Interview: Ricardo Baptista Leite, HealthAI and UNITE Parliamentarians Network for Global Health

We recently sat down for a chat with Ricardo Baptista Leite about the potential and considerations for artificial intelligence, key learnings from his career and his thoughts on the digital health landscape in Portugal.

Along with his background as a medical doctor, Ricardo has experience in a number of settings including his current roles as CEO at HealthAI, global agency for responsible AI and health; founder and president of the UNITE Parliamentarians Network for Global Health; national spokesperson for health in Portugal’s Social Democratic Party; and guest lecturer at NOVA Medical School in Lisbon. 

Hi Ricardo, thanks for joining us! Can you tell us about your current role and background?

I came CEO for HealthAI in May 2023, but my first life was as a medical doctor trained in infectious diseases. I’ve served in politics as a four-term member of parliament in Portugal, I’ve been a city councillor and deputy mayor of my hometown and I’ve also had an extensive academic career ranging from global health, health politics and digital health.

In 2017 I founded a non-governmental organisation which I continue to preside over today – the UNITE Parliamentarians Network for Global Health. It is a network of current and former members of parliaments, congresses and senates from over 105 countries around the world. With the support of the World Health Organisation (WHO), our aim is to work towards science-based, evidence-driven policies for better health for all. 

HealthAI: the purpose 

We are a non-profit foundation under Swiss law, based in Geneva. Initially HealthAI was founded in 2019 under the name I-DAIR (International Digital Health and Artificial Intelligence Research Collaborative).

When I came on board, it was clear to everyone on the board and in the team that we needed to rethink our positioning as an organisation. 2019 wasn’t a long time ago, but the world has transformed since then. The pandemic saw acceleration of digital adoption and the widening of digital divides and societal gaps, but it also saw the rise of artificial intelligence from largely a research topic to a mass consumer product.

In the face of all of this transformation, HealthAI embarked on an in-depth process to speak to to governments, legislators, scientists, technologists and more, to hear viewpoints and considerations. One word kept coming up – fear. That fear was relating to AI and machine learning, and it stems from many factors, from lack of understanding of the technology to fear that the technology will take over jobs and human capacity. At the end of the day, it’s fear of the unknown.

Despite this fear, there is a lot of investment in the AI space for health in particular. But if people are fearful, whether it’s the regulators and policymakers or the citizen, this can lead to a brick wall where people don’t adopt the technology in the long run.

All this has fed into the thought process behind what HealthAI’s role is and where we fit in. We’ve designed a model in which we will end up with a global regulatory network for responsible AI in health, ensuring that each country has the tool to validate AI technologies in accordance with international standards. We’re not the ones developing those standards – that’s the remit of WHO and related organisations, and we have been working with WHO since we were founded.

Our aim is to make sure that the capacity exists in each country so that each country, with their own sovereign independence, can validate AI tools. We’re working to connect regulatory teams around the world into one global network, to allow sharing of knowledge to help accelerate the validation process safely and tackle any challenges that may arise – for example, through enabling the sharing of early warning systems to highlight issues or unintended effects. At its core, our work is about helping to ensure safe, quality, equitable and effective AI tools for all citizens when it comes to health; and it’s also about supporting investment and adoption of technology with the potential to improve health outcomes.

The potential of AI

My role at HealthAI has been a dramatic change of career for me, and that’s because I honestly believe that we now have the technology and computational capacity to embrace AI and machine learning and core related technologies, to actually transform systems and health in particular. We didn’t have that five or 10 years ago.

High-income countries have been pushing for what we call disease-driven models, in which we spend almost all of our resources reacting to diseases. The focus has been on people attending hospital when they are sick and healthcare systems trying to cure them or make them comfortable. But we know that if we address the multiple determinants of health early on and throughout life, in a consistent manner, we can transform that disease-driven model into a system that is focused on health, wellbeing and quality of life. We can lower the burden of disease on society, we can lower the demand on health systems, and we can free up resources to treat the people who inevitably will get sick.

The technology needed to do this was non-existent until very recently, and I think AI will play a very important role. We’re already seeing AI being used in many fields, with imaging probably one of the most advanced at this time given the way that it can perform analysis and detection on images. But there’s much more down the road in terms of population health, diagnosis, early detection and warnings, even prevention.

AI has a key role to play in freeing up time so that clinicians can get back into contact with their patients too. That may seem a contradiction, but I do believe that machine learning can help us re-conquer the compassion and humanisation of healthcare that we have in many ways lost. I read a study from the UK which said that 70 percent of the time, when the patient is in their GP’s office, they are looking at the back of a screen whilst the doctor is typing. We need to get that screen out of the way, we need to get back to face-to-face contact with eye contact, where doctors have the time to do a physical assessment and hold a proper conversation. Every big tech company is investing in what they call virtual scribes, which aim to collect all of the information about an interaction and process it for the electronic health record without the doctor needing to input the data themselves. There are a lot of things like this which I believe over the next few years will become standard.

The important thing is that we make sure that it is inclusive, that access is equitable. If we do that from the start – and that’s one of the advantages of being at the crest of this wave – it’s an opportunity to design this right from the start. That’s something we haven’t done with past technologies, and we need to learn our lessons from that. Ultimately, doing this will benefit everyone; because if we have a healthier population, we won’t need as many resources to treat such a high number of patients. Our healthcare workers, who are over-stretched and tired across the board, will have more time to care and will be supported to be more effective in their work.

This is the positive angle of what AI can bring to the health system – we just need to make sure that we mitigate the risks along the way.

UNITE Parliamentarians Network for Global Health: the role of digital

As a network of legislators from over 100 countries, we work with current and former policymakers. We focus on three main pillars: health as a human right, understanding the importance of strengthening health systems, and global health architecture and governance.

Digital has a presence across these three areas. The first pillar focuses around developing universal health coverage, and that involves trying to ensure access to digital in the most rural parts of the world so that people can use it to access healthcare.

For the second pillar, strengthening health systems, the role of digital is critical. As part of this work, UNITE has partnered up with Fondation Botnar (a Swiss philanthropic foundation seeking to improve health and wellbeing for young people across the world, advocating inclusion of young voices, equitable use of digital technologies, and supporting innovative programmes and research). We have created a digital health policy desk which is designed to promote good practices when it comes to policy and promotion of digital health. The initial focus is on several countries including India, Tanzania and Argentina.

It’s amazing to see the advancements that can happen just by raising awareness and building capacity. It has led to policymakers truly engaging and understanding that digital needs to be perceived not as purchasing computers and thinking that it will solve the problem, but actually using digital to make the transformation from that disease-driven model to one that focuses on prevention, quality of life and wellbeing.

Key learnings

Last year I read a book that really impacted me, called ‘Power and Progress’ (Daron Acemoglu and Simon Johnson). It looks at the evolution of technology over the last 1,000 years. The authors point out that every time a new technology has come out, the owners of that tech have said that it would change the world and enable everyone to live a better life. But most of the time, this hasn’t happened. In most cases, the technology has come out and benefitted the few rather than the many.

The few times that we have seen technology have a societal impact where even the most marginalised benefit, was when the technology was designed and deployed from the start to be fair, inclusive, equitable and accountable. These are the principles that we now transport into what we call responsible AI.

Technology is fascinating. Most of us who work in this space love it. But we need to have a very clear conscience of our history, as humanity, and how we have sometimes failed in the past. We need to make sure that we leave a better world for future generations, and to do that, we need to make sure that technology follows those principles that we call responsible. As well as making sure that they have the impact that they were designed to have, we need to make sure that there are safeguards and mechanisms in place to detect when we fail.

When I got into med school, one of the first things you learn as a medical student is primum non nocere – first, do no harm. This principle is also applicable to digital health. First, do no harm doesn’t mean avoid risk at all costs. It means mitigate all of the risk that you can and make sure that the benefits clearly outweigh the risks, just like with medicines. With medicines, there are adverse effects that we know about, that we tell patients about when we prescribe them. But we know that the vast majority will benefit from the potential good that the medicine will do, versus the minority who may experience side effects – and we make that prescription in the knowledge that the potential to benefit outweighs the harm that may occur. We need to use that kind of logic as we design new models for digital.

At HealthAI, we’ve been very much inspired by the medicines model. Before technology is deployed into a market, there should be a regulatory process, there should be an authorisation to access that market. It’s in the interest of companies too, because nobody wants to be liable of possible negative consequences of their own technology. If there are mechanisms and clear rules, it becomes easier for the companies to know what they need to comply with and how to get access to new markets. By creating a global regulatory network, we are hoping to learn from the lessons of things that perhaps weren’t done as well as they could have been with medicines regulations.

Digital health landscape in Portugal

Portugal is going through a tremendous reform in terms of its health system. We have upcoming elections so we still have to see how that will play out.

Looking back to the last decade or so, Portugal has been in the forefront in many aspects. Between 2011 and 2014 Portugal imposed a number of regulations which seem trivial now, but at the time they were quite groundbreaking. Electronic prescription of medicines was one; it is essentially the only way to get access to medicines these days in Portugal, and it was critical during the pandemic. There is home care for patients who are still under hospital care but monitored remotely via technology – we’re seeing those programmes advance a lot at the moment.

In terms of interoperability, about 15 years ago Portugal created a platform where every hospital, even if they are using their own electronic health record, can access patient data from a common cloud service.

There is some fear that a lot of the money being invested in digital, which is in the hundreds of millions of euros, is being used to update hardware. I would say that is a missed opportunity, if we are not able to use that funding, that one-shot opportunity, to make use of digital transformation to go beyond purchasing computers. We don’t just want to transform what we are doing on analogue and make it digital, we should be using that transition to reform and redesign the health system all together.

We have our own national health service in Portugal, some great past experience to build on and amazing healthcare workers. I think Portugal has the potential to do many things within its health system, but there needs to be clear vision. Let’s see what comes out of the next election.

What would be the one thing you would do, if you had the opportunity in the Portuguese health system?

I believe that if you have a role to change things in your health systems, you have to think of it from two levels. One is what we would call your emergency response – making sure that patients get access to a family doctor and that you reduce the waiting lists that are crippling health systems around the world, with Portugal no exception. For that, you need an emergency programme. But that does not solve structural problems.

The first structural thing I think Portugal needs to do is create a health data agency, where all of the health data is collected. It makes your health system much more efficient, because you are capable of following in real time the evolution of what is happening in the health system at the patient level and at the healthcare worker level, and you can perfect the system as you move forward. You can only fix what you measure and what you know.

Also, looking at the rise of technologies such as synthetic biology and precision medicine and machine learning, we know that the quality of data is going to be critical to success. It’s a question of being prepared and building that repository.

At the same time, if you want to ensure early access to the best treatments for patients in your country, then having a health data agency makes it much easier for clinical trials for example.

These are just some examples of how such an approach would put Portugal in the vanguard. Having a national health service of our own is a huge opportunity for change that may not be there 10 years from now. I believe we have what it takes; we just need the right vision and leadership.

Rounding off the interview, Ricardo urged anyone who may be interested in HealthAI to reach out. 

It’s very important that countries come on board – that anyone who has something to say about this is part of the process from the beginning. We are hoping to see countries validate AI tools from 2025 onwards; we’ll then have a global repository with all of the validated technologies. Hopefully, we can co-create globally and we can put AI to the service of the people. That is only possible if everybody chips in. Click here to find HealthAI’s contact details.

Many thanks to Ricardo for taking the time to join us.