Fairness inside and out: A situated approach to algorithmic allocation in complex sociotechnical systems

Abstract

This article outlines a framework for modeling and simulating complex sociotechnical systems in which an allocation mechanism acts as the interface (and sometimes a barrier) between the public and institutions. Two examples contextualise algorithmic allocation challenges: the Amsterdam school choice and organ allocation for transplant patients. We highlight how algorithmic fairness does not guarantee systemic fairness, and propose a situated approach with institutional modeling and social simulations. With the increasing adoption of AI in decision making, a situated simulation approach provides an alternative to opaque institutional governance and decision making.

The mechanism, institutions, and people

Sociotechnical systems are formed of technical and social components; in present-day societies, most technology is used within a social environment. Mindful of algorithmic discrimination cases, researchers have sought ways to measure the fairness of technical systems. The impact of a technology on its surrounding environment, however, is not always clear, especially when complex social dynamics are at play. Designing a “fair” technical component is not a guarantee of bringing fairness to the system as a whole. Selbst et al. argue that this is due to a focus on solutions (i.e. “make the outcome fair”) instead of a focus on the process (i.e.”make the system fair-er”) [1]. We now need ways to understand the impact of a technical system on fairness, within the technology, and without it.

Resource allocation problems are routinely faced by public institutions, be it in the form of determining who gets access to benefits, or which infrastructure to renovate among a set of proposals. The decision making process forms in institutions, bound by laws of fairness and non-discrimination. However, institutional decisions change the dynamics of the system before they take action, while they are communicated, and after they take hold, altering the behaviour of the social system.

Social simulations can estimate the effect of policy changes by dynamically modeling the social and institutional aspects of sociotechnical systems [2]. The field of institutional modeling investigates the interplay of individual and institutional agents within complex sociotechnical systems [3].  Social and institutional simulations might thus guide the process of creating fairness throughout the system and not only within the mechanism. We use the framing of simulations to explore allocation mechanisms and their impact on complex sociotechnical systems.

Algorithmic allocation

We propose an approach to modeling sociotechnical systems under specific conditions: resource allocation with a registry (here called mechanism) facing the public in one direction and based on rules determined by one or multiple institutions. The communication between public and institution occurs through the mechanism, which is designed to optimize for a certain outcome. Value preferences inform the outcome, but are not always explicit, nor uniform across parties. The institution designs the rules of the allocation mechanism based on (i) its internal principles, and (ii) a fair outcome for the public. Without communication between public and institutions, the rules are decided based on inferred preference models, i.e., the institution designs the mechanism to please the assumed value preference of the people and reach a “fair” outcome (Fig. 1).

In this setting, which we contextualise in two examples below, the mechanism design affects the behaviour of agents independently of its inherent degree of algorithmic fairness. Specifically, we encountered two cases that pose what seem to be “already-solved” allocation problems. Upon further scrutiny, we found underlying, more complex dynamics.

Figure 1. Motivating setup: A sociotechnical system consisting of agents, a mechanism, and policy actors. The agents provide an input to the mechanism, and are affected by its output, while a policy actor sets the rules for the mechanism.

Figure 1. Motivating setup: A sociotechnical system consisting of agents, a mechanism, and policy actors. The agents provide an input to the mechanism, and are affected by its output, while a policy actor sets the rules for the mechanism.

As shown in the examples, the mismatch between the allocation rules and the preference model of the population influences the mechanism’s efficacy, prompting gamification for those who have the resources to invest in understanding and playing the mechanism’s rules. In the second example, the complexity of conflicting institutional values limits the mechanism’s fairness and efficiency.

This raises questions of prosociality, trust, governance and fairness outside algorithmic bounds. How do people respond to a mechanism that does not align with their preference model (and perhaps their values)? How can institutions consider the longitudinal effects of algorithmic allocation within the process of policymaking?

Amsterdam school choice

The Amsterdam school choice system is an especially useful example of a sociotechnical system where the deployment of algorithmic allocation led to unexpected changes in the behavior of the social system, causing continuous updates to the algorithm and subsequent degradation of trust in the system. It is also a good example of when a poorly designed “fair” mechanism leads to diminishing prosocial behavior.

In Amsterdam, there is an open-choice policy when moving from primary to secondary school [4]. Group 8 students (equivalent to 6th grade in the US) are allowed to pick any school within their education level (e.g., vocational, general secondary, pre-university, etc.) anywhere in the city, unrestricted by their zone of residence. Every year, students are asked to rank 8 to 12 schools (based on education level), and then a centralized matching algorithm automatically matches students to schools.

The system is communicated to be based on the famous Deferred Acceptance algorithm [5], a New York based school choice algorithm which won its author the Nobel prize in Economics in 2012 [6]. However, the algorithm is modified in several key places to fit the open-choice policy in Amsterdam.

Firstly, the Deferred Acceptance algorithm is a two-sided matching method, meaning that students and schools both have preferences over each other and are then matched accordingly. In Amsterdam, schools do not have a preference over students and therefore this preference is simulated with the means of a random lottery number. This choice was also grounded in fairness, as with a random lottery, every student has an equal chance of getting a good lottery number. Secondly, the Deferred Acceptance algorithm does not specify a fixed number of schools to rank. In Amsterdam, however, a policy named “placement guarantee” was introduced, where students are guaranteed a position if they rank a fixed number of schools. This guarantee is ensured by increasing the capacity of schools by a marginal amount in a second round of allocation, where students who listed the required number of schools in the first round and still did not get a placement are eligible, and are then allocated using the increased capacity in the second round. These changes unsurprisingly led to the matching algorithm performing very differently from its Nobel-prize-winning counterpart, creating problems of inefficiency and inequality.

Random lottery numbers led to an inefficient allocation of schools, increasing dissatisfaction among students and their parents [7]. Moreover, the “placement guarantee” policy led to strategic gaming from the parents, where they are incentivized to report schools they do not prefer just so they can ensure eligibility for the second round [8]. This further degraded the system’s efficiency, as well as its fairness, as parents from privileged backgrounds are better able to apply strategies than parents from marginalized communities.

The authorities responsible for the school choice system have repeatedly come under public scrutiny for continuous changes to the system without successful results [9]. This has led to a degradation of trust in the institution.

Underneath this allocation problem is a complex sociotechnical issue, one that requires:

  1. Making clear what values the system is actually trying to serve, and whether these align with what parents themselves care about.
  2. Understanding how the rules of the mechanism change social behavior, so that reported preferences are seen not just as choices, but also as responses to risk, incentives, and unequal access to information.
  3. Identifying problems that are easy to miss if we only look at fairness within the mechanism itself, such as distorted preferences, unequal strategic burden, and declining trust in the system.
  4. Looking beyond the matching rule alone, and instead supporting better communication, better alignment between stakeholders, and more situated policy design.

This requires a multidisciplinary sociotechnical approach, one in which a social simulation model can help make the problem and its tradeoffs easier to communicate and discuss. It also requires a systematic way of eliciting stakeholder values and using those discussions to work toward a shared understanding of what the system should aim to achieve.

Organ allocation systems

Fairness plays an important role in organ allocation systems. For patients on the waiting list to receive a transplant, waiting time is a strong determinant of short-term survival, and long-term quality of life. Multiple factors influence the structure of the waiting list and the distribution of donated organs, particularly those from deceased donors. Initially, biological compatibility between donor and recipient seems to provide a baseline allocation rule: the most compatible donor-recipient match (considering blood type and HLA presence) should be prioritised to ensure the best graft survival outcomes. However, the length of the waiting list and persistent scarcity of organs complicates the allocation problem.

Cold ischemia time restrictions (meaning how long an organ is deprived of blood flow before its quality deteriorates beyond utility for transplantation) brings into consideration logistics, donor and recipient location and a corollary of geographical factors such as regional allocation rules, coordination practices and transplant capacity. Allocation policies have been studied via simulations and algorithmic optimization for decades, with awareness of the complex interplay of medical, economic, political and legal factors.

The other component of the system is the prioritization of patients within the waiting list structure. The state of the patients is dynamic, with probabilities of becoming too ill to receive a transplant. The waiting list design attempts to accommodate for this by modeling the disease progression and setting thresholds for transplant eligibility.

In the U.S., Organ Procurement Organizations (OPO) and Transplant Centers’ performance is evaluated competitively based on how many organs were retrieved and how many successful transplants were performed [10], adding economic incentives to the mix.  This influences the local center’s decision to accept available organs or reject them in the hope of a better quality alternative.

Even seemingly aligned bioethical values can create conflicting interests, especially if multiple institutional actors are pushing for their preferred outcomes. Beside the responsibility to ensure “fairness” in allocation, the meaning of “do no harm” manifests differently for Transplant Centers (i.e. reject lower quality organ offers) and OPO (i.e. provide as many quality organs as possible), exacerbating inefficiencies. Concerning the value preferences of the patients themselves, little is known. Without a channel of communication to the algorithmic rule setters, and with conflicting interests among institutions, we risk optimizing for less relevant values.

Most importantly, the algorithm of allocation can be gamed by multilisting. Multilisting is the practice of assigning one patient to multiple waiting lists across Transplant Centers, which initially seemed to alleviate the length of the waiting list at the national scale in the U.S. However, this came at the cost of individual fairness (not everyone can be listed in multiple registries as not everyone can afford to quickly travel across states to receive a life-saving transplant) and collective fairness: while the national wait time decreased, regional variance in wait time can increase [11]. Multiple organ offers also seem to produce a utilitarian gain in efficiency by reducing organ wastage and time to transplant, but may do so at the cost of societal trust in the system [12].

Within this critical healthcare system, the allocation mechanisms endlessly attempt to reconcile fairness and efficiency. The value prioritization shifts from face-value fairness (e.g. centralised FIFO allocation) to utilitarian fairness (prioritizing patients with “the most to gain” from a transplant) or need-based fairness (prioritizing the most sick patients based on disease models with thresholds for exclusion), or introducing market logic to the system (monetary rewards to centers, multilisting, multioffer). Formalizing any value-rule into algorithmic allocation mechanisms creates, as in the example above, new ways for the system to be strategised upon, shifting the locus of inequality and obscuring its methods.

Decontextualised fairness as an attribute of technical (sub)systems has already been criticized [1]. The algorithms designed for organ allocation systems present a clear example of the Framing and Formalism abstraction traps, in which fairness evaluation stops at the technical part of the sociotechnical system and its formalization generates new, unaccounted behaviours in the system. Some literature acknowledges these limitations, suggesting we might expand our abstraction boundary, or even consider other processes beside algorithmic allocation [13,14]. In the absence of a consensus of what “fair” organ allocation is, we might want to shift our focus to a process approach. Social and institutional modelling provide the best toolset for this endeavour.

Our proposal

We propose a four-step approach for studying complex sociotechnical systems in which an allocation mechanism mediates between the public and institutions. The goal is to understand how to embed algorithmic allocation mechanisms in a wider system of stakeholder values, behavioral adaptation, and institutional feedback. As the Amsterdam school choice reminds us, the algorithmic allocation must be designed to accommodate a response to the mechanism itself. To this end, we consider social/institutional simulations as the most eligible, situated approach.

The four steps are as follows:

  1. Value elicitation: The first step is to determine which values the mechanism is meant to serve, and whether those values are actually shared by the stakeholders affected by it. Mechanisms are often designed around an inferred preference model: institutions assume what matters to the population and encode those assumptions into rules and objectives. But in high-stakes systems, these assumptions may diverge from the lived priorities of the people who interact with them. A situated approach therefore begins by making these values explicit and contextable.
    For example, in the Amsterdam school choice, policymakers may prioritize procedural fairness and avoiding unassigned students, while parents may care more about genuine access to preferred schools, reduced strategic burden, transparency, and trust. This gap matters for how the system performs in practice. Within organ allocation, value elicitation is needed to clarify which purpose the allocation system serves within the transplantation system as a whole, and what systemic fairness means to stakeholders. Although this might not result in a univocal “solution”, it lights the fire to improve procedural awareness. The value elicitation should start from Question 0, meaning without the assumption that an allocation mechanism is mandatory [15].
  2. Modeling and simulation: The second step is modeling and simulation. The simulation model is not the end goal, but a structured approach to facilitate and open communication around assumptions, tradeoffs, and possible interventions. If the response of the population to policy is modeled, strategic gamification can be accounted for in the simulated scenarios. In systems such as school choice and organ allocation, the mechanism does not act on fixed inputs. The inputs themselves change in response to the mechanism. Parents adapt their reported preferences strategically; OPOs and patients respond to waiting list structures, matching rules, and institutional incentives. Social simulation makes it possible to examine these interactions explicitly and to ask not only what outcomes a rule produces, but how that rule changes behavior across the wider system.
  3. Identifying bottlenecks and blind spots: The third step is to identify systemic bottlenecks and blind spots. Mechanisms are often evaluated in terms of fairness or efficiency within the allocation procedure itself, but this can obscure deeper problems elsewhere. A mechanism may be fair on paper while placing informational or strategic burdens unevenly across groups. It may also optimize one part of the process while ignoring upstream or downstream failures. A situated simulation framework helps uncover these blind spots by tracing feedback loops across the system: strategic adaptation, unequal ability to navigate rules or exploit advantages, changing interpretations of fairness, and degradation of trust over time. The modeling of heterogeneous agents and institutions allows the representation of multiple values and goals.
  4. Policy recommendations: The final step is policy recommendations. These recommendations should go beyond a technical redesign of the mechanism itself, as the system is sociotechnical; interventions may also need to address communication, participation, institutional coordination, trust, and policy stability. As the approach is situated within a community of stakeholders (institutions and population), the policy recommendations are tailored to local needs. This step can be expressed in policy briefs, appointment of committee and representatives to coordinate across stakeholder groups.

The approach is intended to be iterative. Fixed time intervals between iterations allow for policy to take action, and structure the process of altering it. Moreover, they facilitate participation of stakeholders that are not institutional, constructing the communication channel that was lacking in the initial setting (Fig. 1).

Conclusions

Algorithmic allocation mechanisms are a component of critical sociotechnical systems where institutions and populations interact. We argue that their fairness should be evaluated inside the algorithms and outside of them, encompassing their effect on the system they become a part of. With the increasing use of AI to automate allocation processes, aligning the values of stakeholders and opening communication channels between the population and institutions becomes our priority. A four-step situated approach with social and institutional simulations is presented. The approach shifts the focus from a fair outcome to a fairer process. While we do not claim that the approach is perfect, it provides a step forward in the integration of algorithmic allocation and fosters a procedural, situated view of fairness.

References

[1] Selbst, Andrew D., danah boyd, Sorelle A. Friedler, Suresh Venkatasubramanian, and Janet Vertesi. 2019. “Fairness and Abstraction in Sociotechnical Systems.” In Proceedings of the Conference on Fairness, Accountability, and Transparency, 59–68. New York: Association for Computing Machinery. https://doi.org/10.1145/3287560.3287598.

[2]  Lorig, Fabian, Fabris, Bertilla, Tucker, Jason. 2025. “Hybrid-Human Policy Modeling: Enhancing Decision-Making Using Social Simulations” Frontiers in Artificial Intelligence and Applications. Doi: 10.3233/FAIA250675

[3] Ghorbani, Amineh. 2022. “Institutional Modelling: Adding Social Backbone to Agent-Based Models.” MethodsX 9: 101801. https://doi.org/10.1016/j.mex.2022.101801.

[4] Ruijs, Nienke, and Hessel Oosterbeek. “School choice in Amsterdam: Which schools are chosen when school choice is free?.” Education Finance and Policy 14, no. 1 (2019): 1-30.
https://doi.org/10.1162/edfp_a_00237.

[5] Abdulkadiroğlu, Atila, Parag A. Pathak, and Alvin E. Roth. 2005. “The New York City High School Match.” American Economic Review 95 (2): 364–67. https://doi.org/10.1257/000282805774670167.

[6] Nobel Prize Outreach. 2012. “The Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel 2012.” NobelPrize.org. https://www.nobelprize.org/prizes/economic-sciences/2012/summary/.

[7] Het Parool. 2026. “Weer Minder Achtstegroepers Kunnen Naar Eerste Voorkeursschool, Volgend Jaar Wordt Het Beter.” Parool.nl. https://www.parool.nl/amsterdam/weer-minder-achtstegroepers-kunnen-naar-eerste-voorkeursschool-volgend-jaar-wordt-het-beter~b0ec8fd5f/.

[8] Tasnim, Mayesha, Paul Verhagen, Tobias Blanke, Erman Acar, and Sennay Ghebreab. 2025. “Modeling Strategic Risk in School Choice: A Case for Transparent Design”. Proceedings of the AAAI/ACM Conference on AI, Ethics, and Society 8 (3):2470-79. https://doi.org/10.1609/aies.v8i3.36731

[9] Het Parool. 2026. “Loting voor Middelbare School Weer Terug naar Oude Systeem: 12 in Plaats van 9 Voorkeursscholen.” Parool.nl. https://www.parool.nl/amsterdam/loting-voor-middelbare-school-weer-terug-naar-oude-systeem-12-in-plaats-van-9-voorkeursscholen~b7972bda/.

[10] Washburn, Kirt. 2012. “Maximizing Donor Potential: Evolving Organ Procurement Organization Metrics and Optimizing Organ Distribution and Allocation in the United States.” Liver Transplantation 18 (suppl. 2): S1–S4. https://doi.org/10.1002/lt.23507.

[11] Harvey, C., and J. R. Thompson. 2016. “Exploring Advantages in the Waiting List for Organ Donations.” In 2016 Winter Simulation Conference (WSC), 2006–17. Washington, DC: IEEE. https://doi.org/10.1109/WSC.2016.7822245.

[12] Erazo, Ignacio, David Goldsman, Pinar Keskinocak, and Joel Sokol. 2022. “A Simulation-Optimization Framework to Improve the Organ Transplantation Offering System.” In 2022 Winter Simulation Conference (WSC), 1009–20. IEEE. https://doi.org/10.1109/WSC57314.2022.10015431.

[13] Thompson, David, Larry Waisanen, Robert Wolfe, Robert M. Merion, Keith McCullough, and Ann Rodgers. 2004. “Simulating the Allocation of Organs for Transplantation.” Health Care Management Science 7 (4): 331–38. https://doi.org/10.1007/s10729-004-7541-3.

[14] Feccia, Mariano, Arianna Freda, Maurizio Naldi, Gaia Nicosia, and Andrea Pacifici. 2026. “Modelling and Simulating the Organ Donation Process Using Bootstrap and Event-Driven Process Chain Representation.” Journal of Simulation 20 (2): 135–51. https://doi.org/10.1080/17477778.2025.2486709.

[15] Dahlgren Lindström, Adam, Dignum, Virginia, Ericson, Petter, Titareva, Tatjana and Tucker, Jason. 2025. “Responsible AI Self-assessment Workshop: Start with Question Zero”. https://aipolicylab.se/2025/09/05/responsible-ai-self-assessment-workshop-start-with-question-zero/ AI Policy Lab, Published September 5, 2025. Accessed April, 2026.

Policy gap: AI and the determinants of public health

There is growing interest in how artificial intelligence (AI) can be applied in public health – from individual-level interventions such as diagnosis, treatment, and patient follow-up in healthcare, to broader public health applications like health data analysis or pandemic response. Ongoing debates about regulation have already led to guidelines, including those from the WHO (2021, 2024).

An important but neglected policy area concerns the secondary effects of AI technologies on public health. Here is a clear regulatory gap. Previous technological revolutions such as electricity and the internet reshaped society and lifestyles, with downstream public health consequences – such as rising sedentary behavior and cardiovascular disease. Already today, we can identify several potential risks and opportunities linked to AI development that must be addressed if we are to safeguard population health in the future.

Key determinants of health likely to be affected include work, relationships, cognition, physical activity, and psychosocial stress. Below are some examples and potential policy responses.

Work

The labor market impacts of AI remain uncertain, but some groups – such as translators and illustrators – are already reporting falling demand due to generative AI (Society of Authors, 2024). Even with opportunities for retraining, job insecurity and layoffs are often perceived as personal crises, with heightened risks of substance use disorders, depression, cardiovascular disease, and suicide (Kim & von dem Knesebeck, 2015; Zellers et al., 2025). Policymakers must be prepared from a public health perspective, for example through preventive health communication and scalable stepped-care interventions that can be expanded as needs increase.

Relationships

Strong social relationships are among the most important protective factors for health and wellbeing (World Happiness Report, 2024). Their effect on mortality risk is comparable to that of well-known risk factors such as smoking and binge drinking (Holt-Lunstad et al., 2010).

While AI services may help alleviate loneliness or coach users toward better social skills, there is also a risk that they replace human relationships due to their convenience. Researchers such as Mahari and Pataranutaporn (2024) have called for regulation in this area. One proposal is to mandate that non-humanized chatbots be the default in vulnerable settings such as health and wellness apps, to reduce the risk of users anthropomorphizing and misusing the technology (De Freitas & Cohen, 2025).

Cognition

AI tools may enhance cognition by supporting personalized learning or compensating for bias. At the same time, emerging evidence suggests they might impair higher-order functions over time. Just as books and calculators shaped cognition through cognitive offloading, AI tools may lead to declines in problem-solving, planning, and decision-making – especially among younger generations growing up with them. Although research is still limited, small-scale studies point in this direction (Gerlich, 2025).

Such changes could have broad societal implications, including dependence on AI, loss of critical thinking, and increased vulnerability to manipulation. They also carry direct health consequences: cognitive functioning is closely linked to outcomes such as emotion regulation, longevity, and resilience against neurological diseases like Alzheimer’s (Lövdén et al., 2020).

Sedentary Behavior

AI-driven tools for both work and leisure risk reinforcing already high levels of sedentary time by shifting more tasks to screen-based, automated, and remote interactions. Prolonged sedentary behavior is associated with higher risks of all-cause mortality, cardiovascular disease, type 2 diabetes, and certain cancers, even after adjusting for leisure-time physical activity (Biswas et al., 2015).

Psychosocial Stress

Rapid social change, including AI adoption, can heighten uncertainty, worry, and job insecurity – all well-established psychosocial stressors linked to poor health outcomes, including cardiovascular disease, mental illness, and elevated mortality (Guidi et al., 2021). Strengthening digital self-efficacy can help buffer these effects (Zhao & Wu, 2025), highlighting the need to monitor and address psychosocial consequences alongside technical and clinical AI governance.

Catastrophic Risks

Alongside gradual effects, there is also a class of extreme health risks from AI systems, including catastrophic accidents or loss of human control. Though their probability is debated, the potential scale-up to and including human survival – makes them relevant to a comprehensive public health framework. As with rare but devastating hazards like nuclear accidents or novel pandemics, AI warrants systematic assessment and planning.

POLICY RECOMMENDATIONS

To ensure AI development produces the best possible outcomes for public health, it is not enough to regulate AI applications within healthcare alone. Public health must be integrated into all AI policies, alongside other overarching sustainability perspectives such as climate, equity, and human rights. Here are three proposals:

1. Integrate public health into AI regulation

Frameworks governing AI development and deployment should explicitly include public health provisions. For example, the EU AI Act (Article 5) prohibits AI systems designed to manipulate user behavior in ways that cause significant harm to self or others. The EU Digital Services Act (Article 34) requires very large online platforms to assess and mitigate systemic risks, including those affecting public health and mental wellbeing. Digital services with underage users must be safe and free from harmful content, regardless of their size.

As with food safety standards, technologies should meet minimum health requirements. Consumers have a right not to be exposed to foreseeable risks such as disrupted sleep, distorted body image, or social dysfunction, where such harms can be anticipated and prevented.

2. Build AI capacity within public health institutions

Knowledge of AI remains limited among many public health professionals and officials. Capacity must be strengthened through education, recruitment, and expert networks so that AI-related challenges can be managed at local, regional, national, and international levels.

Global advisory bodies such as the WHO could support governments in integrating public health perspectives into national AI strategies, beyond the medical applications currently emphasized.

3. Stimulate research on AI and public health

Research on the public health effects of AI remains scarce. Neither the International AI Safety Report (2025) nor the MIT AI Risk Repository currently list health risks as a category. Most existing studies focus narrowly on healthcare applications rather than upstream determinants of health.

We need systematic investigation into emerging effects as well as foresight analyses to anticipate future impacts. By mitigating risks and promoting health benefits, AI can be developed in ways that support rather than undermine public health.

This is an initial attempt to articulate the secondary public health dimensions of AI as a societal challenge. I welcome comments, suggestions, and ideas.

References

Bengio, Y., Mindermann, S., Privitera, D., et al. (2025). International AI Safety Report (Research Series No. DSIT 2025/001). UK Department for Science, Innovation & Technology. 
https://assets.publishing.service.gov.uk/media/679a0c48a77d250007d313ee/International_
AI_Safety_Report_2025_accessible_f.pdf

Biswas, A., Oh, P. I., Faulkner, G. E. J., et al. (2015). Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: A systematic review and meta?analysis. Annals of Internal Medicine, 162(2), 123-132. https://doi.org/10.7326/M14-1651

De Freitas, J., & Cohen, A. (2025). Unregulated emotional risks of AI wellness apps. Nature Machine Intelligence, 7(6), 813-815. https://doi.org/10.1038/s42256-025-01051-5

Helliwell, J. F., Layard, R., Sachs, J. D., De Neve, J.-E., Aknin, L. B., & Wang, S. (Eds.). (2024). World Happiness Report 2024. Wellbeing Research Centre, University of Oxford. (World Happiness Report)

Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta?analytic review. PLoS Medicine, 7(7), e1000316. https://doi.org/10.1371/journal.pmed.1000316

Gerlich, M. (2025). AI tools in society: Impacts on cognitive offloading and the future of critical thinking. Societies, 15(1), 6. https://doi.org/10.3390/soc15010006

Guidi, J., Lucente, M., Sonino, N., & Fava, G. A. (2021). Allostatic load and its impact on health: A systematic review. Psychotherapy and Psychosomatics, 90(1), 11-27. https://doi.org/10.1159/000510696

Kim, T. J., & von dem Knesebeck, O. (2015). Is an insecure job better for health than having no job at all? A systematic review of studies investigating the health-related risks of both job insecurity and unemployment. BMC Public Health, 15, 985. https://doi.org/10.1186/s12889-015-2313-1

Lövdén, M., et al. (2020). Education and cognitive functioning across the life span. Psychological Science in the Public Interest, 21(1), 6-41. https://doi.org/10.1177/1529100620920576

Mahari, P., & Pataranutaporn, P. (2024, August 5). We need to prepare for “addictive intelligence”. MIT Technology Reviewhttps://www.technologyreview.com/2024/08/05/1095600/we-need-to-prepare-for-addictive-intelligence/

Slattery, P., Saeri, A. K., Grundy, E. A. C., et al. (2024). The AI Risk Repository: A comprehensive meta?review, database, and taxonomy of risks from artificial intelligence. arXivhttps://arxiv.org/abs/2408.12622 (arXiv)

Society of Authors. (2024, April 11). SOA survey reveals a third of translators and quarter of illustrators losing work to AI. Society of Authors. https://www.societyofauthors.org/2024/04/11/soa-survey-reveals-a-third-of-translators-and-quarter-of-illustrators-losing-work-to-ai/

Regulation (EU) 2022/2065 of the European Parliament and of the Council of 19 October 2022 on a Single Market for Digital Services and amending Directive 2000/31/EC (Digital Services Act). (2022, October 27). Official Journal of the European Union, L 277, 1-102. http://data.europa.eu/eli/reg/2022/2065/oj

Regulation (EU) 2024/1689 of the European Parliament and of the Council of 13 June 2024 laying down harmonised rules on artificial intelligence (Artificial Intelligence Act). (2024, July 12). Official Journal of the European Union, L 2024/1689http://data.europa.eu/eli/reg/2024/1689/oj

World Health Organization. (2021). Ethical guidelines for the application of AI in public health (applications such as screening, treatment, pandemic response strategies)https://www.who.int/publications/i/item/9789240029200

World Health Organization. (2024, January 18). WHO releases AI ethics and governance guidance for large multi?modal models in health care and medical researchhttps://www.who.int/news/item/18-01-2024-who-releases-ai-ethics-and-governance-guidance-for-large-multi-modal-models

Zellers, S., Azzi, E., Latvala, A., Kaprio, J., & Maczulskij, T. (2025). Causally-informative analyses of the effect of job displacement on all-cause and specific-cause mortality from the 1990s Finnish recession until 2020: A population registry study of private sector employees. Social Science & Medicine, 370, 117867. https://doi.org/10.1016/j.socscimed.2025.117867

Zhao, X., & Wu, Y. (2025). Artificial intelligence job substitution risks, digital self?efficacy, and mental health among employees. Journal of Occupational and Environmental Medicine, 67(5), e302-e310. https://doi.org/10.1097/JOM.0000000000003335