Health care workers join Prime Minister Mark Carney as he announces a new federal AI agenda, at Toronto General Hospital, on June 4. The landmark investment in health as 'mission one' for Canada’s new AI for All Strategy is an ideal launch-point to build globally relevant health AI.Cole Burston/Reuters
Fahad Razak is Canada Research Chair in Healthcare Data and Analytics at the University of Toronto, and Amol Verma is Temerty Professor of AI in Medicine at the University of Toronto; they are internists at St. Michael’s Hospital, and co-lead the VITAL health-data initiative, which received funding from Canada’s AI strategy and provincial sources. Kumanan Wilson is professor of medicine at the University of Ottawa and an internist at Bruyère Hospital.
The next geopolitical contest may not just be fought over oil or critical minerals. It may also be fought over who controls our data, and the artificial intelligence platforms and technology ecosystem built around those data.
Health data and AI systems will shape the next generation of medical advances and the future of how our health system works. Algorithms that identify cancers earlier, allocate hospital resources and accelerate drug discovery will help us respond to pandemics or other health system crises.
For Canada, this presents both a risk and an opportunity. Prime Minister Mark Carney has warned that the global order is fracturing, pushing countries to rethink economic and technological sovereignty. Health AI belongs squarely in that conversation, but Canada cannot compete head-to-head with the United States or China in a brute-force race for AI dominance.
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Instead, Canada should lead the creation of an ecosystem among middle powers for health AI, built on shared data governance and technology platforms.
Canada already possesses one of the world’s most valuable health-data assets, an unexpected byproduct of two of our most important national ideals. Our single-payer health system generates comprehensive data across nearly the entire population; decades of immigration, meanwhile, have created one of the most diverse societies on Earth. That combination of diversity and comprehensiveness, across 42 million people, matters enormously for health AI.
Many existing AI systems are trained on relatively small and homogeneous populations, raising concerns about bias when applied elsewhere. Canada’s diversity means we look more like the world than nearly any other jurisdiction, making us well positioned to build health AI that is globally relevant. The landmark investment in health as “mission one” for Canada’s new AI for All Strategy is an ideal launch-point for reaching this ambition.
But Canada acting alone will not be enough.
The centre of gravity in AI development is consolidating among a small number of American and Chinese technology giants with unmatched computing power and scientific talent. And much of the world’s digital infrastructure is controlled by U.S. companies subject to the CLOUD Act, which can compel them to provide access to data to Washington.
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Worryingly, access to cutting-edge AI algorithms can be summarily throttled; the U.S. government’s decision to suspend access to Fable 5/Mythos 5 models to all non-American entities is a case-in-point. As AI becomes embedded in routine health care, this represents a growing and significant vulnerability.
European countries have understandably responded with increasingly aggressive data-sovereignty laws and steps such as banning American platforms. But this fragmentation comes at a cost. Isolated national data sets limit the scale and diversity needed to develop AI systems that perform fairly and reliably.
Middle powers could pool their strengths, and share the enormous financial costs of advancing health AI development, while preserving national control over data and algorithms. Emerging common data standards and “federated analyses” mean data do not need to leave a country to contribute to AI development. Algorithms can be improved through the diversity and size of data sets spanning multiple countries, while the underlying health data remain secure within each country’s borders.
A middle-power consortium could mitigate dependence on either the Americans or Chinese ecosystems and would have enormous financial consequences. The global health AI market is projected to exceed US$1-trillion within the next decade. Canada has long struggled to translate scientific excellence into companies that can lead on the world stage. Health AI offers a rare opportunity to change that trajectory.
International health-data collaboration is also essential for better patient care. More diverse multinational data sets can reduce AI bias and improve fairness, a critical first step given widespread public worry about AI. Shared AI systems could also have far-reaching consequences for the health system, from improving medical triage to strengthening pandemic preparedness.
In an era of worsening political division both within and across countries, health AI collaboration may also prove politically valuable and sustainable. Few issues command broader public support than improving health care.
The infrastructure of 21st-century medicine is being built today. Canada is a country that historically has exerted influence through coalition building and institution creation. This is precisely the kind of moment where that identity matters.