The Future of Regulation:-2030 a changed world
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This brief highlights fifteen areas of significant change – technological, economic, political, social and environmental – which will reshape our world over the next 20 years, and discusses some of the potential implications within health care. Individually each of these changes presents major challenges to governments; collectively, they will increase the complexity of the context within which governments will operate and demand new, faster and more flexible approaches to public debate and regulation.
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The Future of Regulation:-2030 a changed world
- 3. 99 Multi-polar world powers Climate change/ extreme nature New metrics, new meaning Low cost business models Population imbalances Generation effects 3D printing – fashion to organs Public Interest and Regulation Aspirations and expectations Pollution : public health Profiling the personal Peakonomics Definition of reality Shocks and mortgaged futures Power of mobile rising Smart, digital and trackable www.shapingtomorrow.com
- 4. 10 What’s driving change Climate change, population imbalances & resource pressures force a rethink A multi polar world creates new complexity, aspirations and new solutions New technologies reveal new connections, levels of detail and understanding www.shapingtomorrow.com
- 5. 11 11 What’s driving change Embedded intelligence and digital technologies revolutionise where, when and how we do everything Personalised and on demand solutions abound Generational differences and debt mountains create new pressures New metrics bring new priorities and new players www.shapingtomorrow.com
- 6. 12 Fewer and simpler regulations Simplification + verification rules OK! Ethical debates need time, trust and transparency www.shapingtomorrow.com
- 7. 13 Think ahead, or play catch up forever More interdisciplinary, cross departmental solutions Who’s responsible when it’s personal? www.shapingtomorrow.com
- 8. 14 New approaches blur boundaries Bottom up collaboration, not top down control for engagement Greater variety of care models demands flexibility www.shapingtomorrow.com
- 9. 15 Global solutions and provision need coordinated global controls Remote everything makes for systems vulnerability www.shapingtomorrow.com
- 11. 31 31 http://www.technologyreview.com/biomedicine/25171/?a=f Potentially feeling suicidal Thinking abut something familiar http://www.sciencedaily.com/releases/2008/01/080102222813.htm www.shapingtomorrow.com
- 12. 36 Ration or revolution? From ‘cure me’ to contracts and incentives? From no frills airlines to no frills care? Quality, cost and complex supply chains Embedded intelligence and new levels of analysis Privacy- what’s that? Cybercrime, terrorism and other systems vulnerability Tolerance and intolerance rising? No more animal testing? Personalised medicine on demand? Skills shortages and robo-lleagues? (Robot+Colleagues) Ultimate consumer choice and control www.shapingtomorrow.com
- 14. 38 38 No more free lunch? www.shapingtomorrow.com
- 15. 39 39 You get what you pay for www.shapingtomorrow.com
- 18. 42 42 Transparency brings local, personal, instant, quality service www.shapingtomorrow.com
- 19. 43 43 Disasters waiting to happen www.shapingtomorrow.com
- 20. 44 44 Need to be agile and resilient www.shapingtomorrow.com
- 21. 45 45 Animals get the same rights as humans www.shapingtomorrow.com
- 22. 46 46 Treatment how, when and where I need it http://www.economist.com/node/15543683 www.shapingtomorrow.com
- 23. 47 47 Talent wars and robot ethics www.shapingtomorrow.com
- 24. 48 48 Whose life is it anyway? www.shapingtomorrow.com
- 25. 49 Global collaboration on public interest and regulation will be widespread Intelligent thinking, using technology and embedded intelligence to best effect, will radically change regulation Intelligent social media will analyse, alert and manage responses between stakeholders Stakeholders will examine actions in the light of public interest implications Systems thinking will be the norm within government and between different stakeholders Transparency and trust have replaced privacy and secrecy Preventative models and personalised care are the national and international norm Global competition for patients via tourism and telemed/care services No new large hospitals commissioned Services designed, delivered and controlled locally and personally, not nationally www.shapingtomorrow.com
- 26. 50 Develop early warning systems Create a regulations roadmap covering the next 15 years ‘What If’ scenarios to examine actions, reactions and options Back-cast what needs to be done now to stay ahead of the game Map and characterise the complexity of the interdependent change agents Generate a series of parallel case studies Conduct stakeholder surveys on regulations affecting consumer behaviour, demographic shifts, and economic long-term cycles www.shapingtomorrow.com
Notas del editor
- This is based on our scanning, futures experience and based on the BRIEF
- 2030A VERY different world. Some of these changes will be familiar, some not so.EACH =major shift in own right, combination = huge change, radically new responses. Raises issues of:Balance and trade offs: economic growth versus carbon/ climate; cost to this versus future generations – e.g. climate and tax to pay/ provide for care etc; Blurring boundaries: private: public: voluntary – eg CSR/ Fairtrade; as more personal health/ causes known etc where does responsibility lie? Layers of reality. BRIEF outlines each, and raises questions, not time here for detail - LEAH/ LJUBICA have......
- http://www.capitolhillblue.com/node/49178Climate etc: low carbon, clean, minimum resource use approaches in ANY area will be the norm. Health and hospitals any care included. Population: shortages here but need for MASSIVE job creation in emerging economies – migration west if fails? More instability? Economic opportunity?, but resource/ climate implications? Lost generations here? despite boomers retiring and skill shortages.http://paragkhanna.org/?p=76Multi polar: Canada need to make self known/ visible. Negotiations trade etc more complex G8>G20, and rising. ALSO radically new business models, frugal innovation – new competition, including health heading our way. http://en.wikipedia.org/wiki/TranshumanismNew tech: a transparent world. Electronically trackable+personal – genetic/ neuroscience information on tap; but also opportunities for new approaches to research, data collection, and regulation etc.
- Embedded: remote, in situ services, wherever, whenever.... New providers and approaches. Local, but also international / global providers/ competition. Personal: profiling the personal.... Makes connection, choices and consequences more explicit; new responsibilities and new solutions. Tax/ debt burden on future generations growing: we may see a rebellion? Economic stability not guaranteed anywhere... Beyond GDP: everything is connected, in a different way.... ECOnomics; Net National Product – to include wellbeing/ happiness – France and UK. Changes definitions – health becomes as much about work and good housing as it does physical state.
- Simplification of regulation will be expected, so that all stakeholders can act effectively within the system. Without this approach, an avalanche of regulation to try to control complex situations is likely to result. So too is an ocean of litigation. http://www.hw-group.com/case_studies/cs54_concrete_beton_monitoring_en.htmlSimpler ‘rules’ such as ‘do no harm’ combined with always on, smart technology to provide verification and spot checks of compliance and status may become the norm. http://www.theguardian.com/society/2007/nov/02/children.youngpeopleTransparency and trust among and between all stakeholders will be essential to achieve the frameworks needed to foster radical innovation. The range and speed of technological change will mean that regulators are constantly playing catch up. Looking ahead and wide will be essential. An interdisciplinary cross government approach which takes a long term view of change will be essential – to avoid surprises and costly mistakes and reduce unforeseen consequences. The kinds of choices and trade-offs which may be necessary, as well as the ethical debates likely to arise from new technologies will demand open collaboration and innovation in order to engage stakeholders in the changes necessary.
- Simplification of regulation will be expected, so that all stakeholders can act effectively within the system. Without this approach, an avalanche of regulation to try to control complex situations is likely to result. So too is an ocean of litigation. Simpler ‘rules’ such as ‘do no harm’ combined with always on, smart technology to provide verification and spot checks of compliance and status may become the norm. Transparency and trust among and between all stakeholders will be essential to achieve the frameworks needed to foster radical innovation. http://www.global-integration.com/blog/matrix-management-breaking-the-silos-2The range and speed of technological change will mean that regulators are constantly playing catch up. Looking ahead and wide will be essential. An interdisciplinary cross government approach which takes a long term view of change will be essential – to avoid surprises and costly mistakes and reduce unforeseen consequences. http://www.genomicslawreport.com/index.php/tag/personalized-medicine/The kinds of choices and trade-offs which may be necessary, as well as the ethical debates likely to arise from new technologies will demand open collaboration and innovation in order to engage stakeholders in the changes necessary.
- http://userwww.sfsu.edu/swilson/thames/chapter9data.htmlNew models of care and an increasingly global market with a range of different styles of and approaches to provision and variable cost models will make regulation more difficult while also requiring internationally coordinated approaches. Boundaries of sectors, nations, responsibilities will blur.http://vimeo.com/33672718http://www.theguardian.com/culture-professionals-network/culture-professionals-blog/2013/mar/15/flexible-working-culture-sector-workplaceAs health care becomes both more personal and more preventative, regulation will be even more difficult. Transparency will be essential to avoid massive complexity and litigation. So too will flexibility, agility and speed of response. A more global market place will require international collaboration on regulation, standards locus of responsibility and transparency. System security to protect data but also ensure power supply and communications (e.g. for remote monitoring) will create a complex system of responsibilities.
- New models of care and an increasingly global market with a range of different styles of and approaches to provision and variable cost models will make regulation more difficult while also requiring internationally coordinated approaches. Boundaries of sectors, nations, responsibilities will blur.As health care becomes both more personal and more preventative, regulation will be even more difficult. Transparency will be essential to avoid massive complexity and litigation. So too will flexibility, agility and speed of response. http://edelmaneditions.com/2012/08/global-vs-local-who-controls-the-agenda/A more global market place will require international collaboration on regulation, standards locus of responsibility and transparency. System security to protect data but also ensure power supply and communications (e.g. for remote monitoring) will create a complex system of responsibilities.
- Canada better off than mostMigration?North west passage – livelihoods/ economics/Migration of new diseasesNew land for AgricultureIncreased potential for conflict on Canadian soil?QUESTION: What are the implications for public interest and regulation?How prepared are health systems for crises? How resilient are populations at the individual and community level? To what extent can and should policy makers intervene before unlikely, rare but high impact events occur? At what stage should individual freedom to travel be restricted because of the wider need to mitigate and adapt to climate change? Should discussions of options like personal carbon budgets be as much a health as an environmental issue? Where is the balance of public interest and therefore how tight should regulation be?What implications would opening up areas of land to settlement and agriculture in the north have on service provision?Would new territories attract new immigrants?To what extent can Canada transfer its peacekeeping role to health promotion relative to climate change – a different kind of peacekeeping?
- Not just China and India:6 of 10 fastest growing in Sub Saharan Africa – huge growth to come; huge opportunity, but resource / carbon implications huge. South : South trade, new alliances and powerQUESTION: What are the implications for public interest and regulation?How well equipped is Canada to negotiate and forge alliances in this new, increasingly complex multi-polar world? To what extent can and should Canada rely on or separate itself from America in doing so? How well placed is Canada to take advantage of the enormous opportunities of the emerging markets? How could Canada take advantage of its own health care excellence to forge links and create opportunities? Will the need to remain economically competitive be the main driver of public interest and regulation?
- WHO’s GROWING out to 2050.
- Emerging economies are the new innovators: faced with cost constraints, relatively poor but huge markets / demand, they have found new ways to do things:Tata Nano – stripped out everything non essentialM-Pesa has been providing mobile banking and payment systems to the unbanked in Kenya and the Philippines – and elsewhere for years.Godrej & Boyce Manufacturing has developed a $70 fridge that runs on batteriesOpen heart surgery in this hospital can cost $2000, rather than anything between $20,000 and $100,000 in the USA. Shetty is now setting up a hospital along similar lines off the coast of Miami. QUESTION: What are the implications for public interest and regulation?To what extent can Canada begin to implement and learn from these low cost models? How can the risks be weighed up relative to the benefits? Are there opportunities for insurance policies to fund ‘overseas provision’ of lower cost health care, at first in situ, but then remotely? If health tourism continues to grow and in instances where quality and care is inadequate so that patients have major after effects, will governments need to foot the bill, or will consequences of personal choice and risk need to be set out? Will tighter controls be needed?http://www.shapingtomorrow.com/nav-frameset.cfm?hl=http%3A%2F%2Fwww.csmonitor.com%2F2006%2F0816%2Fp03s03-usec.html
- 2030 = 8 billion; 2050 = 9 billion > How do we feed them?West = ageing; emerging = growing – except China – will age sooner than we expect.By 2040 Africa and Middle East will have largest working age population, hungry for jobs and better lives. QUESTION: What are the implications for public interest and regulation?How will governments balance the different demands and needs of individual health and choice, with global risks of climate change, and the significance of meat in the food sector? Could we see mechanisms or incentives to ‘encourage’, although not proscribe, dietary changes? How well equipped are government departments for such interdisciplinary issues?Canada’s overall population is forecast to grow, but predominantly among the over 30s, and in particular the over 60s. Only medium high growth population projections anticipate any growth in younger age groups. Will the combination of more accessible land, potentially large numbers of migrants worldwide for a variety of reasons and perceived quality of life make Canada an attractive option for immigrants? Would the economic benefits outweigh the perceived and actual costs? Which might serve public interest best?
- With economic growth come aspirations, increased consumption and opportunity … but also increased use of resources, increased energy demand , increased urbanisation, increased meat consumption, increased pollution and emissions….…… Meat production is being highlighted as a source of GHGs: and less consumption recommended for health AND environmental reasons.Canadian cities are some of the most ‘live-able in the world, with 4 in the top 20. cities tend to have lower carbon per capita, but pollution in cities is rising, smart technology can help…. QUESTION: What are the implications for public interest and regulation?To what extent should health become a more significant factor in city planning and building design – e.g. walkable communities, safe street environments? How can arguments about additional costs be overcome by demonstrating the long term savings and benefits elsewhere against the short termism of politics?To what extent can major infrastructure investments be justified when debt levels are already high? How can Canada ensure regulatory frameworks which build and retain current forms of quality of life, while also capitalising on new developments?
- Air pollution is a recognized problem for respiratory diseases. Obesity is seen as a public health ‘epidemic’, likewise the growing numbers of people diagnosed with autism.Is there a link? New research indicates it could be air pollution, although this remains to be proven. Other impacts include increased cancer risk, decreased intelligence. In the U.K. the first globally successful lawsuit was brought against Corby Town Council for neglect in polluting the environment with asbestos causing child birth deformities 30 years ago! Scientific evidence of pollution in the child was shown to come from this asbestos and is a weak signal of how regulations and legal issues may need transforming in the decades ahead.QUESTION: What are the implications for public interest and regulation?If air pollution is shown to be a significant factor in obesity, cancer, autism and reduced intelligence – will governments be sued for not acting to clean city air?If air pollution becomes a more tangible issue – i.e. combines with concerns about health, and especially children’s health, how can governments use this to motivate people to change their behaviours about car use, to justify infrastructure and clean technology investment?If it is increasingly possible to identify the precise source of pollution affecting individuals, and potentially causing serious health problems, will there be greater litigation and will governments need to implement clear polluter pays policies?
- Spread of western problems.....
- Arguments about whether or not or when we will, reach peak oil continue: what is undisputed is prices are rising. BUTOil, water, coal agricultural land, quality of soil, phosphates, lithium, neodymium – to name but a few that have all been described as ‘peaking’, i.e. that easily accessible supplies are rapidly being exhausted. The EU has drawn up a list of critical high tech industry resources where supplies are vulnerableAnd the west over-consumes: the west continues to consume resources at a rate the equivalent to that of 3 planets worth of resources; 5 planets worth for the US (see eco footprint map)Low/ minimum resource use will be the norm: companies are already making major investments to create closed systems, reducing/ reusing all resources where possible. Waste tip mining is becoming viable. QUESTION: What are the implications for public interest and regulation?Major companies are making significant investments to reduce carbon footprints and resource use. How can governments ensure that services such as health care are as green and sustainable at every level as possible?What combinations of incentives and controls can be used to achieve the levels of radical innovation and behaviour change needed?
- Canada’s national debt stands at $1.1 trillion, approximately $32,506 US per capita. This per capita debt is higher than that of Greece -$35,403, Ireland- $28,758 and Portugal - $18,959. Consumer debt is also running high, and getting higher. It topped $100,000 per family recently, and debt to income ratios are running at 150%, or $1500 to every $1000 earned. Levels of household debt and the need to curb them and inflation could result in radically reduced consumer spending and a downturn in the economy in the short term. Austerity measures to address debt are having varied success. Major external shocks could turn a mild contraction into another major global recession. The middle east uprisings; default in the Eurozone; natural disasters such as those in New Zealand and Japan. What if the next big earthquake and tsunami were in silicon valley?QUESTION: What are the implications for public interest and regulation?How crisis proof are Canada’s services? How would Canada’s health service respond to a 25% cut in funding?
- Machines will talk to machines; humans will interact with machines; machines will keep track of things; machines will keep track of humans; oh, and humans will interact with humans. Our homes, our clothes, our cars, our dustbins, our infrastructures... everything will have embedded intelligence and connectivity, plus the ability to monitor, interact and send messages, be programmed, interrogated and data analysed. By 2020 we are likely to have about 50 billion different devices connected to the internet.Machines can also learn from each other, as a set of intelligent planes did in a recent research project. Affective technology enables machines to ‘understand humans’, such that sensors in the new top of the range VW Passat, can now monitor and prompt drivers, if they appear to be getting tired at the wheel, that they should take a rest.Robots are moving out of the factory into the pharmacy, the kitchen, the hospital ward and the office. Japan is investing heavily in care robots in order to address skill shortages. QUESTION: What are the implications for public interest and regulation?How well placed in Canada to develop and introduce smart technology and even robots into health and care to address skill shortages and potentially reduce budgets?Who would pay for the investment to install such technologies in people’s homes? How might the state recoup such costs in order to balance the books and the benefits?What training is needed to encourage health and care professionals, many of whom are unaware of the options or technology’s potential, to implement and encourage the uptake of radically new solutions? What safeguards and regulations concerning privacy and security may be needed?The use of virtual surgery, robots and new forms of medical equipment and the use of non-medical equipment to support health will require radically new forms of regulation.
- Currently an estimated 500 million smart phones are in use; by 2015 that is expected to reach 2 billion. Phones rather than PCs are used to access the internet, although tablets and embedded intelligence may overtake them by 2030.Apps have revolutionised how we can personalise our phones, and adapt them be an ever more integral part of our lives. So far 10 billion apps have been downloaded from the Apple App store. Android apps are expanding and have the advantage of openness/ interoperability between different brands.Now, there are approximately 17,000 health related apps and a recent report suggests that by 2015, about 1/3 of smart phone users will access health information . They are also getting adaptations e.g. to make them into microscopes. At present that is DUMB information. As phones include new capabilities and we store more personal data – health records, even our personal genomes so mobile health will become very very intelligent. Pollution monitors, health advisers, lifestyle checkers, allergy support advice..... QUESTION: What are the implications for public interest and regulation?How well prepared are health and care providers for a hacktivist attack? How disruptive would denial of service or interruptions to communications be on health and care provision?How can the Canadian Government use these new communication media to best advantage?
- Extending realities will enable new ways of coming together, new approaches to training and leisure. Real reality (RR) can be extended or enhanced by Augmented Reality (AR); whole other worlds have been developed for gaming and training, and increasingly medical treatment, which are totally virtual (VR). Teleconferencing is becoming telepresence and soon with holographic images to bring people into the room together. Holograms of security staff are appearing in airports to try to encourage passengers to remember to dispose of liquids before security checks. 3D films, TV and gaming devices are becoming commonplace. Haptic technologies are enhancing our digital experiences with touch, smell and other sensations. Soon we will be able physically to interact with holograms almost as though they were there – even to the point of dancing with one. VR in healthcare can help speed up the healing processes of burns victims – by using snow scenes; reduce stress and improve mood in depressed patients by changing the decor and view. Medical facilities have been recreated in Second Life to help trainee doctors learn and practise. Online gaming helps people learn to collaborate as well as fight, and has been shown to develop skills of persistence and determination. But there are also dark sides. Even with these low levels of altered layers of realities, concerns about addiction, transfer of aggression from virtual to real worlds, altered brains and thinking are rising. QUESTION: What are the implications for public interest and regulation?How could virtual worlds be used to ‘create’ and provide health services as well as healthier living environments in remote regions? Or in regions where climate made living conditions challenging but necessary e.g. if the Northwest Passage were open some of the year and the development of arctic resources grew? For example, underground cities are being explored in Siberia.To what extent might the growing concerns about how computer use is changing our brains lead to demands for greater controls of augmented or virtual reality use and applications?
- Science is digging deep inside the workings of the human body and mind, changing our understanding of how things work what causes illness and potentially how to cure, or better still prevent many of the major lifestyle related, fatal, chronic or degenerative diseases that afflict us. Neuroscience is changing our understanding of the brain and can now recognise where different types of thoughts occur.Brainwave interfaces are also make huge strides. Research continues into the use of brainwave and nerve based controls for prostheses, wheelchairs and ‘techno-trousers’ to assist walking – even games and an iPhone app. Likewise genetics – we can now get our personal genome for <$500; in 2030 it will be the norm, and automatic? One current result is the emergence of citizen science. Individuals willing and able to ‘experiment’ on themselves are using a combination of self interest – e.g. a man who has early signs of dry macular degeneration- plus cheap genetic profiles costing $500, and the mass of information on the internet.And proteomics: By 2030, we may see the $500 equivalent to personal genome profiling. We may have all this data on our ‘phones’. Biometrics such as voice prints and brain waves or vein maps may protect this highly personal data, since they at present, cannot be forged.QUESTION: What are the implications for public interest and regulation?To what extent should citizen scientists who experiment on themselves then share results be ‘allowed to get on with it’?How effectively can the use of profiling services be controlled as they become cheaper, more detailed and more widespread, given that they can advertise and reach customers globally?Screening for genetic selection e.g. in IVF treatment is illegal, but as our knowledge of the workings of the brain increases, will we see demand for ‘ability enhancement’ to address skills and talent shortages, or simply for personal gain? How will regulators define the boundary between selection and treatment? How would the likely gaps between haves and have-nots that this would encourage sit with Canada’s values and more collective identity?Where are the boundaries between we can and we should, as more and more new technologies emerge which delve into the inner workings of the human body? Who should decide?
- 3D printing creates objects line by line, layer by layer using a printer not totally dissimilar to the ones found in most offices and homes. They can use a growing range of materials , accuracy is improving and the price of the equipment is falling, some now cost as little as £10,000, although the more sophisticated ones still cost £100,000s.3D printing helped revolutionise prototyping, reducing costs and timeframes. The same quantum changes may soon be felt in manufacturing and even healthcare. High end designs and manufacture, services which create bespoke products and research into new applications such as 3D printed food are helping improve sophistication and create acceptance. Work on 3D printed prosthetics has been going on for some time, now researchers are developing a system that allows them to print directly into burns. Other organs may be next using our own cells generated on demand using new techniques. Organ transplants may be revolutionisedQUESTION: What are the implications for public interest and regulation?Could we see increased demand for cell harvesting and storage and how would that be managed and regulated? By whom?Will members of the armed forces be required to store cells to increase the potential for treatment? Other risky professions such as fire fighters?
- Generations have different approaches and attitudes, shaped by events and technologies as they grow up. The marketing industry has developed key names and characteristics to capitalise on these. There are also issues around dependency ratios and tax burdens as already indicated. But there are other issues: The lost generation – young people face much higher levels of unemployment than the rest of the working age population: in Canada the rate is 16%. The impacts are not just in the present. People who experience unemployment when young tend to have more health problems, poorer family relations, lower self esteem, earn less once employed – not just when young, but throughout life.We now live in a growing sense of fear – in the buzz of 24 hours news, and global disasters. Innovation and entrepreneurialism need energy and forward looking and risk taking; they in turn need resilience and good mental health. QUESTION: What are the implications for public interest and regulation?How could governments respond if younger generations actively resent and refuse to have their futures mortgaged to pay for health care for the boomer generation? How will governments balance the short term protests of current generations, whose access to care, pensions etc may be curtailed if radical changes are introduced, with the need to be fair to future generations? How can the costs – personal and financial – of long term health issues arising from youth unemployment be mitigated? How can investment in job creation or enabling contribution be offset against health benefits? Should alternative forms of contribution be required, on health grounds?
- Corporate social responsibility ahs become an embedded part of business; the market for Fairtrade produce is expanding; philanthropy is becoming popular among silicon valley billionaires and companies ‘help people give as they pay’ Doing good pays, and companies are increasingly judged on these values. At a government level, in 2008 the French President announced the intention to explore Net National Product as an alternative to GDP for measuring economic success and wellbeing. Recently, the UK government has also been discussing the development of a similar index.Greater affluence is increasingly shown NOT to enhance happiness. ON a world happiness map Canada scores 10th world wide . QUESTION: What are the implications for public interest and regulation?How can government departments create genuinely interdisciplinary, cross government department responses to these complex issues?The boundaries between public, private and voluntary sectors are blurring as new approaches and new measures of success emerge: how well equipped is government to respond to and regulate this new world?
- Western nations are facing a health care cost tsunami – Boomers, rising expectations etc.E.g. US health care cost up 4.9% for 40 Years= 16% of GDP. if nothing changes = 100% in 100years!Unless we are radically to ration healthcare and support – or create huge inequalities based on ability to pay, we have to find radically new solutions to creating abundant access to care and support. We need the power of disruptive innovation and open innovation - e.g. successful companies such as P&G, Netflix, Kraft foods, BMW, Airbus/EADS; Science too is learning open innovation – where outsiders bring new insights and new solutions.E.g. Bob Metcalfe looking to revolutionise energy to make it clean and abundant. BUT radical innovation CHALLENGE the status quo and entrenched ideas of ALL stakeholders. Overcoming these and making the new options acceptable is a major barrier to change.
- At present: Health care systems have to treat people regardless, even if major lifestyle choices cause the problems. Growing knowledge of personal risk factors – as a result of genetics, neuro-science, exposure, lifestyle – will make win:win preventive care rather than curing possible. The locus of responsibility and the impacts of choices will become more explicit and part of the care equation. Encouraging behaviour change will be necessary. Mexico incentives programme – now in 40 countries world wide, pays the poor when they meet certain conditions; Citizen scientist when confronted with genetic ‘proof’ of vulnerability to heart problems, changed his waysIn future:Could we move towards a world where personal contracts on lifestyle and behaviour were part of health promotion and care? Will wider definitions and other factors become part of that equation/ contract? Given the known health benefits of work, if governments failed to provide suitable economic conditions provide economic conditions, might citizens sue?
- Emerging economies are becoming major innovators – in cars, electronics, appliances, healthcare, clean water. Faced with rising expectations among their populations, but also significant income constraints, the need to improve health care for national and economic reasons – they are taking radically new approaches. Heart surgeon Devi Shetty has applied ‘Henry Ford management techniques’ to heart surgery: high numbers of operations bring low costs and high quality. He is now building a hospital off the coast of Miami. No frills airlines provide the core benefit – getting somewhere, but at radically lower cost; as a result, air travel and new destinations became accessible to millions. Could the same apply to health care?How long before such models and providers arrive in Canada?Health tourism is increasing as consumers look for choice, control and quicker responses. Could we see health insurance provision based on an agreed list of overseas only providers? Longer term we may see remote care from overseas as tele-everything becomes the norm.
- Supply chains in all sectors are becoming more complex. Quality control and management have been in the news for all the wrong reasons recently: since 2009 Toyota has recalled 12 million cars; BP was nearly destroyed; Cadbury found salmonella in its chocolate. Drug recalls are also rising. 1742 in USA in 2009;300% increase in 12 m Long lead times on drug – testing etc - + consumer demand for new / latest solutions requires new approaches to balance competiveness and quality. As treatments more personalised i.e. Genetic base, drug development will change and so will the boundaries of responsibility. How will regulation respond to these levels of complexity.
- Embedded intelligence combined with the growing ability to profile personal information will provide real time, localised, personalised data collection and analysis. 1 The power and potential use of mobile phones is rising: m-payment is widespread in places like Kenya; Apple has recorded 10 billion app downloads since 2009; adaptors are turning mobiles into microscopes; at present there are about 17,000 health related apps – but they use ‘dumb’/ static information. Soon we will store even more personal information on our phones – health records, even our Personal genomes; phones could have pollution and other sensors inbuilt. Soon apps will be able to integrate and interact with a vast array of data making intelligent analysis possible. 2 Embedded intelligence could also reduce waste. Best before dates protect, but also cause wastage. In the UK drug wastage = 0.3% of total NHS budget. Vitality launched AT&T enabled, intelligent pill bottles to monitor and remind drug taking - could reduce waste, help manage multiple prescriptions for chronic problems.3 This combination of data and analysis could be captured automatically for research could; people could use mobiles as pollution detectors; disease outbreaks can already be tracked by app. In future: 4 Simple rules cold replaced detailed regulation, backed up by ‘black box’ aircraft / lorry taco graph type monitors could emerge. Simplification + verification may rule. If governments don’t clean up air pollution or other problems, citizens will be able to collect and analyse data and may sue; or polluter pays principles will prevail. Apps will be part of regulation as well as provision.
- Sat nav and location based services – Groupon, Foursquare, Facebook places etc – all ‘know where we are; convenience overcomes any concerns about privacy. The growing interconnection of the internet will mean a loss of privacy in return for personalised services and information. Consumers are beginning to recognise the value of their own information; in future it will be far more detailed and far more valuable. Access to ‘Personal value banks’ – genes, lifestyles, health etc – may have to be paid for by those using it . Protection and security of identity and data and trust in the systems will be at a premium. The Lifestyle : Gene : choices equation will be increasingly transparent. The solutions more personalised.
- Systems are getting smarter and more interconnected, and becoming more vulnerable. Cyber crime is a major part of organised crime, and now also a terrorist threat. Infrastructures are a prime target, and especially the control systems communications. E.g. Stuxnet Hacktivism is becoming part of protests – targeting websites of companies on a ‘hit list’, for whatever reason. E.g. PayPal and Amazon and WikiLeaks. Disasters do happen. NASA also examined the growing risk of solar flares ‘taking out power systems’ ; the resulting widespread total blackouts would shut down life as we know it in about 48 hours. Quebec had minor solar flare related blackouts in 1989. How effective are back up systems required to be? Where would responsibility lie if remote systems failed mid-operation? Or if data were corrupted in transmission?
- Canada is traditionally a very tolerant and open country and culture. As new media reduce shared content and increase personalised content, especially around news, so opinions can be reinforced and not challenged. Intolerance may grow. Canada has had fewer extreme protests e.g. against stem cell research, abortion or animal testing than the USA or UK. But as cyber attacks become the weapon of choice, greater intolerance may invade and external attacks may arrive. How could regulators respond fast enough?
- Growing numbers of research projects reveal the intelligence and feelings of animals. Moves are afoot to grant animals sentient being status. If that happened animal testing would fundamentally change forever. Genetic profiling shows that even species such as mice, share vast amounts of genes and were more similar than we thought. Biological modelling enables us to replicate what may be happening. New 3D microscopes allow us to see the inner workings of cells in real time. Citizen scientists are conducting tests on themselves using cheap genetic tests, information from the web then sharing the results to build a dataset.. Personalised medicines, and improved cell growth techniques, real-time monitoring and genetic profiling of predisposition may fundamentally change the nature of drug development and testing and even the need for animal testing. What new regulatory frameworks will be needed?
- 3D printing has moved from prototype printing to product development; initially luxury one-off items, but now more varied ones. It is revolutionising manufacturing cost models: small scale, small runs, even one-offs are viable. It is also being used in medical applications.Work on 3D printed prosthetics has been going on for some time, now researchers are developing a system that allows them to print directly into burns. Other organs may be next using our own cells generated on demand using new techniques. Organ transplants may be revolutionisedQUESTION: What are the implications for public interest and regulation?Could we see increased demand for cell harvesting and storage and how would that be managed and regulated? By whom?Will members of the armed forces be required to store cells to increase the potential for treatment? Other risky professions such as fire fighters? Drug wastage is growing. In the UK it costs an estimated £300 million per year. In the USA the cost is even higher and rising. Could on demand, 3D printing of pills arrive? Locally produced, on demand? Would it reduce wastage?
- Skills shortages are forcing new approaches to care.Affective technology means that robots, computers and other machines can begin to understand and read our non verbal communication and emotions. The new top of the range VW Passat has a tiredness monitor which watches and senses eye movement and other indicators of tiredness, and prompts the driver to take a rest. It also means that robots are able to move out of the factory into offices, hospitals, pharmacies and soon homes.In Japan they are making major investments in care robots. In Korea, they have the aim of having a robot in every home by 2020. In the USA one forecast predicts that robots could replace 50 million jobs by the mid 2040s.Korea has spent 3 years developing a robot ethics charter to protect both individuals and robots. Work is known to be a critical factor in health and wellbeing. How would the wider issues and balances of economic cost, competitiveness and skill shortages, be balanced with the detrimental impacts of joblessness or under-employment for millions? Where will the public interest and therefore the focus of regulation lie?
- Consumers are used to controlling what they do when, where how, what they buy.Patients are becoming consumers of health, which will change attitudes and expectations of services and providers. Choice is becoming a mantra in health and other public services. Chronic conditions and illnesses are part of the ageing process and health care continues to ‘cure’ problems to the end. But putting quality into life, not just quantity is receiving growing recognition and debate. The boomer generation have been at the forefront of change in consumer behaviour for 40 years; they are in the process of changing the approach to ageing, retirement and soon: death. They do not want the ‘inconvenience’ of ageing, want to stay fitter longer, and able to enjoy life. More of them may want to choose when and how they die. How could a sensible, non-sensationalist public debate and new regulations deliver the necessary checks and balances to protect the vulnerable while also enabling a growing expectation of choice and control, even of timing and nature of death?
- In the brief we have set out forecasts for 2015; 2020; 2025 and 2030.These forecasts indicate possible developments en route to a changed world of 2030. They are suggestions only, they aim to challenge thinking.
- This brief is a ‘quick’ look at what is driving change and some of the effects those changes might have. More detailed and extensive views of the future, plus ongoing scanning are needed to take these ideas forward into real policy options and new forms of regulation.