In the last few years, we have seen an explosion in the scale and scope of AI health, a trend only exacerbated by COVID-19. Due to the uptake of AI applications in health, the global health landscape has seen significant shifts. To help understand this development and how best to achieve the potential of AI health technologies, it is necessary to critically look at the global political economy through which AI health technologies are made possible. There is a need to see this political economy as embedded in the everyday relations through which healthcare functions. The everyday level of how patients and healthcare professionals engage with AI health technology is essential to knowing how these new tools can help tackle forms of discrimination and other obstacles currently preventing universal health coverage.

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.

Despite initial suggestions that the COVID-19 pandemic affected everyone equally, it quickly became clear that some were much worse affected than others. Marginalization—including poverty, substandard accommodation, precarious or no employment, reduced access to healthcare and other key public goods—was clearly correlated with higher rates of both contagion and fatality. For Sweden, COVID-19 inequality could be seen along clear racial and socio-economic lines, with some of the first high death rates seen amongst Somali communities, where individuals had contracted the virus through unsafe employment as taxi drivers transporting wealthier Swedes home from their winter holidays. At the same time, actors on the extra parliamentarian far-right in Sweden were quick to blame the country's relatively high per-capita fatality rate on persons born outside Sweden working in the healthcare and care home sector. Media frames affirming racial stereotypes grounded in cultural racism circulated across the ecosystem of alternative media in the country. In both healthcare and the media, we see growing forms of exclusion disproportionately affecting migrants. Such intertwined exclusions in Sweden, as the article argues, are a sign of a wider disintegration of Swedish society in which individuals lose trust in both the core institutions as well as across different parts of society. Drawing on Davina Cooper's understanding of the relationship between the state and other public institutions with individuals as based on “touch,” the article explores how exclusionary practices impact this relationship. Our key argument is that, whilst ostensibly such practices often most materially hurt minority groups (e.g., migrants), they are indicative of—and accelerate—a broader disintegration of society through undermining a logic of “care” necessary to sustain social bonds.

Migration management policies in many states have marginalized significant numbers of individuals on the basis of their precarious residency status, negatively impacting their health. This article looks at how three European states with high levels of contagion - France, Sweden, and the United Kingdom - adapted their migration management policies to the changed circumstances during the Covid 19 pandemic in which there was new pressure for prioritizing population health over other concerns. The analysis compares globally-recognized 'best practices' for migrant health during the pandemic with policies adopted by France, Sweden, and the UK - selected as prominent migrant-hosting states and that experienced high rates of Covid-19. The article draws on supplementary evidence through interviews with civil society organizations working directly with migrants living on the margins of society - what are termed here 'marginalized migrants' (MMs). As the article concludes, the national policies often fell below international 'best practices' such that migration management was often prioritized over population health despite the crisis. The perspective developed in this paper is important for understanding where migration control policies have been prioritized over public health.

Main Findings:

AI systems are increasingly being used to shift decisions made by humans over to automated systems, potentially limiting the space for democratic participation. The risk that AI erodes democracy is exacerbated where most people are excluded from the ownership and production of AI technologies that will impact them.

AI learns through datasets but, very often, that data excludes key parts of the population. Where marginalized groups are considered, datasets often contain derogatory terms, or exclude explanatory contextual information, that is hard to accurately categorise in a format that AI can process. Resulting biases within AI design raise concerns as to the quality and representativeness of AI-based decisions and their impact on society.

There is very little two-way communication between the developers and users of AI-technologies such that the latter function only as personal data providers. Being largely excluded from the development of AI’s role in human decision-making, everyday individuals may feel more marginalized and disinterested in building a healthy and sustainable society.

Yet, AI’s capacity for seeing patterns in big data provides new ways to reach parts of the population excluded from traditional policymaking. It can serve to identify structural discrimination and include information from those otherwise ignored in important decisions. AI could enhance public participation by both providing decision-makers with better data and helping to communicate complex decisions – and their consequences – to wider parts of the population.

Den här rapporten ger en sammanfattning av de seminarier som organiserades under våren 2021 av PHEDKommissionen för framtiden för hälso- och sjukvården efter covid-19, som bjöd in till vittnesmål från hälso- och sjukvårdspersonal, tjänstemän, tankesmedjor, forskare, civilsamhället och andra intresserade parter baserat på de erfarenheter de fått och lärt sig av under pandemin. De vittnesmål som framfördes kom från många olika geografska platser och många olika nivåer, vilket gjorde dem relevanta både för Sverige och globalt. De fastställer fera centrala rekommendationer för att skydda och förbättra folkhälsan. Dessa rekommendationer både kompletterar och i hög grad utökar de rekommendationer som togs fram i den första rapporten, som var mer fokuserad på Sverige (”Ojämlikhet i samhället gör oss sårbara för pandemier”) och baserad på vittnesmål från hösten 2020, och som kan nås via: https://phed.uni.mau.se/. Den stora mängd erfarenheter som sammanfattas här går långt utöver pandemiperioden och tillhandahåller idéer och praktisk vägledning för att skydda och stärka människors hälsa så att den blir mer motståndskraftig inför framtida kriser. 

This report summarises the Spring 2021 sessions of the PHED Commission on the Future of Healthcare Post Covid-19, which invited testimony from healthcare practitioners, civil servants, thinktanks, researchers, civil society, and other interested parties based on their experiences learnt during the pandemic. The evidence presented came from multiple geographies and levels, making it relevant both to Sweden and globally. It identifes several key recommendations for protecting and improving public health. These recommendations supplement and greatly expand upon those identifed in the report (‘Societal inequity makes us vulnerable to pandemics’) based on testimony from Fall/Autumn 2020, which can be accessed via: https://phed.uni.mau.se/. The wealth of experience summarized here goes well beyond the pandemic period, providing ideas and practical guidance for protecting and strengthening human health to be more resilient in the face of future crises.

This chapter compares health communication towards migrants living at the margins of society – undocumented migrants, asylum seekers, and refugees – within the different Scandinavian countries (Denmark, Norway, and Sweden), to understand the present state of health communication and its role in both strengthening and, where being unequal, segregating societal inclusion within the Nordic region. We know that such migrants often experience health challenges related not only to their migratory journey, but often caused by the precarious situation in which they are placed upon arrival in host countries. Past studies show significant challenges in obtaining care, and difficulties with communication, including cultural awareness. Where health communication fails to meet the needs of a diverse population, we see growing societal segregation that often follows racialized structures with long-term consequences for society.

This article focuses on the conflictual relations at the heart of what we call 'municipal contestation'. This global phenomenon sees cities and other local governments - sometimes together with non-governmental players - contest policies proposed or implemented by higher governmental authorities, which they perceive as threats to their policy positions or local communities. Bridging public policy studies and social movement theory, we develop a new typology identifying conservative, moderate and radical ideal types of municipal contestation. In addition, we explore the dynamics of contestation, with municipalities 'moving away' from the institutional status quo when they shift from conservative to more moderate and radical forms of contestation, or 'moving towards' the status quo when they find it difficult to sustain such action. The article illustrates this typology and contestation dynamics by drawing on case studies involving resistance to central COVID-19 restrictions in England; municipal opposition to carbon capture and storage in the Netherlands; and a European campaign against a proposed European Union-United States trade agreement. We conclude how this general framework can be applied, refined, and adapted for further comparative and longitudinal studies.

International guidance set forth recommendations to protect marginalized migrant populations during Covid-19 given the significant inequalities in terms of social and economic well-being reported in the literature. However, a cross-country study of three European countries with high rates of Covid-19 infections and deaths has shown that migrant well-being has significantly decreased since the outbreak of Covid-19 in Europe from March 2020 and that policy measures to help those marginalized populations have been insufficient. The conclusions on migrant well-being during Covid-19 draw on interviews with prominent civil society organizations in all three countries that work specifically on migrant health and welfare. All interviews were semi-structured and conducted between October and November 2020. The analysis mainly focuses on objective/material measures of well-being related to access to health care, information on prevention of infection, housing and exclusion by host population.