As the Clinical Editor of TEDMED, I have been lucky enough to speak to some of the biggest thinkers and innovators in health care. Their thoughts and actions are inspiring, but as I sat stage-side at the 2013 event I struggled to shake off one simple thought: “demand for health care has outstripped supply and will continue to do so”.
This is a powerful thought. It has grown inside me ever since I started reviewing nominations for TEDMED. It has stayed with me these past few months as I did my weekly reading of over 400 articles in and around health care and innovation. There are new approaches to care every single week, and yet it’s clear they won’t be enough; demand for health care will simply continue to outstrip supply.
The reasons are well documented. People are living longer but unhealthy lifestyles are leading to more chronic conditions. This increases the demand for care, and yet our ability to treat these conditions is limited. Combined with this, is the very nature of research – the more we learn, the earlier we look to intervene in people’s lives. The net effect is that people are supplied (and eventually get accustomed to and demand) health care both earlier and for longer.
We cannot keep providing more and more health care. We cannot afford it. Every country has to decide what slice of its gross domestic product (GDP) it wants to spend on health care: in the US it’s 18%; in England it’s 9%; in China it’s 6%. Although the slices are different between countries, the problem is the same – it’s too much.
For me, this issue is a personal one. I recently had back surgery, and, while the skill of the neurosurgeon is not in doubt, my health care providers cannot give the kind of ongoing services that I need to stay healthy. Some of this is a structural problem – health care services are simply not structured to provide ongoing care. However, it’s also a resource problem; with so much demand the acutely unwell have to be prioritised.
Instead, I looked at my environment and my community to stay well. I consume services not available through traditional health care. I rely on people who are not clinicians. In short, I found services – or value – outside of the current health care system. As a result, the simple thought – that demand for health care has outstripped supply and will continue to do so – led to a simple question: “is it possible to realise new forms of value in one’s community to maintain one’s health?”
I started reading about social capital, the value that exists between individuals and groups. It’s been shown that social capital can offset the negative consequences of poor education on health. It seems to do this by helping people to develop resilience, coping skills, self-esteem and autonomy. It made me realise that, unknowingly, I was harnessing social capital to stay healthy after back surgery.
Perhaps predictably, my first thought was to see whether new technologies might be used to harness the health-related value of social capital. I was influenced by my use of AirBnB, a service that lets people rent their spare rooms. Their underlying technology, a peer-to-peer (P2P) platform, has essentially helped people realise the dormant value in their homes. I wondered whether patients might be able to create new value by driving innovation in health. Riffing off P2P, I called this “We2C” – how “We”, the people, can lead and engage “C”, the clinicians.
In hindsight, We2C was a red herring. It’s undoubtedly an important tool to shape the supply of health care but it does not necessarily add new value. That’s not to say, however, that technology is a red herring. AirBnB, and many services like it, have created new value thanks to the growing digital infrastructure in the world.
I believe it’s time for us to explore whether we can find new forms of value in one’s community to maintain health. I am calling the currency of this value “Wellth”. I suspect that, before the growth of the health care industry, communities had lots of Wellth. That is why I am describing it as a “reclaimed” currency.
Wellth is not wellness. The latter is often created by incentive programmes aimed at individuals with a view to reducing long-term risk of disease framed within existing health care costs. Wellth is about creating new value that is immediately realisable through communities.
I’m aware that “Wellth” is currently a nebulous concept. That is why I have asked a small group of thinkers and doers to join me in exploring what it is. It is my hope that together we will end up with a working definition that we can embed in different types of organisations to see how we might deliver and nurture it. Our intention is to have monthly meetings at which we debate key aspects of what Wellth might be. We will share our thoughts as Despatches, and we welcome any and all feedback.
Demand for health care has outstripped supply and will continue to do so. It is imperative that we search for new forms of value. My search is starting in our own communities.