Placing public interest – not Big Tech – at the heart of AI & health policies: Interview with Fanny Voitzwinkler and Elise Rodriquez from the Global Health Advocates (GHA)

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It’s not easy to navigate the intricate dynamics of the AI field, when AI is perceived as a silver-bullet for healthcare. And indeed, technology has enabled some remarkable breakthroughs. But it might (or might not) surprise you how corporate interests can get in the way of the public interest. This conversation with our grantee partner Global Health Advocates (GHA) will help you navigate this dynamic and hopefully leave you feeling more optimistic about supporting public interest voices in this space. 


Elise Rodriguez is the Head of Advocacy & Fanny Voitzwinkler is the Development Director at Global Health Advocates. They have both been working in advocacy roles for health and development NGOs throughout their careers.

Based in Paris and Brussels, GHA has been advocating to advance health rights for the past 15 years in France and towards the EU institutions.

 

EAISF: Your mission is to ensure that policies in France and Europe sufficiently address health inequalities. How does AI come into the equation and what prompted you to start working on AI and health?

In recent years AI has been portrayed by decision makers, industry and global health institutions alike as a silver bullet for improving health outcomes. It attracts considerable political attention and significant amounts of capital, as well as public funding, which requires scrutiny. Investments are shifting and as a civil society organisation we’ve been monitoring whether the use of taxpayers’ money (in several policy sectors),actually do improve health outcomes as claimed.  

In 2022, GHA and its Board decided to include the digitalisation of healthcare as one of its priority in its new 2022-2027 strategy, looking at the negotiation and then implementation of the European AI Act and the Digital Services Act in France. We have been facing very similar advocacy challenges in other key policy fields (Research & Development policies and Big Pharma, taxation of the financial sector, the privatisation of aid etc.) where there is a power imbalance between the corporate sector (private profit) and the State (public interest) and we’ve been keen to develop our capacity on Health & Tech since.

EAISF: What are some of the most common AI applications in healthcare and what impacts they have on people in care and future patients?

Today, AI is mainly used to help healthcare professionals facilitate diagnoses or analyses. Radiology is one of the first fields in which AI has been integrated, as algorithms have proved effective in reading medical images and detecting fractures or cancer. Other algorithms can be used to analyse patients’ medical records with a view to preventing certain diseases or improving the management and treatment of certain illnesses. AI can also be coupled with medical devices that enable patients to monitor their disease and for doctors to carry out this monitoring remotely. Finally, more and more hospitals and healthcare facilities are developing algorithms to organise patient care. These include, for example, algorithms for triaging emergencies or calculation algorithms for allocating transplants.

These AI systems have the potential to improve care, accessibility and quality for patients but also represent a risk to the health and rights of certain groups if they are not well designed and thought through. Indeed, algorithms may contain biases (ethnic, gender, age, etc.) that can lead to unsatisfactory results for certain parts of the population. For example, a diagnostic algorithm may be less accurate for women, people of colour or the elderly, depending on how it has been developed, leading to potential errors in medical management.  

EAISF: What capacity has the grant from the Fund unlocked for Global Health Advocates in the last 2 years?  Where have you been able to achieve the greatest impact? What have you found most challenging in doing this work?

We found it challenging that AI and the tech field can be quite technical and intimidating at first. Public interest is not at the heart of conversations on AI and health. There is a strong imbalance between the heavyweight Big Tech/Pharma lobbying to loosen the rules vs. civil society pushing for stronger regulation in the public interest. A rather ‘tech-solutionist’ political environment makes it difficult to voice our messages. France has put digital issues at the heart of its economic strategy with a particularly pro-business approach and competences residing with its Economic Ministry. Few voices outside civil society challenge the mainstream “start-up nation” narrative. France also has a very limited regulation appetite, with digital issues often being left to self-regulation by companies

We are proud of our campaign “Soignons nos Algos” [from French: “Heal our algorithms”] that presents concrete policy proposals to ensure optimal conditions for the development of a trustworthy AI in healthcare. The grant helped us emerge as the only NGO working at the intersection of health and technology, but also helped establish contacts with digital rights organisations and institutions in France. We now feel empowered to navigate this issue and hopefully provide important contributions to the health field. It also encouraged us to look at connecting topics such as AI and sexual reproductive health and rights, algorithmic pluralism but also disinformation in healthcare.

EAISF: Your advocacy on health equity and AI takes place mainly in France. What are some of the lessons that you would like to share with other health equity organisations and funders interested to support this work across Europe? 

The opportunity that we got with the support of the Fund to build our capacity has been unique and few donors give space for organisations to develop their knowledge before planning campaigns or developing projects. 

Funders already investing in digital rights advocacy should broaden their spectrum and help fund organisations in sectoral spaces (health, education, employment).The bridge between digital rights and other advocates need to be more actively built, cross sectoral coalitions need to emerge so that we can effectively participate and weigh in public debate. 

Our main lesson for health organisations who want to start tackling the issue would be: get out there, meet partners, digital rights advocates, even without expert knowledge, find a common campaign you can get engaged in to learn, participate and show your interest.

EAISF: Imagine the recently re-nominated President of the European Commission has 5 minutes to hear you out. What should she do in the next 5 years to make sure AI helps, not hinders access to healthcare?

We would remind her of her role as Europe’s top regulator. Competitiveness has always been a policy priority of the European Commission. Why not make it work for public interest in the coming 5 years… for a change?

We would encourage her to remain firm with tech giants in the coming legislature and ensure she will have civil society’s back in this endeavour. She should ensure Big Tech does not dilute any of the AI Act provisions in the subsequent negotiation of the AI Code of Practice.

We would encourage her to give a strong political signal when it comes to DSA enforcement and the regulation of Very Large Online Platforms. She should show the world how Europe is equipped to regulate the influence of Big Tech in our democracies, and tackle fake news, hateful content and disinformation online. She should encourage algorithmic pluralism and bust open the architecture of existing social media platforms.

EAISF: what books or podcasts on health and tech justice have you enjoyed recently?

The Limit podcast featuring David Chavalarias from the Institute of Complex Systems “Les réseaux manipulent-ils nos opinions?”. 

We also very much enjoyed Privacy International’s long read series on tech and health. It helped us a lot in wrapping our thoughts around the topic. The COVID19 Resource Hub developed by the EU DisinfoLab was absolutely brilliant to help us start working on disinformation and healthcare.

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