While digital technologies have immense potential to advance precision public health among diverse communities around the world, they also present a myriad of challenges to researchers, scholars, policymakers, frontline workers, and individuals alike.
At a panel session on “Harnessing Digital Technologies to Advance Global Precision Health and Development,“ co-hosted on June 23rd by Stanford Center for Population Health Sciences, the Department of Epidemiology & Population Health, and the King Center on Global Development, moderator Stephen Luby (Stanford Medicine) expressed the importance of considering AI and machine learning tools within their larger contexts, especially as we approach major public health problems such as the COVID-19 pandemic. “As enamored as we are with big tech and AI, we still need to work within the broader political and social ecology of public health if we are going to advance towards a solution.”
Embracing the potential of AI/machine learning to promote precision public health and equity
Each panelist introduced some of the inspiring and impactful work being done by their organizations at the intersections of digital technology and precision public health.
Keynote speaker Brigitte Gosselink presented a couple of current projects she and her team at Google.org, Google’s philanthropic arm, have undertaken in collaboration with other organizations to ensure that all people can benefit from AI, advanced analytics, and digital technologies. One example was Makerere University’s AirQo project, which represents an innovative approach to reducing the significant number of deaths attributable to air pollution in Africa. AirQo researchers designed low-cost, solar-powered air pollution sensors and installed them on buildings and motorcycle taxis in Uganda in order to generate forecasting data that can be shared by mobile app and used by governments and schools to inform policy and ensure public safety. The AirQo team is currently considering how a similar approach might be applied in other African countries.
Manisha Bhinge recounted the ways the Foundation, a non-governmental organization, has used data and analytic tools (specifically frontline technologies, visualization technologies, and systems that analyze/generate data through remote sensing means, such as satellites and GIS technology) to accelerate progress on the world’s greatest public health challenges. While Bhinge reflected on the various applications of data driven by tech in precision population health, particularly in the fields of sexual and reproductive health, maternal health, under-5 health, and communicable disease, she emphasized the importance of keeping our eyes on the bigger picture: “The tools and the technologies are important, but the purpose and the outcomes that we want to drive are paramount.”
Stanford biologist Giulio DeLeo presented his team's work on fighting Schistosomiasis, a debilitating parasitic disease of poverty, endemic in 74 countries in tropical and subtropical regions and affecting more than 200 million people worldwide. They found that targeting both the freshwater snails serving as intermediate hosts for the parasite that causes infection and their habitat would be necessary to remove the environmental reservoir of the disease. DeLeo and colleagues deployed simple automated drones with cameras to capture the field site where they were working to visually identify suitable habitats for the snails that amplify the parasite. They soon began employing systematic drone mapping, taking hundreds of images and tracking vegetated habitats where the snails thrive. To track habitat on much larger geographical scales, they integrated drone and satellite imagery by using machine-learning techniques and algorithms, and, along with their research partners from Politecnico di Milano (Italy), used mobile phone data to investigate how people’s movement contributes to disease transmission.
Assessing the challenges to precision public health presented by digital technologies
While their presentations spoke to the tremendous benefits of using digital technology to push the needle towards precision population health, the panelists agreed that the challenges encountered by researchers, scholars, and healthcare workers while pursuing this work are numerous and daunting.
All of our panelists described significant information gaps, and the substantial ways these gaps undermine public health response. The panelists reflected on how the COVID-19 global pandemic, and the devastating crisis in India, have highlighted the need, not just in India but across the globe, for increased infrastructural support, more varied and effective communications channels, and more vital information about virus variants and case location. This lack of information has had devastating system-wide effects for diverse populations, including for healthcare providers working in hospitals and also for family members caring for their sick loved ones.
Community engagement and operating at scale were two more challenges faced by our panelists in their efforts to advance public precision health and equity through technological (and other) means. Luby summarized these challenges in the following terms, “as enamoring as these technologies are, the hard work of convening the groups to come together to actually move this forward so we can make progress in one place and then do that in a way that is scalable, are issues we are still working on.”
Put another way, the questions of how to get vital information into the hands of those closest to public health problems, how to successfully take on the challenge of getting all interested parties (especially community leaders) to sit at the same table, and finally how to scale up technical solutions so they can impact more parts of the world are not simple to answer. In spite of the inherent challenges, the panelists agreed that population public health absolutely depends upon successful community engagement (at all stages of addressing a problem and implementing a solution, including data collection and analysis) and scaling-up solutions in an equitable way.
On the future of digital technologies and precision public health
Though our panelists are working in different industries (big tech, NGO, and academia) and from diverse disciplinary perspectives, they are aligned in their sense of hope that digital technologies can drive equitable solutions to the world’s biggest precision public health problems.
For De Leo, trained in disease ecology and mathematical modelling, this great potential might be realized in the field of infectious diseases, especially in developing effective treatments against environmentally transmitted (waterborne, soil transmitted and vectorborne) diseases. “In precision public health, there is untapped potential for precision mapping of transmission hotspots for environmentally transmitted diseases, which would allow us to fine tune environmental and medical interventions when they are most needed and effective. This can be done successfully when the ‘old fashioned’ and much needed laboratory and field work in parasitology and disease ecology is integrated with the super-power of digital technology.”
For Gosselink and her team at Google.org, working to make AI-enabled solutions available to more organizations and more communities is a priority. She shared recent collaborative research that pointed to innovative approaches to designing, implementing, and distributing point-of-care diagnostic tools, communications tools that lean into language differences, and agricultural yield prediction tools as especially promising at this point in time.
Looking to the future, Bhinge and her colleagues at The Rockefeller Foundation believe NGOs have a vital role to play in pulling together early warning systems that could have substantial benefits for parts of the world especially affected by the COVID-19 pandemic. This work would entail driving precision approaches, especially around virus variants, and strategically evaluating the bioinformatics capabilities in affected countries so early warning systems can be more tailored and effective.
Dr. Luby closed the event with a message of confidence in the work being done by each of our presenters and their collaborators, “I am really encouraged by the forward thinking of all our panelists who, from different perspectives, see ways they as individuals and as groups can contribute.”