The future of healthcare

As we saw earlier, some of the common indicators we use to measure health have recorded rapid changes during the past decades. Global life expectancy, for example, has increased from 52 years in 1960 to 72 years in 2015. Major progress has been made to tackle diseases, such as polio, which was a major killer up until 1950 and then was almost eradicated by the close of the century. Advances in research and technology have produced medicines and devices that have the potential to save lives around the world if we solve the problems of ensuring access to these new resources. If anything, the current pace of change is accelerating. So what might the future look like for health and health care?

Let’s look at some of the trends, risks, and opportunities. Examining our global frameworks can give us some indication of the changing priorities in global health. The Millennium Development Goals, or MDGs, were the framework for global development from 2000 to 2015. They preceded the current Sustainable Development Goals. MDGs focused on child and maternal health and tackling infectious diseases like HIV, TB, and malaria through mechanisms such as the Global Fund. This fund claims to have saved 20 million lives since 2000 by focusing on specific diseases and investing $4 billion US dollars a year to tackle HIV, TB, and malaria. With the introduction of the SDGs, there is a move away from this more narrow, single-disease focus to consider new threats to health.

As well as maintaining targets around communicable diseases and child and maternal health, SDG3, the health goal, addresses a large number of other health challenges. These include non-communicable diseases, substance abuse, road traffic accidents, and access to sexual and reproductive health care services. This is before we even start to consider health through the lens of other goals that are intertwined with health. As we saw earlier on this week, economic development is closely intertwined with health outcomes. If we consider 2015 figures from the World Health Organisation on leading causes of death in low, middle, and high income countries, we can see different trends associated with economic status. Among richer countries, the non-communicable diseases, such as cancer and diabetes, are increasing in prevalence.

Diseases associated with ageing, such as dementia, also increase as life expectancy rises and more people reach old age. Among low-income countries, the burden accounted for by infectious diseases is still high. We anticipate that continuing current global trends, more and more people will be lifted out of poverty at a faster rate over the coming years. This means that many of the diseases of high-income countries will become more prevalent in low-income countries, too. One example that Ross spoke about this week was the prevalence and balance between under- and overnutrition globally. In this rapidly-changing context, I asked our panel of experts what they think the future of health and health care holds.

I think non-communicable diseases, such as diabetes, such as obesity, are going to become much more problematic in parts of the world where perhaps they’re not so problematic at present as people lead more sedentary lifestyles, as they lead more urban lifestyles. And that’s going to have impacts on other areas of health as well, of course. I think there’ll remain the problem of infectious diseases, different kinds of infectious diseases, new and emerging infectious diseases. I think we have a double challenge to face. The only thing that’s absolutely obvious is the whole issue of poverty, socioeconomic iniquity. All the work that WHO has started working on with, for many years already now, on socioeconomic determinants of health is very, very important.

If we don’t focus on the poorest people and try and figure out how these people can have access to a healthy living environment, healthy lifestyles, healthy diets, we’re not going to be able to ensure health in the future. The other thing is going to be looking at the environment. Right now what we are doing is– I don’t think we have a healthy environment. I think the health– people really need to get very serious about ensuring that environment is healthy. Yeah, thanks. In 20 years, expect greater role of technology.

As I talk right now in the School of Public Health, we are training health informaticians, who are going to revolutionise flow of information on health, medical information, from one area to another area, between ministries, between the health facilities and so on and so forth. These people really will be their work, and we expect big, big changes in health care. Service should be faster.

Databases should be linked up.

And we have staff who are really, really more dedicated, because they are facilitated by the information. Well, just as the movement on planetary health has taken hold, you know, looking at the health of ecosystems and stability of our global climate as supporting our civilisation, I think that, you know, in the next 20 to 50 years, the health care sector and practitioners will– that they will value– they will understand the value of the natural world with a stable climate. And that instead of thinking of medicines first and treatment, thinking upstream, that, you know, a much larger underlying determinants of health. And that includes healthy ecosystems, stable climate, and healthy environments. Our experts raised some important points for us to consider further.

They pointed to the rise of non-communicable diseases alongside the importance of keeping up the fight against familiar and emerging infectious diseases. They also highlighted the importance of new technology and the need to consider a systems approach to health, ensuring adequate access to health services, health insurance and medicines, but also considering broader environmental factors and socioeconomic determinants, which provide the context for health and well-being. Adding to what our experts have said, we must consider changing world demographics. The world’s ageing population and increasing life expectancies mean that we must figure out how to tackle diseases of old age, such as dementia. And we must learn to manage diseases that now present as chronic conditions, such as HIV.

During our discussion of the NOURISH project earlier this week, we saw how HIV can be managed with medication. However, ongoing treatment may present additional challenges to those living with HIV, such as higher cholesterol and other co-morbid conditions. As well as facing emerging challenges to health, our global community has access to increasingly-sophisticated tools to fight disease. New technologies are increasingly ubiquitous and have the potential to solve the problem of access to health care. For example, through telemedicine. The World Economic Forum recently stated that the smartphone will become one of the most powerful tools for access to health.

In the next steps, we will explore some of these ideas further using case studies to look us antibiotic resistance, brain health, and innovation in health care delivery.