The field of artificial intelligence (AI) is rapidly influencing health and healthcare, but bias and poor performance persists for populations who face widespread structural oppression. Previous work has clearly outlined the need for more rigorous attention to data representativeness and model performance to advance equity and reduce bias. However, there is an opportunity to also improve the explainability of AI by leveraging best practices of social epidemiology and health equity to help us develop hypotheses for associations found. In this paper, we focus on explainable AI (XAI) and describe a framework for interdisciplinary expert panel review to discuss and critically assess AI model explanations from multiple perspectives and identify areas of bias and directions for future research. We emphasize the importance of the interdisciplinary expert panel to produce more accurate, equitable interpretations which are historically and contextually informed. Interdisciplinary panel discussions can help reduce bias, identify potential confounders, and identify opportunities for additional research where there are gaps in the literature. In turn, these insights can suggest opportunities for AI model improvement.

Large language models (LLMs) hold immense promise to serve complex health information needs but also have the potential to introduce harm and exacerbate health disparities. Reliably evaluating equity-related model failures is a critical step toward developing systems that promote health equity. In this work, we present resources and methodologies for surfacing biases with potential to precipitate equity-related harms in long-form, LLM-generated answers to medical questions and then conduct an empirical case study with Med-PaLM 2, resulting in the largest human evaluation study in this area to date. Our contributions include a multifactorial framework for human assessment of LLM-generated answers for biases, and EquityMedQA, a collection of seven newly-released datasets comprising both manually-curated and LLM-generated questions enriched for adversarial queries. Both our human assessment framework and dataset design process are grounded in an iterative participatory approach and review of possible biases in Med-PaLM 2 answers to adversarial queries. Through our empirical study, we find that the use of a collection of datasets curated through a variety of methodologies, coupled with a thorough evaluation protocol that leverages multiple assessment rubric designs and diverse rater groups, surfaces biases that may be missed via narrower evaluation approaches. Our experience underscores the importance of using diverse assessment methodologies and involving raters of varying backgrounds and expertise. We emphasize that while our framework can identify specific forms of bias, it is not sufficient to holistically assess whether the deployment of an AI system promotes equitable health outcomes. We hope the broader community leverages and builds on these tools and methods towards realizing a shared goal of LLMs that promote accessible and equitable healthcare for all.