Michael and Kimberly (host) discuss whether AI is good for healthcare; healthcare as a global system; radical shifts precipitated by the pandemic; why hype stifles nuance and innovation; how science works; the complexity of the human condition; human well-being vs. health; the limits of quantification; who is missing in healthcare and health data; the political-economy and material impacts of AI as infrastructure; the doctor in the loophole; the humility required to design healthy AI tools and create a resilient, holistic healthcare system. 

The digitalization of health care is currently subject to extensive hype (both negative and positive), which obscures its potential to benefit humanity. Science and Technology Studies have described the computational translation of health information as “datafication,” often from a critical stance in which such technologies limit agency of patients and clinicians. Conversely, health care has long since been structured along highly unequal lines with high levels of inequity, in which parts of the population experience reduced healthcare access. In addition, there are high levels of health illiteracy, where some groups are not only unaware of their own health needs or how to access health care, but the healthcare system is itself lacking key information on the needs of those individuals. In that context, digital systems able to handle and communicate large datasets are often heralded as a solution for better connecting patients and the healthcare system within a holistic model. To help bring much-needed nuance to our understanding of digital health care, the article looks to the example of digital dental health—both implemented and potential—within Skåne in Southern Sweden, with a mix of an advanced welfare model healthcare system combined with a diverse population consisting of many foreign-born nationals. By interviewing dental professionals working in Skåne, we investigate the intersection between the theoretical arguments and the practical constraints and opportunities for digital health.

This paper draws upon the theoretical literature on migration policy and health, and empirical data on three European states with differing welfare models - Sweden (social democrat), France (conservative), and the United Kingdom (liberal) - during Covid-19, to highlight the often hidden and contradictory politics through which refugees, asylum seekers, and undocumented migrants were forced to navigate during the most uncertain period of the pandemic. Although migrants' treatment during Covid-19 was generally better in Sweden with a social democrat welfare tradition, we see migration management priorities greatly undermining the extent to which welfare systems function overall for the benefit of population health. Furthermore, Sweden's recent political shift to the right exacerbates those negative tendencies. As the paper shows, there was considerable effort by civil society and local government to fill the gap where national governments failed to protect this group, stepping in to provide health information, and support.

Whilst artificial intelligence tools are already have significant impacts upon academic education, our starting point as scholars should always be to first ask: why do we provide academic education? The practices, values, and rationale contained in however you answer that question provide the guidelines by which to relate to AI. The Social Sciences and Humanities are comparatively well-placed in the ‘AI age’ because critical thinking, an area in which our subjects excel, is seen as one of the core human skills AI cannot automate. 

Whilst AI risks undermining the validity of many exams through enabling easier plagiarism, misuse of the technology most threatens our education wherever it accelerates loneliness and a disconnect between students and lecturers through replacing human communication. We therefore need to put new resources into building academic communities amongst students and lecturers.

Take-home papers as a form of examination are under threat but we still need to train students’ writing skills. Colleagues are now shifting to sit-down exams, but to protect writing skills we need time for in-person academic discussion to assess students’ learning, e.g. also if they’ve written a text. Increasing space for in-person academic discussion forms part of a bigger goal to build and strengthen our academic learning communities within each programme so students do not feel isolated and alone with AI.

All the Nordic states (except for Iceland at the time of analysis) have published a national artificial intelligencestrategy (NAIS) document. The NAISs provide a window through which to view a consolidated point where statesset out a socio-technical imaginary ostensibly focused on the impact of AI on the national society but, in so doing,communicate present-day value-laden assumptions. These future visions see an expansion in the scale and scope ofprivate-sector-driven AI applications in healthcare provision as inevitable, positive, and justified based on a promiseof efficiency. In so doing, the NAISs institutionalise a shift in how issues of participation, deliberation, and inclusionin health are structured in the future. The article asks what kind of ‘welfare’ the NAISs present for the Nordic regionwith respect to the governance, role, and ownership of AI healthcare. In so doing, it reveals how the NAISs providea vehicle by which to enable a paradigm shift in state–market relations that is, nonetheless, hidden from politicalscrutiny through its technological futurism

Trust in AI healthcare technologies is often treated as an obtainable end-state enforceable byregulation, in which developers can claim their product to be ‘trusted’. The article shows thelimits of this approach, arguing instead for a processual understanding in which trust isunderstood to be dynamic and forever a state ‘to come’. The argument is developed byconsidering several types of trust relations amongst key stakeholders in AI healthcare, includingwhere developers often distrust users. Drawing on political theory and Coactive Design, thearticle argues that trust relations as a negotiation are integral to a well-functioning designprocess that not only supports the moral acceptability of AI healthcare technologies but also theirinnovation and efficacy.

AI’s role in healthcare has been hyped both via utopian and dystopian narratives, with the latter often used to argue that the technology is the only saviour to a labour and cost crisis. The problem with hype is that it undermines the nuance and debate needed if we are to use this still-largely-speculative technology for societal good. Where such technology is dominated by big firms based far away, how can municipal care providers ensure sufficient control to maintain quality when using AI? What procedures and processes are necessary to ensure that the use of AI in, for example, care assessment decisions doesn’t erode basic values and democratic rights within the welfare model? In considering these questions, the talk will outline the key political and ethical issues faced when adopting AI in healthcare with a particular focus on the welfare model.

Health services and medical research are subject to growing use of ADM. Whilst such technology brings many benefits, it is important to understand that it is not just a tool but involves a more fundamental shift in the infrastructure through which healthcare takes place. Where that development is driven by the private sector, it also indicates a wider paradigmatic change in how healthcare is provided. To ensure that ADM in healthcare follows an equitable path that benefits humanity, it is necessary to begin asking critical questions as to the power relations through which it is taking place but also it maintains and strengthens as the technology becomes ubiquitous. The chapter expands on the notion of the everyday as a means for contesting the current elitist and exclusionary model of ADM in healthcare by drawing upon two other related but distinct approaches to the everyday-‘Everyday International Political Economy’ in which the everyday can sometimes take power through institutional and economic means, and Davina Cooper’s focus on ‘everyday utopias’ as a space in which actors can perform alternative ways of social and political being. An enriched understanding of the everyday provides a means to reimagine the automation of healthcare as a sphere for collaborative future-making that is much more equitable than the currently skewed economic model for global health.

The term ‘artificial intelligence’ has arguably come to function in political discourse as, what Laclau called, an ‘empty signifier’. This article traces the shifting political discourse on AI within three key institutions of global governance–OHCHR, WHO, and UNESCO–and, in so doing, highlights the role of ‘crisis’ moments in justifying a series of pivotal re-articulations. Most important has been the attachment of AI to the narrative around digital automation in human healthcare. Greatly enabled by the societal context of the pandemic, all three institutions have moved from being critical of the unequal power relations in the economy of AI to, today, reframing themselves primarily as facilitators tasked with helping to ensure the application of AI technologies. The analysis identifies a shift in which human health and healthcare is framed as in a ‘crisis’ to which AI technology is presented as the remedy. The article argues the need to trace these discursive shifts as a means by which to understand, monitor, and where necessary also hold to account these changes in the governance of AI in society.