On 4-5 June 2020, the Global Health Centre of the Graduate Institute, in collaboration with the Centre for Sustainable Healthcare Education (SHE) of the Faculty of Medicine at the University of Oslo, jointly convened an online workshop on digital tools, artificial intelligence (AI), health and human rights. The workshop brought together over 40 participants, including academic researchers from Europe and the US, international civil society leaders, the tech sector, and UN officials to explore the risks and opportunities raised by the rise of these new technologies.
The deployment of digital technologies for health holds enormous potential as a catalyst for the attainment of the health-related Sustainable Development Goals (SDGs). The timing of the workshop coincided with the ongoing COVID-19 pandemic, which is accelerating the use of digital tools, as well as drawing attention to the potential pitfalls they raise. The workshop, initially planned to meet in person, was moved online in response to the crisis.
Digital health is the field of knowledge and practice associated with any aspect of adopting digital technologies to improve health, from inception to operation. Digital health also encompasses such emerging areas as the use of advances in computing sciences, big data, genomics and AI to advance health outcomes, including the use of biometric data for public health surveillance. The potential impact of such technologies is broad in the application of these technologies. The workshop thus responded to several emerging white papers, reports and strategies from UN agencies and experts. For example, the WHO draft Global Strategy on Digital Health 2020 – 2024 emphasizes its vision of digital health technologies ‘that allow people to manage their health more effectively, improve caregiver-patient communication and monitor the impact of policies on population health’. The 2018 World Health Assembly Resolution on Digital Health urged countries to:
"prioritize, as appropriate, the development, evaluation, implementation, scale-up and greater utilization of digital technologies, as a means of promoting equitable, affordable and universal access to health for all, including the special needs of groups that are vulnerable in the context of digital health".
At the same time, workshop participants noted, WHO and other new global health agency strategies have yet to fully clarify how they intend to apply human rights standards or ethical standards to their work, including the UN Guiding Principles on Business and Human Rights, and concerns and recommendations raised by the High Commisioner for Human Rights and UN Special Rapporteurs in 2019 in regards to transparency and accountability of the state’s applications of digital technology to health, privacy concerns, algorithmic biases in artificial intelligence, and the expansion of state surveillance, among others. Speakers raised concerns about weak national governance of relationships with the private sector, and limitations on individual autonomy and meaningful informed consent; researchers showed that even when people appear to “opt out” of mobile phone surveillance, their data may still be gathered and shared without their knowledge.
As workshop participants argued, while new technologies and artificial intelligence present significant opportunities to expand access to health services in developing countries, these new tools also present real risks, especially to marginalized and criminalized populations affected by HIV and tuberculosis (TB) and to women and girls who must access sexual and reproductive health services (SRH) in contexts of gender inequality. Discriminatory laws and systemic inequalities fuel the HIV and TB epidemics. New tools such as biometrics and mHealth could enable marginalized peoples and women to be precisely pinpointed, creating heightened risk of targeting by state and non-state actors for stigma, discrimination, arrest or violence.
At the same time, participants also pointed to resistance to some of these expansive forms of surveillance. In Kenya, civil society groups are actively contesting the use of reproductive health mobile phone apps to track, identify and target women considering accessing legal and safe abortions. While some states, such as China, have raced to implement expansive forms of surveillance, there remains a lively public debate over the legality and appropriateness of, for example, facial recognition deployed in public subways. In Detroit and other cities in the U.S., civil society groups are empowering local communities to know what data is gathered about them by police and private companies, and to exercise individual data sovereignty rights by refusing to be tracked.
By bringing together over stakeholders and experts a broad range of institutions and fields we were able to discuss these issues with particular emphasis on opportunities, pitfalls, and the road ahead for digital tools, health and human rights. We identified gaps in research but also within legal frameworks, in community ownership of technology as well as gaps in the knowledge base needed both for human rights advocates and scholars alike who work on human rights and digital technology. The temporal gap between the tech industry and society at large oftentimes led to a disparity in knowledge and in conceptualization of potential uses and abuses of such technology. A key point made at the workshop was that more work needed to be done in order to identify knowledge gaps such that affected communities, scholars, and human rights advocates could educate one another about their respective fields (for instance, blockchain technologies, AI, or the role of civil society in global health governance) and advocate for equitable use of digital tools in order to ensure equitable health outcomes. Finally, a more overarching discussing was held in terms of data ownership and who owns our data, produced at the interface between technology, our bodies and health.
It was clear to all who participated that while the ongoing COVID-19 crisis has highlighted some crucial issues when it comes to human rights and digital technology and health, the impact that digital tools and artificial intelligence has and will have on our collective human rights in the future is only now being tentatively mapped. The workshop offered a space to discuss and reflect on these issues. While the constraints of an online meeting meant that we were only able to touch on the surface of these issues, we hope and will work to continue this dialogue between different sectors and actors. Core members of the planning group continue to map the road ahead and will develop further work on these issues. As we move forward we hope that we can expand upon the workshop and include more people into the discussion, while calling for more critical reflection upon the interface between digital technology, health, and human rights.