We sat down with Dr Karen DeSalvo, Chief Health Officer at Google, who reflects on her exceptional journey, with a career deeply rooted in public health and social determinants, and joining Google amidst the rapid changes brought by the COVID-19 pandemic. Here, she discusses the evolution of her priorities and Google’s role in advancing equitable healthcare through technology.
You mentioned that upon joining Google, the change of pace, especially during the COVID-19 pandemic, was rapid and significant. How have your priorities and professional focus evolved in response to these dynamic conditions?
The priorities of the work increasingly aligned with my own, particularly in prevention and upstream thinking, providing more knowledge and insights to everyone. My career has focused on social determinants of health and public health improvement, alongside practising medicine. At Google, we help people gain more knowledge about themselves, which is crucial for better health. From a priority standpoint, I feel I’ve influenced the company to see its role in improving public health, not just medical care, despite the pressures and challenges in the healthcare system.
It seems no specific country is thriving post-pandemic. However, given the existing technologies, why do you think there has been a slow adoption of these advancements in various sectors?
I think some of it is that healthcare is human and humans are complex and varied. No two patient stories are the same; everyone has their own history, context, genomics and epigenetics. While it is possible to create systems providing general support, such as in maternal health where we know the necessary actions before, during and after pregnancy, the challenge is not knowing what to do but in the context and delivery. Access is another major issue—some people lack financial means, linguistic access, the ability to take time off work, or fear using the system.
COVID-19 highlighted that technology can help meet people where they are, rather than making them come to the healthcare system. Telehealth is a prime example of this shift, becoming common globally. People began testing themselves for COVID-19, much like those with HIV have done and tracking their health information. This shift opens opportunities for equitable access since technology can reduce barriers like travel and time off work. For instance, AI technologies like Google’s that translate informational videos on YouTube can reach more people without added complexity. People also started to keep their vaccine records in apps, such as the NHS app and the Indonesian government’s app, fostering trust in self-management.
Another key point is the importance of non-proprietary technology for improving access and equity. Unlike the first wave of digitisation, where bespoke data models were common, there’s now an emphasis on interoperability and data standards like FHIR (Fast Healthcare Interoperability Resources). Governments are adopting these open standards to ensure data moves with people, not staying static, which empowers both individuals and the systems they interact with. This approach aligns with work I did in the US government on harmonised open standards, which Google also supports to enhance data interoperability and equity in healthcare.
Given that those who would benefit most from health and medical technology often cannot afford it, what is Google doing to ensure their tools and technologies are accessible to a wider audience?
We have a few ways that we do that work. Firstly, a broader philosophical comment, is that there are places in the world like Japan and India where technology is introduced to the ecosystem and costs go down. These are healthy economies where technology improves access and lowers prices. In the US, new technology is often thought to increase costs, but it doesn’t have to. General-purpose AI and technology not built on bespoke hardware can help lower costs by using tools and technology that people already have. Even though wearables may be out of reach for some, there are many sensors on people’s phones and most people globally have access to smartphones. We aim to build tools that are compatible with older versions of Android since 3 billion people have access to Android phones, which arent always the latest version. For example, with Google Lens, which can take a picture of a skin lesion and show possible diagnoses, we built it to work well on older Android phones. We always consider inclusion and equity in our technology development.
Your team has been described as putting healthcare into our pockets and our homes. What would your message be to those people who are still sceptical about both the quality of care that you’ve received and concerns around cybersecurity and data?
Just like we need inclusion by design, we need privacy by design. Here’s the key thing: people want to understand that we handle their information responsibly. On platforms like YouTube, especially in search, we don’t push ads against health information and we don’t track their activity without consent. When signing in on YouTube and asking about preferences for AI, if users consent, their watch might track steps and sleep. We work with people around the world based on information and consent.
In healthcare, it’s different. For instance, if someone wants to use their phone to take their temperature with a regulated device, they can do that. This feature is currently approved in the US, with plans to expand to other countries. Users will know their temperature and it will be stored on their phone. We also aim to make it easy for users to share their health data, such as temperature or AFib detection, with their providers. This can be done through Health Connect as the data storage layer or via an API with electronic health record companies.
Regarding care delivery, AI models can’t smell, but they can see and hear, enabling telehealth to do many things. However, it’s not always sufficient for every situation; sometimes in-person visits are necessary. Most people begin their health journey by learning more about their condition. When we think about having health information on our phones, it means starting with knowledge so that when you visit the doctor, have a home visit or use telehealth, you’re prepared with questions and informed about your health.
For those deeply involved in technology and looking to leverage it more in healthcare, what should they focus on and prepare to invest in for the future?
I think for the general public and doctors alike, GenAI is an exciting technology with great promise for scientific discovery, treatment and prevention. However, it’s still very early in the journey. At Google, we’re still learning what good and safe applications look like and how to tune the models to be factually accurate. You don’t want creative responses about something as serious as chemotherapy; you want solid evidence behind it. Building reliable models is a fast-evolving science, with ongoing work from us and other companies. While the future is promising, it’s crucial to understand that these are early days.
In terms of investment, I tell my teams: to think about when email was first introduced. Many of us had to learn how to use it and now it’s second nature. The same goes for GenAI tools. They’re being integrated into documents, slides, worksheets and emails. People interested in technology should not only consider its use in healthcare but also get comfortable using it in everyday life. This helps in learning how to prompt models, discern the information they provide and take extra steps to verify accuracy.
Click below to share this article