness, transparency, accountability, reliability, privacy, security, and inclusion. It is crucial to ensure that AI systems and their outputs are understood and accountable to stakeholders, including patients and clinicians.

Furthermore, the analysis advocates for a policy of accountability in AI development, ensuring that products are safe before being released to the public. Brad Smith, Microsoft’s President, has testified in the US Senate Judiciary Subcommittee, stressing the importance of accountability and safe AI deployment. The argument is that technology creators should take responsibility for the impact of their technology.

The value of cross-sector partnerships is also highlighted, particularly during the pandemic. Different types of partnerships, including governance-sponsored consortiums, privately funded consortiums, and community-driven groups, have played a crucial role. The argument is that cross-sector partnerships are invaluable in addressing health crises.

Moreover, the analysis recognizes the importance of standards work during the pandemic. The use of smart health cards to represent vaccine status, the development of smart health links encoding minimal clinical information, and the efforts of the International Patient Summary Group in standardizing clinical information for emergency services are underscored. The argument is that the momentum around this standards work should be maintained and expanded.

The analysis also acknowledges the challenge of keeping up with the pace of innovation.

Additionally, it emphasizes the importance of gatherings and dialogue among people with similar interests for advancing in the field. It also advocates for the integration of technological training into the academic system.

In conclusion, the analysis highlights several key points relating to health, technology, and social determinants. It underscores the importance of addressing social determinants of health, utilizing data and technology to understand and address disparities, forming partnerships, promoting digital skilling, adhering to responsible AI initiatives, ensuring accountability in AI development, valuing cross-sector partnerships, acknowledging achievements in standards work during the pandemic, and addressing the challenges of innovation. It also recognizes the significance of gatherings and dialogue and the integration of technological training into the academic system.

Debbie Rogers

The analysis highlights the potential of mobile technology in Sub-Saharan Africa to improve health literacy, personal behavior change, and access to health services. In 2007, more people in Africa had access to mobile technology compared to the so-called global north or western countries. This demonstrates the widespread use and availability of mobile technology in the region. REACH’s maternal health program in South Africa has reached 4.5 million mothers, representing 60% of the mothers who have given birth in the public health system over the last eight years. The program has had several impacts, including improved uptake of breastfeeding and family planning.

Low-tech solutions, such as SMS and WhatsApp, can also empower individuals in their health. These low-tech solutions are highly scalable and can be designed with scale and context in mind. Given the ubiquitous nature of mobile technology in Africa, massive scale reach is possible, thereby increasing access to health information and services.

Additionally, designing digital health solutions with a human-centric approach and considering the larger system can enhance health literacy. By placing the human at the center and acknowledging their existence within a larger system, health literacy can be improved without widening the technology-related divide. Using appropriate language and literacy levels makes digital health services more user-friendly. Furthermore, making these services accessible for free or at a reduced cost decreases the barriers to access.

Ignoring the wider context and blindly implementing digital solutions can inadvertently increase the digital divide. It is important to understand the contextual understanding and the impact of these solutions on the existing system. Ignoring the wider context can lead to unintended consequences and exacerbate existing inequalities.

Addressing systemic issues is crucial for improving health in Sub-Saharan Africa. Currently, Sub-Saharan Africa has 10% of the world’s population, 24% of the disease burden, and only 3% of the health workers. Simply training more health workers without addressing these systemic issues will not improve the statistics and may even worsen the situation.

Telecommunication companies can play a role in promoting health equity and bridging the digital divide. The Facebook Free Basics model, for example, provides essential information that is free to access, and people who are given this free access to data then go on to use the internet more, making them more valuable customers. Collaborating with telecom companies to reduce message costs further enhances digital health access. As the reach of large-scale programs increases, the costs for telecom companies are reduced, benefiting both the companies and the access to health information for users.

Digital health solutions should work in harmony with the existing health system. Creating a digital health solution should not overburden the system, and feedback mechanisms are crucial to understand the impact of these solutions on the overall system.

Biases in creating digital health services can be reduced by having a diverse team. The biases that exist in these services are often a result of the people building them not being the ones using them. Having a team that is diverse in terms of gender and race can address these biases and ensure that digital health solutions are more inclusive and equitable.

During the COVID-19 pandemic, digital health played a crucial role in reducing the burden on healthcare professionals and empowering patients with information. Large-scale networks such as Facebook, WhatsApp, and SMS platforms provided quick and reliable information to people, proving the effectiveness and importance of digital health in times of crisis.

Long-term investment in digital health infrastructure is crucial for preparedness. Digital health platforms that served the needs during the pandemic may no longer exist and need to be maintained for future use. Another pandemic is inevitable, thus preparation is necessary to ensure a timely and effective response.

Technology can be utilized as a great enabler to decrease health inequalities and improve digital literacy. By leveraging technology, health services can reach marginalized populations and bridge the gap in access to information and services. Digital health is a mature field with the potential for large-scale implementation, as evidenced by numerous case studies of successful implementations.

There is excitement and a positive view towards the role of youth in the evolution of the digital health field. Engaging youth and integrating their perspectives can lead to innovative solutions and advancements in the field. This aligns with the broader goals of SDG 3 (Good Health and Well-being) and SDG 4 (Quality Education).

In conclusion, mobile technology, low-tech solutions, and digital health have the potential to significantly improve health outcomes in Sub-Saharan Africa. Designing solutions with a human-centric approach, addressing systemic issues, collaborating with telecommunications companies, and considering diversity can enhance the effectiveness and inclusivity of digital health services. The COVID-19 pandemic has further emphasized the importance of digital health in reducing burdens on healthcare professionals and empowering individuals with information. Long-term investment in digital health infrastructure and harnessing the potential of technology are vital for achieving health equity, reducing inequalities, and improving overall well-being.

Rajendra Gupta

The analysis highlights the importance of digital health training for various stakeholders in the healthcare sector. Firstly, it emphasises the need for policy makers to be adequately trained in digital health. The International Society of Telemedicine and E-Health, with memberships in 117 countries, is an influential body in promoting digital health training. Additionally, the World Health Organization (WHO) has established a capacity building department in 2019 to support policy makers in this area.

Moreover, it is essential for frontline health workers to receive affordable and accessible digital health training. In India, ASHA workers, who are the first responders in healthcare, will be provided with affordable £1 training in the next two months. This will enable them to effectively utilise digital health tools and technologies in their work.

Patients also need to be trained to use digital health technology effectively. They should be educated on how to open an app, use it, and understand privacy and security measures. The International Patients Union is actively involved in training patients to use digital technology, ensuring they can benefit from its potential in managing their health.

The analysis also highlights the role of governments in addressing health equity and the digital divide, particularly in low- and middle-income countries (LMICs). Governments, such as India, have launched initiatives to provide digital healthcare access to underprivileged populations. For instance, India offers free telemedicine services through 160,000 health and wellness centres across the country. Additionally, the government has rolled out 460 million health IDs with plans for 1 billion under the digital health mission. These efforts help bridge the gap in healthcare access and promote health equity.

A well-crafted policy and substantial government investment are deemed essential for the successful implementation of digital health programs. The Indian government, for instance, has established a national digital health mission and is investing in advanced systems like artificial intelligence and natural language processing to enhance telemedicine services. They are also rolling out the Ayushman Bharat Health Account number (ABHA number) to further support digital health initiatives.

Digital health is seen as a promising solution for health inequity and has the potential to bridge the gap between urban and rural healthcare service delivery. Technologies such as conversational AI and chatbots can offer basic health consultations for routine problems, while the creation of 460 million health records in India demonstrates the progress being made in digitising health information.

The analysis also acknowledges the role of technology during the COVID-19 pandemic. It highlights fast-track vaccine development through global collaborations and the use of artificial intelligence for repurposed drug use. The delivery of 2.2 billion vaccinations digitally through a COVID App further demonstrates the readiness of technology in responding to the pandemic.

The momentum of using technology in the health sector must be maintained, with government incentives and flexibility in telehealth during the pandemic playing a crucial role. Additionally, digital literacy is important for anyone in the health sector, with initiatives such as the Digital Health Academy collaborating with Google to create developers for health. Courses on robotics, artificial intelligence, and digital health are being developed to ensure that individuals at all levels of the healthcare sector possess the necessary skills.

It is further highlighted that those who do not understand digital health risk becoming professionally irrelevant. Therefore, it is crucial for healthcare professionals, including doctors, to stay updated on digital health developments to better serve informed patients.

The analysis points out that scalability is crucial in healthcare. This means that the ability to expand digital health initiatives and ensure they are accessible to all is of utmost importance in order to achieve the desired impact in improving healthcare delivery.

Overall, the analysis underscores the importance of digital health training for policymakers, frontline health workers, patients, and the broader healthcare sector. It highlights the role of various stakeholders, including private organisations, civil society, and governments, in promoting digital health literacy, addressing health equity, and bridging the digital divide. The analysis also highlights the potential of technology in managing healthcare, particularly during the COVID-19 pandemic. Moreover, it emphasises the need for digital literacy and scalability in order to maximise the benefits of digital health in the healthcare sector.

Yawri Carr

The analysis delves into several key topics related to digital health and technology. One of the main focuses is the Responsible Research and Innovation (RRI) Framework, which aims to harmonise technological progress with ethical principles. The framework advocates for policies that preserve digital rights and establish mechanisms of accountability. This is seen as crucial in guiding the development of digital health technologies, ensuring that they are ethically sound and aligned with societal values.

Ethical considerations in the development of digital health technologies are explored further. It is argued that in competitive environments, where efficiency, speed, and profit are prioritised, ethical concerns can be compromised. This tension between ethics and industry objectives highlights the need for a careful balance between technological advancements and ethical principles, ensuring that technology is developed in a responsible and sustainable manner.

The involvement of youth in digital health is highlighted as a significant factor in bridging the digital divide and enhancing digital health literacy. Youths can play a crucial role in the research process, ensuring that interventions are culturally sensitive and address the specific needs of their communities. Innovation challenges and mentorship programmes are seen as powerful tools for guiding youth in the development of their ideas. Additionally, digital health literacy programmes can be initiated to equip young individuals with the necessary skills and knowledge to navigate the digital health landscape effectively.

The analysis also emphasises the importance of youth participation in internet governance policies. By actively engaging in discussions and decision-making processes, young advocates can ensure equitable access to digital health resources. It is argued that youth coalitions can amplify their collective voice on topics such as digital health equity, ultimately driving positive change and promoting inclusivity in healthcare.

Innovation hubs are suggested as a collaborative platform where young innovators, healthcare professionals, and policymakers can come together to create solutions for digital health challenges. The involvement of supportive companies and resources can aid in filling innovation gaps and promoting meaningful advancements in the field.

During a pandemic, telemedicine and the implementation of robots are highlighted as crucial. Telemedicine enables the delivery of remote healthcare, minimising contact and reducing the risk of contagion for healthcare workers. Robots, on the other hand, can perform tasks considered dangerous or dirty, thus protecting the health of patients and medical professionals.

The analysis also supports the initiative of Open Science, emphasising the importance of open access to data and research. Costa Rica’s proposal for an open science initiative to the World Health Organization (WHO) is highlighted as a positive step towards facilitating collaboration and partnerships for the advancement of digital health technologies.

The role of technology in emergency situations is underscored in the analysis. It is argued that technology can help protect healthcare professionals and patients during emergencies, providing essential support and resources to mitigate risks and ensure effective healthcare delivery.

Finally, the analysis recognises the value of ethicists’ work and emphasises the importance of their active involvement in discussions about responsible AI. Ethicists are seen as vital in ensuring that the development and deployment of AI technologies align with ethical considerations and respect for human values.

In conclusion, the analysis provides a comprehensive examination of various aspects of digital health and technology. It highlights the importance of ethical considerations, youth engagement, innovation hubs, and the role of robots and telemedicine. The insights gained from this analysis further emphasise the need for responsible and inclusive development of digital health technologies, while recognising the value of collaboration, inclusivity, and ethics in driving positive advancements in the field.

Man Hei Connie Siu:
So, hi, everyone, both on-site and online. Welcome to our workshop titled Equity, Closing the Gap with Digital Health Literacy. My name is Connie. I’m a 22-year-old biomedical engineering student and also a United Nations International Telecommunication Union Generation Connect youth envoy with a passion for internet governance. So, in the next 85 minutes, we’ll be exploring how digital technologies have transformed healthcare, especially during the pandemic. However, despite progress, digital health has not necessarily improved health equity. Low digital health literacy and the digital divide are still persisting, 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. Geraldine 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 policymaking. 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 pathbreaking 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. Geraldine 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. Geraldine, over to you.

Geralyn Miller:
Yeah, great, thanks. And thank you for inviting me today to participate in this. So the lens I’m gonna take from this is really based on something that is known as social determinants of health. So I wanna 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% 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 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 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 datasets 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 out of 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 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 are localized in 23 different languages. So in summarizing, I just wanna say that we look at this 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.

Man Hei Connie Siu:
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 constraint settings? And additionally, how can partnerships between nonprofit 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?

Debbie 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 in health in Sub-Saharan Africa, we have 10% of the world’s population, 24% of the disease burden, and only 3% 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 healthcare, 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 a 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 that doesn’t widen the divide that many technologies already put in place.

Man Hei Connie Siu:
Thank you very much, Miss Devi. 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 health care scaling needs for digital health?

Rajendra Gupta:
Thanks, Connie. Firstly, I congratulate you for picking up this very important topic. And secondly, I’m a little worried for. for such a long question because after 5 p.m. almost like 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 E-Health. 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 a 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 and 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 policies take time to translate. I mean, people like Debbie would need people to help her 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, Rajen, 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 things flow down the line because government makes policies which get implemented as programs. So that’s one level of competencies that I’ve 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 who 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 have 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 one billion health IDs. Our health consultations, teleconsultations, have crossed 120 million. I think that is the first point, so I’m inverting the process from policy to let’s first have implementation. When the government rolls out at such level and scale, automatically, you will start feeling the need of trained people in this. I think this is one thing, but more than structured courses, it will be more of continuous upscaling 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. I think we need to keep that training as fluid and make it more as a continuous upscaling program for people across health care. We are not waiting for government policies. We are rolling out as digital. 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 post-graduate 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 upscaling 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, organizations 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 front-end 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 have not done justice to this topic. Thank you.

Man Hei Connie Siu:
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.

Yawri Carr:
Hello, everyone, dear organizers, participants, and guests. 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 of 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 and 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 that 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 the 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 taken in 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 unaccustomed to such arrangements, promoting a reconsideration of the layout. Also taking into consideration that these kind 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 kind 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 while the project is also aiming to develop a toolbox to facilitate implementation 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 a 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 faces 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 maybe 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, digital 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.

Man Hei Connie Siu:
Thank you very much, Jari. 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 our, you know, 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, you know, what he terms safety brakes for AI that manages any type of critical infrastructure or critical scenarios, including health. And, you know, 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 either 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 as they intended? How do you monitor for things, 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.

Man Hei Connie Siu:
Thank you very much, Ms. Cherilyn. 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?

Debbie Rogers:
Thanks. I think one of the most interesting examples of how mobile network operators have really had a big impact on 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. 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 out 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.

Man Hei Connie Siu:
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 health care access for marginalized communities and also what policy measures should be prioritized to ensure equitable digital health access?

Rajendra Gupta:
Thank you, Connie. This depends on the economic status of the country. So when you have an LMIC country like India, so I’ll give you an example of what was done. So we understand that there is a sizable population which is underprivileged, which is 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-centres and private centres into health and wellness centres and put telemedicine as a part of it. So what happens is 160,000 health and wellness centres now across the country offer you telemedicine. Then we created a eSangeevani programme, which is a telemedicine programme which is you can get a doctor consultation for free, so that is across specialities, that’s why it’s 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 talking from a southern state to a doctor in a 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, you know, 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 you know, we actually will be probably the first country to work towards what I have championed is that let’s work to make digital health for all by 2028. And this for those who work in health care and more so in public health. Forty-five years back in Alma-Ata, we promised health for all by 2000. It’s 23 years after the deadline that we’re still not close to that. At least we can, you know, 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, then 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. Where do you start as 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 Givni, 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. In fact, I go further line and say, if you’re not into digital health, you’re not into health care. Don’t talk health care. That’s the truth actually. Thank you.

Man Hei Connie Siu:
Thank you very much, Professor Gupta. Finally, to Jerry, 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, for example, 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 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 Internet Society. We have a 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 kind of topics. Also, third, it would be engagement with multi-stakeholder processes. So not just the IGF, but also in other kind 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-led 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 a hops in which a young innovators healthcare professionals and policymakers can create a solutions together in the sense, it would be also a 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 a youth can feel that they are able to become a 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 detail health task forces, because in several regions, you’ve let task forces focus on creating policy recommendations for integrating digital health into broader internal governance frameworks. Also, you’ve led data privacy campaigns in which youth can also, for example, create dialogues in various communities, and they can make provide awareness about the importance of robust data privacy match measures in digital health technologies that people and common patients can also understand why is important to protect their privacy when they go to a when they access some kind of detail a health tool and a global youth hackathons for health, in which in there are health challenges that can develop on innovative apps and platform addresses specific healthcare needs that are in. Yeah, specifically related in the communities of these youth. And I also consider in another action. It’s a this movement also have paid internships that in students can also have access to internships that are paid so that they can equally participate in in a practical application of what they are learning at university or what they are in our sitting. So, um, well I think that by actively participating in these initiatives in active 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 understand. I consider they could understand a rapidly a how the how the technologies can help them but also their challenges, their issues and they can also in become more active as they are not just the future but also the present.

Man Hei Connie Siu:
So thank you. Thank you very much Jerry 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 onsite participants would like to raise their questions, please feel free to walk up to the mic.

Audience:
Hello I’m Nicole, and my YouTube student in Hong Kong. In case of another pandemic like covert 19 nowadays. How do you think the current digital health can be developed and improve 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 facilities as it will be crowded with a lot of people or elderly. Thank you.

Debbie Rogers:
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. And so what we found is that when an issue is something that happens to somebody else, then there isn’t. It isn’t seen as a need to provide people with the right information, but when covert 19 happened, everybody was affected, nobody had the information. It didn’t matter if you were the president of the of the country, or if you were a student at a high school, no one had the information about the pandemic that was needed and so we’re able to use really large scale networks and things that were already there like Facebook, like WhatsApp, like SMS. platforms to be able to get information to people extremely quickly, and 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. 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 citizens’ hands, and this isn’t something that needs to be hoarded by the medical fraternity. 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. 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. 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 you know 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 saw a lot of that during the pandemic, literally 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 a 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.

Rajendra Gupta:
Thanks. Firstly, another COVID shouldn’t happen. That’s first. 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, what technology repurpose drug use artificial intelligence, that’s why we did it. I think almost every country, our country use COVID app, we deliver 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, we’ll always be ready with us for anything that comes our way. Thank you.

Man Hei Connie Siu:
Jerry, would you like to provide a response?

Yawri Carr:
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 that is 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 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. 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. The data can also be accessed without having to pay, without having to make a patent of that. 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.

Man Hei Connie Siu:
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. 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?

Rajendra Gupta:
I’ll take that because of the couple of initiatives we are learning. 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 CoLabs. 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 next three months, we’ll be starting courses for class eight 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 have doing courses, which are very elementary level for people to understand rather than going to deep dive into tech. So 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 ecosystem perspective. Thank you.

Man Hei Connie Siu:
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 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, you know, training as well. 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.

Man Hei Connie Siu:
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.

Debbie 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.

Rajendra Gupta:
I think I would say that in this age where patients are more informed, if not, you know, than anyone about health conditions, about the treatment options. It is high time doctors know them before patients start selling 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 health care, 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. And lastly, I must say thanks, Connie, for putting up this wonderful panel discussion.

Man Hei Connie Siu:
Ms. Jolin?

Geralyn Miller:
Yeah, first off, I want to start by expressing my gratitude for being included in this, it was a wonderful opportunity. I wanna 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, 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, yeah, 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 in 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, a profit so that ethicists can also have a 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 that youth led initiatives that could strengthen the mission of digital health literacy. Nowadays, can in the future, so developed in a very good environment that it’s inclusive, that it’s included marginalized communities and all the population. So I consider that now healthcare and digital healthcare should not be more a privilege, but also a right. And yes, and I’m very thankful also for the opportunity to be here and to express, Yeah, my opinions and to talk about youth as well. Thank you very much.

Man Hei Connie Siu:
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 so much. Okay bye. Bye bye. Bye bye. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you.