Creating The Future Of Health

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A joint commission appointed by The Lancet & Financial Times wants to explore how digital health technologies can help achieve the Sustainable Development Goals. The final report is expected later this year. I speak with Aferdita Bytyqi, Senior Coordinator of the Secretariat, to find out what we can expect from the initiative.

What was The Lancet & Financial Times Commission titled “Growing up in a digital world: Governing health futures 2030” established for?

This joint Commission, between The Lancet and the Financial Times, started as a novel partnership – bringing two very different co-conveners to focus on the cross-sectoral and multistakeholder impact of technology on our health and lives. Partnering with the Financial Times would enable the Commission to engage stakeholders beyond the health community and with the private sector. So, this was the first time that the Lancet had partnered in such a way.

This joint Commission Governing health futures 2030: Growing up in a digital world explores the intersections of digital, health, and youth transformations in a digital world.  We set out to consider the governance required to take advantage of the opportunities of AI and digital technologies for health, with special consideration for young people and those in LMICs.

But, as I said, this is how it started. The Commission has become much more than the delivery of a report. Across the institutions that our Commissioners represent and within our Secretariat, we see a lot of activity to support this report, from roundtable policy events, private sector convening to youth-led consultations to global communication campaigns. We hope that this work will accelerate collaboration, influence policy, thought, and act as a catalyst to bring change in this field.

Why was the project launched? What’s the goal and what does ‘2030’ in the title mean?

While there are a number of ongoing discussions about digital transformations in health and what this means for the delivery of healthcare, this project was launched out of a need to investigate the unique opportunities for and risks to children, young people, and future generations. We stopped to look at how digital technologies and data tools can improve the health of all people, especially the young and those in resource-poor settings. And how governance structures can be developed to keep up with the rapid pace of digital change.

Having said that, one of the main goals of this work is to raise awareness about the digital health rights of children online and the risks to health futures if digital technologies in health and health data go ungoverned and unequally distributed.

‘2030’ is in the title to reinforce the timeline of the Sustainable Development Goals and, particularly, Universal Health Coverage. We’re seeing that digital and internet access – and all that comes with it – is increasingly becoming a determinant of health and influencing other political, commercial, social, and environmental determinants of health. Decisions taken over the next ten years, including those with regards to the digital transformation across all areas of life, will impact future health and well-being.

How does the Commission work, and what’s the timeline of the project?  

The Commission is led by two Co-chairs, Ilona Kickbusch and Anurag Agrawal, 17 Commissioners, and the Secretariat, which support the delivery of this Commission report by the end of this year. We are further supported by our conveners and our partners. The team has worked together to perform a comprehensive literature review of existing work, build consensus around the main ideas and recommendations of the report, and pull it together into the powerful text we hope it will become. 

During the lifetime of the Commission, we have established new partnerships and reached out to numerous youth networks which will support the dissemination of the report’s recommendation and key messages. The project from inception to report launch is over 34 months. When we announced the Commission in October 2019 at our first Commission Meeting in Berlin, little did we know that Covid would accelerate the focus on digital health systems’ design and governance and how to ensure equitable governance models. Following the launch, we hope to engage across new and existing audiences and key stakeholders to disseminate the report’s messages and translate this policy into action.

The Commission report is peer-reviewed to the same rigorous standards as all Lancet content, and it will be launched in September 2021.

The Commission Launch at the Charité, Berlin. Left to right: Dr Rohinton Medhora (CIGI); Dykki Settle (PATH); Dr Soumya Swaminathan (WHO); Prof Ran Balicer (CLalit Research Institute); Prof Olivia Banner (University of Texas); Dr Naomi Lee (The Lancet); Nanjira Sambuli (Independent); Chris Fabian (Unicef), Prof Miranda Wolpert (Wellcome Trust); Dr Michael Adelhardt (GIZ); Heyo Kroemer (Charite); Dr Anurag Agrawal (Co-Chair); Prof Ilona Kickbusch (co-chair); Amandeep Gill (i-Dair); Dr Deborah Lupton (UNSW), Dr Andrzej Rys (European Commission); Aferdita Bytyqi (Sr Coordinator); Njide Ndili (PharmAccess Foundation), Dr Emanuele Capobianco (IFRC), Andy Wyckoff (OECD); Andrew Jack (The Financial Times).

In the introduction to the Commission, we can read that “governance models have not followed the pace of innovation.” How does the Commission want to change it so that digital and data tools will be incorporated in the design of health systems?

The Commission acknowledges that digital and data tools are already being incorporated into the design of health systems but that this is happening unevenly and without global governance. This poses a detrimental risk to human rights and health equity today, which will have generational implications. Our focus on young people and future generations aims to highlight these long-lasting implications further. How will health futures be shaped by new technologies and the plethora of data collected by digital devices? What groundwork must we lay now so that we safeguard future generations against these human rights and equity risks?

Our report is a signal to policymakers to think seriously about how they design and govern digital health systems – something that is inevitable but, still today, within our capacity to shape at global, regional, and national levels. In our work, we have learned that youth should be positioned to enquire and opine on the potential harms they may face now and in the future if governance models do not begin to meet the pace of innovation. We need a coordinated response if we are to bolster the 2030 Agenda on Sustainable Development further.

Are digital health and artificial intelligence understudied?

Absolutely. Despite all the hype, news interest, and reporting on digital health and AI, we lack a concrete evidence base to understand the impacts of digital health and AI on global health and well-being, particularly for vulnerable populations within and across countries. This is not to say that there isn’t emerging thought and academic theory in the field. However, much of these conversations and explorations are still occurring in an ‘epistemic bubble’ that risk exclusion of LMICs, women, youth, the elderly, and others. We need to grow our repository of case studies, support dialogue on the impacts of these technologies on our health and improve the digital health literacy of populations so that they are more equipped to engage. That’s one of the many reasons why this Commission has focused on extending beyond academia to the private sector and global youth themselves. We need to listen, and we need to engage all stakeholders.

The Commission is working on the report planned to be out at the end of 2021. What can we expect from the paper?

If all goes as hoped, expect it to start a new conversation about how we govern health futures, centering health and well-being for all, recommendations and key messages, and the leadership of youth. It is our hope that, through the report and our communication outreach, we will encourage widespread discourse on and a multistakeholder response to governing health futures.

Most importantly, you can expect to read the views, statements, and calls to action of youth, collected across surveys and consultation driven by partners like UNICEF, the Berkman Klein Center for Internet & Society, and by our very own youth team. We also hope to continue our research and to grow our repository of case studies globally.

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