Machine Learning Applications in Population and Public Health: Guidelines for Development, Testing, and Implementation

Machine learning (ML), a subset of artificial intelligence, uses large datasets to identify patterns between potential predictors and outcomes. ML involves iterative learning from data and is increasingly used in population and public health. Examples include early warning of infectious disease outbreaks, predicting the future burden of noncommunicable diseases, and assessing public health interventions. However, ML can inadvertently produce biased outputs related to the quality and quantity of data, who is engaged and helping direct the analysis, and how findings are interpreted. Specific guidelines for using ML in population and public health have not yet been created. We assembled a diverse team of experts in computer science, statistical modeling, clinical and population health epidemiology, health economics, ethics, sociology, and public health. Drawing on literature reviews and a modified Delphi process, we identified five key recommendations: (1) prioritize partnerships and interventions to support communities considered structurally disadvantaged; (2) use ML for dynamic situations, such as public health emergencies, while adhering to ethical standards; (3) conduct risk assessments and bias mitigation strategies aligned with identified risks; (4) ensure technical transparency and reproducibility by publicly sharing data sources and methodologies; and (5) foster multidisciplinary dialogue to discuss the potential harms of ML-related bias and raise awareness among the public and public health community. The proposed guidelines provide operational steps for stakeholders, ensuring that ML tools are not only effective but also ethically grounded and feasible in real-world scenarios.