"La liberté pour Rêver"

“Health is an eternal theme of humanity – and a strong, healthy and sustainable society is our common pursuit. So let us dream, but then let us return here to earth to do the work that is needed to attain health and harmony at home." Minister Chen Zhu, Minister of Health, China, 2013.” (2)

‘Opening a window to the future….

It is a warm Wednesday in January 2050 in Santiago. The newscaster is reporting the latest performance figures for the city, and Ana frowns as she hears that wellbeing and air quality have both dropped a few points. In the centenary year of the landmark Doll and Hill study on smoking and lung cancer this is not good for public relations! She makes a mental note to discuss this with the City Forum later in the day. For now she has to prepare for a visiting delegation from Tokyo, Lagos and Los Angeles who have come to finalise the protocol connecting the electronic data and remote sensing systems for maintaining population health across their megacities. Ana has kept in touch with them online in the peer to peer learning platform as they all connected years ago to the same cyber‐ engineer supporting their 3D vaccine printers. With Saito from Tokyo, Meng from Lagos and Raul from Los Angeles she had many long debates over the years on issues ranging from how to rebuild solidarity, to what the priorities should be for planetary health. She can’t wait to see them again!’ (2)

Opening a window to the present….

It is a warm Wednesday in ‘outback’ Australia, 2015.  A world away from Santiago 2050. The sheep are ‘full wool’ and need to be shorn. The air is pure and fresh and the skies are clear.

So what brings us from the bucolic ‘outback’ scene to the apparently inevitable and inexorable journey to the perils of 2050? Many things and they impact both directly and indirectly on healthcare.

Chief amongst them is the ageing of the population. This does not just burden healthcare and healthcare resources directly but indirectly as it places pressure on the environment – where in the future will water come from, what will we breathe if we have no forests and if the atmosphere we live in is dense with harmful chemicals?

We face a future characterised as follows:

• ‘We will live longer lives, with greater possibilities for healthy ageing’ (but a danger of unhealthy ageing). ‘; 
• We will be more urbanised and interact more with artificial intelligence;
• Climate change and scarcities of energy, water, biodiversity and food will have a fundamental impact on health and survival;
• Science and technology will advance rapidly, with linkages across information, robotic, health and bio- technologies, profoundly affecting public health and medicine’.

Amongst the ominous, good things are happening:

• “In Bangladesh, continuous lifelong, portable, electronic health records are being developed based on unique biometric identifiers assigned at birth as part of universal vital events and health information systems”. Dr Tim Evans, James Grant School of Public Health, Bangladesh
•  “In Shanghai they have community-based self-help groups organized with government input that help each other in terms of learning how to control their blood pressure and blood sugars, how to live a healthier life, group exercise etc. I think we need more innovative ways to deal with ageing.” Meeting delegate, January 2013 
• “We need to put health not only in the hands of doctors, nurses, pharmacists or dentists- like many of us here, including me - but health must also be in the hand of the active citizen.” Suwit Wibulpolprasert, Ministry of Public Health Thailand, 2013 ⁽²⁾

But progress is uneven and dependent on visionary individuals or teams.

• ‘Large, centralized institutions with top-down, expert-driven thinking may not be the only, or best sites for the ideas, leadership and action for health futures’. ⁽²⁾

So all this leads me to ISQua’s own humble attempts to shift world thinking about how to shape our healthcare future. In two months a group made up of the world’s big thinkers and clever thinkers will tackle this problem. The ISQua Innovations and Systems Change Working Group has invited these people to take part in a workshop at the ISQua Annual International Conference to talk about shaping the future of healthcare.

There will be around 30 in all brought together for a day to share information about how their various countries and people are understanding and planning for the inevitability that if we keep delivering healthcare the way we are currently delivering it the system will crumble under the weight of an ageing population with expensive comorbidities and a deteriorating environment. We will be faced with unpleasant and unthinkable choices such as who to treat and who to leave untreated. But the option of not thinking about these things is not open to us.

In addition to gathering information of how healthcare is delivered in different countries and innovative approaches to this, amongst the questions to be addressed are:

1. Does your government and do your healthcare authorities recognise an ageing population as posing a threat to future generations’ wellbeing?

2. Do you consider the ageing of the population to be a problem in your country? If so how will this manifest itself in your context? If not a problem why is it not so?

3. What are the consequences of the ageing of the population in your part of the world?

4. What if any steps are being taken by government and healthcare authorities in your country to address the problems of an ageing population?

5. Do you consider the steps being taken to be appropriate/adequate (if not, why not)? How might you approach this differently?

6. Is there any recognition in your country of ‘the patient journey’ as a means of improving healthcare quality and redistributing the cost burden?

7. Is it sustainable to continue to focus on hospital care as a means of addressing healthcare needs, especially in the light of the ageing population? What are the alternatives?

8. Would a shift to a primary care focus (or homecare focus) ameliorate the burden imposed on healthcare delivery as the population ages?

9. What do you see as possible solutions to the future challenges facing healthcare?

The future cannot be the same as the past.
We must start to address these issues now before we are so overburdened and overwhelmed by the immediacy of the problems that will surely come that we are powerless to deal with them.

The work we do now may ameliorate the problems for us but, importantly, may provide a better future for the people of 2050 such as those in Santiago we were introduced to at the beginning of this story.

前人栽树,后人乘凉 “One generation plants the trees, another enjoys the shade” Chinese proverb.

Peter Carter
Chief Executive Officer
July 2015

References
(1) "La liberté pour Rêver" and "La liberté pour parler" are essays written in French by French Nobel laureate J. M. G. Le Clézioand translated into English as "Freedom to Dream" and "Freedom to Speak" and published by World Literature Today .
(2) Dreaming the Future of Health for the Next 100 Years White paper from the Global Health Summit Beijing China, January 26-27 2013