From Asking “What” to “Says Who”: Examining Social, Political, and Economic Forces Shaping Artificial Intelligence in Healthcare

Artificial intelligence (AI) is widely portrayed as a transformative innovation poised to revolutionise healthcare in the 21st century. Promoted by technology companies, this forward-looking narrative is often adopted uncritically by decision-makers, despite limited evidence of AI’s clinical effectiveness in real-world contexts and the persistence of numerous regulatory, professional, organisational, ethical, and governance challenges. In healthcare systems characterised by pluralism and complexity, the trajectory of AI is shaped by the strategic decisions and actions of diverse stakeholders who mobilise their social, political, and economic power and resources to influence dominant narratives about AI and to advance specific visions of the future of healthcare. This paper critically examines such influences by specifically focusing on how market imperatives, algorithmic logic, and the entrenched marginalisation of certain populations impact technology development and care delivery. It aims to investigate how particular actors and power dynamics affect AI research, commercialisation, and sustainable integration into healthcare systems. Because AI can reinforce and deepen existing power imbalances and inequalities, this paper calls for public policies grounded in social justice, fairness, and the public interest. These policies should aim to mitigate systemic harms and promote equity in healthcare.