Evolving Perspectives on Healthcare Algorithmic and Artificial Intelligence Bias 

Posted on June 10, 2024 by Caleb J. Colón-Rodríguez, DrPH, MHSA, Public Health Analyst, Division of Program Operations, Office of Minority Health, U.S. Department of Health and Human Services

Since we published our first blog on bias in healthcare algorithms and artificial intelligence (AI) less than a year ago, we have already started to see a progressive shift in how the healthcare industry recognizes and addresses these biases. In late October 2023, President Biden signed an Executive Order on the Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence recognizing that “harnessing AI for good and realizing its myriad benefits requires mitigating its substantial risks” and a society-wide effort to address these risks. By December 2023, 28 healthcare providers and payers voluntarily committed to the safe, secure, and trustworthy use and purchase of AI in healthcare. 

Let’s explore this topic further and learn how experts are working to set the ground rules for healthcare technology. 

Developing a Framework  

A December 2023 article in Journal of the American Medical Association Network Open brought a team of experts together to figure out how we can make healthcare technology better for everyone. The panel developed a conceptual framework for users at all levels to apply in all phases of a health care algorithm’s life cycle.  

The five guiding principles the panel came up with are: 

  1. Promote health and health care equity during all phases of the health care algorithm life cycle. 
  1. Ensure health care algorithms and their use are transparent and explainable. 
  1. Authentically engage patients and communities during all phases of the health care algorithm life cycle and earn trustworthiness. 
  1. Explicitly identify health care algorithmic fairness issues and tradeoffs. 
  1. Establish accountability for equity and fairness in outcomes from health care algorithms. 

Let’s take a closer look at each of these guiding principles.  

Defining the Game Plan

Just like in sports or games where rules ensure fair play, the guiding principles set up rules to make healthcare technology fair. Here's what the experts suggest: 

  1. Health Equity in Every Step 

What It Means: On a sports team, every player is crucial to winning the game. Likewise, computer algorithms need to consider all players not just the starters or the stars. 

Plain language: The technology should work well for everyone, no matter where they're from or what they look like. 

  1. Transparency and Clarity 

What It Means: The way these healthcare algorithms and AI work should be as clear as the game plan shared in a team huddle. Everyone should grasp how the play is going to unfold.  

Plain language: Everyone should know how computer algorithms make decisions about health. 

  1. Engaging Everyone 

What It Means: Just as a coach picks players from various positions to form a winning team, people from different backgrounds should contribute to creating these healthcare algorithms. 

Plain language: If you're making something for everyone, everyone should have a say in it. 

  1. Identifying Fairness Issues 

What It Means: Just like a referee in a game, there should be checks to make sure the healthcare algorithms are fair and not biased. 

Plain language: Regular check-ups ensure the technology treats everyone equally. 

  1. Accountability for Fair Outcomes 

What It Means: The people who make these healthcare algorithms are the team captain. They are responsible for making sure the technology is fair and their teammates adhere to the game rules. 

Plain language: If something goes wrong, it's their job to fix it and make sure it's fair. 

Why Are These Guiding Principles Important? 

Imagine if a sport was made easier for some players and harder for others based only on where they live or how they look. That wouldn't be fair, right? It's the same with healthcare technology. We need to make sure these tools help every patient equally, no matter who they are. 

Your Role in This Big AI World 

Stay Informed: Learn about these issues of fairness and transparency in healthcare algorithms. The more you know, the more you can help make things better. The guiding principles emphasize the importance of working closely with patients and communities to build trust. Also, it is crucial for someone to take responsibility to ensure that the outcomes are fair for everyone involved and to promote health and healthcare equity. 

Be a Voice: Share what you learn. When you talk about equity, transparency, trustworthiness, fairness, and accountability you help others understand how important it is. We can all contribute to improving and making healthcare more equitable by sharing the guiding principles. 

Towards a Fairer Future in Healthcare 

The U.S. Department of Health and Human Services Office of Minority Health is focused on helping to reduce differences in health outcomes, known as health disparities, for racial and ethnic minority populations and American Indian and Alaska Native communities. By disseminating these AI guiding principles, we can help promote health equity in the AI technology doctors use.  


Chin, M. H., Afsar-Manesh, N., Bierman, A. S., et al. (2023). Guiding Principles to Address the Impact of Algorithm Bias on Racial and Ethnic Disparities in Health and Health Care. JAMA Network Open, 6(12), e2345050. https://doi.org/10.1001/jamanetworkopen.2023.45050