Last night our UK hosts for the Future of Health discussions very kindly held another event in London. Strategic North and the partners, Raise the Bar, had an evening reception where we shared some of the key insights from the Future of Health and other discussions last year. Looking at a wide range of issues, this talk covered public health issues, changes in health care funding, the increasingly significant role of data, the ageing challenge and the need to ensure better healthcare for all. A short video of the evening is available here.
The healthcare and wellness industry is going to drive the world economy of the 21st century. Globally healthcare is already well over a $6 trillion industry. But, despite its size, it only addresses about 30 per cent of the world population; nearly 70 per cent is nowhere near receiving decent healthcare services. We need a revolution in order to service the entire market.
The major issue is primarily revolving healthcare. The world’s first heart surgery was done in Oslo in 1895 – well over a century ago. A hundred and twenty years later only 10% of the world’s population can afford it. We can and must do better. The future cannot be just an extension of the past. It must embrace new technology, implement innovative approaches and aim higher than people previously thought possible.
The 21st century will see a rapidly growing demand for healthcare, but this demand looks unlikely to be met in the way the past century was. For one thing, to treat the 21st century’s problems with a 20th century approach to healthcare would require an impossible number of doctors. For another, caring for the chronic diseases that are growing in prevalence are not what doctors are best at.
Before we explore the future challenges and options, we should however recognize that over recent years we have already achieved a good deal. Globally, on average, we have never been so healthy, wealthy and educated. Although there have been long-term improvements in health delivery and care, it is over the past few decades that progress has really started to build momentum. This has happened partly because advances in technology, public health and governance have all aligned, and partly because there has been shared understanding of what the big issues are and how to address them. As the IMF has highlighted, child death rates have fallen by more than 30%, with about three million children’s lives saved each year compared to 2000. Deaths from malaria have fallen by one quarter in the same period.
But, as the WHO points out, we still have major challenges to address:
- The average annual rate of decline of women dying due to complications during pregnancy and childbirth is far below target to reach the Millennium Development Goal
- While HIV infections have declined by 33% globally, sub-Saharan Africa still accounts for 70% of all new infections
- Although the global tuberculosis mortality rate has fallen by 45% since 1990, multi-drug resistance TB continues to pose problems with an estimated 450,000 per year developing it.
- In 2012 almost half the world’s population were still estimated to be at risk of malaria with Africa bearing 80% of new cases and 90% of associated deaths
- Moreover, as the current e-bola pandemic in West Africa highlights, our ability to prevent such disease epidemics is limited, primarily due to low levels of public health in many key centres of major population.
Increasing access to affordable essential medicines is vitally important but several factors undermine availability in many countries. These include poor medicine supply and distribution, insufficient health facilities and staff, low investment in health and the high cost of many medicines.
Contrasting the world’s most developed healthcare market with that in India we can see many significant issues. US healthcare spend is spiraling upwards above 18% of GDP while in India, for example, the figure is just over 4% against a global average of 10%. Worldwide health spending is expected to increase by 5% next year. In India, where the government has now promised to introduce universal health insurance, spending is expected to rise by 18%.
While US life expectancy at birth is now around 80, in India we have just reached 67. Over the past thirty years, our infant mortality rates have dropped from 118 to 42 per 100,000 births compared to less than 5 in the US. In the US the prevailing market means that a healthy person can expect to spend $142,000 on out-of-pocket health expenses in the 20 years after turning 65. If they have a chronic disease this figure doubles and if they live until 90, they will need an extra $75,000. In the US there are 2.5 physicians per 10,000 population: in India we have 0.7.
Many in the ‘developed’ world are focused on the benefits of technology improving the effectiveness and the efficiency of healthcare. With many countries expecting to be spending up to a fifth of GDP on healthcare by 2050, the need for more effective use of resources is clear.
Certainly the potential to use information to drive for more personalised care may well open up access and raise quality while controlling costs. Especially in the pharmaceutical arena, personalized medicine and the prospect of customized therapies based on more sophisticated diagnostics is a major focus for many researchers and the opportunities for genetically orientated pharmacogentics are substantial. With most current medicines only working for 1 in 10 patients and many $1bn blockbuster cancer drugs effective with 25% of patients, the potential for bespoke treatments is significant. However, some see that, in the short term, these innovations will be primarily focused on the developed world’s more established healthcare markets and will take time to have global impact.
Tele-health, and especially ‘m-health’ has already shown great promise globally. Especially in sub-Saharan Africa and India but also elsewhere in Asia, the opportunity to use mobile as a platform for both curative and preventative healthcare has been attracting much attention from governments, entrepreneurs and the mobile networks alike. With real-time monitoring an increasing norm and the entrance of major global technology companies such as Apple and Google into the area of personal and remote monitoring, the potential is indeed significant. While the business model for preventative healthcare is yet to be fully defined, those such as McKinsey and the GSMA see this as a means of saving of $200bn a year just in treating chronic diseases across the OECD and BRIC countries.
Alongside these significant new platforms shifts there is also the need to improve access to effective treatment of fast rising chronic diseases. According to WHO figures, by 2020 major chronic diseases are expected to contribute to 73% of all deaths and 60% of the global disease burden. Moreover, 79% of the deaths attributed to these diseases will continue to occur in the developing countries. Addressing this requires both behavioural changes across many areas of society around consumption and exercise as well as structural change in the way healthcare and sick-care is provided. If we are going to stem the rising tide of chronic disease and deal with its consequences we need a far more integrated approach to wellness and healthcare that works across all societies and not just a select few. We need to integrate primary, secondary and tertiary prevention and health promotion across sectors and different disciplines.