By MIKE MAGEE
Two decades ago, I was heavily into health visioning. I learned quickly that it was relatively easy to predict what would happen, but much more difficult to accurately peg when it would happen.
At the time, I promoted “7 Visions.”
- Health is Political.
- Home-Centered Health Care
- Reconnecting The Family
- Techmanity
- Lifespan Planning Records
- Collapsing Databases
- The Planetary Patient
These futurist predictions were grounded in reality, values, science, and leadership. In short, they had the benefit of historical context provided by the World Health Organization (WHO).
The WHO had spent the first five years of the new Millennium actively engaging the question “What is health?” A large part of this thought process has involved defining what health is not. They determined it was not the health care system. It was not the reactive elimination of disease. It was not a simple commodity to be weighed against all other commodities in society. It was different from these things, and more than these things.
In their eyes health was universal and common to the people of the world, independent of geography, race, income, gender, and culture. Health was an active state of well-being that encompassed mind, body and spirit. It was the capacity to reach one’s full human potential, and, on a larger scale, a nation’s potential for development.
Dr. Gro Brundtland, former director-general of the World Health Organization, wrote in the World Health Report 2000 that “The objective of good health is twofold – goodness and fairness; goodness being the best attainable average level; and fairness, the smallest feasible differences among individuals and groups.“
Now a quarter century later, the notion that health as a human right and a preferred state of being, rather than a set of disconnected functions or services, is increasingly being embraced. How we organize, fund, distribute, and integrate the services that allow for health – that remains up for debate.
I was brought back to this “vision” thing by two interactions this past week. The first was a text from a 3rd year undergraduate student from Harvard. He wrote: “Hi Dr. Magee- I’m – – – – -, a junior at Harvard doing a project on US Healthcare. I’m very interested in the hospital-at-home model of healthcare, and stumbled upon your book, ‘Home-Centered Health Care.’ Do you have a moment to chat so I could ask you a few questions? Thanks!” More on the conversation in a moment.
The second interaction was a request to connect with a young health care professional who for the past 7+ years has “directed comprehensive health information management (HIM) operations and data governance for a premier multi-campus system across the New Jersey and New York corridor.”
She wrote: “Hi Mike, thanks for connecting. I’ve been following your commentary on the medical-industrial complex and the systemic challenges facing healthcare delivery today. Your perspective as a medical historian is incredibly valuable right now….I was actually just reading up on the shift in healthcare reform conversations lately out of curiosity, where do you see the biggest structural blind spot in how we’re currently approaching it?”
These two interactions within a few days of each other sent me back to the 2005 vision paper. They were cuing up the three major questions of “futurists”:
- Where are things going?
- Where is the pay dirt?
- What will disrupt actualization?
As it turns out, I was right in a few of my predictions 20 years ago.
- With continued aging and enhanced survival, 4 and 5 generation families are becoming commonplace. With this comes expanded need for community-based health care givers, chronic disease management, and specialized housing.
- My vision of collapsing health databases (the merger of medical research databases, clinical health information applications, and consumer health and wellness databases) has arrived. And with the aid of AI, Lifespan Planning Records are on the near horizon.
- One feature, “techmanity,” (the humanized interface between computerized devices and human beings) is today a reality. Whether that is a good thing, and whether it will displace hands-on health workers is an open question.
- As for the Planetary Patient, global warming is no longer deniable, and the momentum is in favor of replacing carbon fossil based fuels. E-autos have hit a speed bump in the US, but that is temporary. As for nuclear power, the cost and delays in implementation will likely be overtaken by local solutions like solar, and wind. Countervailing winds and negative environmental impacts of AI mega-data centers remain to be determined.
Back to the Harvard student, he was entrepreneurial. Our conversation quickly turned to pursuing business opportunities. He asked where I would concentrate my energy if I was him. I said I would explore the intersection between the housing sector, aging insecurity and dependency, and health information planning.
As for pay dirt? Income disparity and the subsequent broad economic impacts will continue to accelerate, even with a change in leadership. They will share space with workforce decline as birth rates decline and immigrants are turned away. Lack of adequate housing for increasingly compromised multi-generational families is already a problem and will grow exponentially in the near future. These vulnerable populations will be challenged further by lack of adequate access to health insurance and health services.
The opportunity? Invest in firms committed to designing new innovation housing solutions for multi-generation families. Think of them as a modern day replacement of the old and disintegrating three story family dwellings that were built at the turn of the century for 3-generation manufacturing families.
Who will design and build out safe, secure, affordable, connected dwellings of the future? How will they be designed to encourage family and community connectivity and advanced health planning? With long-term care facilities (expensive and difficult to staff) already plagued with quality control issues and institutionalized loneliness, can investors in a healthy aging shift swiftly and seamlessly into investing in healthy homes. I think the timing this time is right!
Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex. (Grove/2020)