This article was first published on July 27, 2022 in STAT.
To paraphrase Canadian-American speculative fiction writer William Gibson: The future of healthcare is already here; it’s just unevenly distributed.
We live in a world where science continues to produce marvels: Researchers can load miniaturized human organs onto microchips to simulate how the human body will respond to experimental treatments. Gene therapies exist that not only treat cancer or sickle cell disease but may cure them.
At the same time, half of all people in the world lack access to basic medical care.
I had the privilege to join political, business and cultural leaders at the World Economic Forum’s annual meeting in Davos, Switzerland, in May to help steer the global community’s response to the world’s most pressing challenges. As CEO of a company with a mission to transform global health, I was struck by what the Kenyan humanitarian activist Umra Omar said on the forum’s closing day: “We’ve already built the Ferrari of healthcare. What’s missing is the road.”
While innovations rightfully grab the headlines, these advances won’t benefit the millions of people who need them without collective action to deliver them at scale. The question is, how will that be done?
Here’s where I think leaders should focus to help bring healthcare innovation out of the lab and into the exam room—or, better yet, the living room.
Covid-19 exposed the fragility of the global healthcare system. But I’m reminded of the saying, “Only earthquakes bring forth lofty mountains.” So what has the pandemic taught us?
Health inequity is a threat to the global order. As new Covid-19 variants slingshot around the world, it’s quaint to think that policymakers in the developed world once believed that they needed to vaccinate only their own populations. Humans are too interconnected today for this outdated way of thinking.
Economic stability is impossible without strong public health. As President Lazarus Chakwera of Malawi put it so succinctly in his Davos panel on investing in health equity, the pandemic has shattered the illusion that public health is “merely” a social issue—it is an economic one as well. The looming possibility of a global recession makes this clear. I also reject the idea that social ills are less urgent than economic ones.
Do more of what’s working for healthcare delivery (and certainly not less). From the delivery of medicine by drone in India to a belated acceptance of telemedicine in the U.S., the pandemic forced a global rethinking of how healthcare is delivered. In the developing world, where the medical and technological infrastructure is nascent, people say they want more innovation. In the developed world, where the infrastructure is robust, there is resistance to change and even signs of regression. The temptation to backslide can be strong—and must be guarded against.
No one should receive inferior healthcare because of their race, gender, income or place of birth. But many do. Unfortunately, the adage “If you build it, they will come” does not apply here.
Access to healthcare currently depends on money, gender, race, geography and many other intertwined, deep-seated factors. And access is only the most obvious measure of health equity. Consider this: If I get sick, there’s a very good chance I will continue to work from home with minimal disruption. But for a single mother whose work doesn’t permit this flexibility, getting sick may force her to choose between working sick—and thereby exposing others and risking further health complications—or losing income and possibly even a job. Ultimately, she, her family and her community will bear the negative effects.
Tackling the problem of health inequity requires considering not only access to care but also who bears the ultimate consequences of inequity and how those consequences are distributed.
Overcoming health injustice requires human-centric design, focused government policy and partnerships that include stakeholders with a range of interests and incentives to contribute. Here’s an example of how this works: In Philadelphia, public health systems, community organizations and the pharmaceutical company Novartis have teamed up to address the dramatically higher incidence of cardiovascular disease present in the city’s low-income neighborhoods. They are doing this by targeting specific populations through trusted community institutions like churches and barbershops.
It is a noble (and promising) project, but to get more life sciences companies to engage in partnerships like this, advocates for greater health equity must be prepared to articulate not just the moral case for addressing social ills but the financial case as well.
The future solvency of global health systems will depend on the ability to shift resources from managing disease to preventing it. A survey conducted by ZS, the company I lead, of more than 4,000 U.S. adults and doctors conducted in September 2021 found that roughly three in four of those surveyed want more focus on prevention. Yet less than 3% of current healthcare spending in the U.S. and E.U. is allocated to preventive care. The rest goes to disease management. To future-proof global health systems, we need to target a split of healthcare spending: 30% for preventive care, 50% for curative care and 20% that never gets spent.
Biotech innovation is happening too slowly. While many of today’s health technologies and treatments are worthy of awe, the pace at which they’re helping patients has been too incremental. We are at risk of biotech creating a few incredible advances that don’t add up to the healthcare revolution we need given the scale of the challenges we face. Here’s how to fix that.
Pharma must think bigger by aspiring to develop drugs with revolutionary potential. Novel science alone should not drive research and development; advances such as more efficient, pragmatic trials must be pursued that have the potential to deliver the biggest impact to the most people in the least amount of time.
Governments must make innovation easier by removing outdated constraints on innovation, especially in mature healthcare markets, and enact policies that create incentives to spur cutting-edge research. It takes an average of 17 years for healthcare innovations to move from discovery to patient use. It shouldn’t take a pandemic to show us that’s far too slow. High-income countries owe it to the rest of the world to lead the way in this.
Artificial intelligence can identify some types of cancer faster and more accurately than clinicians, detect Parkinson’s disease and congestive heart failure from the sound of a person’s voice and sift through a huge volume of compounds to spot tomorrow’s cures. But it is also open to misuse—and even abuse—through privacy invasion, theft of sensitive data, biases that reinforce existing power structures and other risks.
One possible way to strike a balance between AI’s promise and its perils is by using inclusive design, by which I mean that those most at risk for misuse or abuse participate in AI’s creation and design. But since this may not be practical in many cases, I suggest a framework for building trust based on three principles.
Responsibility. AI has the power to solve a limitless variety of challenges. Developers must be cautious and conscious about choosing the “right” ones those with the potential to do the greatest good while limiting harm.
Competence. To gain acceptance, AI must work as advertised. Like humans, it will never be infallible. But it must work better than alternatives, and real-world evidence must be leveraged to validate (and re-validate) its effectiveness.
Transparency. Doctors and patients must be fully informed of both the risks and benefits of whatever AI-based application they may be using.
Connected health holds the power to transform how people everywhere access healthcare. But with healthcare as inequitable as it is today, solutions for making it more equitable must fit their environments. Only 27% of low-income countries (and 57% of middle-income ones) have broadband networks—a significant impediment to widespread adoption of digital health tools, telehealth and other advances that could dramatically improve access to healthcare in lower-income countries.
On the plus side, many of these countries have no powerful, entrenched healthcare systems to dislodge. In India, for example, there is a shortage of roughly 1 million doctors, leaving tens of millions of people without access to basic medical care. When this is the status quo, wearables and AI-driven smartphone apps supplemented by drone delivery and comparatively low-cost community health workers—become a highly attractive alternative.
A country such as the U.S., on the other hand, has a reasonably good technological infrastructure to support digital health innovation. But it’s also home to a deeply entrenched healthcare system comprising a tangled web of players, many working at cross-purposes and most with a bias toward maintaining the status quo. While my smartwatch may be able to alert me to a potentially serious heart condition, will my local hospital admit me based on this solitary signal? And if it does, will my insurer cover the visit?
The messy U.S. healthcare system, with its focus on disease management rather than prevention, is not currently set up to accept this kind of proactive approach to medicine.
Bringing quality healthcare to all won’t be easy, and it can’t be accomplished by a single entity acting alone. Tension will always exist between the hunger for fast, revolutionary innovation and the need for steady progress that engages every stakeholder who stands to gain—or lose—from change. While innovation may happen faster when parties act alone, scaling innovation is impossible without broad partnerships between multiple stakeholders.
So while today’s healthcare ecosystem consists of a jumble of stakeholders to align and connect, the scale and complexity of the challenges necessitate a collective approach. Only a coalition of public and private enterprises, acting through a mix of enlightened self-interest and desire for the common good, hold the power to deliver on the promise of transforming global health.