Code & Conscience #011

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In this Issue

I discuss the interrelationship between technology and health. Why it's raising eyebrows, its advantages, ethical dilemmas, and how tech leaders/engineers need a better approach to ethics.

The Role of Technology in Public Health

2020 was one of the weirdest years of my life, but to be honest, I feel it was a weird year for all of us. Besides sitting in our houses or hustling for toilet paper, the COVID-19 pandemic ushered in a new way of implementing technology in public health. We saw healthcare workers, patients, and everyday people use technology to learn about the health crisis, manage patient treatment, and curtail outbreaks.

After the pandemic, we still see technology being adapted in newer ways to improve the healthcare sector. For example:

1. Telemedicine/Telehealth: By using telecommunications technology, patients can get quick access to medical care, especially in remote areas. This reduces the cost of multiple visits, the spread of contagious diseases, and is convenient for the elderly.
2. Vaccine Uptake and Distribution: Vaccine Connect is a digital platform developed by the Public Health Agency of Canada (PHAC) to provide logistical support for the administration, surveillance, and reporting of vaccines. Other countries adopted similar versions to share educational materials, electronic consent, reminder systems, and predictive algorithms to forecast demand and minimize wastage.
3. Wastewater Monitoring Systems: After its success in providing early warning signals for pathogens like polio and gastrointestinal diseases during the COVID-19 pandemic, it is now being used in Canada to monitor antimicrobial resistance (AMR), tuberculosis, and substance use.
4. Artificial Intelligence (AI): AI is increasingly being integrated into healthcare, especially for patient diagnosis and treatment. For example, predictive analytics can analyze large datasets for patterns and risk factors associated with diseases, then try to predict and manage outbreaks. AI also assists medical professionals in analyzing images for disease conditions, and Generative AI (GenAI) helps inform patient monitoring using text, images, audio, and video.

Ethical Dilemmas and Concerns

Despite the clear and arguably outstanding benefits of integrating tech with public health, it has raised some eyebrows:

1. Bias in AI: According to research co-authored by Fay Payton, AI algorithms used in healthcare can perpetuate biases and blind spots, particularly for Black and Latinx patients. This results from training data that fails to incorporate the cultural backgrounds and daily living circumstances of patients of color. Another contributing factor to bias is the lack of representation among AI developers in medical research.
2. Privacy Concerns: Preserving patients' information is a major challenge when integrating technology with public health. Patients' data are prone to cyberattacks and leaks during transmission or processing. So there’s also a need to train healthcare providers on data privacy, software/hardware use, and security.
3. Widening the Digital Divide: Approximately 37% of the world’s population lacks access to technology. With wider adoption of telehealth, more people could be excluded from healthcare, especially if there isn’t a deliberate plan to include them. The disabled population can also be adversely affected.
4. Data Sovereignty: For Indigenous communities, concerns about data sovereignty remain critical. With data records scattered across multiple jurisdictions, it is difficult to ascertain who owns the data and what their rights are. This becomes even more complicated when the data is used by global intervention communities.
5. Increased Bottlenecks: A pilot program by the Centers for Medicare & Medicaid Services, starting in January 2026, will test using AI for prior authorizations in traditional Medicare. Introducing this could delay or deny care and undercut one of the immense benefits of traditional Medicare.
6. Public Health Dilemmas: The health sector is riddled with challenges, making it harder to build effective tech solutions. Just this year, CDC staff staged a massive walkout in protest of US Health Secretary RFK Jr.’s anti-vaccine policies, Florida removed school vaccine mandates for children, and UnitedHealthcare’s CEO was k!lled—allegedly over algorithmic bias in healthcare denials.

The deeper you look, the more complicated the use of tech in public health gets. We’ve seen incidents of public health workers spreading misinformation and disinformation on social media (especially on TikTok), disease surveillance systems misallocating resources, and algorithmic bias reinforcing medical discrimination. Another big question is, “Will we still have human healthcare workers?”

Simply put, the integration of technology in any sector will always raise eyebrows, with the highest probably in healthcare. That is why the advocacy for ethics can never be overemphasized. We must get this right!

As tech leaders and engineers, we must stop seeing ethics as an unnecessary bump in the road when shipping solutions.

Whether you’re creating for the health sector or not, you need to see ethics as essential, not just a checkbox.

Around the Web

📖 How State Tech Policy Can Promote Health Information Integrity: Lessons Learned from the COVID-19 Pandemic by Jennifer John and David Scales​

📖 Transforming Healthcare: Why Innovation Alone Isn’t Enough by Shikha Gupta

📖 HHS Asks All Employees to Start Using ChatGPT by Jason Koebler​

▶️ Watch on YouTube: The Importance of Women’s Health Data by Sheena Franklin​