The Risk to Population Health Equity Posed by Automated Decision Systems: A Narrative Review
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Artificial intelligence is already ubiquitous, and is increasingly being used to autonomously make ever more consequential decisions. However, there has been relatively little research into the consequences for equity of the use of narrow AI and automated decision systems in medicine and public health. A narrative review using a hermeneutic approach was undertaken to explore current and future uses of AI in medicine and public health, issues that have emerged, and longer-term implications for population health. Accounts in the literature reveal a tremendous expectation on AI to transform medical and public health practices, especially regarding precision medicine and precision public health. Automated decisions being made about disease detection, diagnosis, treatment, and health funding allocation have significant consequences for individual and population health and wellbeing. Meanwhile, it is evident that issues of bias, incontestability, and erosion of privacy have emerged in sensitive domains where narrow AI and automated decision systems are in common use. As the use of automated decision systems expands, it is probable that these same issues will manifest widely in medicine and public health applications. Bias, incontestability, and erosion of privacy are mechanisms by which existing social, economic and health disparities are perpetuated and amplified. The implication is that there is a significant risk that use of automated decision systems in health will exacerbate existing population health inequities. The industrial scale and rapidity with which automated decision systems can be applied to whole populations heightens the risk to population health equity. There is a need therefore to design and implement automated decision systems with care, monitor their impact over time, and develop capacities to respond to issues as they emerge.
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