Whether we are young, old, pregnant, or suffering from a long term condition, most of us know at some level that keeping as healthy as possible is key to everything else that we want to do in life – being there for our family and friends, achieving in our job or enjoying our recreation. And society wants us to stay healthy too – so that we can be more productive and, crucially, make fewer demands on health and care systems. But how will this be achieved, and what role can new technologies play?
Just as now we can scarcely remember how we organised our lives before mobile phones and the internet, the pace of development in health technologies is such that envisioning how these new technologies may be used by citizens and health systems in the preventive context 20 years from now feels like an almost impossible task. But predict we must – for although we don’t know which technologies will bear fruit, we do know that some of them will. And unless we try and make sense of what might happen and what the consequences might be we are simply blowing in the wind – subject to all sorts of forces acting randomly in many different directions.
The PHG Foundation has never been one to shy away from problems that seem too big to tackle. Twenty years ago we were asked a similar question about genomics – what difference might it make and what needed to be tackled if we were to optimise its use for health. Our resulting report Genetics and Health set out most of the issues that would be important; and now looking back from a position where genomics is taking its place in mainstream medicine, we can say that we identified most of them thus helping to set the development agenda that has been so effective.
But predict we must – for although we don’t know which technologies will bear fruit, we do know that some of them will. And unless we try and make sense of what might happen and what the consequences might be we are simply blowing in the wind – subject to all sorts of forces acting randomly in many different directions.
The My Healthy Future programme
In My Healthy Future we are looking at a bigger, wider picture that embraces the full breadth of biomedical and digital technologies and how society can use these to stay healthy. We are taking an approach of background analysis, workshops and wide stakeholder involvement. Essentially we envisage that society is moving into a future of more personalised disease prevention, where new technologies are used to understand individual risks of ill-health and appropriate interventions are offered. Unpicking the central question requires that we delve into many contributory areas:
- What technologies are out there – and what is their potential? How might individuals and health systems access and use them? Will this differ between different population groups and what will be the result of these differences? What might be the impact –for good or bad - for individuals, health systems and society? How can we promote the former and mitigate the latter?
- The ideas of overdiagnosis, overdetection, unnecessary medicalisation, where it is postulated that ‘too much medicine’ may have a net harmful result
- The importance of person centred healthcare: the need to empower individuals and citizens, consider them holistically, involve them in decision making and retain the vital clinical, compassionate and caring elements of care; and to balance this in a system that appears to be driven by technology
- Data – and how we obtain, regulate, store and share, both as citizens and society
PHG Foundation we have established an ambitious work programme for My Healthy Future. Some of our thinking is now starting to emerge – and you will be able to follow this on our website. For example, we have already looked at a range of new technologies and asked the question what these may do for health, whether they are ready yet and some of the complexities of introducing them. These are available as individual infographics and in summary form on our website. We have also reviewed the policy background and how it leads up to and supports (or sometimes detracts from) more personalised preventive care. We have started to think about the whole theme of person centred care and will be challenging ourselves and our correspondents to consider how person centred care can be maintained, and even strengthened, in an era of more technically supported and informed care.
The opening phase includes four workshops, each focused on one life stage (from pregnancy to old age), each involving a wide set of stakeholders and each contributing a set of context specific issues to our melting pot of ideas.
The reproduction workshop
At our first workshop, on 15 January 2018, an invited panel considered the potential of new technologies used in preconception, antenatal and postnatal periods. The world may certainly look very different – different forms of families emerging as a result of assisted reproduction technologies; a much enhanced ability to spot those at risk of pregnancy complications – and, hopefully the possibility to ‘reframe’ risk for women currently considered as high risk (for example older mothers or those with high BMI); all sorts of mobile apps, or home devices that enable women to monitor their own pregnancy; and at the neonatal stage, more screening and more monitoring of the health of baby and mother and the relationship between them.
The prospect of these technologies coming to fruition was met with mixed feelings by those round the table. Though positive about some of the health improvements they might offer, there were worries about how the health system will cope, how far this will drive up cost and who will pay, the emerging drive from the commercial sector, and the potential for widening health inequalities as a result of differential access.