The World Health Organization famously define health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” so whilst it’s perhaps long overdue, it’s not surprising that a growing number of healthcare providers are turning their attention to preventing disease rather than just curing it.
The UK’s new health minister Matt Hancock has made prevention a fundamental tranche of his tenure, and outlined his vision for prevention in a recently published paper, in which he identified prevention as one of his three priorities going forward.
“Prevention is about helping people stay healthy, happy and independent for as long as possible,” he says. This means reducing the chances of problems from arising in the first place and, when they do, supporting people to manage them as effectively as possible.”
The logic behind this is hard to dispute. Not only do people live a better life when they’re physically and mentally healthy, but earlier detection of problems is both cheaper and more successful in terms of delivering effective interventions.
The role of technology
Just as effusive as Hancock is about the importance of preventative care, so too is he about the role technology can play in delivering this. The potential for large quantities of data to be generated via wearable health devices is something that I’ve touched on numerous times before, especially when that data is combined with genomic and electronic medical data to provide a holistic perspective on each of us.
Swiss co-operative company Healthbank have shown the possibilities via a recent partnership with Germany startup Thryve to integrate data from over 200 different wearable devices into a single repository for each user. The partnership aims to not only aggregate this data, but provide interpretation of it to a scientifically proven level.
Similarly, health insurer Vitality highlighted the behavioral changes possible via wearable devices in a recent partnership with Apple that was documented in a study produced by RAND Europe. The study involved over 400,000 Vitality customers, who were each given an Apple Watch for free, and told that if they maintained a certain level of activity over the following two years, they could keep the watch.
The data from the study revealed a 34% increase in activity levels for those individuals using the watch, in an outcome that Vitality believe shows how powerful technology mixed with behavioral science can be in prompting us to live a healthier lifestyle.
“This landmark study contributes to a deeper understanding of how people can be incentivised to live fitter and healthier lives,” said Discovery Chief Executive and Vitality founder, Adrian Gore. “The significance for individuals, the insurance industry and wider society is profound.”
The risk of health inequalities
It’s an approach with much to commend it, and indeed recent research from the University of Michigan highlighted how incentives can boost things such as medical adherence. The challenge however is in ensuring these benefits are spread throughout society, even to its most disadvantaged corners.
Whilst Vitality insist that their sample included a wide cross section of society, the fact that it was solely made up of people with private health insurance does suggest that the more disadvantaged were not among them. This is a challenge as behavioral health issues tend to be greatest in areas of highest deprivation.
Recently the House of Commons released a report and action plan on tackling childhood obesity. It’s estimated that nearly 1/3 of children aged between 2 and 15 are overweight or obese in the UK, with this trend getting worse. The challenge is greatest in the most deprived areas, but policies are generally blanket ones that fail to take account of the unique local circumstances.
“Children are becoming obese at an earlier age and staying obese for longer. Obesity rates are highest for children from the most disadvantaged communities and this unacceptable health inequality has widened every year since records began. The consequences for these children are appalling and this can no longer be ignored,” the authors say.
Whilst projects such as the European Commission’s BigO aim to utilize technology to tackle such health inequalities, the reality is that it will require a transformation in the kind of roles and skills contained within the healthcare workforce.
Health coaching
In Reverse Innovation In Healthcare Vijay Govindarajan highlights the work of Iora Health. The healthcare startup have attempted to disrupt healthcare by keeping patients out of hospital whenever possible. Rather than waiting until patients are unwell and requiring expensive treatment, their service revolves around so called health coaches, who work in the community to do all they can to keep people healthy and well.
“Our Health Coaches are relationship builders between the patients and their care teams,” Iora say. “They are screened and hired for their ability to connect deeply with people because our Health Coaches are more than caregivers.”
It’s an approach that the research conducted to date suggests can be hugely beneficial. For instance, one paper from 2016 found health coaching to be beneficial in reducing blood sugar levels. This was followed by a second paper involving health coaching in Turkey and Denmark, which found that participants who received coaching for a year were able to reduce their blood glucose levels by an average of 6%. This doesn’t sound much, but the International Diabetes Foundation regard a 1% reduction as a significant improvement.
Alas, the creation of such roles was not something that was on the agenda at Vitality, and in the Topol Review into the future staffing needs for the NHS, it wasn’t something that emerged as a priority either. As such, the potential for such gains in preventative care being spread across society have to be called into question.
“Vitality has demonstrated the effectiveness of using technologies to encourage healthy behaviour changes of benefit to individuals and healthcare systems. But in the population who don’t have access to the technologies this same virtuous circle can still be highly effective with health coaches – appropriately trained carers and health professionals – providing the support and stimulus until, with increasing acceptance of the role of technology in our lives, there will be progressive shift towards standards of care that promote health supported by universally accessible technologies,” Imperial College London’s Professor Nicholas Peters told me recently.
The introduction of new technologies into the healthcare system has a long and torturous history, but so to does the introduction of new skills and new ways of working. Evidence from across the economy shows us how difficult change is for any institution to achieve, but it’s something that healthcare must tackle head on if it is to successfully transition towards a preventative focus.
