Tiago Villanueva: Should we “own” our health?


I don’t often have the chance to meet people like Ron Dembo, who have a vision and ideas that could change the world, or at least the world of healthcare. Dembo is the CEO and Founder of Zerofootprint, a software and services company that makes environmental impact measurable, visible, and manageable to businesses, governments, institutions, and individuals. His company reduces environmental risk and cost through behavioural change and has recently entered the healthcare arena too.

For him, the future of medicine will be a combination of technology, a system of rewards and nudging, and will be highly influenced by social science and behavioural economics. He recently gave a talk in London organized by C3 Collaborating for Health to show what it will be all about. He gave many examples to explain his views, and one of them was that cars nowadays are supercomputers equipped with ubiquitous sensors that allow us to anticipate mechanical problems before they appear. Cars are thus being measured far more than people, and he feels we would all benefit by deploying sensors everywhere using mobile medical applications that will allow real time monitoring of endless parameters. This could be, say, a bracelet that acts as a pedometer or measures sun exposure, a band-aid that monitors the heart rhythm, a wrist sensor that tells how stressed we are, or an iPhone than can work as a glucometer. He is thus convinced that we need to start “owning” our health and move from a “sick care system” to one focused on prevention, where people exercise enough, have a proper diet, and avoid environmental pollution. He stressed that one in eight people died because of air pollution in 2013.

Of course, it’s easier said than done.

In the city of Toronto, Canada, where he is based, the prevalence of diabetes is higher in areas of the city where there’s less availability of public transport, fewer doctors, and where affordable and nutritious food is more difficult to obtain (especially for those without a car). He calls these areas “food deserts.”

Even though healthcare professionals need to play their part in helping such communities change their behaviour in terms of diet and exercise, it is clear for Dembo that we must look beyond medicine, as behavioural change is not only a medical problem, but involves other variables like transport, for example. And even though social science and behavioural economics tell us that providing rewards to people is essential to foster behavioural changes, there is no “silver bullet” to change behaviour, as different people require different types of reward. But there might be a “silver platform.” There is hope that the use of “big data” obtained through all this monitoring could create “evidence based rewards.” Some cities in Canada are already using a “social currency” called “Good Coins.”

The idea is that when one “coin” is issued and spent, “the world measurably gets better,” unlike existing rewards systems (e.g. frequent flyer programmes, or chemist and supermarket points systems) that are flawed and often provide pernicious rewards.

“Good Coins” can be earned by doing things like walking 30 minutes a day, saving energy, complying to prescribed medications, or eating appropriate food. These “coins” can then be spent on things like health tracking devices, food in health restaurants, or carbon-neutral travel.

Dembo expects doctors in the future to prescribe both apps and medicines. Prescription-only apps are already available, for example, for diabetes management. Prescribing things like bike-sharing memberships may become run-of-the-mill in the future.

So ultimately, he feels that doctors will make patients their medical assistants, in the same way companies like IKEA turn us into a part of their production and delivery process, or cities make us into garbage sorters.

Several people in the audience raised several concerns surrounding the mass use of data. One of the concerns was related to the excess of useless or uninteresting data (“databesity”), and lack of useful intelligence. Ron Dembo said that this was partly a technological problem and that it will be important to consult the right experts in order to get the right analytics. Others wondered whether data collection might be prone to abuse, which Dembo acknowledged is a potential threat. He said that there will always be risks and misuse, but he considered that this is ultimately so useful that no one can stop this “revolution.” There was also some concern that this seems like medicalising prevention. Only time will tell whether there are reasons to be as optimistic as Ron Dembo.

Tiago Villanueva is the editorial registrar, The BMJ.