After the recent European Health Forum Gastein, which had the theme of “A Healthy Dose of Disruption”, we have been reflecting on the real meaning of, and need for disruption in our health systems. Having met attendees ranging from senior policymakers, to tech leaders, to climate activists, can we draw any conclusions about what real disruption is, and how this will help or hinder our collective endeavours to improve population health?
Is disruption needed?
Developed countries worldwide face the same struggle; how to transform health systems designed around reactive, time-limited, curative care for working age people into systems suited to preventing ill-health at the same time as meeting ongoing care needs for highly complex patients, all while providing a positive patient experience within a sensible cost envelope. Developing countries increasingly face these same challenges, as well as others such as inadequate infrastructure, shortages in the workforce and access to medicines. These issues are integral to addressing global priorities for action such as those set out in the Sustainable Development Goals (SDGs): for example ending the AIDS epidemic, delivering gender equality and reducing inequalities. While progress is being made in some of these areas, in others, we are moving in the wrong direction; clearly, the status quo is inadequate. We can all agree that disruption is required to ensure our health systems are sustainable and fit for purpose.
What is disruption?
The picture is less clear for the real meaning of disruption in healthcare, and for the theories of change for such disruption to address the challenges described above. Typically, disruption is framed around technological innovations, while leading technologists are looked to as potential saviours. This is a very narrow view – and perhaps simply an incorrect one. Can we consider it truly disruptive to monitor our health status at home, when our mobile phones tell us when to leave the house in time for our meetings, and give us advice on the shortest route – including up to date traffic reports? Today, technology is incorporated in every aspect of our lives. Smartphones have replaced paper maps. Video chats and online communication platforms have replaced face-to-face interactions. And while these may sound innovative, do they really help us address the challenges our health systems face? We can’t help but wonder if we are focussing on the right type of disruption in health.
Technological advancements clearly have a significant role to play in all areas of healthcare. Our caution relates to the balance of enthusiasm and effort on these areas compared to the fundamental systems we work within. New analytical techniques can help provide insights ranging from the design of gene therapies though to proactively identifying the populations most at risk of poor outcomes later in life. But solutions still need delivery systems to get them to the people who need them. Highly sophisticated life-extending treatments can be hugely beneficial for those that receive them – but their distribution is not equitable, and these same treatments play a part in increasing the investment required in health services (perhaps with very limited resultant population health gains). AI-based interfaces can be convenient for working age people, but it is hard to see how they can help the part of the population that needs more meaningful human contact and relationships, not more medicine.
Where is disruption needed?
A more useful focus of disruption would be on better enabling the fundamentals of high quality care, providing meaningful outcomes for people as individuals and supporting them to remain healthy in a way that makes sense to them. Consider, for example, the rise of vaccine hesitancy: for the first time in decades, we are seeing increases in a number of previously controlled diseases. Measles cases have increased by 30% globally. While this is due to a number of reasons, central is a “lack of confidence” from parents and caregivers – a problem exacerbated by the poorly regulated technological innovations of social media. Similarly, we know that PrEP is highly effective at preventing the spread of HIV, but that it is not available to those who need it. Even where available, PrEP can remain undispensed, in part due to already excluded individuals’ reticence to disclose their condition to a system in which their voices are poorly represented.
So what disruption would help with this? Building a hierarchy which better reflects the workforce and populations they serve would be a good start, and listening to a wider range of voices than the typical (“pale, male, and stale”) sages. We often hear the leaders of innovation in healthcare criticise those who resist innovation in order to protect their jobs, but how often do we apply that critical eye to our own roles and responsibilities within the system?
Kendall Jamieson Gilmore, Margot Neveux, Véronique Bos
The authors are Young Gastein Scholars who attended the European Health Forum Gastein in October 2019. Kendall & Véronique are HealthPros Fellows based in Italy and the Netherlands, respectively. Margot is a Policy & Projects Coordinator at the World Obesity Federation in London, UK.