IGF 2021 – Day 3 – DC-DDHT Health Matters: Data & Technology In The Healthcare Sector

The following are the outputs of the captioning taken during an IGF virtual intervention. Although it is largely accurate, in some cases it may be incomplete or inaccurate due to inaudible passages or transcription errors. It is posted as an aid, but should not be treated as an authoritative record.



>> AMALI DE SILVA: Let's start, good afternoon to you and early morning from my, I think Asia and Australia, it's evening.  Very welcome to our session.  We are the U.N. recognized IGF Dynamic Coalition on data driven health technologies and have absolutely the greatest ‑‑ oh, that you have to play an intro first, okay.  Okay, IGF 7, please play your intro.

>> We all love in a digital world, and we all need it to be open and safe.  We all want to trust.

>> And to be trusted.

>> We all despise control.

>> And desire freedom.

>> We are all united.

>> AMALI DE SILVA: Okay, thank you very much, IGF.  And now we can start.  So we are the United Nations recognized Dynamic Coalition on data driven health technologies and a very warm welcome to everyone who has joined us Todd, and the main part of the session, part 1, will deal with authors who have won our first book of the Dynamic Coalition, and it is called health matters, technologies driving change in health care, a community of thought.

And it is a diverse set of articles, they go into great depth, share a lot of knowledge and insight into their various aspects they are dealing with, and have the greatest pleasure to invite some of the authors who are with us to share an introduction to each one of those chapters.  So without further ado, I'm going to invite Alex Buckham to please share with us his insights, please.  Alex, the floor is yours.

>> ALEX BUCKHAM: Good afternoon, Amali, and good afternoon everyone else, it's a great pleasure to be here.  My paper addressed some of the issues relating to the impact surveillance has on mental health and well-being with a particular focus on contemporary mass digital surveillance programs, state surveillance programs.

The continued use of mass surveillance programs that collect and store all of the data we generate while using our phones  is usually justified on the grounds they are a great help to protecting the national security.  They have been repeatedly shown to be unlawful and completely ineffective of preventing terrorist attacks.  The chances of these attacks happening, especially in the west, are routinely and grossly exaggerated.  There's documented evidence for this.

These programs repeatedly found to be ineffective and unlawful, which eerily resemble English professor now infamous panopticon model for social control have huge impacts on the collective right to privacy and mental health and well‑being also.

Privacy is described by one Edward Snowden as the foundation of all other rights, and as Chris Tavelies says, the key that unlocks the aspects of yourself that makes you most you and most vulnerable.  The worst thing you've ever done, said and thought, your inadequacies, your mistakes, traumas.  It is central to the human experience.  In the words of Marie Helen Morass, when intimate details of an individual's private life are collected, stored and disclosed to others without their consent, it's damaging to the individual.  The disclosure may trigger emotions like anxiety, fear and humiliation.

My article included information from various reports that found that normal law-abiding Americans fear of prosecution led them to stop searching for words like Al Qaeda, dirty bomb, chemical weapon and Jihad after learning of the Snowden revelations.  American journalists self‑censored for the exact same reason.   Surveillance has been demonstrated to negatively impact levels of anxiety and fatigue, it showed continuous monitoring negatively impacts stress, anxiety and degrees of trust.

Importantly, they reveal the literature on surveillance severely neglects the impact programs of this nature have on communities of nonwhite, nonmale and nonrich people, what are characterized as high crime or unfamiliar neighborhoods.

They argue that black males as risk for social, physical and mental health challenges.  Ever improving surveillance technologies such as those constituting the U.S.'s total information awareness program, are only purported to objectively assess crime trends and aiding the work of law enforcement.  However, historically crime in the U.S., and across the world, has been characterized in no small part in racist, sexist and classist terms.  So ushering in new surveillance technology without dealing with the fundamentally discriminatory societal problems will only serve to perpetuate and exacerbate preexisting issues.   The historical record of states working to undermine democratic principles target minorities.  Further afield, excuse me, traditionally those who become targets are those whose values actively contradict those of powerful dominant actors within a particular state.  This explains the last section of my article which discusses how the FBI as part of the co‑intel program placed Martin Luther King, Jr. under intense surveillance, allegedly demonstrating his indiscretion to him and his wife  and a note urging him to commit suicide.  The episode caused King to suffer a real emotional crisis.

Targeted surveillance is said to be essential in every society to keep the population safe from dangerous criminals, however, mass surveillance does not achieve this, and is proven harmful to many peaceful, law-abiding people in a variety of contexts, causing significant harm to mental health and well‑being, thank you for listening.

>> AMALI DE SILVA: On our web page all of these articles are listed.  So you will be able to read in depth the work that Alex has written about.  So thank you very much, Alex, a fascinating piece, very relevant, obviously to health, and technology.  And in an era of AI and incredible data gathering, you've made excellent points there that we must ‑‑ I'm sorry.

>> Can everyone mute their speakers, thank you so much.  Yeah.  So thank you very much for that.

Okay.  Thank you.  We are going to move on now.

Then our next speaker is Frederic Cohen, please.

You have the floor.

>> FREDERIC COHEN: Hello, everyone, thank you for this invitation.  I will talk to you about our articles ‑‑ my article for our for health matters and give you a summary.  And the between our economy and postponing and bio‑technologies to support humanity, we have had a partnership with a different possibilities to develop a cloud which can be inclusive, and timely relevant.  It invites stakeholders to take numerous possibilities in order to benefit to their whole community.

The international cooperation is enhanced, and the future of our work is to share some ideas for industry worldwide and public policy‑making.  The member state of China is an opportunity to we enable development goals.  We increase security which concerns both the global network and the local.  In the pandemic, people of the world have found new solutions to protect the environment and to improve the air quality.  It is a case the project of Roberto Arias in cooperating data from universal crowd sourcing.  It has become an emergency issue to provide an efficient regulation of energy from different sources.  In particular, water pipe work and world public which have to work with synergy to enable transport and communication for people with disabilities as well as to achieve a new step of development.  To the community based on a power plant has great interest as it will provide wireless energy for everyone.  The scientific exchanges have inspired another technology which includes a system of defense against nuclear weapon, reasons of suggest natural manipulation, a combination from the digitization and further progress they have to be explored.  Automation in the processes were posed to implement tools that will facilitate the flow and the World Bank should support this transformation in the services to offer grants.  Thank you very much for your attention.

>> AMALI DE SILVA: Great, thank you very much, I'm a little frazzled here, thank you very much.  I just want to state again that all these articles are found on the Dynamic Coalition web page, which is found on the Dynamic Coalition under the tab such intersessional work of IGF.  You would be able to read these articles in detail.  Most of these articles are several pages and our authors are providing you with a summary and please recommend you read them, because that you are fantastic.

So I'm going to move on to the next person, and that would be Jorn.  Erbguth, the floor is yours.

>> JORN ERBGUTH: If I can share a slide, I would project one slide.  So far, I don't have the route to do so.

>> AMALI DE SILVA: I would just proceed.

>> JORN ERBGUTH: Just proceed.  My topic is inherent limits of AI, meaning deep learning in health care.  We hear a lot of fuss about AI, and I see at the same time there is still a big lack of understanding what AI actually is.

When we hear about AI being programmed, deep learning is not programmed, it is trained.  So there's nobody making the rules, nobody defining the rules, but it's just trained by examples, by data.  And that training will always create zero tops.  So even if you have the best possible selected data, you will end up with stereotypes, and stereotypes means bias, this is always the result of training deep learning, and also there is a much bigger issue that is often overlooked, this training will create training artifacts.  Artifacts means that in a seamless situation, a system will fail.  This is something that ‑‑ I see I now got the rights to share the screen.

So here training artifacts that will result in a system failure, with wrong results in a seamless situation, we see it when a Tesla hits a truck standing on the road because it is somehow different than it was expected to be, and those artifacts are always there, and they will easily be found automatically and be exploited, or they will just have the system give wrong results in certain situations.

This is, of course, very problematic in health care, and we are talking about systems like boxes, and they are block boxes, even if you open up the block boxes and look at what's happening there, the logic inside is so weird, it doesn't make any sense.  Reasonable transparency is not possible.

What are the consequences of not understanding AI, meaning deep learning, AI that is working that way?  The best training data will still produce stereotypes and bias.  So don't focus too much on training data.  You will have bias anyway.  Even the determination of bias is  ‑‑ underlines the same issues as the bias itself.  Depending on the test data, you will discover any bias you want to have.  So there will always be bias, and you can't function it.  And you have always unexpected failures of the system.  This is not avoidable.  So using the systems can give good results, but you have to be aware of these results. These systems are not working with a normal logic, but they are using kind of some associated way to come to a decision.

It's like a gut feeling.  So you need to expect the system to be what they are, and if you can't deal with it, don't use it, or use them ‑‑ these systems in a way that you can handle these kinds of problems.  To give you an example, when you have automatic detection of cancer on x‑ray images, doing it purely through these kinds of systems would be very problematic, but if you have first a human who does the diagnosis and then these kinds of systems that will signal that a system might disagree with the human and then another human will review the first human's decision, and you could avoid the problematic aspects of deep learning, and attempt use it for good.  If you look at the legislation coming up, the EU legislation, the EU AI act currently being discussed is this in this direction.

So you need to have the right safeguards when you use AI and you can't fix the system as these kinds of problems inherent to deep learning, thank you very much for listening, thank you, Amali for organizing it.  So we can have the next speaker, thank you.

We can't hear you.

>> AMALI DE SILVA: Thank you.  Very important area, Jorn and follows through with what Alex was talking to us about.  We will go back to Alex at the end of the speaker cue, we want to make sure he is recorded in here as well, we are not sure what editing will be done for the online record there, Alex, we'll go back to you at the end.  We are going to go on with Galia, please, you have the floor.

>> GALIA KONDOVA: Thank you, Amali.  My research in the last years has been concentrated also on technology and the blockchain technology and similarly to Jorn, I have been looking for applications in this technology in the health care sector.  And the research is a combination of the aspects that Alex talked about, privacy, and health care and the new technology.  And the one big problem, as we are aware of in the health care sector is data and the privacy of the data.  Now, the blockchain as a technology promises to provide the technological solution for having the patience, the user in the driving seat.  One tool would be a digital identity, a digital word in which the patient or the user of the data could actually manage their own personal data and share it with the different actors in the health care system.

And our piece of work has focused on a very recent application of this technology, especially in the area of the COVID certificates.

Here we have looked at the IBM digital health pass.  The IBM digital health pass provides a solution on the blockchain that allows for sharing this personal information, like a COVID certificate, with the so‑called issuers, the different bodies within this network, and the user.  And we have described how this project has been structured.  It is based on the four distinct layers, but what is more important is that the user at the end simply has to show it as we know it to the institution or the entity that needs to verify the certificate.  In the background, through the blockchain, actually the verifier can prove with the issuer of the certificate this is a valid certificate.  And

Those of you who are interested into this use case, can read our article where we also have a diagram and description of the project.

Thank you.

We don't hear you, Amali.

>> AMALI DE SILVA: Thank you so much, Galia, we'll move on to her man, please, you have the floor.

>> HERMAN RAMOS: Thank you.  I don't know if it is possible to share the screen.

Okay.  Anyways, basically the work that I share is about like exploring the adoption of Internet of things in health care because we saw with the pandemic, that created or accelerated the adoption of digital technology.  These kinds of technology that we adopted during the pandemic was multiplied the current problems.

We see now it is important to look to the future, and one of the points in health care is about facilitating the whole ecosystem.

The internet of things will basically help achieving that by improving the quality of service.  Basically, internet of things, we have different kinds of definitions that also can depend on the situation and also the application, I will use the definition of internet of things for things related or Interconnected objects that are able to collect and transfer.  Basically the main point of internet of things is to collect data.

When we look to health care, we see that there's a possibility of ‑‑ improve the health care providers by using data we can collect from hospitals using medical devices, and this can be applicable to home health monitoring device and other main situation.  And we see that it's important to ‑‑ when we talk about investing in internet of things, we find out there are important issues or points we have to take into account.

One of the first points is about literacy, because we know that medical doctors will have to use these kinds of system that is important for them to have the kind of knowledge not only to use the system, but also to provide any kinds of solution to issues that can arise from the function of the whole system.  Other point is about familiarization of internet of things with the patients and the users.  Because we know that users must have the necessary information about the benefits of internet of things in their life, and how the internet of things will improve the quality of their care.  So it's important for them to have the necessary information to avoid also misinformation about these kinds of technologies.  And other point is about ‑‑ we are talking about collecting data, so it's important to health to establish standards that includes data protection regulation and privacy standards to ensure that all products, all devices, all products we are going to use are in compliance with these kinds of standards and avoid data breaches or use of data for other purpose that is not for the health care.

And last point will be about cybersecurity.  We know that with the increase of digital technologies, there is increased cyberattacks in the cyberspace.  It's important to invest in cybersecurity across all the tools and platforms that will be using inside internet of things.  Also risk reports, because it's important to not only the team that will be involved in implementation of the system to know about the possible vulnerabilities, also solution, it's important to get to know the patients and the users, about the necessity of protecting themselves about these kinds of attacks.

So as a conclusion here, I would say that basically the development of innovative technology in combination with advancement of securities, is pushing in transforming the health care system.  So in the coming years, we'll see not only the internet of things will play a crucial role in health care, but will see also artificial intelligence and also innovative solution that will provide and is access to health care, will also provide an efficient way to ‑‑ of service and also will provide access to a modern health care treatment, and this can be done not only by going to the hospital, but in the comfort of my home or my house, without the necessity of moving around.  So thank you, I will just stop here, thank you.

You are muted, Amali.

>> AMALI DE SILVA: Thank you, again, her man.  Yeah, very interested, we know we'll see a lot of development when it comes to 5g and 6g and dealing with older peoples and how they access and me new technologies as well is going to be something we will be very interested in.

So I'm going to move onto our next speaker, Dr. Christin Tan, you have the floor.

>> CHRISTINE TAN: Hi, esteemed members of our IGF Dynamic Coalition, and everyone on site and online joining us today.  Good day, everyone.  My name is Christine Tan, I'm currently working, in China FIOT open lab, and we are a nonprofit platform company, promoting digital technologies, our focus area is internet of things, IOT as well as emerging digital technologies that go hand in hand with IOT, such as AI, 5g, wireless telecommunication, big data and blockchain.

We have worked extensive at the leading edge of digital technologies, and the end user applications.  As well as help to set industry standards.

In the recent years, digital health care has become an important area of research and development, particularly in view of the aging population in some countries, as well as the global pandemic COVID‑19 that hit us hard in 2020.  Indeed, we are still recovering from the aftermath of COVID and learning to respond, adapt and live with new variants of the virus.  In view of these global challenges, we would like to launch into the topic of discussion for today, digital technologies for new health care applications, under the COVID‑19 pandemic, which is also the title of my paper that you can find one like.

Were the pandemic disrupting the lives of people worldwide, we see new social norms emerging, such as prolonged periods of working or studying from home, and the ubiquitous pandemiological, the increased need for personal, chronic health management at home.

Thanks to digital technologies, such as IOT, smart wearable devices, QR codes and apps, large numbers of people can now be tracked effectively across wide regional areas to contain the pandemic, we see some examples of this wide scale tracing in China, Singapore, Australia, U.S.  However, this raised several social issues that the earlier speakers have alluded to, such as, for example, elderly's steep learning curve for such new technologies, and also the accessibility of people to SmartPhones, wearables and devices, also the data privacy and surveillance usuals, has contact tracing become a Pandora box?  I'm actually pleased to note there was a session a few days ago in this year's IGF, dedicated to the discussion of the paradox of contact tracing.

Furthermore, on the advances in digital technologies, such as 5g, which allows for remote monitoring of patients at home, by health care professionals who are many kilometers away, this is particularly useful for patients with chronic disease, and who are unable to access local hospitals or clinics that are closed due to COVID‑19.

Some examples of these remote health care applications include 5g based monitoring of patients with cardiac conditions with alarms in the event of patient distress, and even a somewhat cost‑self screening test for COVID‑19 at home.

Again, we see patient data privacy as a concern here.  Additionally, these new remote health care situations may necessitate new health care business models.  For example, how would insurance cover dialysis at home, versus the traditional dialysis centers.

Another interesting use case is sports lessons for school children at home.  Thanks to COVID‑19 and this new social with people sawing at home, there is now a tendency for weight gain due to the sedentary lifestyle of people.

Through digital technologies such as wearable fitness watches and camera tracking, teachers can now set exercise regimes for children to complete at home and not just language or math lessons.

AI algorithms also track heartbeat trends to make sure the wearable is indeed worn by the student and not their parents or pets.

Student movements are tracked by gyro scope and meter sensors in the watch, which are subjected to AI algorithms, to determine the kinds of exercises that are being performed.

So in summary, we see that digital technologies have enabled many innovative health care innovations in response to COVID‑19 situation.  However, with these new applications, there are also new challenges, like the learning curves for new technology, data privacy concerns, it is imperative that we reach out to the end users in the community to get their feedback and to understand their concerns so that we can make improvements.  We also need to consider the implications of these new social interaction modes and new economic models that are brought about by them.  Overall, I'm delighted that digital technologies are being used to combat the pandemic and help the world become more resilient, grow stronger as a global community.  Fight COVID‑19 better, build back better and collectively through international IGF consultative sessions like these, try to make sure that no one is left behind.  Thank you for your kind attention and I look forward to your inputs and discussions.

>> AMALI DE SILVA: Thank you so much, that's very much appreciated.  So far, we have covered just a very wide set of topics, and it's been fascinating.

I now move on to Dr. Karina Tyrrell, you have the floor.

>> VIVIAN DE TUSSLEK: I'm Vivian, I've been unable to access using a link, so she has given me hers.  I also co‑authored the article.  So hopefully I can also speak to that article, which is all about investing in the technologies that drive change in health care. 

   So my name is Vivian Detusslek.  I'm a general partner at asset rise management.  We are a venture capital firm, so pretty well placed to see some of the trends and the current status of the digital health landscape, which is what I'll talk to you about today and talk about the investment picture and the challenges we are seeing today and how we can capture and support the rising demand for digital health solutions through public and private investment.

So I'll start by saying, even without the acceleration of demand for digital delivery of health care from COVID which many of us experienced over the last months and continue to experience, there are other trends or additional trends which have been supporting this demand growth in the digital delivery of health care.  So those include, first, aging populations, and chronic disease burden which has led to this increase in demand.  Secondly, we see we have health care costs rising faster than our ability to pay.

And thirdly, we are seeing a declining health care work force, which means we need to achieve more with fewer people.

So all these trends point to both an increase in demand, but also an acceleration.  The so how can we do more with less?  Of course, digital delivery can answer some of that demand, if harnessed effectively.

In addition to that, we are looking, we can see regulatory changes, and a trend in the consumerization of health care.  What that means, we are seeing consumers who prioritize convenience and prevention and choice when it comes to health care.  So this further supports growth in digital health solutions.

As a result, we have seen digital health solutions attracting increased investment.  So those areas, for example in the first half of this year of 2021 that were most highly funded, those include research and development, R&D, on demand health care, fitness in well‑being, treatment of disease and consumer health information, those are the value propositions, on the clinical indications side, those have been the highest funded, mental health, cardiovascular disease, diabetes, primary care and substance use disorder.

We have seen that funding as a whole is increasing.  So in the U.S., for example, again, in the first half of 2021 of this year, there was more investment capital allocated to this sector, digital health in particular, not just health care, digital health than in the whole of 2020, stood at $14.7 billion.

So, you know, the demand picture is growing and accelerating, the investment picture is growing, however, there are many challenges that still remain, and many of those include the inability to scale some of the early stage companies, and there are many operational challenges that mean even if we have incredibly novel digital health solutions, sometimes these do not get the squall in order to be effective and to him pact, you know, impact patients out there effectively.  What are those challenges and the ways we can think about addressing them?  On the ability to scale, there's often restricted opportunity to develop and fund solutions, developed by those with direct experience of patient care.  So we find that those who have that direct experience of patient care are often best placed and understand best how to develop digital health solutions.

So there are some programs such as the U.K.'s clinical entrepreneur program, these programs are growing, however, it can still be ‑‑ they are still in nascent  and our health care systems to adopt.  Regulatory challenges, invests can support but helping founders not only navigate the regulatory landscape.  I can talk about that in a minute.

But ‑‑ so looking at this early-stage funding, you know, we can't just have the private sector be funding these digital health solutions, because we need to help them get past these risky earlier stages, so we think strategic incentives are needed.  To this can come from strategic distribution partners, from governmental R&D tax incentives, research and development tax incentives and from grant funding and not just from private institutional involvement.  But if we combined all these, we are looking at a picture where these challenges very moving these early-stage businesses up the curve can be helpful.

I wanted to address the operational challenges, so these include data ownership, data protection, intra‑operability, fragmentation, as well as training health care professionals to adopt new technologies.  Again, these challenges can be overcome with support on global collaboration, from organizations such as the United Nations and the world health organization, and so these include, for example, adoption of the global strategy, and these are where we can capture the capture the huge opportunities to increase access.  By addressing these challenges, we can properly harness those opportunities provided but digital health, to increase access, reduce cost, and improve quality of care.  Thank you for listening.

>> AMALI DE SILVA: Thank you so much, Vivian, thank you very much and thank you to your team for writing the paper for us, that brings finance into this as well, which is excellent and is a great driver, as we know, into dealing with technology, and that was highlighted, actually, at the ITU this year in terms of that need for public‑private partnerships to connect the last mule and then, as we would like to have quality internet to provide health care and other, you know, educational and economic services to the population.

Now we are almost at the end, and I just want to say a few things.  Myself, I wrote a couple of opinion pieces, and one was to highlight quantum technologies, it will have a significant impact on health care, yet to be determined fully, definitely going to be the case.  The use of statistics, you know, I'm very much of the opinion that actually statistics should be developed further, you know, and I think we will have new innovation with that coming from artificial intelligence, especially quantum technologies and so forth.

I think also the emotional side of artificial intelligence is going to be something that we need to look at, possibly from a health care perspective, and as, you know, Alex talked about, surveillance and so forth, wellness of people, I have an article talking about that and humanity and so forth, I wonder whether human beings will get a little bit jealous of technology and something that we need to think about.  You know, in the old days we talked about robots taking over the world and so forth.  But this could be a very real thing.  I think that emotional side of people using and developing and being ‑‑ losing jobs to artificial intelligence is something we should consider.

Now, given our two years of work ‑‑ with this Dynamic Coalition, something that has come to light, what I term the rights of passage, data, data is moving from one database to be used in perhaps not the original purpose the data was collected for, as others have stated.  It means the data may have to go through what I call sort of rites of passage, you know, how good is the quality of data when it moves from one system to another.  All our authors have spoken about that.

I know there are various systems in place, you know, IEEE, international standards, ITU standards, ISO standards, there are all kinds of frameworks in place.

I want to suggest from our perspective, and I would go back to an article, the writer is not present with us, I will go back to this after I say this, I think we should look at seven rights for quality data success use in our applications going forward, and especially the data sharing.  The rights ‑‑ I'm talking rites of passage, I was looking at the approach, the whole approach intent and so forth, inclusion, as Alex was talking about, including everybody in, the design and data management, just protections, such as privacy, communications, and this can be communications that are people centered, technology centered, and the feedback, it's very important to have feedback, as Herman talked about risk management.  And something used in business, a framework out of Australia, New Zealand looks at this kind of that feedback system.  Feedback is very important.

Then we need to talk about implementation and delivery.  Is it all effective?  Over the past two years, what I've seen, you know, highlighted from our Dynamic Coalition, seven sort of qualities for success.

I want to go back, and we had a submission of an article from Emma Slade, she is a British lady who was in investment banking, gave that up and became a yoga teacher and became a Buddhist nun.  I want to read some sections from this article from you.  At first I wanted how to make a helpful contribution to this debate.  As I pondered the ethics, technology and medicine.  I wondered if that was for me a Buddhist nun, separating out the idea of ethics into a distinct category anyway.  While the word ethics can be considered as a separate area of study, I'm tempted to see it's more the very ground in which all other disciplines and ideas try.  From the Buddhist point of view, supporting the development of development of the human mind, many things develop together, in an Interconnected way, rather than separation.  This is a living idea of the Buddhist philosophy of interdependence, it is clear change or movement is not possible when there are missing spokes to a wheel, she talks about eight parts.  She says it's right understanding, right thought, right speech, right action, right livelihood, right effort, right mindfulness and right concentration.

She puts it right in front.  And goes on to say, what might this basic culture of rightness mean in the debate?  We have been asked to be considered.  What would we say if it was said right technology, or right medicine?  She goes on to say, what about right medicine or right technology in understanding?  Right technology or right medicine in thought?  Right technology or right medicine in speech?  Right technology or right medicine in action?  Right technology or right medicine in livelihood.?  Right effect for technology and medicine.  Right mindfulness of technology and medicine and right concentration for medicine and technology.

Just going to that at the end, in cultivating it, we can expect three pillars to be brought out from Buddhist perspective.  And it says refrain from harm, to practice doing good, and to train one's own mind.

I'm going to the bottom of her article, and she concludes by saying, in some ways I have wondered and enabling supportive technology is the panacea to, driven by the o the wish to the are leave suffering.  My understanding is that the algorithms which are increasingly driving well‑being acts are raising this possibility.  If someone shows a propensity to study right mindfulness, that will ensure that you are offered more and more mindfulness support, even more game changing the core principle of nonharming incorporated into the framework of algorithms.  When we look at the world, we witness again and again the ease of which causing harm to others, to animals and to nature, while more trans e transparency interconnections have highlighted this in so many ways, environments, supply chains, how much further could we go supported but technology?

So beautiful piece, I encourage you, again, to go our online book and read these articles in detail, which would be really very, very beneficial, I think, for anybody working in this space.

Now I do want to go back to Alex, would you be willing to share your piece again, I don't want it to be missed out if they don't do an edit.

>> ALEX BUCKHAM: No problem, no problem at all.

Basically my paper addressed some of the issues related to the impact that surveillance has on mental health and well-being.  With a particular focus on contemporary mass digital state surveillance programs, the continued use of mass surveillance that collects and stores all the data we generate while using phones, laptops and so on, is usually justified on the ground there are great help to protecting state and national security.  Yet they've been repeatedly shown to be completely ineffective and unlawful when it comes ‑‑ completely unlawful and completely ineffective when it comes to preventing terrorist attacks.  The chances of these attacks occurring, especially in the west is routinely and grossly exaggerated.  That you repeated found to be ineffective and unlawful which resemble English philosophy Benson panopticon model of social control and have huge impacts on our mental health and well-being.

The privacy described by one Edward Snowden as the found fountainhead of All other rights, Christopher Valize.  The key that unlocks the aspects of yourself that make you most you and most vulnerable.  The worst thing you've ever done, said and thought, your inadequacies, your Mayes takes, your traumas.

Privacy is absolutely central to the human experience and in the words of Marine Helen Morass, when details of an individual's private life are collected, stored and disclosed to others without their consent, it's damaging to the individual, the disclosure may trigger emotion like anxiety, fear and humiliation.

Though my article included information from various reports that found, for example, normal law-abiding Americans fear of prosecution led them to stop searching for words like Al Qaeda, dirty bomb, chemical weapon and Jihad after learning of the Snowden revelations, the findings demonstrated American journalists self‑censored for the same reason.

Surveillance has been demonstrated to negatively impact levels of anxiety and fatigue, similar findings showed continuous monitoring negative impacts anxiety.  The literature reveal surveillance severely impacts the programs of this nature have on communities of nonwhite, nonmale and nonrich people in which, and what are characterized as high crime and unfamiliar neighborhoods.  They argue the Black males as a result of high surveillance and discrimination, for social, physical and mental health challenges.  Ever improving surveillance technologies constituting the U.S.'s total information awareness program are only purported to objectively assess crime trends aiding the work of law enforcement.  However, historically, crime in the U.S. and across the world has been characterized in no small part in racist, sexist and classist terms.  And so ushering in new surveillance technology without dealing with these fundamentally discriminatory societal problems will ineffably only serve to perpetuate and exacerbate preexisting issues.  Historically record of states working to subvert democratic movements and peaceful civil society initiatives and target minority demographics at home and abroad is worrying rich in the U.S., the U.K. and elsewhere.  Traditionally, those who become targets are those whose values actively contradict those of powerful, dominant actors in a particular state.  This explains the last section of my article which discusses how the FBI, as part of the co‑Intel program placed Martin Luther King, Jr. under intense surveillance, sent him and his wife a surveillance tape demonstrating his indiscretions and a note inviting him to commit suicide.  Why would I mention this, because the episode caused king to suffer a, quote, real emotional crisis, targeted surveillance is essential in every society to keep the population safe from dangerous criminals, however, mass surveillance does not achieve this, and has proven harmful to many peaceful, law-abiding people in a variety of cop texts.  Including causing significant harm to their mental health and well‑being.  Thank you.  Back to you, Amali.

>> AMALI DE SILVA: Thank you so much, Alex, and yes, so apologies to everyone on what happened right at the beginning.

So now we will move an open discussion and before we start that, we want to share with everyone that we are having what we are calling a symposium at the moment, but it will be some workshops in the new year, and Herman, would you like to share something on yours?  Okay.  We are going to have a focus on youth and, which is great, on day zero, there was a special interest in youth, and we are hoping we can support that as well, and Herman will take the lead on that one, being a former IGF youth ambassador.  And we also hope to deal with indigenous health, and tie that into the environment as well.

Those are our plans going into the new year, we want to open it, this discussion to anyone to share their viewpoints, share with us what they think the Dynamic Coalition should work on for 2022‑23 and so forth, and to start that off, I want to give the floor to Dr. Amado Espinosa, can you start this section for us.  We appreciate it.

>> AMADO ESPINOSA: Yes.  Thanks, Amali.  Thank you very much to everybody for your encouraging participation, I think it has been a very good job that you have summarized into this very short session, I'm ‑‑ we are in Latin America really keen in knowledge to learn about the best practices and experiences of the applications of technologies into the health care sector.  I am a physician myself with a specific area of practice and I am ‑‑ I am supporting some initiatives in Mexico which are at this point related to the implementation of the personnel record, the medical record, how to standardize and provide the proper regulation, which is necessary to take advantage of the technology as well, and certainly for the sake of the ‑‑ the growth of this DC.  It is important to allow people, specifically from this sector in Mexico who really do not have a clear idea what those Internet Governance means and how can we really equate in terms of data governance, data sharing, data security, and all these requirements that we do have in order to be able to operate new technologies in the same dimension or in the same speed they are showing up or coming up into the market.  Of course, we want to organize a workshop in Mexico, together with all of you, it would be very interesting having this different participation and different perspective that you already have shared with us.

I think for the very first time, we can offer or we can introduce the general proposal in terms of what is really happening, this kind of discussion or remarks like we are having here, I think they are also very important because at the end of the day, it is the output of the of many sessions, many hours of reflecting about what is really behind this black box of AI and how does really this work and how blockchain can really provide an advantage in terms of how to encode or control the security of the information for the health data and how can we help patients and physicians to safely exchange in a remote environment the data that is necessary to come up with a proper diagnosis and treatment.

What you have already put together in this first publication, I really congratulate you and recognize the amount of work that is inside and certainly we want to join the group and also, of course, through the leadership of Amali to getting connected with the work that the WHO and ITU are already developing in this working group for health care ‑‑ or of course we will be very grateful to receive all this feedback and to learn how to also be part of the decision of the health care services in our region.  Thank you very much.

>> AMALI DE SILVA: Thank you very much.  And yes, just to highlight, we do actually work closely with ITU, their writers here are part of the book, who are from the also ‑‑ also part of the ITU conversations as well, and this year as well, we were honored to be able to participate on the high‑level panel at the WSIS forum.  So we try to actively work with them and have started working with WHO as well with their partnership with the ITU.  So please welcome to everyone who may be joining us who are not part of our Dynamic Coalition, please join us, we really wish to discuss new frontiers in this emerging area, we think obviously we have heard about the investment and there's going to be ongoing investment increasingly so, I believe, from the public health side as well.

So please be with us ‑‑ I think for anything, we have a good foundation, we can expect great things, but if the foundation is not strong, then obviously the building can collapse.  So what we do here at the Internet Governance Forum is to look at good foundations and ethics, co‑policy area that they ask us to discuss.

So given all that, we would love to have audience share with us their views.  And Amado, do you have any other people in the room with you.

>> AMADO ESPINOSA: We have two participants, yes.  One of them is willing to take the floor.

>> AMALI DE SILVA: So we are going to give two minutes to each participant, please you have the floor, from Poland.  Anyone else, please, can you put your hands up, when you're online so we can identify you as well, please.  Please, you have the floor in Poland.

>> AMADO ESPINOSA: Do it by yourself, introduce yourself.

>> Audience: Hello, everybody, I'm co‑secretary of the Swiss IGF, I wanted to briefly share with you the outcome of a very interesting discussion we had on this year's national IGF, on particularly the digitalization has helped enough to combat the COVID crisis.  Quite an interesting thing in particular, and the discussion turned around, to have data protection regulations, the authorities turned to say on a blind spot, so we heard one public official in charge of the pandemic measures for every region just complaining that he has to take decisions on virtually no information because the health sector was so probably rightly so, in general, was so closed since health is personal information.  There are, she was quite unable to take a recent sensible decision.  To cut a long story short, we noted that it's really a conflict of interest and not just data protection, as important as it is.  It's competing among competing rights which needs assessment by the regulators.

>> AMALI DE SILVA: Thank you for that insight.  Yeah, we are also very concerned about privacy and data sharing, it has been something this Dynamic Coalition has been very interested actually in the past two years we would encourage you to join us in this conversation so perhaps we can have that conversation 2022 in depth.  We appreciate that contribution.  Anyone else, Amado.

>> AMADO ESPINOSA: If I may make a comment, shortly, yes, I totally agree that the health care sector has been always very respectful of the personal data because also all the legal processes behind are so strong, mainly in west countries or west economy countries.

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For example, this tracking COVID tracking apps from the large companies, couldn't make it, for example, the German government who invested a lot of money in its app, and they couldn't make it to get used into the population.  I think it's two sides of the problem.  It's not only the authorities, and the institutions from health care, but also patients are a little bit afraid that when the data is shared, they can have some kind of professional or social or other kind of problems, legal problems, for example, in the U.S., the population, who is not properly documented, they are afraid that through this kind of data repositories, can't get ‑‑ can get into problems, then I ‑‑ I'm certainly sure that this kind of forums, like the IGF, we provide to policy decision‑makers and also the ‑‑ the people responsible for the data sharing in the health care sector, a huge amount of trust and confidence in order to look for how the ‑‑ the work of the organization or some other international organization can provide this framework for this global repository of data sharing, which will lead us to population health, and global health modes and stuff like that.  Certainly we are dealing with ‑‑ yes, please, go ahead.

>> Audience: Short reply to that.