Imagining a Future American Culture of Health

Kim BellardOne of the most thought-provoking articles I've read lately is Tom Vanderbilt's Why Futurism Has a Cultural Blindspot in Nautilus. In it, he discusses how our technological visions of the future seem to do much better on predicting the technology of that future than they do the culture in which they will be used.

As he says,

But when it comes to culture we tend to believe not that the future will be very different than the present day, but that it will be roughly the same. Try to imagine yourself at some future date....Chances are, that person resembles you now.

We need to keep this in mind when thinking about the future of healthcare: not just the nifty new technologies we'll have, but who and how we expect to use them.Mr. Vanderbilt quotes historian Judith Flanders: "Futurology is almost always wrong because it rarely takes into account behavioral changes." She believes we look at the wrong things: "Transport to work, rather than the shape of work; technology itself, rather than how our behavior is changed by the very changes that technology brings."

He cites a great example of a 1960's film about the office of the future that actually wasn't so far off in terms of the technology we'd be using, but it missed that there would be women in those offices. Or, no doubt, that there would also be minorities, or that careers wouldn't be spent working for just one company, along with a nice pension at the end.

Mr. Vanderbilt concludes: "It turns out that predicting who we will be is harder than predicting what we will be able to do."

All too often, especially in healthcare, we develop technology to solve incremental issues, not foundational ones. All too often, especially in healthcare, we develop technology and then try to fit it into our existing culture, rather than imagining the culture we want and developing technologies to help achieve it.

It's not so hard to imagine how technology will change what health care is likely to look like in the not-so-distant future.

• We'll be monitored 24/7, from our hearts to blood to our microbiome and more.
• We'll get real-time feedback -- from A.I.s and humans -- on all that information so we can take appropriate actions.
• We'll always have our doctors available, in some form, and with all of our records available to them -- and us.
• We'll have much better information about what works for who when, making treatment options clearer and more evidence-based.
• We'll have ever more precise treatment options, from drugs with pinpoint accuracy to surgeries done at the cellular level by nanobots to modifying genes.
• We'll get most of our care done at home or close to home.

The technological seeds for all of these are already here, and are already being used in some form. The leaps to their widespread use are evolutionary ones, not revolutionary ones. They won't be fully arrived by 2020, but will be well along by 2030 and certainly in place by 2050. The specific details of their execution may surprise us but probably not the goals.

But, like imagining that "office of the future" in the 1960's, what will the healthcare system in which they are used look like?

Here are some open questions about the culture in which all these cool technologies will be used:

• Will we live in a culture that accepts health problems becoming financial disasters for some people?
• Will we live in a culture in which poor people can expect to get less care, to be less healthy, and to live less long?
• Will we live in a culture in which where you live dictates how well and how long you live, and the quality and quantity of care you receive?
• Will we live in a culture that treats social determinants of health and public health as secondary considerations?
• Will we live in a culture that treats health as primarily a medical concern, with too many people delegating responsibility for their health to their healthcare professionals and expecting some kind of medical interventions to deal with any health problems?
• Will we live in a culture that expects "treatment at any cost for any chance," especially for terminal issues?
• Will we live in a culture that treats services like dental, vision, or "custodial" care as step-children?
• Will we live in a culture with an ever-growing array of medical experts -- M.D., D.O., D.C., Ph.D., D.P.M., PharmD, D.M.D., O.D., N.P., P.A.s, PTs, Au.D, to name a few (and not to mention sub-specialists)?
• Will we live in a culture that treats medical expertise as primarily a local/state-level issue, rather than a national/international one?

If the healthcare system of the future looks pretty much like the healthcare system of today, just with more and better tech, we will have failed. And probably be broke.

We need a different culture for health, and that culture needs new designs. Marcus Engman, the former head of design for Ikea, told FastCompany:

I want to show there's an alternative to marketing, which is actually design. And if you work with design and communications in the right way, that would be the best kind of marketing, without buying media.

I read that and I think "healthcare." Healthcare does a lot of marketing, in many forms, but its ideas about design are more about aesthetics and revenues than about health or patients. Substitute "health care" for "marketing" in Mr. Engman's quote and we start to get to what Steve Downs calls Building Health into the OS -- that is, designing to make health an integral part of our daily lives. That's design. That's a culture change.Mr. Vanderbilt wonders why cultural change is so hard to predict, but speculates: "For one, we have long tended to forget that it does change. Status quo bias reigns." Healthcare has gotten more expensive, and often more confusing and more impersonal. We have many more options, but often less idea what to do about them. These are not the cultural changes we wanted.

We have a culture of health care -- or, more accurately, of medical care -- rather than a culture of health. Technology can exacerbate this, or help change it. It's up to us to imagine the future in which we're most likely to be healthy.