Exploring the future of healthcare
The concept of the “future citizen” that the FCI is concerned with revolves around a number of themes – mobility and globalization but also quality of life in domains such as education or healthcare. The challenges faced by the latter sector across the globe are numerous and highly dependent on the societal composition of each country or region. As regards the demographic numbers, the United Nations expects the global population to increase from 7.7 billion now to 9.7 billion by 2050, with the number of people over the age of 60 being approximately 2 billion by that point. Societies will urgently need to prepare for the consequences of one in six people being over 65 years old by 2050.
Many societies in Europe but also in Asia are ageing. FCI has previously explained how this may explain why multiculturalism is on the rise in East Asia. Africa, on the other hand, is experiencing a demographic boom. The Worldbank shows how Sub-Saharan Africa has a birthrate of 4,8 births per woman compared to 1,7 for the OECD countries. The implications for healthcare are that some countries need to work out how to care for a rapidly growing number of people who are suffering from more complicated and resource-demanding conditions that naturally develop in older age, while others are still struggling to implement universal healthcare coverage – defined by the World Health Organization as people having access to the health services they need, when and where they need them, without financial hardship.
With citizens becoming more assertive and educated, healthcare is going through a similar process as for example education. Just as key concepts for the future of education are “independent learning” and “student ownership of the learning process”, experts predict a radical reimagining of how healthcare will be delivered, even in the next five to ten years. Some companies claim that “new technological capabilities point to a future where healthcare provision is proactive and continuous, rather than reactive. This spans a wide range of stages of healthcare, from treatment options for sick people once conditions have developed, to being equipped to better manage and monitor our own health on a customised basis”.
Concrete steps are being taking in this direction, for instance through smart clothing. The Japanese company Toray explains that “patients can simply wear a smart, wired-up undershirt, which gives them the freedom to live normal lives while being continuously monitored if needed”. This intrusive way of monitoring patients can be seen as an empowerment but also as a straightjacket. As new tools are being developed to increase patients’ quality of life, it should not only be asked which functions are technologically possible, but which ones are normatively desirable. While the expectations for the next five years of an expert panel brought together by The Economist seem to represent a continuation of current developments (including more robotics and virtual reality in health care), their expectations for the next twenty-five years as regards designer babies and human brains being directly connected to AI raise many ethical questions. What is left of free will if, as predicted, my bathroom mirror is equipped with technology that can assess my health and I will be punished (in financial or social terms) if I don’t act on its instructions to remedy the situation?
These kinds of questions are obviously also explored by companies such as Toray, which recognizes the responsibility to address privacy and other issues preemptively: “Data being collected from wearable technology is the epitome of ‘personal information’. We can store and collect such data, but how are we going to ensure its security? As businesses grow, regulations will be increasingly put in place and we need to be very well prepared”.
Governmental regulations indeed need to be drafted in a way that allows freedom of choice for citizens and patients. The example of health insurance premiums being raised to prohibitively expensive levels for patients who do not comply with far-reaching monitoring is all too well-known. Whether technological developments will therefore lead to patients’ empowerment, as hopefully predicted by Deloitte, is an open question. Deloitte presents a nuanced picture, though. Stating that interoperable data and AI can empower consumers in ways that are difficult to visualize today, and that data about individuals, populations, institutions, and the environment will be at the heart of the future of health, it also claims that health stakeholders will need to earn the trust to be awarded with this data: “Consumers might not be willing to share this information with organizations that don’t offer value, or that aren’t trusted. Consumers tend to trust hospitals and physicians more than other health care organizations … Health stakeholders should consider ways to earn the trust of these empowered consumers”.
Although difficult to imagine in this age with growing bureaucracy, most commentators expect that consumers instead of institutions will be at the center of the health model in the next twenty years. Moreover, health is likely to revolve around sustaining well-being rather than responding to illness, and health will be defined holistically as an overall state of well-being encompassing mental, social, emotional, physical and spiritual health. In that connection, spiritual leaders such as the popular Indian mystic Sadghuru claim that up to 70% of all illnesses is mind-created and only 30% is caused by external influences. Explaining that while ancient societies always saw disease as something wrong and that modern societies have started to treat disease as normal because there is a whole industry thriving on it, Sadghuru notes that spiritual practice aimed at the “retuning” of mind and body will be immensely beneficial for its health effects.
There are different health indexes around that measure national policies. Their utility and scope differ considerably. Developed by the private sector in collaboration with representatives from several dozen countries and international institutions, the Global Digital Health Index is currently a very basic tool designed as an interactive digital resource that tracks, monitors and evaluates the use of digital technology for health across countries.
More interesting is the “Future Health Index” developed by Philips, another company at the forefront of health developments. Through its index, which in particular examines the role of technology in the health system, Philips ranks the health care systems of countries based on the criteria of access, satisfaction and efficiency. The number of countries included in the index is limited but shows substantial differences between countries (for instance the US scores markedly better than Brazil in terms of accessibility, but considerably worse in terms of efficiency). A complementary report highlighting current trends points out that China and Saudi Arabia are forerunners in adopting new technologies, with 94% and 85% of healthcare professionals using digital health technology or mobile health apps compared to only 64% in Germany. Philips, finally, is also heavily involved in the development of companion and assistive robots. Rather than considering robots an alternative to humans, it sees them as an adjunct which can, working alongside humans, augment care.
On the institutional level, many organizations are active in the field of healthcare. As for Europe, the EU stresses the national character of healthcare by explaining that it “does not define [national] health policies, nor the organization and provision of health services and medical care. Instead, [EU] action serves to complement national policies and to support cooperation between member countries in the field of public health”. The EU’s third Health programme (2014-2010), which is too broad and general to be readily summarized here, is coming to an end. The EU, being aware that ageing populations are one of Europe’s main concerns, has also started different projects that focus on frail older patients.
This focus on longevity and frailty in the west somewhat contrasts with the problems found in other parts of the world. Universal health coverage being one of the 2030 Sustainable Development Goals, the World Health Organization shows that the world is off track in reaching the this goal, with its most recent report noting that only between one-third and half the world’s population were covered by essential health services.
Author: Dr. Olivier Vonk