Ana Estela Haddad

Artificial intelligence (AI) is rapidly reshaping the landscape of health care, from clinical diagnostics and disease surveillance to the prediction of individual health risks. Yet, its immense promise will only materialize if the tools we deploy work for everyone. Algorithms trained on incomplete or biased datasets risk embedding historical health disparities and can replicate patterns of uneven data representation, thereby limiting accuracy and generalizability across population groups. Addressing algorithmic bias should be treated as a core health quality standard, comparable in importance to safety and efficacy evaluations, to ensure consistent performance across all segments of the population. This paper aims to frame algorithmic bias in health-related AI as a quality, safety, and governance challenge for health systems rather than solely a technical problem for developers. It aims to inform policymakers, regulators, health system leaders, and developers by translating existing scientific evidence and regulatory guidance into operational governance considerations, with particular attention to the realities of low- and middle-income settings in the region of the Americas. This paper synthesizes existing knowledge and institutional experience into a practical, regionally grounded policy perspective. To operationalize this perspective, this paper first outlines the main forms of algorithmic bias relevant to health systems—including representation, measurement, aggregation, and deployment biases—and illustrates how each can emerge across the AI lifecycle. It then situates these technical challenges within the broader digital health context, where structural, commercial, and social dynamics may amplify inequities. This paper discusses the implications of biased data for emerging areas such as precision medicine before proposing a governance-oriented framework for bias mitigation that spans design, validation, deployment, and postmarket monitoring. It concludes with priority governance actions for policymakers, regulators, and health system leaders to embed fairness as a measurable component of health system performance.

Teledentistry has emerged as a promising strategy to improve access to urgent dental care for pediatric populations, particularly in underserved areas; however, evidence regarding the agreement between telescreening and in-person assessment for pediatric dental emergencies remains limited. This before-and-after study, nested within a randomized controlled clinical trial, evaluated the level of agreement between diagnoses and risk classifications obtained through telescreening and in-person consultation in children aged 3 to 13 years presenting with dental pain. All participants underwent synchronous telescreening using a standardized questionnaire and were randomized into two groups; the present analysis included 130 children allocated to telescreening followed by an in-person consultation, which was performed by a blinded examiner unaware of the telescreening results. Agreement between treatment decisions (urgent vs. elective) was assessed, and pain outcomes were monitored at baseline, 7 and 15 days using the Wong–Baker Faces Pain Scale. Agreement between telescreening and in-person evaluation was observed in 49.2% of elective cases and 26.9% of urgent cases, with infrequent changes in treatment decisions, including 6.9% of cases reclassified from urgent to elective and 0.8% from elective to urgent. Pain scores showed a significant reduction over time (p < 0.001), with median values decreasing to zero at both follow-up assessments. These findings indicate that telescreening demonstrates good agreement with in-person evaluation for the identification and management of pediatric dental appears to be a viable and effective alternative for initial screening and referral, although adherence to subsequent in-person care remains an important consideration. Trial registration: Brazilian Clinical Trials Registry (ReBEC): RBR-523hrsx.

This study aimed to describe and analyze the implementation of the “ARTSUS-SP” strategy in the city of São Paulo, which incorporated Atraumatic Restorative Treatment (ART) into the School Health Program to expand and improve students’ access to dental care through treatments provided in public primary schools. Methods Data analysis was guided by the Sustainable Oral Health Framework. In the qualitative phase, the research teams examined meeting minutes and speeches from the Specialist Committee, comprising professors (n = 6), graduate students (n = 10), managers (n = 3), and supporting health and education professionals (n = 40). This analysis focused on training stages, strategy adoption, and facilitators and barriers to implementation. In the quantitative phase, a descriptive analysis was conducted considering the number of participating Basic Health Care Units, children treated, teeth restored, and reported pulp exposure. Results The pilot project and training program were well accepted and aligned with team needs. Key aspects included the hybrid training course and the incorporation of local contextual factors. Quantitative data demonstrated an increase in coverage, with 10,300 children receiving care and 23,638 decayed teeth restored over a six-month period. Conclusion Implementation was supported by motivated leadership and well-trained teams, resulting in a positive impact on access to dental care. However, barriers such as high staff turnover and resource limitations remain critical challenges to long-term sustainability.

This article presents the foundations, methodology, and territorial analyses that underpinned the creation of the Index of Criteria for the Distribution of Financial Resources for the Digital SUS Program (ICSD), developed by the Department of Information and Digital Health of the Ministry of Health, to promote a more equitable distribution of resources of the program. The methodology involved the use of variables, such as rural-urban typology (2017), the Social Vulnerability Index (SVI) (2015), the Brazilian Connectivity Index (Índice Brasileiro de Conectividade - IBC) (2022), the medical specialists density per inhabitant (2023), the percentage of own revenues allocated to health (2022), SUS hospital beds (2023), specialized health care establishments (2023), outpatient production (2023), as well as the attraction indices for health services, of varying complexities, used in the classification of the Region of Influence of Cities (2018). The results revealed regional inequalities and highlight the need for strategies to strengthen digital health in territories with greater vulnerability. This study also discusses the application of the ICSD in the health macroregions and the simulations that guided resource transfers within the Digital SUS Program, aiming to reduce inequities and promote territorial justice.

This article presents the theoretical foundations, methodological approach, and key findings of the situational diagnosis conducted by the Department of Information and Digital Health, part of the Ministry of Health, covering the country’s 120 health macroregions within the context of the SUS Digital Program. The methodology included the application of an electronic questionnaire with 32 objective and discursive/open-ended questions, organized into four sections: health networks and service delivery, workforce, training and continuing education, and macro-regional priorities and digital transformation in health. The situational diagnosis aimed to support the development of Digital Health Transformation Action Plans, based on the organization of the Health Care Network (HCN). Analysis of the questionnaire responses revealed relevant inequalities across territories, directly impacting the organization of the Networks. These asymmetries directly affect the organization of HCNs. It is argued that regionalized planning and the strengthening of digital health - especially in areas of greater vulnerability - constitute effective strategies to reduce regional health inequalities.

Resumo O artigo apresenta fundamentos teóricos, metodologia e principais resultados do diagnóstico situacional conduzido pela Secretaria de Informação e Saúde Digital, vinculada ao Ministério da Saúde, abrangendo as 120 macrorregiões de saúde do país, no contexto do Programa SUS Digital. A metodologia incluiu a aplicação de um formulário eletrônico com 32 questões objetivas e discursivas, organizado em quatro seções: redes de saúde e prestação de serviço; força de trabalho; formação e educação permanente; e prioridades da macrorregião e a transformação digital na saúde. O diagnóstico buscou subsidiar a elaboração dos Planos de Ação de Transformação para a Saúde Digital, tendo como premissa a organização das Redes de Atenção à Saúde. A análise das respostas evidenciou desigualdades relevantes entre os territórios, impactando diretamente a organização das Redes. Defende-se que a regionalização do planejamento e o fortalecimento da saúde digital, com atenção especial às áreas com maior vulnerabilidade, constituem estratégias eficazes para a redução das desigualdades regionais em saúde.

Resumo O artigo apresenta os fundamentos, a metodologia e as análises territoriais que fundamentaram a criação do Índice de Critérios para a Distribuição de Recursos Financeiros para o Programa SUS Digital (ICSD), desenvolvido pela Secretaria de Informação e Saúde Digital do Ministério da Saúde com o objetivo de promover uma alocação mais equânime dos recursos do programa. A metodologia considerou variáveis como a tipologia rural-urbana (2017), o Índice de Vulnerabilidade Social (2015), o Índice Brasileiro de Conectividade (2022), a densidade de médicos especialistas por habitante (2023), o percentual das receitas próprias aplicadas em saúde (2022), os leitos hospitalares do SUS (2023), os estabelecimentos de saúde de atenção especializada (2023), a produção ambulatorial (2023) e índices de atração para serviços de saúde de diferentes complexidades, conforme a região de influência das cidades (2018). Os resultados evidenciaram desigualdades regionais e apontam a necessidade de estratégias para fortalecer a saúde digital em territórios de maior vulnerabilidade. O artigo discute a aplicação do ICSD nas macrorregiões e as simulações que orientaram as transferências de recursos, visando reduzir iniquidades e promover justiça territorial.

UNSTRUCTURED Artificial intelligence (AI) is rapidly reshaping the landscape of health, from clinical diagnostics and disease surveillance to the prediction of individual health risks. Yet, its immense promise will only materialize if the tools we deploy work for everyone. When algorithms are trained on incomplete or biased datasets, they risk embedding historical health disparities and can replicate patterns of uneven data representation that limit accuracy and generalizability across population groups (1). Addressing algorithmic bias should be treated as a health quality standard, comparable in importance to safety and efficacy evaluations, ensuring consistent performance across all segments of the population. This editorial aims to inform both policymakers and technical experts, offering a framework that bridges scientific rigor with practical, regionally grounded governance models.

This article analyzes the evolution of telehealth regulation in Brazil, with emphasis on its integration into public policies through the SUS Digital Program, an initiative coordinated by the Secretariat of Information and Digital Health of the Ministry of Health. It is a narrative review based on normative analysis of legal and regulator y instruments, including laws, decrees, ministerial ordinances, and resolutions issued by professional health councils. The study organizes the trajectory of telehealth into three major phases: pilot initiatives and initial legal frameworks; progressive institutionalization supported by ministerial programs; and regulatory consolidation with Law No. 14,510/2022, which authorizes the permanent practice of telehealth. It argues that the COVID-19 pandemic acted as a catalyst for normative and operational changes, enabling the expanded use of telehealth across all levels of care. The findings align with previous research highlighting the role of telehealth in expanding access and improving quality of care, particularly in remote regions. The creation of the Secretariat of Information and Digital Health and the launch of the SUS Digital Program mark a new phase in which telehealth is embedded within a broader strategy for the digital transformation of the Brazilian Public Health System. The data support studies that emphasize the need for coordinated actions, ongoing investment in infrastructure, professional training, and digital governance. The evidence suggests that the advancement of telehealth legislation is consistent with international guidelines and may contribute to greater equity in healthcare delivery.

The objective was to prototype new hybrid models for formative evaluation of health competencies, exploring the potential of biodesign. The activities were developed in an inter-unit college discipline called Development of Medical-Hospital Solutions, having biodesign as the conceptual framework. Multidisciplinary teams from Universidade de São Paulo (USP), Brazil were involved, with Health Sciences, Performing Arts, Design and Engineering backgrounds, representing 50 undergraduate students, 3 postgraduate students, 5 faculty members and 3 external faculty members. The students worked in interdisciplinary groups during 28 synchronous virtual meetings, guided by active methodologies. The students identified and validated real needs, developing 6 innovative and applicable prototypes, focused on hybrid learning and evaluation of interpersonal communication, healthcare planning, interprofessional sharing, ethics, decision-making, patient safety and remote simulation of physical examination. The results demonstrated the potential of biodesign for prototyping new evaluation processes, such as building spaces for the application and learning of competencies.