Future-Proofing Healthcare and Medicine

In this episode of Impetus Digital‘s Fireside Chat, I sat down with Bogi Eliasen, Director of Health at Copenhagen Institute for Futures Studies, for a thought-provoking and intriguing discussion around the future of healthcare. Among many other things, we explored the future of genomics, personalized health, healthcare data, and digital health, along with the work Bogi is doing as part of the “FutureProofing Healthcare” project.

Here is a sneak peek of our conversation:

Q: I’m especially interested in you expanding on your view around system incentives, because, at the end of the day, systems thinking is really based on “energy goes where the money flows”. People need that incentivization to be able to encourage certain kinds of behavior. Can you speak around that first lego block of planning and enabling?

A: Let me just first make the connection. What we have tried to do is that we have some vital signs in the index, and, in these blocks that you are mentioning, they are connected. If you see that you want to strengthen, or you have a weakness, or you want to work or enhance something that you see in the index, you can go into these blocks and see if those are the parameters, this is the area and then there is some inspiration for.

For the system thinking and dynamics, yes, what we have done the last five or ten decades, depending on where you are in the world, is a huge leap forward, but it has also been what is often labeled as a one-size-fits-all approach to health and it has been beneficial. We know today, and we have the insights to understand that we can do better than giving the same to everybody. That is where personalized health comes in. Currently, there is not much incentive to work in that way.

You need to take a risk in order to do it, both in the hospital system as a health service provider and also as a company when you work with that. The other side is that when we go back and look at the last 200-300 years, the lifespan in the richer part of the countries has gone from just below 30 years on average to almost reaching 90. The one that became the oldest 300 years ago, they reached the same age as they do today. So, we have lifted the average lifespan but not the peak lifespan.

That is often misunderstood when we work with this and when you then look into all this research about especially old people, the centenarians. It actually shows that a majority of them are old because they never were ill and not because they were well-treated in the hospital system. There are other things we would need to begin to look at outside. When we look at what really accelerated the lifespan in the majority part of the world, it’s clear that hospitals help a lot with accidents and communicable diseases but also clean water in schools, better working conditions, better roads, and education in general. That’s what we also need to understand in health going forward. It needs to be the bridge between the clinical side and the non-clinical side of how do we make that work together, and that leads to prevention.

The incentives for prevention just isn’t there. That will probably require new payers today. I will say this quite hard and brutal, but we have some free-riders in the system, the biggest ones are the insurance companies and the pension funds. They need to come into this game and be a part of the risk-takers because they have the benefit of the prevention as well. Prevention needs us to begin to think in lifespans and not in one-year budgets or four- or five-year political cycles but from cradle-to-grave, or womb-to-tomb as we begin to say now, because we can already work before we are born.

We need to understand where is their potential value in a society that can be capitalized on in different ways when you provide improved quality of life and well-being. That needs to be the goal, the goal shouldn’t be to build more hospitals or more technology. It’s how do we provide increased quality of life and wellbeing due to lifespan?

Will we still need treatments? Of course, we will still be ill, but the challenge for societies, what makes the health system non-sustainable, is that for every year we gain, we take with us half a year with a disease. If our work activity due to lifespan is the same, and we live 30 years longer and half of them are with a disease, it’s obvious that that is not good. Economically, it doesn’t work for wellbeing or personal reasons, and dignity is not good either. That’s where we need to push that forward. How do we do that? We need to ask questions…

For more of our discussion, you can watch the whole Fireside Chat with Bogi Eliasen, or listen to the podcast version, below.

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