Audio: Listen to this article
The ill-health and economic burden caused by cardiovascular diseases, diabetes, chronic respiratory conditions, cancer and mental illness has continued to grow through 2020 while world attention has been focused on covid-19’s rapid spread.
The financial drain from these and other non-communicable diseases (NCDs) is calamitous, with the global costs likely to reach an estimated €39 trillion between 2010 and 2030. The human fall-out in reduced life expectancy is as equally disastrous as the economic hit to people’s lives. Across Europe, type 2 diabetes alone is increasing its prevalence in most age groups, with 60 million people diagnosed with the condition.
The great hope has been that advances in information technology (IT) will enable the synchronisation of health management systems, energise personal responsibility, revolutionise social behaviour and provide transformative therapy. Telemedicine, remote monitoring and wearable measurement devices are positioned as saviours, recalibrating patient contact and treatment delivery while algorithms interrogate data to create better and cheaper healthcare.
The realisation of those goals has been slow, but the pandemic appears to be an accelerant for health IT to reach its potential. In the UK, more than 434,000 downloaded the National Health Service (NHS) app—which gives people access to NHS services such as booking appointments and viewing medical records—during the first month of the coronavirus lockdown compared to 915,500 in the previous 12 months.
“Technology and data can play a vital role in making our healthcare systems more sustainable, both now and in the future. There are two main factors that are putting significant strain on our healthcare systems, ageing and chronic disease,” says Jan Philipp Beck, head of health at the European Institute of Innovation and Technology (EIT), which is funded under the European Union’s Horizon 2020 framework.
Beck says artificial intelligence (AI) has the potential to streamline or even eliminate administrative tasks, freeing up anywhere from 20% to 80% of a healthcare professional’s time for more productive work.
During the covid-19 outbreak, 95% of triaged patient enquiries were resolved without the need for a face-to-face doctor consultation. In the longer term, I believe that we will never go back to a practice where the patient journey starts with a face-to-face GP consultation
DATA PRIVACY CHALLENGE
The NCD Alliance, a group of 200 organisations across 170 countries dedicated to improving world health, believes digital health provides cost-effective healthcare support, particularly in emerging countries where the lack of established systems has provided the freedom to deploy more ambitious technology. The alliance also believes that health IT allows countries to tailor services to local needs, strengthening the prevention message and allowing multiple interventions along disease pathways.
But advances into healthcare by the IT giants are clouded by public concern that personal information might be turned for a commercial profit rather than societal good. Fears about who has access to personal data and losing control over how it is shared are rife among the general public, says Beck.
“A common assumption is that patient data will be sold to large corporations for profit. Their concern is understandable but their Amazon account or their social media profiles collect much more data than any healthcare provider would ever even have the capacity to know,” adds Beck.
“The public does need more and better information about how data sharing in healthcare works. They need to know how it’s being used and to have the control to opt out when they want to. There is also the debate around whether patients should be compensated for use of their data if, for example, that data helps launch a new treatment that is marketed for profit.”
James Barlow, professor of healthcare technology and innovation management at the UK’s Imperial College Business School in London believes attitudes are softening around data sharing but adds: “The big unknown is around the global tech giants, Google, Apple, IBM and Alibaba, who are increasingly getting involved in healthcare. Their business model is data, personal data, that’s how they work and make their money.”
“So the questions are to what extent are we prepared to let Apple be a doctor in the future and either make profit out of our personal health data or share it with others? We haven’t even begun to address that problem. I think that’s a challenge particularly as those companies will be part of healthcare in the future.”
CARE NOT HOSPITALISATION
Conversely, an area for huge technological progress is in recalibrating healthcare systems rather than marching towards Big Brother style access to medical records. The Future Health Index 2020, published by Philips, revealed that 81% of health care professionals under the age of 40 believe digital health technologies could reduce their non-clinical workload while voicing mounting frustration over its slow adoption.
“The really big gains are going to be had from organisational changes such as new ways of funding services, increased integration between primary, secondary and social care and rethinking how we provide and deliver services and support people with long term conditions,” Barlow adds.
“Technological innovation certainly plays its part in underpinning those organisational changes, but it’s the boring stuff that actually will really bring maximum benefits across the next five to ten years,” he says. “It is clear that new technology can make a difference in the health and social care sector by shifting demand away from expensive hospital care with improved community and primary care. That is something we ought to be concentrating on, but to date have not done as much as we should have.”
While technology is relatively simple, Barlow notes that the challenge is deploying it across complex eco-systems. This is likely to involve a new chain of responsibilities and relationship needs. The clear benefit, however, is that telemedicine can be used to monitor and evaluate interventions for people who have been identified as being at risk with diabetes or another NCD.
“It helps you pick up and intervene with problems earlier to slow the rate at which people need to go into hospital,” he says. “By placing a sort of electronic security blanket around them, we can also mitigate some of the risk of discharging them out of hospital so there are benefits at both ends of the care pathway.”
So the questions are to what extent are we prepared to let Apple be a doctor in the future and either make profit out of our personal health data or share it with others? We haven’t even begun to address that problem
THE CORONAVIRUS TIPPING POINT
Healthcare systems, often hard-set in established practice, may have been slow to take up the promise of digital technology, but the pandemic has kick-started its uptake.
“Covid-19 has shown that digital health tools are highly effective, add value and actually enhance the continuity of care, both for immediate reactions to highly contagious viruses and also ensuring the treatment of long-term conditions continue normally,” says Murray Ellender, founder of e-consult, a triage platform used by the National Health Service in England. The platform has seen a 500% take up in doctors’ surgeries over two months in mid 2020.
“During the covid-19 outbreak, 95% of triaged patient enquiries were resolved without the need for a face-to-face doctor consultation,” Ellender adds. “In the longer term, I believe that we will never go back to a practice where the patient journey starts with a face-to-face GP consultation.”
His view is echoed by Chris Barker, CEO of Spirit Healthcare, which offers an online monitoring platform for people with long term conditions across healthcare settings. “We have jumped ten years in terms of tech take up. Our system is evidence-based, but over the last five years’ adoption had been slow paced, but now we are getting calls from right across the spectrum about deploying our system,” he says. “Covid-19 is a tipping point for digital care. The world has moved.” •
TEXT Danny Buckland — ILLUSTRATION Trine Natskår
The novel coronavirus pandemic has exposed the fault lines in both global and national health infrastructures, highlighting inequalities and structural flaws. There has never been a timelier moment to focus on how to improve the resilience of health systems
A decade of initiatives to combat non-communicable diseases have failed to curb their growth. Policymakers need a more comprehensive approach that recognises the complexity of these health failures and takes lessons from successful infectious disease campaigns
Non-communicable diseases, obesity and the covid-19 impetus for building better health systems
Policies to curb NCDs need to consider broader environment for good health
Non-communicable diseases and their risk factors seem to be common among certain groups of friends and families. Genetic reasons aside, the concepts of social contagion, shared spaces and a tendency for similar people to associate (known as homophily), might explain why these diseases appear to be more infectious than their name suggests
The number of people living in cities is projected to rise from 55 % to 68 % of the world’s population by 2050, according to the United Nations. Strong leadership and multi-sectoral planning can make our cities far healthier for human habitation
Digital health solutions have the potential to enhance the reach and capacity of the health workforce and the efficiency of health services, write Katie Dain and Lobna Salem of the NCD Alliance. They have been a key factor in battling the covid-19 pandemic, helping health systems to function under tremendous pressure, particularly in lower and middle-income countries (LMICs), where care resources tend to be scarce even in non-pandemic times
Rates of obesity are skyrocketing, and more comprehensive policies are needed to fully address the complex causes of the condition
The obesity crisis has been a long time in the making, gathering force despite more than a decade of individual initiatives to reduce the numbers of seriously overweight people. Comprehensive policymaking that touches on the complex roots of obesity has huge potential to reverse the progress of a deadly epidemic linked to growth in economic prosperity
As obesity reaches epidemic levels globally, experts are reflecting on the mixed results of policies implemented over the past decade and asking if obesity should be treated as a disease more than as a lifestyle choice that individuals can modify
Populations in more than one in three low-income countries are hit by a double burden of malnutrition in the form of both obesity and undernutrition. Effective nutrition programmes can help countries overcome the double malnutrition challenge