Unpredictable Patterns #104: AI, public health and soft power
A memo to Europe, especially the Nordics and Baltics, on health care, AI and opportunities for soft power and citizen benefits
Dear reader,
Thank you for the comments on the last note on cities! Urban policy is one of these interesting subjects that seems so obvious, yet never really is utilized to the fullest extent - it is interesting to think of why that is.
One suggestion that I found intriguing is that cities have been stripped of power to such a degree that they cannot function - on their own - as political domains. This is of course true, and an interesting discussion to add on to the one in the note is what a devolution policy would look like for cities.
This week’s note will move to another level and discuss geopolitics. It is partly a continuation of the note on demographics, but more than anything it is an attempt to highlight why public health may be a key future vector for geopolitical power. And how Europe could draw on this insight to build much more soft power than it currently has with new technologies.
Public health and power
Plato, in his Republic, often compared the structure of the ideal state to the structure of the human body or soul. Just as the soul has distinct parts—reason, spirit, and appetite—Plato imagined the state as comprising different classes fulfilling different roles: rulers (philosopher-kings), auxiliaries (warriors), and producers (craftsmen, farmers, etc.). Each segment, like each part of the body, must work in harmony under the guidance of reason (the rulers). When any one segment tries to dominate or fails to perform its function, the state, much like a body afflicted by disease, falls into disorder and injustice.
The notion of the ‘health’ of the state aligns with how health functions in the human body. In a healthy individual, bodily systems are balanced; organs perform their specialized tasks, and no single part overshadows the others. Similarly, a just state aligns each class with its proper task and upholds justice as the unifying principle—akin to a body’s equilibrium. If one component becomes too powerful—like unchecked desire or corrupt leadership—the entire entity becomes diseased. This serves as a powerful metaphor, emphasizing that the well-being of the political community depends on each part’s fulfilling its designated role without overreach, securing civic virtue and stability.
But the health of the state is much more than just a metaphor - the actual health of a state, it’s public health, also matters greatly for how it functions politically and specifically for how it is able to create, exercise and manage geopolitical soft power.
The connection between population health and national power operates through multiple causal vectors. Primary among these is the relationship between health outcomes and economic productivity - healthy populations generate greater output per capita, maintain longer working lives, and require less resource allocation to medical care.1
Health diplomacy2 is not a new phenomenon. Historically, we could see, for example, the Soviet Union deploying health care systems, funding and technology as a means of influence.
The Soviet Union's Semashko System, established between 1920-1930 (and originally conceived in 2017 after the October revolution by Nikolai Semashko3), revolutionized healthcare delivery by creating the first state-run, centrally planned medical system that professed to guarantee universal access to care.4 This model was systematically exported to socialist nations between 1945-1960, with the USSR providing everything from architectural plans for hospitals to standardized medical curricula and equipment specifications.5
In Mongolia alone, this exporting resulted in the construction of numerous new hospitals and the training of thousands of doctors between 1930-1970, transforming the country's traditional Buddhist medicine-based system into a modern healthcare network.6
The Soviets extended their medical influence globally through carefully orchestrated programs targeting strategic regions.7 In Africa, they deployed - according to some sources - more than 60,000 medical personnel between 1960-1980, establishing more than 200 hospitals across Ethiopia, Angola, and Mozambique. The Cuban medical partnership proved particularly successful, with the USSR training over 3,000 Cuban doctors and helping establish 160 medical facilities between 1961-1980. This investment turned Cuba into a medical powerhouse that later deployed its own doctors across Latin America, effectively creating a second layer of Soviet healthcare influence in the region.8
In more modern examples we saw countries using healthcare as a key means of soft power during the Covid-19 pandemic.9 There are also other examples - like Turkey’s use of healthcare to extend influence in the nearby region10, India’s work in Africa11 and the EU’s work in central Asia.12
The re-emergence of health diplomacy as soft power in the age of AI
We are currently witnessing a resurgence of health diplomacy.13 From having been an undervalued component in the geopolitical competition, it is likely to become far more important.14 If the earlier examples of health diplomacy were around the provision of organisational models, training and doctors - this new wave will have a different set of drivers.
The convergence of healthcare with advanced technologies - particularly AI, biotechnology, and precision medicine - has created new strategic chokepoints. Unlike traditional medical innovations which could be reverse-engineered or manufactured through alternative processes, modern healthcare advances often require complex technological ecosystems that few nations possess.
This technological sovereignty extends beyond physical infrastructure to encompass:
Advanced computational capabilities necessary for drug discovery
Massive healthcare datasets required for AI model training
Sophisticated biotechnology platforms for developing advanced therapeutics
Complex supply chains and processes for specialized medical equipment and services
This transformation warrants systematic examination through multiple analytical lenses. Several structural changes are now driving the transformation of healthcare from public good to strategic asset:
Compute and other technological dependencies
The embedding of restricted technologies (like advanced AI systems) into core medical processes creates inherent access barriers. Export controls on dual-use technologies now effectively function as healthcare access controls.
This is especially interesting when we look at compute. Compute will matter not just for training new models (this is where the focus often stops today), but because you need inference compute to ensure real-time monitoring of the public health of a country. A quick guesstimate of the compute required for different kinds of health care intervention is sobering.
Let’s look at a modest toy model here.
The first bottleneck is in scaling diagnostic AI from its current specialized role to a general diagnostic assistant. Say, as an example, that radiology AI systems process around 1,000 images per day per hospital. To provide full diagnostic coverage for all patient interactions, we could estimate that hospitals would need to process about 10,000 images or diagnostic interactions per day—a 10-fold increase. For example, if the inference cost is roughly $0.20 per image, then 1,000 images cost $200 per day. Scaling up, 10,000 images would cost $2,000 per day, which adds up to approximately $730,000 per year. Considering potential increases in compute prices and additional overhead, these costs could reasonably reach the $1–2 million per year per hospital range. And this is probably at the low end.
The second major challenge comes from real-time patient monitoring. Assuming that each ICU patient generates about 2GB of data per day (as another guesstimate), a hospital operating at 80% capacity with 500 beds (approximately 400 patients) would produce 400 × 2GB = 800GB of data daily. Over a year, that amounts to 800GB × 365 ≈ 292,000GB, or roughly 292TB. However, if we account for overhead from additional sensors, data redundancy, and multi-modal inputs, the annual data load could approach 800TB. Processing this enormous volume of data in real time would require a significant scaling-up of edge computing resources—likely a 5-fold increase - at least - over current capacities.
Finally, personalized treatment planning represents another critical compute bottleneck. Future AI systems will need to integrate vast amounts of data for each patient—including extensive medical histories, high-resolution genetic data (say 200GB per patient), current diagnostics, and treatment outcome data. If current systems take several hours to process the information for one patient, then scaling this capability across a hospital—and doing so concurrently with diagnostic and monitoring functions—would require a compound increase in computing power.
Let’s say that to run all these functions simultaneously at scale, hospitals might need a 10× increase in inference capacity, a 5× increase in edge computing resources, and a 3× increase in data center capacity.
This dramatic escalation in compute needs could push healthcare AI costs to levels that rival for example the growth of drug costs15 in hospital budgets, potentially creating a new axis of inequality based on access to computational resources.
Now, this is just a toy model - and I am sure many readers can do better - but it seems unlikely that future healthcare solutions will require less compute.
Data Sovereignty
The critical role of large-scale health data in developing new treatments creates competition for data access and control. Nations with larger datasets gain significant advantages in developing novel therapeutics and diagnostic tools. It would not be surprising to see specific restrictions on data sets that can be used for health research and innovation. Equally, the data protection rules and restrictions on the use of data in a region will determine its ability to use new technologies to discover everything from new drugs to individualized treatements.
Research Infrastructure Dependencies
Modern medical research increasingly requires integration of multiple advanced capabilities - from supercomputing to specialized laboratory facilities. This raises barriers to entry and concentrates innovation capability to those nations that invest in either public infrastructure or private-public partnerships.
Strategic Resource Control
The COVID-19 pandemic demonstrated how control over existing medical resources (vaccines, protective equipment, therapeutic drugs) can be leveraged for diplomatic advantage.16 This lesson has not been lost on major powers, and the production of medical resources is now viewed through a very different lens than before the pandemic.
And while global health challenges like pandemics still require coordinated international response, the mechanisms for such coordination are being challenged and displaced by strategic competition. Nations with advanced healthcare capabilities increasingly face a tension between at least the following options:
Supporting global health as a public good
Leveraging healthcare capabilities for strategic advantage
Protecting technological sovereignty in medical innovation
Maintaining domestic healthcare security
This tension is particularly acute in the US-China competition, where healthcare technology and data access have become intertwined with broader strategic rivalry, and at the same time the international institutions are increasingly weakened.
The US leaving the WHO, seen in this perspective, is, if worrying, not surprising.17
But the potential use of healthcare, medical research and public health interventions to create soft power is not limited to the US and China. Small nations, collaborating, should be able to achieve significant positional advantages. Europe has a significant opportunity in this field - and should it lean into it might well surprise the world as to how well it does (we will come back to how).
This transformation represents a fundamental shift in how healthcare, medical technology and new capabilities function in the international system - from a primarily collaborative domain to an arena of strategic competition. Understanding and managing this shift will be crucial for both health and foreign policy in coming decades.
The Chinese case and the increasing importance of public health
China provides an interesting case study of why public health is increasingly important. China's healthcare system stands at a critical inflection point, where demographic pressures meet technological capability in ways that will reshape not just public health, but geopolitical power dynamics.
As we have noted elsewhere, demographics present the first and most pressing constraint on China's healthcare future. The projected decline from 1.4 billion people in 2025 to around 900 million by 2075 represents more than just a number - it fundamentally alters the political economy of healthcare delivery. At one level, this is about basic arithmetic: fewer workers supporting more retirees - the so-called dependancy ration is, according to some sources18, expected to exceed 50% in 2050. But at a deeper level, it represents a transformation in how healthcare must be conceived and delivered.
The arithmetic of healthcare delivery is changing in another crucial way. When the median age of a population shifts dramatically, the entire infrastructure of healthcare delivery must be reconsidered. This is not just about building more elder care facilities - it is about fundamentally reimagining how healthcare interfaces with an aging society.
China's response to these demographic pressures must be built on a vision of how healthcare technology can be leveraged, and this is important not just for domestic legitimacy, but also for geopolitical advantage. The country's investments in AI-assisted diagnostics, telemedicine, and biotechnology should not be seen merely as domestic healthcare solutions, but as strategic capabilities that can be deployed, offensively, for international influence - and ensure that, defensively, China can maintain its geopolitical position.
Add to this the shift in China's disease burden - with over half of adults now overweight or obese19 - and it seems clear that the country faces a significant public health challenge.
It also seems clear that the Chinese government realizes this. Consider the pattern of Chinese healthcare investments:
Massive funding for AI in healthcare (mirroring broader AI investment trends)
Strategic focus on biotechnology and pharmaceutical development
Systematic development of telemedicine infrastructure
A quick analysis of Chinese patents also reveal the same trend. Ping An, a company that is fairly unknown in the West, has quickly risen to be one of the top patent holders on AI, health and related technologies in the world20 - with a focus on the intersection between insurance, health and technology.
This investment pattern suggests a clear recognition that the country’s ability to manage the healthcare challenges will determine not just domestic stability, but increasingly also the geopolitical positioning in the coming decades. Public health becomes a test of state capacity and technological prowess.
The ability to manage this transition while maintaining economic growth and social stability will be a crucial determinant of China's future power projection capabilities.
An opportunity for Europe - and the Nordics/Baltics
Now, Europe - and especially the Nordics and Baltics - have a great opportunity here. Let’s focus on the Nordics first. With rich health data sets, green energy for data centers and a good relationship with the US, this region should establish a Health Research Zone. This could entail:
Pooling health and census data and making it available through a research foundation, subject to its own lex specialis data protection regime.
Building dedicated future health showroom hospitals, where new technologies can be rolled out without legacy structures and systems.
Revamping medical education from the ground up with a focus on new technologies.
Setting out innovation prizes in health care.
Inviting countries around the world to collaborate around these projects.
In this way the Nordics could become a powerhouse in the perhaps most promising, important and exciting application field for AI. A concentrated and focused public-private partnership here would also create significant geopolitical soft power for all of Europe - if Europe realizes that it needs to craft its soft power in clusters, rather than centrally.
A long trend - the Kardashev scale of healthcare
It is also worth noting that health care is not a short term project by any means. Indeed, we can imagine something like a Kardashev scale21 for health care as well - this is the start of a long, long project. We just need to raise our ambitions a little.
Here is a sketch for such a hypothetical (and wildly speculative) "Healthcare Civilization Scale" that mirrors Kardashev's focus on energy utilization but for healthcare capabilities.
Type I: Individual-Scale Healthcare Mastery
Complete understanding and control of human biology at individual level
Perfect genetic editing capabilities
Full regenerative medicine
Complete neural interface control
Biological aging fully optional
Mental health perfectly manageable
Consciousness fully understood and manipulatable (Can manipulate 100% of biological processes in a single human)
Type II: Population-Scale Healthcare Mastery
Perfect epidemiological control
Complete environmental health management
Population-wide genetic optimization
Collective consciousness management
Species-level biological engineering
Cross-species disease elimination
Perfect biodefense systems (Can manage health of entire planetary population)
Type III: Multi-Species Healthcare Mastery
Control over evolution itself
Creation of new biological forms
Interspecies consciousness transfer
Biological immortality achievable
Perfect ecosystem health management
Creation of new biospheres
Manipulation of life at cosmic scale (Can manage health of multiple planets/species)
We clearly have some work to do!
We could also look at sub-classifications (like Kardashev's decimals). That would perhaps look something like this:
0.1 - Basic preventive medicine
0.3 - Cure for most infectious diseases
0.5 - Control over genetic diseases
0.7 - Aging slowdown
0.9 - Limited biological immortality.
With these specifications current human civilization would be approximately Type 0.4, with some infectious disease control, basic genetic understanding, limited preventive capabilities, emerging biological engineering and partial mental health management.
As an aside - and catering to the even more speculative - it now becomes obvious that there is a connection between power and medicine. It seems obvious that a Type II healthcare civilization would easily dominate a Type I!
Surely a shared goal should be to at least become a type I civilization?
So what?
This transformation of healthcare from public service to geopolitical asset represents a fundamental shift in how we must think about both healthcare policy and international relations. The nation that masters this transformation may well determine the power dynamics of the coming decades.
A simple thought experiments suffices to show why health diplomacy is important and changing: imagine one country manages to find a way to cure cancer, and that their cure is very hard to replicate, because it is based on both new advanced, controlled technologies AND unique data sets as well as massive amounts of compute resources to ensure the treatment is monitored right. What could this country then do with this new capability? How could they influence the political affairs of the world?
What emerges from this analysis is a picture of healthcare not just as a domestic service, but as strategic infrastructure that will increasingly define geopolitical power in the 21st century. The nation that can most effectively solve the healthcare challenges of an aging, urbanized population while managing costs and maintaining innovation speeds will gain significant advantages in international relations as well as more domestic legitimacy.
It would be excellent if democracies could lead here, and indeed, it seems as if there is a significant opportunity for Europe in general and the Nordics and Baltics in particular here.
China's approach suggests a recognition of this reality. Its investments in healthcare technology and infrastructure should be understood not just as domestic policy choices, but as moves in a larger geopolitical game where healthcare capability becomes a crucial form of state power.
What will Europe’s response be? Are we able to focus in clusters and start thinking about health care, technology and data as sources of soft power as well as citizen benefit?One thing seems clear: losing in public health today means losing geopolitical influence at an alarming rate, and Europe could be positioned to do the opposite and lead in public health as a means to create individual benefits and soft power at the same time.
If we want to.
Thanks for reading,
Nicklas
See for example the work of Charles I Jones, eg. Jones, C.I., 2022. “The end of economic growth? Unintended consequences of a declining population.” American Economic Review, 112(11), pp.3489-3527. Jones, in this article notes that many growth theories depend on people discovering and bringing new ideas to market, and that with declining populations the West may face declining growth as well. But it is not just the sheer numbers that matter, of course, but the overall state of the population and its ability to, given that state, drive growth.
When negative health diplomacy becomes something like health colonialism, and we should not be blind to the risks here.
See the excellent Wikipedia article: https://en.wikipedia.org/wiki/Semashko_model
Interestingly it starts to break down in the 1970s with the emergence of new technologies. See Sheiman I. “Rocky road from the Semashko to a new health model. Interview by Fiona Fleck.” Bull World Health Organ. 2013 May 1;91(5):320-1. doi: 10.2471/BLT.13.030513. PMID: 23678194; PMCID: PMC3646351.
The magazine Eurohealth ran a special issue on how this system still influenced medical systems in the countries in questions more than 25 years after the fall of the Soviet Union. Systems shift slowly - this is another advantage of health care system diplomacy. See the issue. Eurohealth 2015; 21(2).
See Asian Development Bank 2023, The Evolution of Mongolia's Health Care System: Reform, Results, and Challenges on the Road to a Healthier Population, Asian Development Bank, Manila, Philippines. https://www.adb.org/sites/default/files/publication/936456/evolution-mongolia-health-care-system.pdf - see also Bolormaa, T., Natsagdorj, T.S., Tumurbat, B., Bujin, T.S., Bulganchimeg, B., Soyoltuya, B., Enkhjin, B., Evlegsuren, S., Richardson, E. and World Health Organization, 2007. Mongolia: health system review.
One interestin example of this was the establishment of specific, bi-lingual medical journals in a number of countries. See Solomon, S.G. (2017). Thinking Internationally, Acting Locally: Soviet Public Health as Cultural Diplomacy in the 1920s. In: Grant, S. (eds) Russian and Soviet Health Care from an International Perspective. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-44171-9_9
See Kirk, J.M., 2015. Healthcare without borders: understanding Cuban medical internationalism. University Press of Florida.
ElSayed, O. (2020). Health Diplomacy As A Soft Power: What COVID-19 Has Taught Us. آفاق آسيوية. https://doi.org/10.21608/sis.2020.184437.
Küçük, A. (2023). HEALTH DIPLOMACY IN TURKEY AS THE INTERFACE OF HEALTH AND FOREIGN POLICY. Abant Sosyal Bilimler Dergisi. https://doi.org/10.11616/asbi.1217166.
Mol, R., Singh, B., Chattu, V., Kaur, J., & Singh, B. (2021). India’s Health Diplomacy as a Soft Power Tool towards Africa: Humanitarian and Geopolitical Analysis. Journal of Asian and African Studies, 57, 1109 - 1125. https://doi.org/10.1177/00219096211039539.
Collins, N., Bekenova, K., & Kagarmanova, A. (2018). Negotiated Health Diplomacy: A Case Study of the EU and Central Asia. The Hague Journal of Diplomacy. https://doi.org/10.1163/1871191X-14010032.
See Emik, K.Y. (2024) ‘Communication in Health Diplomacy’, Jhesp journal of health systems and policies [Preprint]. doi:10.52675/jhesp.1583533. - Emik notes:”Health is increasingly becoming a critical element in countries’ trade agreements, development strategies, security and foreign policy.”
Kevany, S. (2014). Global Health Diplomacy, ‘Smart Power’, and the New World Order. Global Public Health, 9, 787 - 807. https://doi.org/10.1080/17441692.2014.921219.
See Tichy EM, Hoffman JM, Tadrous M, Rim MH, Suda KJ, Cuellar S, Clark JS, Newell MK, Schumock GT. National trends in prescription drug expenditures and projections for 2023. Am J Health Syst Pharm. 2023 Jul 7;80(14):899-913. doi: 10.1093/ajhp/zxad086. PMID: 37094296. https://pubmed.ncbi.nlm.nih.gov/37094296/
See for example: Gauttam, P., Singh, B., & Kaur, J. (2020). COVID-19 and Chinese Global Health Diplomacy: Geopolitical Opportunity for China’s Hegemony?. Millennial Asia, 11, 318 - 340. https://doi.org/10.1177/0976399620959771.
See https://www.whitehouse.gov/presidential-actions/2025/01/withdrawing-the-united-states-from-the-worldhealth-organization/#:~:text=The%20United%20States%20noticed%20its,to%20demonstrate%20independence%20from%20the . Reading this as primarily an economic decision misses a potential more interesting trend, I think.
See https://eastasiaforum.org/2020/01/08/meeting-the-challenge-of-chinas-changing-population/#:~:text=By%202050%2C%20the%20old%2Dage,of%20the%20country's%20demographic%20transition.
This may even have been an underestimation. See Tian X, Wang H. Projecting National-Level Prevalence of General Obesity and Abdominal Obesity Among Chinese Adults With Aging Effects. Front Endocrinol (Lausanne). 2022 Mar 8;13:849392. doi: 10.3389/fendo.2022.849392. PMID: 35350099; PMCID: PMC8957832. “Our projection indicated that approximately two-thirds of Chinese adults would be affected by overweight/general obesity in 2030, and more than 60% of Chinese adults will suffer from abdominal obesity in 2030. Ignoring population aging led to an underestimation of overweight, general obesity and abdominal obesity for women by 3.81, 0.06, and 3.16 percentage points (pp), and overweight and abdominal obesity among men by 1.67 and 0.53 pp, respectively; but the prevalence of general obesity among men will be overestimated by 2.11 pp. Similar underestimations were detected in the estimation from 1991 to 2015.”
See https://group.pingan.com/media/news/News-2020/Ping-An-Ranks-Number-1-In-Top-100-Global-Digital-Health-Patents-For-2018-2020.html and the sponsored article here: https://www.technologyreview.com/2021/03/30/1021421/an-ecosystem-to-overhaul-chinas-health-care/ but also note Meskó, B., Benjamens, S., Dhunnoo, P., & Görög, M. (2023). Forecasting Artificial Intelligence Trends in Healthcare: An International Patent Analysis (Preprint). 2, e47283. https://doi.org/10.2196/47283 — where European companies like Siemens also are doing quite well.
See https://en.wikipedia.org/wiki/Kardashev_scale