Rethinking expertise in artificial intelligence ethics for global health

Abstract Debates on AI ethics in global health often privilege professionalized authority over those most exposed to harm. We argue for the need to consider redistributing ethical authority to affected communities, particularly in low- and middle-income countries, potentially through participatory councils with decision power over evaluation metrics, equity constraints, and deployment. Centering lived experience can strengthen safety, accountability, and decolonial governance, may aid in addressing algorithmic bias and financial toxicity, and could align with WHO guidance for public-interest AI. We offer potential practical mechanisms to co-lead design, trials, and post-deployment monitoring so AI advances health and rights rather than simply reproducing inequities.