🟠 Moderate Evidence
Countries like Canada, Australia, and South Korea must forge new alliances to prevent big tech companies from monopolising health artificial intelligence, according to a new policy framework published in The BMJ. The analysis, led by Dr. Fahad Razak from the University of Toronto, argues that middle powers possess unique advantages in developing equitable health AI systems that serve global public health interests rather than corporate profits.
Key takeaways
- Middle powers like Canada, Australia, and Nordic countries should collaborate on health AI development to counterbalance tech giants
- These nations have strong healthcare systems, regulatory frameworks, and democratic institutions ideal for ethical AI governance
- Data sovereignty and public control over health information are essential to prevent corporate capture of healthcare AI
The middle power advantage in health technology
Middle powers occupy a strategic position between global superpowers and smaller nations, possessing sufficient resources and institutional capacity to lead on health AI without the geopolitical constraints faced by larger countries. Dr. Fahad Razak from the University of Toronto’s Institute of Health Policy, Management and Evaluation argues in The BMJ that these countries can leverage their universal healthcare systems as natural laboratories for AI development.
Countries such as Canada, Australia, the Netherlands, and Nordic nations have established robust data governance frameworks and strong public healthcare systems that generate high-quality, population-level health data. This combination creates ideal conditions for developing AI systems that prioritise patient outcomes over profit maximisation, according to the analysis.
The research highlights how middle powers can avoid the pitfalls that have plagued health AI development in larger markets, where commercial interests often override public health considerations. For more insights on health policy developments, our coverage examines similar regulatory challenges globally.
Breaking free from big tech dominance
Global health AI market concentration
Market share by company type, 2024 estimates
Source: BMJ Analysis, 2026 | Georgian Medical Journal News
The dominance of major technology companies in health AI poses significant risks to healthcare equity and data sovereignty. According to the BMJ analysis, companies like Google, Microsoft, and Amazon are rapidly acquiring health AI startups and forming partnerships with healthcare systems, potentially creating monopolistic control over critical health technologies.
This concentration of power raises concerns about data privacy, algorithmic bias, and the prioritisation of profitable applications over public health needs. The authors argue that middle powers can develop alternative models that maintain public control over health data while fostering innovation through international collaboration.
Building sustainable health AI ecosystems
The proposed collaboration framework emphasises shared governance structures, interoperable data standards, and joint investment in AI research infrastructure. According to the research published in The BMJ, successful implementation requires coordinated action across multiple domains including regulatory harmonisation, ethical guidelines, and technical standards.
Middle powers can leverage their existing healthcare infrastructure investments to create AI systems that address global health challenges such as pandemic preparedness, antimicrobial resistance, and health equity. The analysis suggests that collaborative approaches could reduce development costs while ensuring that AI benefits reach underserved populations.
For healthcare professionals interested in clinical applications of these technologies, understanding the governance implications becomes increasingly important as AI tools enter routine practice.
Regulatory frameworks for equitable AI development
The authors emphasise that middle powers possess sophisticated regulatory systems capable of overseeing AI development while maintaining innovation incentives. Countries like Canada have already established AI governance frameworks that balance technological advancement with ethical considerations, providing models for international collaboration.
Data governance represents a critical component of this approach, with emphasis on maintaining public ownership of health information while enabling responsible sharing for research purposes. The World Health Organization has recognised the importance of such frameworks in its digital health strategies.
Middle powers have a unique opportunity to shape the future of health AI by prioritising public interest over private profit in algorithm development and deployment
— Dr. Fahad Razak, University of Toronto (The BMJ, 2026)
What this means
Frequently asked questions
Which countries are considered middle powers in this context?
The analysis focuses on countries like Canada, Australia, Netherlands, Nordic nations, and South Korea that have strong healthcare systems, democratic institutions, and sufficient economic resources. These nations can act independently while collaborating effectively on shared challenges.
How would this collaboration differ from existing international health initiatives?
Unlike traditional multilateral approaches, this framework emphasises shared governance of AI development rather than just coordination. Countries would jointly invest in and control AI infrastructure, maintaining public ownership of health data while enabling cross-border research collaboration.
What are the main risks of big tech dominance in health AI?
The primary concerns include algorithmic bias favouring profitable patient populations, privacy violations through data mining, and the potential for companies to withdraw services or increase prices once market dominance is established. Public control helps ensure AI serves broader health equity goals.
The success of this collaborative approach will depend on political commitment from middle power governments and their willingness to invest in shared infrastructure rather than competing individually. As AI continues transforming healthcare delivery, the choices made by these nations today will determine whether health AI serves corporate shareholders or global public health interests. The window for establishing alternative governance models remains open, but requires coordinated action within the next few years to prevent irreversible market consolidation.
Source: Middle powers must collaborate on health data and health AI
Was this article helpful?
Disclaimer. This article is health journalism intended for general information and education. It is not medical advice and is not a substitute for professional diagnosis or treatment. Always consult a qualified healthcare provider about your individual circumstances. Full disclaimer →
Related Coverage
Medically reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD. Spotted an error? Contact the editorial team.
