Lately my mind has been percolating around the twin challenges to our collective future of artificial intelligence and global warming. As the mother of two young kids, I must believe in a future where they will be able to experience joy and purpose. Both elements throw doubt on my predictive ability how my little ones will navigate what lies ahead. I also worry about the speed with which our fragmented health care ecosystem can prepare for AI and the need to address the health impacts of a changing, more extreme climate.

The recent Ezra Klein podcast, A.I. Is About to Get Much Weirder. Here’s What to Watch For, discusses recent advances in GPT 4 including being able to pass the bar at the 90^th percentile. He talks about how rapid the skill progression was from version to version and says that while our human society can handle change, we need time to develop policy and system solutions that we may not have here. How will our society be structured if having knowledge, being able to process information, and doing physical tasks are no longer valuable? An AI will have no need to go to law school, to medical school, to school of any kind. The physical structures in which their processing systems live (their bodies?) will be able to be stronger, more resilient, and cheaper than any kind of human labor. They won’t sleep or get hungry or get COVID-19. Our best chess players have already lost to an earlier AI model, Deep Blue, how can we compete? As various AIs move toward an ability to change and improve without the need for human action or oversight, we will have to redefine our relationship to them, to one another, and to our entire economic system.

The impact on clinical care is potentially staggering. An AI could have instant access all published papers and multiple large databases and with time may be able to outperform a person in predictive ability. An AI could monitor a patient 24/7 and be accessible to that patient all hours of the day and night. Machine learning, a component of AI in which programming learns from data to make a prediction absent human insight, has great potential for more accurate diagnosis in medical imaging among other health services. Our Obstetrical Care Outcomes Assessment Program took advantage of machine learning to publish four posters at the Society for Maternal and Fetal Medicine Conference on our ability to predict and the risk factors for severe maternal morbidity, shoulder dystocia, preterm preeclampsia, antepartum stillbirth.

While surveys show that people are currently uncomfortable with a health professional relying on an AI for diagnosis or treatment decisions this may change or have to change with time. Acknowledging this need for better understanding, the New England Journal of Medicine announced a 2024 launch of NEJM AI. Like any technological advancement, we will have highs and lows, opportunities and threats, and the need for transparent understanding and regulation.

Unlike the mixed bag of AI advancements, our changing climate and more extreme weather events feel purely challenging for us as individuals and for our entire health ecosystem.  Allergy season is beginning earlier, fire season has lengthened and become more severe leading to a greater number of people experience smoke exposure and homes being lost, and we are seeing an increase in vector-borne diseases (e.g., from mosquitos). Climate change will have huge impacts on our health and on our health systems and we have yet to fully prepare for this future.

Our upcoming webinar on April 12^th from 12:00 – 1:30  PM PT, Our Climate’s Impact on Health: Acting Now for a Resilient Future will discuss health issues related to our changing climate, current initiatives among Washington state health agencies to address these impacts, and identify action steps our health care ecosystem can take to promote climate resilience and health equity. We all must prepare to support Washingtonians and generations to come.

Despite these uncertainties, I believe in a resilient future. My family just planted three cherry trees in our tiny backyard orchard, an act of faith that we will be around to reap the rewards many years down the line. I find joy and purpose in these acts to build a better future, capturing a tiny but of carbon in the process.

Ginny Weir, MPH, CEO, Foundation for Health Care Quality