Rapid advancements in digital health — spanning technologies like telemedicine, personalized digital nudges, and large language models — present new possibilities for addressing persistent problems in healthcare access, cost, and quality. Yet there is an urgent need for effective strategies to ensure digital health innovations improve healthcare delivery and health outcomes benefiting underserved populations especially in low- and middle-income countries (LMICs).

A new viewpoint paper published in the Journal of Medical Internet Research presents an analytic framework for evaluating the foundations of digital health innovations. Focusing on the digital health landscape in LMICs in South and Southeast Asia, the paper’s co-authors provide actionable recommendations for tailoring and implementing digital health solutions across diverse global health settings.

The co-authors include Siyan Yi, an associate professor at the National University of Singapore’s School of Public Health and a former postdoctoral fellow with the Asia Health Policy Program (AHPP) at Shorenstein APARC; Stanford health economist Karen Eggleston, the director of AHPP; Kochukoshy Cheruvettolil, former senior strategy officer with the Bill & Melinda Gates Foundation’s Digital Health and Artificial Intelligence division; Kiran Gopal Vaska of the National Health Authority, Ministry of Health and Family Welfare in New Delhi, India; and several collaborators from Stanford’s School of Medicine, among others.

Citing the advantages of a “human-in-the-loop” approach to Artificial intelligence (AI) — a collaborative approach that integrates human input and expertise into the lifecycle of machine learning and AI systems — the co-authors emphasize the potential benefits of a “researcher-in-the-loop” approach to digital health innovations in LMICs. Their collaboration for this paper was conceived during a panel discussion on digital health innovation featuring Cheruvettolil, Vaska, and Yi. Hosted by AHPP in October 2023, this event was part of APARC’s Autumn 2023 seminar series, Exploring APEC’s Role in Facilitating Regional Cooperation.

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Building Social Value in Digital Health Adoption

While the promise of digital health is universal, its implementation must address local needs and be tailored to promote adoption, recognizing that underserved populations lack adequate infrastructure and equitable access to healthcare services and digital innovations. Yet it is crucial to balance the social benefits of digital health innovations with the social costs of adoption. It is also imperative to gather evidence and insights on successes and failures when adopting such innovations in diverse local contexts.

To address these needs, the paper's coauthors advocate for a dual approach that combines a top-down, evidence-based strategy focused on designing and scaling national digital health infrastructures with the bottom-up creation of a vibrant ecosystem of local experiments generating shared experience.

“This two-pronged approach of top-down design and bottom-up experimentation, enabled through careful evaluation of effectiveness and impact, allows economies with different starting conditions to seize opportunities to ‘leapfrog’ towards more robust, resilient health systems fitting their contexts rather than imitate the development path of any given current high-income country or region,” the coauthors argue.

This theoretical framework recognizes that the social net benefit of digital innovations is heavily influenced by the initial conditions and the intended outcomes shaped by the local context. For example, in LMICs, persistent disparities in digital access and digital literacy determine the unfolding of the introduction, adoption, and integration of digital health interventions into the broader health system and compound existing inequities in access to healthcare.

Still, the co-authors emphasize that digital technologies can potentially deliver significant, even transformative benefits in LMICs that surpass the impacts seen in high-income health systems — provided that robust oversight and stewardship uphold the “First, do no harm” principle.

Integrated Digital Health Solutions

One of the coauthors’ key recommendations is to create a robust digital health infrastructure with adaptable data architectures, interoperability, and stringent privacy standards. They underscore the necessity of creating an integrated data ecosystem, as exemplified by India's Ayushman Bharat Digital Mission (ABDM), which facilitates personalized healthcare and evidence-based policymaking through effective data management.

Yet varying data standards across countries can pose challenges to comparability and effectiveness, in addition to ethical and legal dilemmas around sensitive health data. Singapore's Personal Data Protection Act and India's Digital Personal Data Protection Act are examples of regulatory frameworks protecting sensitive health information. These regulations are crucial for building trust among patients and healthcare providers — an essential prerequisite for successfully adopting digital health solutions.

The paper also highlights the potential of mobile health (mHealth) interventions and AI applications in revolutionizing healthcare delivery by bridging geographical barriers, expanding access to underserved populations, and shifting care from hospitals to communities. For instance, mHealth initiatives in India and Cambodia leveraging the widespread adoption of low-cost smartphones have shown promise in improving maternal and child health outcomes in low-income settings. Social media platforms further amplify the reach of public health campaigns and community-based interventions by utilizing trusted local voices.

AI is a new transformative force in digital health, enabling advancements in precision health, from diagnosing complex conditions to supporting clinical decisions. For example, in Thailand, a deep learning algorithm integrated into the national diabetic retinopathy screening program provides real-time, specialist-level diagnostics in community settings. AI solutions like this hold particular promise for addressing the challenges of low-resource health systems, including shortages of trained staff and limited equipment.

On the other hand, the coauthors caution against the risks associated with digital health technologies, including misinformation and ethical concerns. Clear data collection, storage, and sharing guidelines are critical, along with measures to safeguard sensitive health information.

Social Legitimacy and Local Partnerships

The paper emphasizes a call to action for researchers, policymakers, healthcare professionals, and civic organizations to invest in digital health infrastructure and foster interdisciplinary, local partnerships to promote need-driven, culturally sensitive, and equitable interventions. By prioritizing community engagement, the co-authors argue, digital health innovations can bridge geographical gaps, enhance healthcare accessibility, and ultimately improve health outcomes for underserved populations.

For example, the NGO Noora Health has successfully leveraged digital health across India, Bangladesh, and Indonesia to improve access to caregiver training. Successful features of their programs include mobile chat services and digital curricula integrated into comprehensive care delivery models that utilize local healthcare systems through partnerships with local governments, policymakers, and community health workers.

Ultimately, the co-authors note that the key to success lies in effectively stewarding health sectors to address priority population health needs and improve equity. “Policies should support the generation of evidence assessing digital health applications so that patients, providers, and policymakers can ask and answer the right questions in a suitable timeframe to enable a virtuous cycle of learning and improvement.” In resource-constrained LMICs, it is also essential to consider the financing levers in the public and private sectors to understand the feasibility of adopting and scaling up. In these contexts, private philanthropy can secure resources, mitigate risks, and generate evidence about best practices and scalability.

In a landscape where technology and healthcare intersect, the path forward must include prioritization of local contexts, engaging communities, and building a robust digital health infrastructure that serves the needs of all. The future of healthcare may depend on it.

As the AI boom fuels an unprecedented surge in demand for chips and computing power, the global semiconductor supply chain has become critical in everything from smartphones and medical devices to cars and fighter jets. At the heart of this industry stands Taiwan, a leader in chip-making infrastructure, encompassing fabrication to cutting-edge research and development. With the People's Republic of China’s threat to Taiwan’s prosperity and stability becoming more acute, it is time for the United States and Taiwan to deepen their partnership in the semiconductor industry, argue Hoover Institution Research Fellow Kharis Templeman and FSI Center Fellow Oriana Skylar Mastro.

In a chapter that is part of a new report, titled “The Silicon Triangle: The United States, Taiwan, China, and Global Semiconductor Supply,” Templeman and Mastro show what the United States might learn from Taiwan’s successful experience in building a leading global role in the semiconductor supply chain and offer concrete opportunities for deeper collaboration given the two nations’ shared interests in chips.  The report is a product of the Working Group on Semiconductors and the Security of the United States and Taiwan, a joint project of the Hoover Institution and the Asia Society Center on U.S.-China Relations.

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Templeman and Mastro’s chapter, “Deepening US-Taiwan Cooperation through Semiconductors,” outlines the history of the Taiwanese semiconductor industry, accounts for its meteoric rise to prominence, and proposes that the United States and Taiwan should seek to use the semiconductor industry to “promote Taiwan’s prosperity and stability by creating an environment that fosters deeper business-to-business, research, academic, individual, and civil ties with Taiwan and other global partners in the semiconductor arena.”

To do so, the authors argue, the United States should actively promote Taiwan semiconductor firm activities, including manufacturing, design, and joint research and development in the United States; income tax abatement for cross-border workers; two-way semiconductor internship programs and academic exchange; semiconductor supply chain information sharing and resiliency planning; and defense industry co-production in Taiwan.

Deterring Invasion

According to Templeman and Mastro, further investment in Taiwan’s semiconductor industry would strengthen long-term U.S. interests there and represent an opportunity for the two nations to broaden their shared civil and business ties that will help to “deepen U.S. commitments to Taiwan’s democracy—and [deter] efforts to end it.”

The authors consider the PRC’s increasingly aggressive rhetoric of reunification and suggest that “leaders in the United States and Taiwan should be realistic about the real threat that the island faces, and their response to that should be to build the capabilities and the confidence of their people to weather coercion and deter attack.” As such, semiconductors represent a natural opportunity for the two nations to “grow substantive people-to-people, business, and even appropriate government ties at the working level […] we can use this momentum to break through long-standing bureaucratic frictions and improve interoperability in our economic and security relationships.”

The PRC threat to Taiwan’s autonomy will continue to grow as the island is increasingly isolated from the broader international community, the authors write. Reversing this trend, they say, “requires both symbolic and substantive assistance on the part of the United States and other countries.”

Deepening collaboration in the semiconductor industry represents a path for the United States to demonstrate its commitment to Taiwan, independent of the rhetorical debate over strategic clarity or ambiguity. The momentum gained through this collaboration would aid Taiwan’s resilience and incentivize other governments and opinion leaders in the region to deepen their commitments to the island, further enhancing cross-strait deterrence.

Societies today are hungry for strategies and solutions that scale growth while improving social outcomes. To spur purpose-driven, innovative responses to the challenges before us, young people must develop skills and approaches grounded in agility, creativity, and empathy. Renowned Japanese rock star, composer, entrepreneur, and philanthropist YOSHIKI shared this advice for doing so:

“As long as you try to make the world a better place, you’ll find your passion. If you believe in yourself, you can conquer anything,” he said while headlining the conference The Future of Social Tech, held on February 23 at Stanford University. Speaking in front of a packed audience and thousands of viewers who tuned in to the livestream, YOSHIKI described how he overcame difficult times and what keeps him motivated. He encouraged Stanford students to redefine failure as a stepping stone to propel themselves forward and practice gratitude. “If you think that way, you can do pretty much whatever you want. Be your own rock star.”

Hosted by the Japan Program at the Walter H. Shorenstein Asia-Pacific Research Center (APARC), the conference kicked off a special event series celebrating APARC’s 40th anniversary. Titled Asia in 2030, APARC@40, the series highlights core areas of the center’s expertise, examines Asia’s transformation over the past four decades, and considers the drivers and shapers of the region’s future.

The conference gathered Japanese and American entrepreneurs, investors, content creators, and educators to share lessons and best practices to accelerate innovation for social impact, or “social tech.” It was the first major university keynote venue for YOSHIKI, a composer, classically-trained pianist, rock drummer, and the leader of the rock groups X Japan and The Last Rockstars. A global rock star and a living legend in Japan, YOSHIKI has pioneered a new brand of visual rock and style and has constantly been pushing his career in new directions, launching products and projects across diverse fields, from fashion and winemaking to finance and philanthropy.

Cultivating Japan-U.S. Partnerships

In his welcome remarks, APARC Director Gi-Wook Shin, the William J. Perry Professor of Contemporary Korea, noted that Japan was one of APARC’s primary research areas since its early beginnings and that the conference embraces that original spirit of keen engagement with Japanese affairs and fostering partnerships between Japan and the United States. 

Consul General of Japan in San Francisco Yasushi Noguchi also offered welcoming remarks, expressing his pride in representing Japan in the United States, two key sources of globally successful technological advancements and content development in the past half-century. The Consul General's office has been critical for the growth of APARC’s Japan Program, generously supporting various activities such as student exchanges, research initiatives, conferences and workshops, and other educational and programming engagements.

As he opened the conference, Japan Program Director Kiyoteru Tsustui, the Henri H. and Tomoye Takahashi Professor in Japanese Studies and deputy director at APARC, explained that, when thinking of Japan in 2030, many Japanese envision a country that plays a positive force in a divided world and that once again becomes a leader of technological innovation. But while there is consensus that such innovation should have social benefits, few have offered clear pathways for realizing this direction. “This conference boldly seeks to find ways forward for entities in Japan and the United States to develop social tech,” said Tsutsui.

Investing in Natural Capital

The morning session of the conference opened with a panel on the future of the environment. Attendees heard from Reiko Hayashi, a director and deputy president at Bank of America Securities Japan Co., Ltd, about sustainable finance in the capital markets and efforts to promote sustainable finance in Japan. Hayashi highlighted steps that Japan’s government is taking to meet its 2050 net-zero goal, its multi-step policy on climate transition finance, and its 2021 revision of the corporate governance code to include sustainability.

Panelist Gretchen Daily, co-founder and faculty director of the Natural Capital Project (NatCap) and the Bing Professor of Environmental Science at Stanford, described the NatCap framework that integrates the value nature provides to society into all major decisions. NatCap partners with a network of hundreds of public and private sector institutions around the world. Daily emphasized that now is the time to capitalize on the momentum in climate action and connect government planners, multilateral financial institutions, private sector partners, and other stakeholders to deliver durable social and economic benefits while securing the world’s stock of natural resources.

Educating Social Innovators

The second panel, which focused on the future of sciences and arts education, featured two trailblazers working to equip new generations with skills and mindsets grounded in imagination, empathy, and curiosity. Sachiko Nakajima, an award-winning musician, mathematics researcher, and educator, shared insights from her work to democratize creativity. As the founder and CEO of steAm.Inc, Nakajima educates the public on the inherent connection between math and music and the importance of including the Arts in STEM (science, technology, engineering, and math). In particular, Nakajima aims to reduce gender disparities and pave the way for more women in STEAM in Japan.

Rie Kijima, an assistant professor and director of the Initiative for Education Policy and Innovation at the University of Toronto, noted that one goal we must strive for is to create an environment where young learners believe they can be catalysts of positive social change. Kijima is the co-founder of SKY Labo, an education nonprofit organization that promotes STEAM learning and design thinking in Japan. SKY Labo's definition of STEAM embraces a human-centered approach to tackling solutions in a playful, artful, soulful way that aims to cultivate a sense of purpose and meaning in young learners. “In our education system today, there's so much emphasis on success,” said Kijima, but one of SKY Labo’s messages is that “we need to fail in order to succeed; every time we fail, we fail forward.”

Strengthening Democracy, Combating Digital Echo Chambers

The afternoon panel shifted the focus to the future of democracy and digital media. Attendees heard from Ken Suzuki, CEO and co-founder of SmartNews, an award-winning news app on a mission to “deliver the world’s quality information to the people who need it.” SmartNews uses AI technology to collect trustworthy news from all over the world and organize it for users in simple interfaces. The app, which aims to burst news filter bubbles, includes what it calls a “News From All Sides” slider — a feature that allows users to get a range of perspectives from different publishers across the political spectrum. “We need an ecosystem with incentives to create high-quality content,” said Suzuki. “Democracy is at stake, but I believe that technology can be used for the good of society.”

The following discussion about paths to addressing the threats to democracy included Francis Fukuyama, the Olivier Nomellini Senior Fellow at Stanford’s Freeman Spogli Institute for International Studies (FSI), and Larry Diamond, the William L. Clayton Senior Fellow at the Hoover Institution and the Mosbacher Senior Fellow in Global Democracy at FSI. Fukuyama reminded the audience that technology itself never fully solved any human problems. “It's only to the extent that our political systems and institutions can guide technology and use it for socially beneficial purposes that technology actually ever manages to solve anything.” The real task, according to Fukuyama, is to figure out how to control the power of social media platforms and other big companies to silence and amplify content in a non-transparent way. He called for making it mandatory for internet platforms to enable users to choose the kind of content moderation they are served.

Diamond emphasized the need for more legal and regulatory action to increase transparency in the algorithms used by social media companies. It is also necessary to socialize social media users to seek multiple points of view and to understand that echo chambers are civically and democratically dangerous. Ultimately, said Diamond, robust civic education is the best way to teach young people about inquiry and rational debate and prepare them to use tools like SmartNews.

“The Hero Is Within You”

At the conference closing session, keynote speaker YOSHIKI joined Ichiro Fujisaki, former Japanese Ambassador to the United States, for a conversation about the future of the entertainment industry and content business. YOSHIKI talked about his experiences working in both Japan and the United States and pursuing new challenges in multiple fields. “The hero is within you,” he said. “It’s never too late to start anything.”

Reflecting on the future of society in the age of AI from his perspective as a musician and entrepreneur, YOSHIKI said, “If humanity is meant to destroy us, AI will do it faster; If humanity is meant to support each other, AI will support us. Let’s live to support each other and love one another, so that when the singularity moment comes, AI will support us.”