It is not surprising that India has a booming healthcare sector, considering that a population of 1.35 billion in 2018 is likely to exhibit myriad morbidities (World Bank, 2018). With a three-fold increase in the healthcare market and governmental projections pushing a 372 billion USD mark in 2022, the sector is ready for significant technological interventions. (IBEF, 2019). On the downside however, the sector is beleaguered by concerns that range from access barriers and poor doctor-patient ratio to affordability and poor healthcare infrastructure. Artificial intelligence (AI) comes with a promise of not only overcoming a majority of these barriers, but also eliminating predispositions, such as the recency bias, in medical sciences. Riding the investment wave AI—robotics and Internet of Things (IoTs) can revolutionise healthcare.
Healthcare concerns can be broadly classified into those which are predictive in nature—pre-empting a problem and providing a solution to abrogate the issue; and, prescriptive, where a treatment is offered based on an informed decision. When AI is deployed to prepare algorithms that help map patterns by collecting and analysing gathered data—both spatial and temporal, it is found that it can provide astounding results in preparing a response ahead of time and influencing outcomes. From early detection of diseases based on analysis of past data, to decentralised diagnostic testing, AI can singularly alleviate healthcare problems in rural and remote areas. AI algorithms are able, with a certain degree of precision, to screen diseases, which can help triaging high priority cases, enhancing the productivity of healthcare professionals.
In India, companies such as Artelus, a Bangalore based AI enabled healthcare unit, works to provide an image-based early detection facility for diabetic retinopathy . The Deep Learning and AI based setup in Artelus can help identify at a primary screening, lesions or abnormalities present in fundus images and report it to the doctor, making it impactful for areas that lack this facility. These healthcare capacities extend beyond the boundaries of hospitals and specialised clinics, reduce cost and improve health outcomes. There are many such applications for various anatomical disorders world over, such as IBM Watson for oncology and many private hospitals in India, such as the Manipal group of hospitals, make use of such interfaces.
Interestingly, AI can also screen mental disorders in its early stages, like depression. Wysa, a bot developed by Bangalore based start-up Touchkin, is delving into the domain of emotional wellness. Supported by human coaches, the bot helps cure depressive thoughts (wysa.io).The app records and analyses various physiological factors like sleep patterns, blood sugar levels and other behavioural insights and predicts the user’s mental health. In the event that the bot identifies an individual who needs intensive care, it refers the case to professionals, who can then intervene.
Niramai, a Bengaluru based healthcare start-up has developed a non-invasive, radiation free breast cancer detection software that uses a high resolution thermal sensing device and a cloud hosted analytics solution for screening thermal images that accurately leads to the early detection of tumours. Orbuculum, another start-up in Bengaluru analyses genomic data to predict a gamut of diseases.
Telangana in fact, has adopted a cloud-based analytics tool developed by Microsoft, for the state’s Rashtriya Bal Swasthya Karyakram, to reduce avoidable blindness among children by screening them for the ailment. Thus predictive AI usage in healthcare can provide actionable insights based on available data and thus improve healthcare penetration.
Prescriptive analytics on the other hand, make use of machine learning to determine the best solution or outcome among various courses of action. For instance, an AI algorithm in IBM Watson for oncology will use information from relevant literature to assess the information from a patient’s medical record and throw up potential treatment options ranked by level of confidence. The oncologist can then use the results along with the supporting evidence to arrive at the appropriate treatment option. Such AI interfaces aid human decision making for doctors and health administrators to use critical data to support clinical, financial and operational decisions. It can lower the cost of healthcare, improve patient efficiency and mitigate operational risks.
This technology has found its way into hospitals in India as well. Manipal uses IBM Watson for Oncology. Max Healthcare,India has deployed the GE Healthcare’s web-based radiology information system—the Centricity RIS-IC. Integrated with the GE -picture archive and communication system (PACS), the programme addresses a healthcare unit’s evolving radiology workflow to enable seamless access to images like X-Ray, MRI and more for patients across locations. It can therefore be used to create an integrated customer record of patients. Fortis Hospital, Bengaluru has partnered with Phable, a healthcare start-up in India, to provide an App to the patients that allows for constant monitoring by the doctor in the event any new symptoms emerge and can also help patients manage medication, tests, diet, exercise etc.
The medical equipment industry are also using AI and machine learning to develop smart wearables and insertables that gather individual data and detect anomalies. The US drug major Abott has launched an Insertable Cardiac Monitor (ICM) that can alert users about irregular heartbeats (arrhythmias) on their smartphone screen (cardiovascular.abbott). Ten3T, another Indian healthcare start-up has launched a wearable device named ‘Smart Patch’ that inter alia measures the patients’ temperature, pulse and blood pressure and provides real time monitoring facility (ten3thealth.com). AI also delves into solving problems related to the pharma supply chain with tools streamlining the entire process from drug generation to delivery. Pharmarack, a Pune based start-up has developed a tool to automate the sales and operational processes of pharma companies (pharmarack.com). It offers management solutions from the origin of order to its completion, in a seamless platform to process, track, and settle all orders, creating complete visibility of business operations in real time.
The AI and machine learning has begun to partner with the medical insurance sector as well. Embedded into existing insurance frameworks, the platform helps insurers to automate and expedite the process, minimising delays and frauds. ICICI Lombard and HDFC bank with their AI and Natural Language Processing (NLP) based chat bots named MyRA and SPOK, respectively, are using AI to categorise, prioritise and respond to customer emails and mine appropriate information for an improved operational efficiency (myralabs.com;
Dhawan 2018) .
Ethical Concerns in AI Healthcare
In 2008, Google Flu Trends (GFT), began aggregating and analysing big data from a range of countries based on Google search queries. GFT then went on to predict or ‘nowcast’ the onset on flu outbreaks days before they were reported by the global Centres for Disease Control and Prevention (Lazer and Kennedy, 2015). However, GFT failed to accurately predict the 2009 global swine flu pandemic, as its algorithm over relied on the Google search patterns rather than the traditional reporting of the disease. In 2013, the GFT failed again, missing predictions by 140 per cent at the peak of the flu season. The project was thereafter closed. It is true that big data is competent to model disease spread and identify emergencies, way faster than traditional methods, but the method and the data used becomes critical in identifying a trend—which is why the GFT lost out. AI and machine learning therefore, needs to be understood in the perspective of its own set of challenges. Apart from the data accuracy concerns, a faulty algorithm can distort the results. In a scenario where humans begin to depend on AI for its decisions, such errors can lead to critical drawbacks in healthcare.
AI, if handled improperly can result in data leaks, which would lead to privacy violations. In India the consent forms for data sharing are not mandatorily filled by the healthcare units—and patients too are barely aware of its need. In practice, doctor-patient confidentiality is in the realm of ethics. Therefore, there is always a chance that the profile of patients can be exploited by companies and consequent data breach can lead to an erosion of trust among the general public. For instance, in 2016, a Mumbai based diagnostic laboratory Health Solutions had to remove over 35,000 medical records of patients which included HIV reports, when its data leaked (Indian Express, 2019). Such breaches are a constant threat that AI needs to combat in order to maintain patient confidentiality.
Then of course there is the single language predisposition that AI holds, where English predominates, making it difficult for the technology to penetrate rural areas. With a huge internet connectivity of over 566 million people in 2018 (The Economics Time, 2019), AI can make greater headway if vernacular usage is encouraged.
Importantly, an AI enabled system thrives on data—generation of poor quality data coupled with poor digital infrastructure and storage can skew results, rendering programmes ineffective. In India lack of trained professionals for data handling also impedes the penetration of AI in this sector. Also, the focus of AI in healthcare in India is nascent and fairly narrow, with disease specific solutions.
Way Forward
AI has significant scope in developing solutions in bettering the lives of humans, and healthcare is a priority area of research. Despite the many challenges AI and machine learning exhibit at present, ground is being made for larger and more accurate predictive and prescriptive programmes. An ambient policy framework by the Indian government that makes for favourable investments in the AI and machine learning sector can help augment the paucity of quality healthcare professionals in many locations of the nation
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On March 31, the World Economic Forum (WEF) released its annual Gender Gap Report 2021. The Global Gender Gap report is an annual report released by the WEF. The gender gap is the difference between women and men as reflected in social, political, intellectual, cultural, or economic attainments or attitudes. The gap between men and women across health, education, politics, and economics widened for the first time since records began in 2006.
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The Global gender gap index aims to measure this gap in four key areas : health, education, economics, and politics. It surveys economies to measure gender disparity by collating and analyzing data that fall under four indices : economic participation and opportunity, educational attainment, health and survival, and political empowerment.
The 2021 Global Gender Gap Index benchmarks 156 countries on their progress towards gender parity. The index aims to serve as a compass to track progress on relative gaps between women and men in health, education, economy, and politics.
Although no country has achieved full gender parity, the top two countries (Iceland and Finland) have closed at least 85% of their gap, and the remaining seven countries (Lithuania, Namibia, New Zealand, Norway, Sweden, Rwanda, and Ireland) have closed at least 80% of their gap. Geographically, the global top 10 continues to be dominated by Nordic countries, with —Iceland, Norway, Finland, and Sweden—in the top five.
The top 10 is completed by one country from Asia Pacific (New Zealand 4th), two Sub-Saharan countries (Namibia, 6th and Rwanda, 7th, one country from Eastern Europe (the new entrant to the top 10, Lithuania, 8th), and another two Western European countries (Ireland, 9th, and Switzerland, 10th, another country in the top-10 for the first time).There is a relatively equitable distribution of available income, resources, and opportunities for men and women in these countries. The tremendous gender gaps are identified primarily in the Middle East, Africa, and South Asia.
Here, we can discuss the overall global gender gap scores across the index’s four main components : Economic Participation and Opportunity, Educational Attainment, Health and Survival, and Political Empowerment.
The indicators of the four main components are
(1) Economic Participation and Opportunity:
o Labour force participation rate,
o wage equality for similar work,
o estimated earned income,
o Legislators, senior officials, and managers,
o Professional and technical workers.
(2) Educational Attainment:
o Literacy rate (%)
o Enrollment in primary education (%)
o Enrollment in secondary education (%)
o Enrollment in tertiary education (%).
(3) Health and Survival:
o Sex ratio at birth (%)
o Healthy life expectancy (years).
(4) Political Empowerment:
o Women in Parliament (%)
o Women in Ministerial positions (%)
o Years with a female head of State (last 50 years)
o The share of tenure years.
The objective is to shed light on which factors are driving the overall average decline in the global gender gap score. The analysis results show that this year’s decline is mainly caused by a reversal in performance on the Political Empowerment gap.
Global Trends and Outcomes:
– Globally, this year, i.e., 2021, the average distance completed to gender parity gap is 68% (This means that the remaining gender gap to close stands at 32%) a step back compared to 2020 (-0.6 percentage points). These figures are mainly driven by a decline in the performance of large countries. On its current trajectory, it will now take 135.6 years to close the gender gap worldwide.
– The gender gap in Political Empowerment remains the largest of the four gaps tracked, with only 22% closed to date, having further widened since the 2020 edition of the report by 2.4 percentage points. Across the 156 countries covered by the index, women represent only 26.1% of some 35,500 Parliament seats and 22.6% of over 3,400 Ministers worldwide. In 81 countries, there has never been a woman head of State as of January 15, 2021. At the current rate of progress, the World Economic Forum estimates that it will take 145.5 years to attain gender parity in politics.
– The gender gap in Economic Participation and Opportunity remains the second-largest of the four key gaps tracked by the index. According to this year’s index results, 58% of this gap has been closed so far. The gap has seen marginal improvement since the 2020 edition of the report, and as a result, we estimate that it will take another 267.6 years to close.
– Gender gaps in Educational Attainment and Health and Survival are nearly closed. In Educational Attainment, 95% of this gender gap has been closed globally, with 37 countries already attaining gender parity. However, the ‘last mile’ of progress is proceeding slowly. The index estimates that it will take another 14.2 years to close this gap on its current trajectory completely.
In Health and Survival, 96% of this gender gap has been closed, registering a marginal decline since last year (not due to COVID-19), and the time to close this gap remains undefined. For both education and health, while progress is higher than economy and politics in the global data, there are important future implications of disruptions due to the pandemic and continued variations in quality across income, geography, race, and ethnicity.
India-Specific Findings:
India had slipped 28 spots to rank 140 out of the 156 countries covered. The pandemic causing a disproportionate impact on women jeopardizes rolling back the little progress made in the last decades-forcing more women to drop off the workforce and leaving them vulnerable to domestic violence.
India’s poor performance on the Global Gender Gap report card hints at a serious wake-up call and learning lessons from the Nordic region for the Government and policy makers.
Within the 156 countries covered, women hold only 26 percent of Parliamentary seats and 22 percent of Ministerial positions. India, in some ways, reflects this widening gap, where the number of Ministers declined from 23.1 percent in 2019 to 9.1 percent in 2021. The number of women in Parliament stands low at 14.4 percent. In India, the gender gap has widened to 62.5 %, down from 66.8% the previous year.
It is mainly due to women’s inadequate representation in politics, technical and leadership roles, a decrease in women’s labor force participation rate, poor healthcare, lagging female to male literacy ratio, and income inequality.
The gap is the widest on the political empowerment dimension, with economic participation and opportunity being next in line. However, the gap on educational attainment and health and survival has been practically bridged.
India is the third-worst performer among South Asian countries, with Pakistan and Afghanistan trailing and Bangladesh being at the top. The report states that the country fared the worst in political empowerment, regressing from 23.9% to 9.1%.
Its ranking on the health and survival dimension is among the five worst performers. The economic participation and opportunity gap saw a decline of 3% compared to 2020, while India’s educational attainment front is in the 114th position.
India has deteriorated to 51st place from 18th place in 2020 on political empowerment. Still, it has slipped to 155th position from 150th position in 2020 on health and survival, 151st place in economic participation and opportunity from 149th place, and 114th place for educational attainment from 112th.
In 2020 reports, among the 153 countries studied, India is the only country where the economic gender gap of 64.6% is larger than the political gender gap of 58.9%. In 2021 report, among the 156 countries, the economic gender gap of India is 67.4%, 3.8% gender gap in education, 6.3% gap in health and survival, and 72.4% gender gap in political empowerment. In health and survival, the gender gap of the sex ratio at birth is above 9.1%, and healthy life expectancy is almost the same.
Discrimination against women has also been reflected in Health and Survival subindex statistics. With 93.7% of this gap closed to date, India ranks among the bottom five countries in this subindex. The wide sex ratio at birth gaps is due to the high incidence of gender-based sex-selective practices. Besides, more than one in four women has faced intimate violence in her lifetime.The gender gap in the literacy rate is above 20.1%.
Yet, gender gaps persist in literacy : one-third of women are illiterate (34.2%) than 17.6% of men. In political empowerment, globally, women in Parliament is at 128th position and gender gap of 83.2%, and 90% gap in a Ministerial position. The gap in wages equality for similar work is above 51.8%. On health and survival, four large countries Pakistan, India, Vietnam, and China, fare poorly, with millions of women there not getting the same access to health as men.
The pandemic has only slowed down in its tracks the progress India was making towards achieving gender parity. The country urgently needs to focus on “health and survival,” which points towards a skewed sex ratio because of the high incidence of gender-based sex-selective practices and women’s economic participation. Women’s labour force participation rate and the share of women in technical roles declined in 2020, reducing the estimated earned income of women, one-fifth of men.
Learning from the Nordic region, noteworthy participation of women in politics, institutions, and public life is the catalyst for transformational change. Women need to be equal participants in the labour force to pioneer the societal changes the world needs in this integral period of transition.
Every effort must be directed towards achieving gender parallelism by facilitating women in leadership and decision-making positions. Social protection programmes should be gender-responsive and account for the differential needs of women and girls. Research and scientific literature also provide unequivocal evidence that countries led by women are dealing with the pandemic more effectively than many others.
Gendered inequality, thereby, is a global concern. India should focus on targeted policies and earmarked public and private investments in care and equalized access. Women are not ready to wait for another century for equality. It’s time India accelerates its efforts and fight for an inclusive, equal, global recovery.
India will not fully develop unless both women and men are equally supported to reach their full potential. There are risks, violations, and vulnerabilities women face just because they are women. Most of these risks are directly linked to women’s economic, political, social, and cultural disadvantages in their daily lives. It becomes acute during crises and disasters.
With the prevalence of gender discrimination, and social norms and practices, women become exposed to the possibility of child marriage, teenage pregnancy, child domestic work, poor education and health, sexual abuse, exploitation, and violence. Many of these manifestations will not change unless women are valued more.
[wptelegram-join-channel link=”https://t.me/s/upsctree” text=”Join @upsctree on Telegram”]2021 WEF Global Gender Gap report, which confirmed its 2016 finding of a decline in worldwide progress towards gender parity.
Over 2.8 billion women are legally restricted from having the same choice of jobs as men. As many as 104 countries still have laws preventing women from working in specific jobs, 59 countries have no laws on sexual harassment in the workplace, and it is astonishing that a handful of countries still allow husbands to legally stop their wives from working.
Globally, women’s participation in the labour force is estimated at 63% (as against 94% of men who participate), but India’s is at a dismal 25% or so currently. Most women are in informal and vulnerable employment—domestic help, agriculture, etc—and are always paid less than men.
Recent reports from Assam suggest that women workers in plantations are paid much less than men and never promoted to supervisory roles. The gender wage gap is about 24% globally, and women have lost far more jobs than men during lockdowns.
The problem of gender disparity is compounded by hurdles put up by governments, society and businesses: unequal access to social security schemes, banking services, education, digital services and so on, even as a glass ceiling has kept leadership roles out of women’s reach.
Yes, many governments and businesses had been working on parity before the pandemic struck. But the global gender gap, defined by differences reflected in the social, political, intellectual, cultural and economic attainments or attitudes of men and women, will not narrow in the near future without all major stakeholders working together on a clear agenda—that of economic growth by inclusion.
The WEF report estimates 135 years to close the gap at our current rate of progress based on four pillars: educational attainment, health, economic participation and political empowerment.
India has slipped from rank 112 to 140 in a single year, confirming how hard women were hit by the pandemic. Pakistan and Afghanistan are the only two Asian countries that fared worse.
Here are a few things we must do:
One, frame policies for equal-opportunity employment. Use technology and artificial intelligence to eliminate biases of gender, caste, etc, and select candidates at all levels on merit. Numerous surveys indicate that women in general have a better chance of landing jobs if their gender is not known to recruiters.
Two, foster a culture of gender sensitivity. Take a review of current policies and move from gender-neutral to gender-sensitive. Encourage and insist on diversity and inclusion at all levels, and promote more women internally to leadership roles. Demolish silos to let women grab potential opportunities in hitherto male-dominant roles. Work-from-home has taught us how efficiently women can manage flex-timings and productivity.
Three, deploy corporate social responsibility (CSR) funds for the education and skilling of women and girls at the bottom of the pyramid. CSR allocations to toilet building, the PM-Cares fund and firms’ own trusts could be re-channelled for this.
Four, get more women into research and development (R&D) roles. A study of over 4,000 companies found that more women in R&D jobs resulted in radical innovation. It appears women score far higher than men in championing change. If you seek growth from affordable products and services for low-income groups, women often have the best ideas.
Five, break barriers to allow progress. Cultural and structural issues must be fixed. Unconscious biases and discrimination are rampant even in highly-esteemed organizations. Establish fair and transparent human resource policies.
Six, get involved in local communities to engage them. As Michael Porter said, it is not possible for businesses to sustain long-term shareholder value without ensuring the welfare of the communities they exist in. It is in the best interest of enterprises to engage with local communities to understand and work towards lowering cultural and other barriers in society. It will also help connect with potential customers, employees and special interest groups driving the gender-equity agenda and achieve better diversity.