By Lorenzo Sabatelli, founding director, GLOBMOD1
With regard to the health and healthcare sectors, I think we are getting everyday smarter and readier to the opportunities and challenges of a smarter world, but more work is needed to ensure that new technologies are used to better satisfy user, e.g. patient, necessities. For instance, it is essential that digital and mobile health systems and applications are designed taking into account the cognitive status of those who will actually use them. In fact, if applications require active participation of users and fairly steep learning curves, their performances will depend on the cognitive status and learning capacity of target patients, and may not be necessarily suitable for population groups that might otherwise greatly benefit from their use.
In general, it would be desirable for health technologies (from drugs to mobile applications) to include or be complemented by automated data-collection systems that allow real-time monitoring of effectiveness (e.g. adherence, intermediate health outcomes, health indicators, etc.) Of course, that would come with a few technical challenges, primarily associated with the volume, high frequency, and heterogeneity of data, and with obvious privacy concerns. Nevertheless, if properly managed and interpreted, this data may contribute to a better (almost real-time) understanding of what is working and what it is not.
«It is essential that new digital and mobile health systems and applications are designed taking into account the cognitive status of those who will actually use them»
This would not only help provide better healthcare but also help ensure sustainability of public health systems, and a fair profit for private insurers and providers. In most cases, the cost of introducing new technology is paid out of a fixed budget, which implies that every time we invest in a new piece of health-technology we are implicitly disinvesting from something else. Prioritization is therefore essential, and needs to be based on scientific, ethical, and economic considerations.
Ageing population, shrinking budgets, and the epidemiological transition from acute deadly diseases to chronic, long lasting and highly disabling diseases is, and will, force policy makers to rely more on technology for planning, delivering, and assessing the impact of healthcare programmes. The final objective is to improve health, and possibly to increase convenience, within the population, and to do it at an affordable cost.
From a global perspective, we are living a very exciting (almost science-fictional) time. With the contribution of multiple disciplines such as public health, genomics, proteomics, phylodynamics, game theory, and artificial intelligence new horizons in the prevention and treatment of diseases, and in the provision of healthcare are emerging. In addition, technology will hopefully take away most of the mechanical and less creative components of health research and healthcare operations, leaving more resources to focus on more creative and rewarding tasks.
«The final objective is to improve health, and possibly to increase convenience, within the population, and to do it at an affordable cost»
This has certainly been the case in the past, technology has freed time and resources for doing other things. Nevertheless, we should not forget that there are differences in health conditions, care, and systems between countries around the world, and sometimes even within the same country. And there are also differences in the way new technologies are perceived and used. There are great variations in the ways health systems are organized and funded, and in their ability to absorb and use new technology, which sometimes may depend on availability and training of personnel, and on the type of patients they have. And if the differences between health systems are big, even bigger (and growing) are the differences between health-information systems.
In the US, massive private and public resources are being invested into building and strengthening health-information capability to collect, analyze, and interpret data at different levels, from individual hospitals to the entire World. In most low-to-middle income countries there is little or no health-information capability, and in Europe we are somewhere in between. Collection and processing of data vary from country to country, and local ability to turn health (and other types of) data into unbiased actionable information is still relatively limited. This translates, into a distinctive operational and strategic disadvantage which will become more acute, and painful, in the forthcoming years.
There are also concerns associated with potential ‘side effects’ of health technology. For instance, with regard to potential addiction to e-health devices, and with regard to the potential economic burden of healthcare on low-income families. If we do not find smarter ways to reduce R&D costs and make health technology accessible and affordable to those who need it, we are going to see, even in Europe, more and more people significantly impoverished as a result of illness, especially of chronic illness.
«The integration of public health with genomics, proteomics, phylodynamics, game theory, and artificial intelligence will open new frontiers in the prevention and treatment of diseases, and in the provision of healthcare»
And then there is the whole issue of ensuring health and wellbeing while also preserving the environmental capacity to support healthy human life. Last year I started working on new quantitative metrics encompassing health and sustainability, and I realized that there is very little work done, and little financial resources to do it.
Getting ready for a ‘smarter world’ entails addressing these issues. Technology is definitely a key component, in the health sector and beyond, but a ‘smarter world’ should not only focus on individual pieces of technology, in a reductionist fashion. It needs to take a systemic approach and use all available resources to help develop individual and collective long-term human potential, ensuring a fair access to opportunities, quality healthcare and education, and a balanced distribution of risks and rewards.
It may all sound overambitious, but it is by setting the bar high, and by asking, and answering, a series of ambitious, and sometimes seemingly foolish, questions that we can mobilize the individual and collective energies necessary to get ready for future challenges, and to promote progress that really makes the world, and allows us all move forward.
1. This contribution was possible thanks to the kind collaboration of the BigDataWeek 2014 event in Barcelona, media140 and the CCCB.