“Health goals, for example, the promise of more rapid and accurate diagnosis and treatment, are often cited as an underlying rationale for the rapid growth of artificial intelligence. But, in practice, without stronger AI governance the profound inequalities and human rights issues in global health risk being amplified.

“The foundations for future AI governance will be laid in the next year, at high speed. Health and human rights experts and advocates urgently need to be part of the conversation and to raise the three following concerns.

  • “Whose security are we prioritizing? Real-world AI-related harms are disproportionately experienced by women and minority communities in high-income countries, as well as by many others in low- and middle-income countries who lack a voice in U.S. or UK tech governance. The familiar critiques apply to AI governance when it comes to reinforcing colonial inequalities: focusing narrowly on protecting wealthy countries from pandemics originating in the rest of the world; and ignoring equally critical and urgent needs of those dealing with weak health systems in the Global South, who are locked out of access to vaccines and more. In many countries with draconian cybersecurity laws, the digital securitization discourse has itself become a cause of insecurity for those targeted by police and authoritarian states. We need to demand digital security for all, not only for elites.
  • “The spectre of self-certification by corporations for AI governance ought to ring loud alarm bells in global health. We have been here before, recently and embarrassingly: The State Party Self-assessment Reports countries dutifully completed for pandemic preparedness led the U.S. and UK to rank themselves highly, only to perform abysmally when they were tested in reality by COVID-19. Any self-certification process for AI safety must have independent review by experts, real social accountability mechanisms to enable communities to have a voice at every level of AI governance and whistle-blower mechanisms to enable anyone to raise the alarm when AI systems cause real-world harms.
  • “Meaningful participation in AI governance. Given the rapid pace of AI development, Open AI rightly notes that laws and policies created now may not be fit for purpose a few years from now and may need repeated iterations. But how will this include robust and democratic community voice at every level? AI critic Timnit Gebru warns, “I am very concerned about the future of AI. Not because of the risk of rogue machines taking over. But because of the homogeneous, one-dimensional group of men who are currently involved in advancing the technology.” In global health, we have already experienced the lopsided influence of the private sector, private foundations, and interested donor states in multi-stakeholder platforms—and we will see this repeated in AI governance without pressure for truly democratic and inclusive governance, with a strong voice for communities and civil society to resist exploitative tokenism and promote meaningful participation in governance.

“In the Digital Health and Rights Project, an international consortium for which I am principal investigator, we are establishing one potential model of transnational participatory action research into digital governance that includes democratic youth and civil society participation from national to international levels.

“In the 1980s, AIDS activists around the world mobilized to demand a seat at the table in clinical trials and in global health governance mechanisms. That movement reshaped the global health landscape and saved millions of lives.

“Today we need to demand a voice in support of strong human rights and global health protections in AI governance.”

This essay was written in November 2023 in reply to the question: Considering likely changes due to the proliferation of AI in individuals’ lives and in social, economic and political systems, how will life have changed by 2040? This and more than 150 additional essay responses are included in the report “The Impact of Artificial Intelligence by 2040”