Creating cycles of prosperity with human digital development for intelligent global health

ABSTRACT

Digital spaces offer expanded economic and social opportunities to exercise human agency. With increasing numbers of people falling into poverty, it is those same people at the margins who hold the key to global recovery. The term human digital development refers to the exercise of human agency using ICTs, in particular human interactions in cyberspace that offer new ways in which people may lead the lives they choose to live. Being healthy is central for an individual’s capabilities and freedoms to bring about improvements in their lives. The role for human digital development in global health lies in the ways in which artificial intelligent applications are used to support people, their providers and institutions operating in low-resource environments. In this way, digital health enables the use of artificially intelligent technologies to achieve improved health outcomes. Investments in human digital development can create positive cycles of prosperity by spurring economic growth.

KEYWORDS:

• Global health
• digital health
• digital development
• human digital development
• human agency
• economic growth

How the fight against infection progresses will shape the future of global civilization (Kenny, 2021, p. 9).

1. Introduction

The irony of our progress against death from infection is that it has helped create the perfect environment for outbreak of diseases to have catastrophic social and economic impact (Kenny, 2021). At a time when global human interaction is central to our wealth and welfare, the opposite is taking place through flight bans, trade restrictions, weakening medical systems, leaving people unvaccinated and people whose livelihoods are taken by pandemic. The most vulnerable populations fell into poverty with more than 700 million people estimated to have fallen into 2020. To offset economic consequences for the severe decline in incomes, governments and humanitarian organizations organized relief efforts. Since early 2020, over $800 billion US cash transfer payments to over 1.5 billion people comprising one-fifth of the world’s population were provided. By 2022 it is estimated that between 656.7 and 676.5 million people are still in poverty (Aiken et al., 2022; Mahler et al., 2022). The inequitable distribution stimulus payments to those in more affluent societies has meant that extreme poverty in the hardest hit parts of the world is worsening. Rising inflation, especially rising food process, are increasing the hardship for those living in poverty. Mahler et al. (2022) found that people living in extreme poverty spend about two-thirds of their resources on food while a person with a daily income of around $50 – a typical income in high-income countries – is closer to a quarter of their income.

Inflation exacerbated from grain shortages caused by the Crimean Sea blockage and strains to global supply chains is causing further hardship in Africa and Eastern Europe. Further economic and social costs of possible prolonged conflict in the Russia-Ukraine war are adding to an increasingly large refugee crisis. Adding to this mix of disasters are the devastating effects of climate change around the world. In Asia (floods ravishing Pakistan), United States (Florida, Puerto Rico), Canada, Europe, and Africa (Nigeria) are testing the strength of their countries’ infrastructures. They are forcing governments to contend with a changing climate that is reaping havoc and displacing multitudes in the wake of the destruction left by hurricanes, forest fires, and drought. The increasingly interconnectedness of the world’s economies, financial institutions, heath systems, and institutions of government are straining against the backdrop of multiple crises. Together these forces may bring the world economy to the brink of recession while increasing the need for government and non-profit services.

At the heart of any recovery from the effects of a prolonged pandemic, looming recession, inflation, war, famine, and rising rates of poverty; is the need for human development. Economic growth needs human development to address the global health challenges that continue to plague many parts of the world. The concept of human development is defined using Sen’s (1990) capability approach as the freedom to live the lives people choose to live. ‘Development starts with individuals who should be able to decide for themselves what they value and have the capabilities to set their own agenda regarding the goals of development and the ways to get there’ (Andersson et al., 2012, p. 1). Research in Information and Communication Technologies for Development (ICT4D) has taken this perspective on human development and offer ICTs as a means to individuals to achieve the lives they choose to live (Andersson et al., 2012; Poveda & Roberts, 2018; Zheng et al., 2018). In particular, ICTs can be used to enhance people’s agency to address development challenges (Poveda & Roberts, 2018). For example, poor fisherman can overcome poverty using cellphone text messaging to find the best prices for their catch. In addition, MPesa and its cryptocurrency version, BitPesa, being used to make mobile payments in countries where local currencies are unusable and open-source software is being used by lenders to offer loans to micro entrepreneurs who would otherwise have no access to capital. An example of digital health is the use of mobile phones to access healthcare in remote and urban parts of the world where local health systems are stressed has enabled people to stay healthy throughout the pandemic.

There is a role for human digital development in addressing global health challenges and in supporting economic growth or recovery. Digital spaces offer expanded economic and social opportunities to exercise human agency where digital health is the use of these technologies to achieve improved health outcomes. The term human digital development refers to the exercise of human agency using ICTs, in particular, human interactions on cyberspace to offer new ways in which people may lead the lives they choose to live. Governments and health services are still battling new strains of COVID-19 while preparing for the next pandemic (Nuzzo & Gostin, 2022). The use of artificial intelligence techniques is not just helping curb the spread of infection, in predicting new disease outbreaks and increasing access to needed services can enable people to be healthy. Being healthy increases individuals’ ability to lead the lives they choose to live. Access to healthcare and education should in principle give people the ability to lead the lives they choose to live thus giving them the capability to function and improve the quality of their lives. Yet, this access remains unequal in many countries even within the countries that are considered rich. People contribute productively to an economy when they are healthy. As the recent pandemic has shown, illness from infection has kept large segments of the population from being able to contribute to the productivity of their economies.

At the same time, more data is generated on all of humanity in the past few years than ever before in the history of the world. There are opportunities to address these challenges through digitally intelligent approaches to global health that offer people the agency to lead the lives they chose to live - including healthcare providers whose services have been particularly strained in the wake of the pandemic. Achieving human development entails investments in education, healthcare, and infrastructures for economic opportunity and self-governance. Central to these infrastructures is access to the internet often through mobile phones, cybercafes and telecenters. Together these investments in human digital development can create positive cycles of prosperity. In the following sections, digitally intelligent approaches to global health illustrate how such cycles of prosperity can be carried out. The papers in this issue offer unique insights into the role of ICTs in development efforts and offer policy recommendations to enable positive cycles of prosperity to take place.

2. Digitally intelligent approaches to global health

Digitally intelligent approaches to global health offer human development which is offering people the agency to lead the lives they chose to live using ICTs (especially through cyberspace) where they can access social and economic resources they need to be healthy. Human development also refers to the support of healthcare providers and similar workers whose services have been particularly strained in the wake of the pandemic. The COVID-19 pandemic reduced global economic growth by an estimated 3.2% in 2020, with trade declining by 5.3%; an estimated 75 million people entered extreme poverty, with 80 million more undernourished compared with pre-pandemic levels (Nuzzo & Gostin, 2022). Nuzzo and Gostin (2022) predicted the pandemic before the world became aware of the cases coming out of China. They state that the likelihood of an even more challenging future of pandemics require investments in maintaining resilient health systems, testing and surveillance, public trust, equity, and strong global institutions. To do so, health systems should become the bedrock of pandemic preparedness; testing capacity is vital to detecting, characterizing and managing crises; building public trust and fostering risk-mitigation behaviors; social vulnerabilities and inequities should be addressed; and global cooperation and robust institutions need to be fostered. The message they offer is that the threat of pandemics is the new normal.

The role of mobile health data as a driver of innovation and its transformation of the digital ecosystem needs to be understood. Aiken et al. (2022) illustrate how machine learning using data from satellites and mobile phone networks can improve targeting of humanitarian aid. They develop, implement, and evaluate a model that leverages recent advances in machine learning that show that such data can help accurately estimate the wealth of small geographic regions and individual mobile subscribers. There is a role for artificial intelligence techniques for healthcare in resource constrained contexts. Ismail and Kumar (2021) offer a role for artificial intelligence global health by suggesting that many of the AI interventions in front line health infrastructures aim to improve existing frontline health infrastructures that deliver last mile healthcare, especially critical in countries of the Global South. However, the perspectives of the frontline health workers operating these health infrastructures and the marginalized communities accessing the healthcare system find rare representation, especially in the voices of the women who make up the healthcare workforce and are the primary care providers in the home. They found AI applications address this need in disease surveillance and forecasting, risk assessment and epidemiology information delivery, behavior prediction, verbal autopsy, health system measurement, data digitization, and data quality control. When these systems support patient choice and agency in seeking carte is when human development can take place.

The large volume of data has created opportunities for applying AI to improve individual and population health, particularly in resource poor settings where there has been strong mobile phone penetration (Wahl et al., 2018). Intelligent digital health can offer support for global health. Jarvenpaa and Markus (2018) offer a data perspective that integrates genetic, health, genealogical, and lifestyle data into platforms involving unprecedented data management challenges because of their scale and multidimensionality. Given the scale and multidimensionality of health data generated through telehealth and mobile devices around the world, there is a role for artificial intelligence in global health (Hadley et al., 2020; Krittanawong & Kaplin, 2021; Schwalbe & Wahl, 2020; Wahl et al., 2018). Current global health initiatives that leverage artificial intelligence are in effective vaccine delivery, diagnosing of diseases, assisting in clinical decision making and scheduling processes (Hadley et al., 2020). Developments in cloud computing, substantial investments in digitising health information and introducing mobile health (mHealth) applications are transforming the digital ecosystem for healthcare. AI applications are being used to predict and model the spread of disease globally. Machine learning (ML) and natural language processing (NLP) tools use data from electronic health records, online media and social media to detect and map infectious disease outbreaks (Schwalbe & Wahl, 2020; Wahl et al., 2018). Deep learning (DL) models can produce human-like text and can assist physicians in repetitive tasks and basic telehealth screening. NLP with DL applications create archives of conversations between patients and physicians. This data is then used to train medical robots to carry out tele-mental health in areas of physician shortage (Krittanawong & Kaplin, 2021).

Challenges arise as to the effects of poor data quality and incompleteness. The nature of machine learning, especially through neural networks, is that the reasoning is a black box. No one really knows how AI comes up with a certain prediction. Overfitting of models and a lack of reporting guidelines in machine learning studies pose problems. The ethical issues such as patient confidentiality violations, health inequality, or misuse and bias from cultural prejudice are real issues that may worsen the lives of people (Angwin et al., 2016). In machine learning models it is the quality of the raw data (i.e. phone signals) that is turned into features or any number of measurements. These features used to train classification models. Once these models learn to recognize features that they have been taught, they can predict outcomes or recommend or offer decisions or diagnosis depending upon their training. Given the type of training they have received, it is not clear how the decisions, recommendations or diagnosis are arrived at. Questions arise as to what extent can such models be relied upon. What is the role of the expert is managing the decisions made through these AI systems?

3. Creating cycles of prosperity

Socio-economic factors create inequities in health outcomes whereby people living in locations with greater resources will have better health outcomes than those who live in rural or areas with limited resources. There appears to be a relationship between access to mobile internet and the ability of people to access the resources they need to stay healthy (Qureshi & Xiong, 2021). Those at the margins become vulnerable to digital biopolitics or efforts by governments and corporations to maximize knowledge and control of populations using digital means for political and economic power. Development economists tell us that economies go through peaks and troughs. The role of government intervention is to ensure that the swings are not too high or too low and that there is sustained growth over time. The role of technology is to increase the productivity of labor at similar levels of capital investment brining about greater levels of economic growth (Banerjee & Duflo, 2009 Roberts et al., 2014; Schumpeter, 1982; Sen, 1990).

The field of development economics arose out of a belief that physical capital accumulation is central to economic growth. The ability of countries to develop depends upon the implementation of technical progress (Boianovsky, 2018). However, the ‘capital fundamentalism’ of development economics has inhibited the indigenous techniques that may actually enable sustainable development to take place (Boianovsky, 2018; Escobar, 2011; Sen, 1990). There is a split between macro-development economists who focus on economic growth, international trade, and fiscal/macro policies and micro-development economists who study microfinance, education, health, and other social programs (Rodrik, 2008). Banerjee and Duflo (2009) are micro-development economists who conduct randomized field trials using a growth theory that does not require the existence of an aggregate production function and can accommodate misallocation of resources. This begs the question: Economic growth at what cost?

Escobar (2011) explains that current climate change disasters are due to misplaced focus on capital projects at the expense of indigenous lifestyles. A human development focus enables longer more sustainable economic growth to take place. Sustainable techniques in manufacturing, production and agriculture may support responsible growth strategies, but would they address the shortages in supply amidst rising demand? As the economy grows, prosperity also becomes more unequal. Increasing inequality may push people to where they are able to take advantage of more efficient technology and increases in inequality will increase growth (Banerjee & Duflo, 2009). Sen (1990) argues that countries with high incomes per capita can have low outcomes in their quality of life, with the bulk of the population being subject to premature mortality, escapable morbidity and overwhelming illiteracy. He explains that economic prosperity is only one aspect of prosperity or enriching the lives of people. He offers the capability approach which sees human life as a set of functionings that relates the evaluation of the quality of life to the assessment of the capability to function. Being healthy enough to be able to earn a living is central to the capability to function. Earning a living is seen to be a means towards an end. This end is seen to be the life a person chooses to live give a set of resources that they are able to acquire.

Research has shown that there is a correlation between the use of ICTs and economic performance in some geographic regions (Adeleye et al., 2021 Chatterjee, 2020; Levendis & Lee, 2013; Mayer et al., 2020; Qureshi, 2014; Samoilenko, 2008;). Recent studies suggest that the effect of ICT adoption differs significantly across sub-regions and ICT innovation enhances the impact of trade on growth (Adeleye et al., 2021). This suggests that there may be a role geographic and technological distances play in the extent to which ICTs enable economic growth in some regions (Wang & Zhao, 2018). In their analysis of spatial patterns of ICT access and use, Pick et al. (2021) found that he most important and prevalent determinant of usage of technologies is the human development index, defined by the UN as an equal weighting of life expectancy, years of schooling, and gross national income (GNI) per capita. Digital health is the use of these technologies to achieve improved health outcomes.

Human digital development takes place when individuals access economic opportunities through their devices connected to the internet. As investigated by the papers in this issue, human digital development takes place when ICTs enhance the positive impact of human capital on labor productivity, ICT diffusion boosts the role of financial development in economic development, growth rates are connected to trade in highly automatable services, particularly in exporting countries with advanced ICT and ICT penetration can support inclusive human development when people are empowered. The forces of human digital development can enable economic growth to be more equitable. As illustrated by the papers in this issue, overcoming digital inequality can take place through digital citizen engagement and empowerment, digital incorporation, proactive adaptation of the technology by key local government intermediaries, telecenters and digital literacy and digital leadership. Vast amounts of data produced through interactions in cyberspace and the many connected devices offering structured (such as geolocation) and unstructured (such as social media) are used to train machine learning models. Intelligence systems that support prediction, recommendation or diagnosis in addressing global health challenges for those living at the margins.

While many intelligent digital health systems offer machine learning algorithms, deep learning and neural network capabilities, it is how these systems are used that determine their efficacy in achieving development goals. Through their use of ICTs, individuals can exercise their freedoms to take advantage of economic opportunities available to them to improve their lives. In this way, they achieve human digital development which spurs economic growth in their communities and helps overcome digital inequality. The data generated from interactions on digital spaces offer the basic raw material for intelligent digital health systems to support global health. The use of ICTs in digital health enable individuals to exercise their freedoms to create improvements in their lives thus adding to economic growth. This cycle of prosperity is illustrated in Figure 1.

Figure 1. Cycle of prosperity.

The key to creating such cycles of prosperity is investing in people living at the margins who have fallen into poverty and are struggling to survive amidst these multiple challenges. At the heart of creating human digital development is addressing healthcare needs of those at the margins using artificial intelligence applications, especially in mobile health. This model illustrates how addressing the healthcare needs supported by intelligent digital health can enable human digital development to support economic growth. The following sections offer papers that offer contributions to how overcoming digital inequality and human digital development take place.

4. Overcoming digital inequality

The first paper in this issue is ‘Digital citizen empowerment: A systematic literature review of theories and development models’ co-authored by Swapnil Sharma, Arpan Kar Gupta, Yogesh Dwivedi and Marijn Janssen. The authors state that governments invest heavily in digital initiatives to develop information societies with connected and actively engaged citizens. However, problems like lacking sustained engagement and quality of participation still plague them. They undertook a systematized literature review on the Scopus and Web of Science (WoS) databases, covering dispersed literature surrounding Digital Citizen Empowerment (DCE) from the past two decades. Categorising the literature under four thematic categories or strategies of DCE: Digital Activism (DA), Multi-channel Service Delivery (MCSD), Participatory Budgeting (PB), and Deliberative Governance (DG) critical comparative analysis is done. A conceptual model of DCE, covering how theories from different inter-disciplinary areas of political, social, and information science influence the development of information societies and DCE is presented. Their contribution lies in the action points their conceptual model that are mapped to policy objectives targeting improved delivery of empowering policy goals by practitioners, and future research opportunities in the context of DCE are discussed.

Richard Heeks is the author of the second paper titled ‘Digital inequality beyond the digital divide: conceptualizing adverse digital incorporation in the global South’ He states that digital systems are significantly associated with inequality in the global South. That association has traditionally been understood in terms of the digital divide or related terminologies whose core conceptualization is the exclusion of some groups from the benefits of digital systems. However, with the growing breadth and depth of digital engagement in the global South, an exclusion worldview is no longer sufficient. What is also needed is an understanding of how inequalities are created for some groups that are included in digital systems. This paper creates such an understanding, drawing from ideas in the development studies literature on chronic poverty to inductively build a model of a new concept: ‘adverse digital incorporation,’ meaning inclusion in a digital system that enables a more-advantaged group to extract disproportionate value from the work or resources of another, less-advantaged group. This new model enables those involved with digital development to understand why, how, and for whom inequality can emerge from the growing use of digital systems in the global South. It creates a systematic framework incorporating the processes, the drivers, and the causes of adverse digital incorporation that will provide detailed new insights. The paper concludes with implications for both digital development researchers and practitioners that derive from the model and its exposure to the broader components of power that shape the inclusionary connection between digital and inequality.

The third paper in this issue is ‘Aadhaar and social assistance programming: local bureaucracies as critical intermediary’ co-authored by Shirin Madon, C.R. Ranjini, and Anantha Krishnan. The authors state that digital identity platforms are a recent e-governance innovation for improving social assistance programming in the development context. This context is located mostly in India's Aadhaar province. While a significant number of studies have been collected on Aadhaar, so far under-researched is the importance of local government practices and processes in shaping usage of the platform to support social assistance programming. In this paper, the authors theorize how local government intermediation on digital identity platforms can improve social assistance programming through a case study of the Aadhaar-enabled Fertilizer Distribution System (AeFDS) in Andhra Pradesh. Their findings show how the relevance of the platform for low-income farmers depends crucially on the proactive adaptation of the technology by key local government intermediaries. From a policy perspective, this result emphasizes the importance of supporting efforts to acknowledge the role of responsive local government agencies in ensuring that centralized digital identity platforms remain relevant for implementing social assistance programming.

Christine Horn and Sandra Gifford co-author the fourth paper titled ‘ICT uptake and use and social connectedness in rural and remote communities: a study from Sarawak, Malaysia.’ They state that the lack of access to Information and Communication Technologies (ICTs) is a key determinant of disadvantage among rural and remote communities in the world that can limit economic development and obstruct digital forms of social and political participation. They discuss how the ability – or inability – to access ICTs affects everyday life in Indigenous communities in remote Sarawak, Malaysia. They focus on social connectedness and on the role of relationships and networks as motivating factors for ICT uptake, for enabling new livelihood strategies and in supporting the maintenance of social networks. Their paper is based on data collected between 2015 and 2017 in 20 villages located in the north-east of the state. Methods of data collections included semi-structured interviews, group discussions and participant observations carried out during multiple visits to these villages over a two-year period.

The contribution of their paper is in the depth of their description in how when ICT access became available, people leveraged new technologies for economic practices that were based on existing livelihood strategies, such as the sale of fish or the production and sale of arts and crafts, or to facilitate the management of small local shops. Many of these practices were based on existing social networks, for instance where people sold fish to their friends, or where such sales took place via digital social networks. The use of mobile phones and smartphones meant that local entrepreneurs could cut down on travel by ordering goods from the city, saving them time and money. The use of ICTs thus enhanced these social economies in small but significant ways. Other participants used their digital skills to address other local issues, for example by sharing information about the roads. While these new practices did not generally result in the emergence of new digital entrepreneurship, they nevertheless constituted an important improvement over previous practices and strategies.

The fifth paper titled ‘Telecentres’ contribution to women's empowerment in rural areas of South Africa’ is co-authored by Abiodun Alao, Wallace Chigona and Roelien Brink. They suggest that the telecentre model was established to provide information and communication technology (ICT) skills to empower people, reduce poverty and unemployment in poor areas. Their study explored the relevance of telecentres as an ideal mechanism to empower women and investigated how telecentres can contribute to women’s empowerment by analyzing five telecentres in rural settings of the Western Cape, South Africa. A qualitative approach was adopted using semi-structured in-depth interviews, focus group discussions, and participant observation to collect data from 39 participants. The Dimensions of Empowerment Theory was used to describe the various empowerment outcomes. These include economic, social, informational, political, and cultural empowerment. The findings illustrated barriers hindering women’s utilization of telecentres which included a lack of computer skills, education, language barriers, gender usage patterns, unemployment, and a lack of awareness. Their study contributes to the ICT4D/HCI gender field and suggests that ICT policymakers consider using telecentres for women empowerment. They found that telecentre use improved rural women's employability, information capacity, communication, interaction, individual empowerment, cultural knowledge, and perception. Given the impact and improved understanding of telecentres’ importance for women's empowerment, their findings serve as a baseline for studying issues relating to gender and women's empowerment.

Mawazo Mwita Magesa and Joan Jonathan co-author the sixth paper in this issue titled ‘Conceptualizing digital leadership characteristics for successful digital transformation: the case of Tanzania.’ The authors state that the objective of this study was to examine the attributes of a compelling leader to lead Digital Transformation in a formal organization. The study conceptualized a digital leader with 26 characteristics grouped into 5 roles. Sample respondents were drawn from some organizations in Tanzania and a self-reported questionnaire was used for data collection. Preliminary analysis involved examining inter-correlation among leadership attributes, dropping 3 out of 26. Exploratory factor analysis of 23 items produced 7 factors which were grouped into 5 roles while dropping 2 factors with one item each. Only 4 factors and 13 items qualified for confirmatory factor analysis which provided better fit for the sample data. The validity check showed that the digital leadership construct somehow converges and the four factors were different from one another. It is implied that good digital leader is anticipated to foster economic growth, promote innovation and entrepreneurship, and improve service deliveries.

5. Human digital development

‘Information technology as a catalyst to the effects of education on labor productivity’ co-authored by John Paul Flaminiano, Jamil Paolo Francisco, and Sunshine Therese Alcantara, is the seventh paper in this issue. They state that while a decline in the dependency ratio provides a window of opportunity for many young economies, relying entirely on population structure changes may not be sufficient to increase productivity as national economies become increasingly knowledge based. Their paper explores the channels of interaction between human capital, information technology, and productivity. Using fixed-effects and two-step difference Gaussian Mixed Models (GMM) panel regressions on data from 121 countries from 1990 to 2017, they estimated log values of labor productivity with respect to log values of capital per worker, labor force size, population size, education, and information technology. They found that education and information technology both have a positive relationship with labor productivity. In addition, they found positive interaction effects between education and information technology. This result suggests that information technology enhances the positive impact of human capital on labor productivity. Their results are validated by robustness checks using alternative proxies for education and information technology and two-step difference GMM to address endogeneity. Policies geared towards improving labor productivity should consider the complementary relationship between information technology and human capital.

‘The moderating role of ICT diffusion between financial development and economic growth: a bootstrap ARDL approach in Saudi Arabia’ is the eighth paper co-authored by Zouheyr Gheraia, Mehdi Abid, Habib Sekrafi, and Hanane Abdelli. The authors state that several studies have proven a positive impact of information and communication technologies (ICT) on economic growth. Nevertheless, some studies have suggested a limited effect, while others have found no statistically significant effect. Faced with this problem, the authors conducted a study with the aim to assess the role of moderation of ICT diffusion between financial development and economic expansion in Saudi Arabia from 1990 to 2019. Using the bootstrap approach for the ARDL model, the results prove that financial development as well as ICT diffusion affect negatively (positively) economic development. The financial development interaction term with ICT diffusion has a positive and statistically significant effect on economic growth. The results suggest that ICT diffusion does not only directly impact economic growth but also increase the indirect impact of financial development on economic growth. This result indicates that ICT diffusion boosts the role of financial development in economic development. This means that financial development can only boost the Saudi economy when ICTs are well developed.

Gwanhoo Lee and Min-Seok Pang co-author the nineth paper in this issue titled ‘How are service automation and national ICT development associated with international trade in services?’ Their study aims to investigate how service automation is associated with the volume of international trade in services and how the interactions of automation, industry, and national ICT development are associated with it. They use data from the United Nations (UN) Comtrade, O*NET Online, the U.N. Global ICT Development Index, and the World Bank Open Data to test their hypotheses. They find that the marginal year-by-year growth rates of international trade in highly automatable services decreased in 2007–2017, whereas those of international trade in less automatable services have increased. ICT development is positively associated with the volume and annual growth rate of a country's service exports, but it is negatively associated with the volume and annual growth rate of the country's service imports. The growth rate of international trade in highly automatable services is lower for importing countries with advanced ICT, but it is higher for exporting countries with advanced ICT. In addition to the direct association between national ICT development and international trade in services, the authors discovered the complex interaction relationships between automation and the volume and growth rate of service import and export. Their study generates new insights into how emerging ICT capabilities (i.e. service automation) interact with existing ICT infrastructure in influencing microeconomic outcomes (i.e. international trade in services).

‘Technology penetration and human development nexus in middle-income countries: the synergy effect of inclusive resources distribution' co-authored by Alex Adegboye, Stephen Ojeka, Olawunmi Tolase, Oluwatayo Omoremi, and Yvonne Jude-Okeke is the final paper in this issue. Their paper examines how interactions between equal distribution of resources and the information and communication technology (ICT) influence inclusive human development (inequality-adjusted human development) for 81 countries from middle-income countries within the period 2005–2017. They use a double-censored Tobit regression as it accounts for the dependent variable with a limited range. It exhibits the behavior that is consistent with the method of estimation. They employ the instrumental variable (IV) for the independent variables of interest to deal with simultaneity or reverse causality due to endogeneity. Their findings are: First, with regard to Middle Upper-Income countries, when they analyze the estimation with/without instrumental variable (IV) procedure, the net effects of the ICT penetration (i.e. mobile phone penetration and internet penetration simultaneously) for inclusive human development are consistently positive while we establish evidence of synergy effects. Second, when they consider the Middle lower Income countries with/without instrumental variable (IV) estimate, they establish that there exist net effects of internet and telephone penetration for inclusive human penetration. In addition, the fact that corresponding conditional and unconditional effects are consistently positive establishes the evidence for synergy effects. In light of established findings for this study, they conclude that equal distribution of public goods such as technologies could play a critical role in promoting inclusive human development. Supplementary policy repercussions are highlighted.

6. Conclusion

There are opportunities for human digital development which, according to the capability approach, is the freedom to live the lives people choose to live through their use of ICTs. There is more data generated on all of humanity in the past few years than ever before in the history of the world. The data on human interactions in cyberspace and the devices they use can be used to train artificial intelligence systems to support prediction, recommendation and/or diagnosis in addressing global health challenges for those living at the margins. Through their use of ICTs, individuals can exercise their freedoms to take advantage of economic opportunities available to them to improve their lives. In this way, they achieve human digital development and initiate subsequent cycles of prosperity. The papers in this issue offer contributions to how overcoming digital inequality and human digital development take place.

Acknowledgements

The author is very grateful to editors Doug Vogel, Peter Wolcott, and Mathias Hatakka for their insightful feedback on earlier versions. It is due to their knowledge, experience, and the extensive reviews they carry out that the publications in this Journal continue to create excellence in the field. Special thanks to Alice Schumaker whose many years in public health helped shape the global health perspective.