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As AI and the 4IR transform healthcare, we must ensure the Global South doesn’t get left behind


Professor Tshilidzi Marwala is the seventh Rector of the United Nations (UN) University and UN Under Secretary-General.

Preventative medicine is as important as curative medicine, and data, including the geographical distribution of diseases and the physical activities of our people, is the new oil that can fuel medical care. At the same time, AI and 4IR technology developments in healthcare need to be affordable for the Global South.

Recently, I was appointed to succeed Peter Piot, the former head of Unaids, as a chairperson of the Africa Health Research Initiative (Ahri). This prompted me to reflect on the Sustainable Development Goals (SDGs), in particular the third SDG, on good health and wellbeing.

I reflected on the trajectory of the life expectancy of South Africans. In 1991, the life expectancy in South Africa peaked at 64 years and dropped to the lowest point of 53 years in 2005 and only recovered to the 1991 levels in 2019. In the same period, the life expectancy of Nigeria rose from 46 years in 1991 to 54 years in 2019 while the life expectancy of the UK rose from 76 years in 1991 to 81 years.

South Africa experienced a decline in life expectancy because of the HIV pandemic. Intriguingly, economic performance (GDP per capita) is closely correlated to life expectancy. In 2014, V Bilas, S Franc, and M Bošnjak argued that life expectancy is an indicator of economic and social development. Good health, the authors assert, improves education, reduces unemployment and leads to better living conditions.

Life expectancy is a good measure of a nation’s health and wellness. So any country that seeks to increase its life expectancy at the same time pursues the goal of good health and wellness. One of the mechanisms that can be used to increase life expectancy is to build health infrastructure, including clinics and hospitals.

In the developing world, including South Africa, the state of infrastructure, especially in rural areas, is appalling. The problems vary from unreliable water and electricity supplies to a lack of basic instruments such as the stethoscope.

In South Africa, we must bring the private sector, which is deemed world-class, into the public service. The much talked about National Health Initiative (NHI) will suffer the same fate as the other state-owned enterprises struggling with inefficiency, corruption, and a lack of talent. Competent people must be appointed to run our hospitals, and adequate budgets must be allocated to ensure that there are enough health workers, adequate infrastructure and a focus on maintenance. 

Another mechanism to ensure good health and wellness is to find a sound balance between preventative and curative medicine. Preventive medicine focuses on preventing the onset of a disease. For example, for type 2 diabetes, instead of focusing only on ensuring that insulin is available for those in need, wellness programmes that focus on exercising and a good diet can be implemented to prevent the onset of type 2 diabetes.

Curative medicine is the practice that solely focuses on curing diseases. Unfortunately, much of our medical training in South Africa is strong on the curative approach and weak on the preventative approach. At the University of Johannesburg (UJ), we intend to establish a graduate medical school that will take university graduates and put them in a four-year medical programme with a focus on preventative rather than curative medicine.  

Of course, key to prevention is to promote a healthy lifestyle, especially through physical activities. Programmes that encourage people to be physically active should be implemented throughout our communities.

I recently started skipping in the mornings and posting videos on social media to encourage others to do so. The uptake on this initiative was impressive, and it included people inside and outside the University. Our leaders in private and public services must be positive role models for wellness lifestyles. Wellness should be part of what is done in the workplace. At UJ, prior to the pandemic, staff and student fun walks were encouraged to promote a healthy lifestyle.

There are also smart solutions that can be deployed. Now that we are living in the era of the Fourth Industrial Revolution (4IR), “data is the new oil” that can fuel medical care.

Firstly, we need to gather as much health-related data as possible. This data should include the geographical distribution of diseases and the physical activities of our people. Such information should be factored into account when we craft health policies. Our health courses should also include health data analytics as a compulsory subject.

Elsewhere, we should implement early warning systems to predict the onset of diseases. Recent advancements in artificial intelligence (AI) offer a unique opportunity to build predictive systems in our health systems. AI is a technology that tries to create intelligence through the use of data, statistics and algorithms. It has been found to be effective in dealing with health-related issues. For example, it has been used to predict the onset of diseases such as diabetes, pulmonary embolism and HIV infection. It is a relatively cheap technology because it does not require a huge infrastructure outlay.

Another issue that we have to focus on to increase global life expectancy is the creation of affordable and appropriate technology. Much of the medical technology is inaccessible in the Global South because of the exorbitant costs.

For example, the X-ray computed tomography (CT) scanner ironically developed by the South African Allan Cormack is not readily available in the Global South. It is, therefore, important that companies in the Global South start manufacturing medical devices with a focus on making these affordable and appropriate for the Global South.  

Ultimately, health and wellness are essential to economic production because they impact the primary production agent, human beings. Of course, the human as a primary production agent is being disrupted by AI-powered agents. Robots are disrupting medical care with positive consequences for the quality of medical care and a negative impact on the employment of people in this industry.

Despite this shift towards automation in the world of work, we have to take care of human beings and put in measures including those outlined above to increase life expectancies. From an economic perspective, this will mean low workplace absenteeism and will ultimately lead to an increase in economic productivity.

As the former United States Surgeon General Joycelyn Elders aptly put it, “health is more than absence of disease; it is about economics, education, environment, empowerment, and community. The health and wellbeing of the people is critically dependent upon the health system that serves them. It must provide the best possible health with the least disparities and respond equally well to everyone.” DM


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