Building health systems capable of leveraging AI: applying Paul Farmer's 5S framework for equitable global health.

Journal: BMC global and public health
Published Date: May 2, 2025

Abstract

The development of artificial intelligence (AI) applications in healthcare is often positioned as a solution to the greatest challenges facing global health. Advocates propose that AI can bridge gaps in care delivery and access, improving healthcare quality and reducing inequity, including in resource-constrained settings. A broad base of critical scholarship has highlighted important issues with healthcare AI, including algorithmic bias and inequitable and inaccurate model outputs. While such criticisms are valid, there exists a much more fundamental challenge that is often overlooked in global health policy debates: the dangerous mismatch between AI's imagined benefits and the material realities of healthcare systems globally. AI cannot be deployed effectively or ethically in contexts lacking sufficient social and material infrastructure and resources to provide effective healthcare services. Continued investments in AI within unprepared, under-resourced contexts risk misallocating resources and potentially causing more harm than good. The article concludes by providing concrete questions to assess AI systemic capacity and socio-technical readiness in global health.

Authors

  • Liam G McCoy
    Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
  • Azra Bihorac
    Department of Medicine, University of Florida, Gainesville, FL USA.
  • Leo Anthony Celi
    Massachusetts Institute of Technology, Cambridge, MA, USA.
  • Matthew Elmore
    Duke Health AI Evaluation & Governance, Duke University School of Medicine, Durham, NC, USA.
  • Divya Kewalramani
    Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
  • Teddy Kwaga
    Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda.
  • Nicole Martinez-Martin
    Center for Biomedical Ethics, Stanford School of Medicine, Stanford, CA, USA.
  • Renata Prôa
    Imaging Research Center, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Joel Schamroth
    Faculty of Population Health Sciences, University College London, London, UK.
  • Jonathan D Shaffer
    Department of Sociology, University of Vermont, Burlington, VT, USA.
  • Alaa Youssef
    Department of Radiology, Stanford School of Medicine, Stanford, CA, USA.
  • Amelia Fiske
    Institute of History and Ethics in Medicine, Department of Preclinical Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany. a.fiske@tum.de.

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