Health Tech

Rebooting Society's Software, Hardware and Mindset

Trond Undheim

• Publisher: Productivity Press
• Year: 2021
• ISBN:
  9781000452266
• Edition: 1
• Topic: Negocios y empresa
• Subtopic: Industria farmacéutica, biotecnológica y sanitaria

Health Tech: Rebooting Society's Software, Hardware and Mindset fulfills the need for actionable insight on what's truly driving change and how to become a changemaker, not just affected by it. The book introduces anybody who wishes to understand how global healthcare will change in the next decade to the key technologies, social dynamics, and systemic shifts that are shaping the future.

Healthcare futurist, investor, and entrepreneur Trond Arne Undheim describes the complex history of public health, why it's so complicated and what the major challenges are right now. He includes a discussion of COVID, why it happened, the cultural factors that have slowed down traditional public health measures, and how innovation can help. He also discusses what is happening in health systems around the world as a result of the pandemic. The book explores certain health tech measures, tools (basic medical devices gradually being upgraded and digitally enhanced), processes, and innovations that are already working well along with others that are in their infancy, such as AI, wearables, robotics, sensors, and digital therapeutics.

The book describes the movers and shakers in the healthcare system of the future, from startups to patient and service providers, as well as the health challenges of our time, including pandemics, aging, preventive healthcare, and much more. The book concludes with a look at how health tech may bring about the biggest opportunity to transform healthcare for decades to come.

Chapter 1 The Complex History of Global Public Health Tech Innovation

DOI: 10.4324/9781003178071-1

Can Public Health Be Defined—And What If Not?

According to the Oxford Textbook of Global Public Health (2015), public health is the art and science of preventing disease, prolonging life, and promoting health through the organized efforts of society. The goal of public health, correspondingly, is the biological, physical, and mental well-being of all members of society. Sound right? Unfortunately, that is not the whole picture. Arguably, public health is both more and less than that.

First off, there is not necessarily anything particularly public about health. Wellness has become a major thrust in health and can be an entirely private endeavor even though it may be influenced by the (public and private) forces of disruption surrounding it. Huge swaths of public health systems are also privatized, which complicates the notion of the “public” aspects, notably in the US. Hygiene, which plays a massive role in health, is also largely a private choice, although it is socially conditioned.

Second, public health has always been connected to innovative technologies, which is arguably interlinked with art and science, but is also its own thing entirely because it emphasizes the application and implementation of specific approaches more than “art” (which juxtaposed with science makes health sound fanciful, magical, and difficult) and “science” (which makes it sound so theoretical and complex).

In reality, public health is neither magical nor theoretical. Instead, it is emergent, contingent, and ever-changing. I am not sure pretending it is not so is such a fruitful approach. The challenge with that fact is, among other things, that it flies in the face of any traditional strategic goal of focusing resources on specific targets. That also backfires for other reasons because once you focus on a specific disease, you are bound to interfere with national priorities which undoubtedly are (trying) to encompass and target a much wider set of diseases that are prevalent across their population.

Third, there is absolutely no agreement on which diseases to prevent, whether prolonging life is a goal in and of itself, and exactly what “promoting health” would mean across different cultures. At times in the history of public health, government or even powerful non-state actor’s promotion of health has been moralistic and demeaning, it has adversely affected (or ignored) specific populations (the poor, blacks, children, women, LGBTQ, the elderly, the African continent, the mentally ill, etc.).

Fourth, and very importantly, health is rarely (or has at least rarely been in a historical context) about all of society. In fact, health is all about wealth in more than one sense. It is, arguably, the biggest economic machine in the world. As such, its successful implementation skews toward the wealthier states, groups, and is also a source of both massive (and necessary) investments and running expenses on behalf of governments and large employers as well as a tremendous source of income for the same. Health is, in that sense, the biggest boon in the history of mankind. The healthy are wealthy and the wealthy are healthy.

Lastly, public health is often so more concerned with the short-term because health problems are urgent, affect human lives, and immediate actions are required to cope with them, yet, the causes of disease, and doctrines about how to deal with them, or live with or around them, have evolved over years, even decades (Perdiguero et al., 2001). In fact, actions carried out in the name of public health can be highly controversial, can have differential effect on each subpopulation affected, and are highly culturally and contextually sensitive.

During the influenza epidemic in 1918, a public health-oriented action was taken in Alicante, a Spanish city located in the Mediterranean coast, ended with the demolition of an entire area of the city and the expulsion of its inhabitants. In November 2020, the entire mink population of Denmark (home of the largest mink industry in the world) was about to be killed off by the Danish government. This was due to the fear of a mutation of COVID-19 that would render vaccines inefficient. However, the government had to reverse course having killed off all infected minks only when realizing this may have been an overreaction.

At the end of the day, that Oxford definition which seemed so simple, contains within it a huge element of vision and is slightly unrealistic as a description of the history of public health, of its contemporary form, and perhaps even misleading in terms of its future. I will need a whole book to unpack why this happened and how and which innovations potentially can change the picture in the decade ahead of us. I am not too worried about the lack of a clear definition—this is what characterizes most fields of rapid innovation. I do, however, worry for folk who spend so much time looking for a definition or the perfect policy approach, that they have no time to innovate. That is why I wrote this book, which I hope will provoke and inspire innovation and change, not just among startups and founders but also spike intrapreneurs in governments, among non-state actors and corporations—as well as social innovation from the ground up.

How Old Is Public Health as an Approach?

International health diplomacy is certainly not new. The quarantine practices of European states in the 14th century might have marked the beginning of modern public health. However, there was broader Eurasian awareness that health effects crossed national borders throughout the Middle Ages. What is also the case is that true international coordination and cooperation on health did not begin that early (Fidler, 2001). But before diplomacy, there was dominance. The colonial period was one of the internationalist expansion with a quite different aim, that of territorial and demographic dominance. Coupled with that often came a countercurrent of humanism, interspersed with patriarchal ideas of applying Western “quick fixes” to the world’s health problems. Typically, this mix of altruism, compassion, and (at times) well-meaning intervention, ended up badly, for a myriad of reasons. Either way, such paternalistic interventions meant that innovation has not always been a force for good, which is a reminder for contemporary exploits as well, whether they occur in emerging economies or in poorer neighborhoods closer to home (Figure 1.1).

Figure 1.1 The history of public health tech.

Colonial Period—Using the Colonies as Laboratories for Tech Experimentation

It has been convincingly argued that the colonial period was characterized by outsourcing testing of new approaches to the “laboratory of the colonies” (Keller, 2007, p. 65). In the extreme, in French Muslim colonies in North Africa, it has meant using psychiatry as a weapon in the arsenal of colonial racism to tame and treat “savages”. The conventional view at the time was to clearly distinguish between moderns and primitives, an idea which now largely is debunked, although it pops up now and again in race discussions and debates over immigration and France’s postcolonial legacy. Arguably, there are also remnants of this logic in the US when you consider the blatant health discrimination in terms of legacy effects, access, and healthspan still faced by blacks or Hispanic immigrants. Whichever way you look at it, colonial medicine was heavily focused on broad sweep, ethically questionable measures addressing public hygiene as a path to lessening disease burdens.

The Birth of International Public Health in the Mid-19th Century

International regimes for public health were set up beginning in the mid-19th century, starting with the International Sanitary Conference of 1851 which was centered on whether to support and standardize cholera quarantine measures.

At the time, the understanding of infectious disease was quite limited. There was widespread belief that plague, yellow fever, cholera, malaria, and typhus were all the same disease manifesting itself in different ways. The 1851 event did lead to a majority decision to affirm cholera quarantines, but few countries ratified the agreement, so on paper, the effect was nil. However, the seed was sown that health was an appropriate topic for international discussions and treaties. The Venice Conference of 1897 was exclusively concerned with plague. A full 14 of these conferences were held until the World Health Organization (WHO) finally was established in 1948 (Howard-Jones, 1975).

Other topics that have been of importance to international health policy throughout the past 150 years, beyond infectious diseases, include labor conditions, transboundary water pollution, international trade in narcotic drugs and alcohol, and occupational health and safety.

As can be readily understood from that variety, developing any kind of sustained competency in public health or health policy has meant straddling impossibly diverse domains that require different types of expertise to succeed. Predictably, and for these reasons, even though it represents potentially the biggest business of all, health policy is often viewed as disjointed, at times disconnected from economic policy by the decision makers “that matter”. Creating a shift in understanding would be fundamental if we believe that health is to become a top political and economic priority and if we want to see a sea change in outcomes.

Influential Non-state Actors Begin to Appear

Throughout this early period of internationalization of (public) health, non-state actors, such as the Rockefeller Foundation, the International Union Against Tuberculosis, and the International Bureau Against Alcoholism, have had pivotal impact, too (Fidler, 2001). That trend continues throughout the next century as well, with new actors entering the stage.

The limiting factor of international efforts of any kind, or of the wish for global mandates, is of course the threat (to nation states) of reducing or at least (potentially) eroding their sovereignty. However, there have (at times) been voices advocating for starting to see health as a human right which got enshrined in WHO’s constitution, although that vision remains unfulfilled (Fidler, 2001).

Bismarck’s imperial Germany first introduced mandatory social insurances on a grand scale (Kuhnle & Sander, 2010), including sickness insurance in 1883, an industrial accident scheme in 1884 and old age and invalidity insurance in 1889. Other European countries followed, some early on (Austria) while others comparatively late (the Netherlands), and in Scandinavia, it has become a key part of their national identity (Van Kersbergen, 2016). In fact, welfare states can be characterized as generous institutions that allocate rights and responsibilities in quite distinct ways, albeit with at least three different models, the liberal (Australia, US, and UK), social democratic (Scandinavia) and conservative (Germany, Austria) model (Esping-Andersen, 1990, p. 55). Welfare states are not necessarily egalitarian in the sense that they distribute evenly or even redistribute, although that tends to be the effect at times, given that certain groups use welfare services more than others.

The Overconfident Public Health Community of the Early 20th Century

During World War I, a pandemic influenza (the 1918 influenza) raged Europe and the US, which had devastating consequences on the world. It lasted almost 3 years and infected over 500 million people across the globe. Estimates of deaths caused by the influenza range between 50 and 100 million. However, because of the war effort, we don’t really know enough about what happened, even how many died from the disease. Tracking of the disease was lacking and media reporting was poor (arguably because journalists did not want to hinder the war effort of their respective countries).

During the early...