Chronic diseases (also known as Non Communicable Diseases or NCDs) represent one of the 21st century’s most significant burdens on worldwide prosperity and productivity. NCDs accounted for the loss of 1.7 billion disability-adjusted life years in 2015, the death of 41 million humans on the planet, and approximately 70% of all disability-adjusted life years lost. NCDs have historically been a problem for high-income countries (HICs) as evidenced by reversing mortality trends in the USA for the past three years after decades of longevity increase. But the rate of increase of NCDs in low-income and middle-income countries now outpaces the growth rate in HICs.
NCDs cause 16 million premature deaths, meaning that approximately 30% of the global death toll could be avoided, and could be responsible for an estimated cumulative output loss of $47 trillion during the period 2012-2030 as demonstrated in a report published in 2011 by the World Economic Forum, in collaboration with the Harvard School of Public Health.
Preventing NCDs by addressing the key risk factors will be essential to curbing their impact and will often prove more effective than concentrating on disease treatment. For example, the global prevalence of tobacco consumption has declined and with it the accompanying threat of cancer, chronic respiratory disease and cardiovascular disease. Decreased air pollution has helped to curb respiratory and cardiovascular disease.
Decreasing the burden of will require a radical transformation through which the causes of disease are recognized and addressed when it comes to cardiovascular disorders, cancer, diabetes, respiratory affections, and not to forget, mental health troubles as every 3 seconds someone in the world develops dementia (the five disease clusters are also collectively referred as NCDs).
Healthcare delivery systems will have to transform radically; capital intensive, hospital centric, interventions driven systems will become ones of the past, as they have demonstrated they are both unsustainable and ineffective.
A credible theory of change is that the future of health and healthcare resides into high-touch, data enabled delivery systems, integrated across the continuum of care from prevention to care delivery, with the patients becoming consumers of most care services in non-acute care settings. Additionally because sick people will always exist, complex care will be transformed by Precision Medicine as enabled by progress in genomics, regenerative medicine and clinical analytics.
Finally as we move from “sick care” to “health care”, a population based approach to health promotion and disease prevention will have to emerge, as enabled by a transformed global health architecture based on purposeful public and private cooperation. This is even more critical as according to OECD, member countries spend on average less than 3% of their healthcare budgets on prevention and public awareness programs.
This is where the need to invest into wellness and healthy lifestyles comes into play. On one end, there is ample evidence that investing into keeping populations healthy can generate significant return through increased productivity, reduced healthcare costs and overall higher level of well-being, as this was precisely documented in a report from the World Economic Forum dating 2015, “Maximizing Healthy Life Years: Investments that pay off”. On the other end, two sets of conditions need to be met for the increased level of investments to happen.
To start with, one needs to appreciate the potential disconnect between investors and beneficiaries. When private health insurers for instance do retain their customers for less than three years on average, what is their incentive to invest into education, decent housing, transportation, access to healthy nutrition, sports and fitness programs, to then see benefits accrue to other payer’s decades later?
New business models would have to then be innovated to encourage insurers into population risk pooling, not to even mention the new financial instruments to be deployed such as social bonds, equity investments, milestone based payments, life-long amortization for the cost of screening programs, or guaranteed loans to bridge the time lapse between short term investment, and large long terms payback. Such models do exist already in many industries; they are well-known to private sector investors, but less so to public policy makers, hence the need for cooperation and public private partnerships with trust at their core to deploy them in the field of health and well-being.
Then, when healthy ecosystems are provided to citizens, a consumer-focused system would recognize the principles of behavioural economics to encourage and enable people to adopt health and wellness behaviours across all aspects of their lives. We all know what to do but we do not do it… Staying healthy is hard because the keystone of sustained well-being is behaviour. Like consumer products and services companies have well understood that, there are quite often very simple cues that can nudge decisions. Present bias, the framing of information, time inconsistent preferences, reminders and prompts, the role of social norms, the way the presentation of choices can influence decisions, are at the core of behavioural economics. They are also masterfully leveraged by successful corporations as key components of their sales and marketing strategies.
In a report published in 2018 by the World Economic Forum “Behavioural Strategies to Strengthen Health Programmes and Policies” those impactful techniques are well documented. Here as well, there is a clear case for an increased level of public private collaboration for them to be transferred from the commercial world to the public one of health and wellness promotion.