Gray matters - preparing for a geriatric planet
This month marks the 20th anniversary of the watershed United Nations Conference on Environment and Development, colloquially known as the Earth Summit, which was held in Rio de Janeiro in 1992.
In the decades since that global conference, people worldwide have been talking a lot about global warming (even if sometimes they don't seem to be doing enough about it). But very few folks are talking about global aging.
That's a conversation Eric Dishman wants to have.
"Whole industries and whole nations are competing to see who can be at the forefront of [green] technologies," Dishman, director of health innovation and policy for Intel's Digital Health Group, said earlier this year. "Gray technologies for global aging," he said, are "sort of the moral equivalent of green technologies for global warming."
And make no mistake: the former poses as much a threat to economies and societies and ways of life as the latter.
This past February, Dishman spoke at the pre-conference for Rio + 20, the United Nations Conference on Sustainable Development, which kicks off in Brazil on June 20. If the Rio conference in 1992 was about global warming, he said, "we want Rio this year to be about global aging. If that was about sustainable energy, we want this to be about sustainable health."
By 2050, we're going to have seven billion people on the planet, and two billion of them are going to be over the age of 60," said Dishman. "No matter what, for the next three to four decades, we have a legacy of chronic care that's going to bankrupt nations if we don't find a new model."
Dispiritingly, however, Dishman says he's “worried about the United States’ global competitiveness on this issue."
Other countries, meanwhile, including many emerging markets, have already made big strides and "are going to bypass a lot of the U.S. and Western Europe, because they don't have to defend this install-base and fee-for-service model that's so hospital-centric," says Dishman. "They'll dive right into consumer engagement models because it makes economic sense for them to do so. Then they can build a broadband infrastructure and HIE. This is why Australia is making a personal health record available to every citizen in the country by the end of this summer, because they see they need to build this 21st century grid – they have to be age-friendly given worldwide demographics."
Toward that end, in his speech in Brazil, Dishman touted the “3Cs” – connectivity, "careforce" and community.
With regard to the first, he stressed the need for a "broadband infrastructure that is ready for 21st century healthcare delivery, all the way to the home." Digital movies and music shouldn't be the only drivers for broadband network development, he said. Telehealth – visits with virtual docs, remote monitoring at home, readable sensors aimed at keeping seniors safe – needs robust telecom capabilities.
Dishman pointed to an Intel project in Mexico to build a solution called Medicina a Distancia, which is seeking to bring "hospital quality expertise to remote and rural parts of the country." Projects like that are cropping up more and more in the U.S. and abroad, of course, but "we still treat such telehealth encounters as the exception to a face-to-face visit instead of the norm," he said. Instead, "we have to make the face-to-face visit the rare exception."
That necessary goal, he added, relates the second of the 3Cs – the need to "skill-shift care to increasingly informed and empowered patients, friends, neighbors and community health workers. We simply cannot train enough doctors and nurses to catch up with the demographic realities of the age wave." Web-based training, social networks and decision support will be "key enablers for a 21st century careforce" to complement overworked and increasingly scarce doctors and nurses.
As lifespans continue to increase on this well-populated planet, "we have to move beyond hospital-and-clinic-centric models to home-and-community-centric models," said Dishman in his Rio speech. "In short, we must learn how to place-shift care to these more inexpensive, accessible settings – for diagnosis, treatment, and prevention." That entails designing buildings and neighborhoods where home care is encouraged and enabled.
Intel has been studying models such as the VA's Home-Base Primary Care program, and various European “hospital at home” models, gauging just how much care is feasibly safe and effective. "We have come to believe that each nation should be exploring how to achieve the goal of shifting at least 50 percent of care done in hospitals or clinics today to the home or community by 2020, as a starting point for building a sustainable healthcare economy," he said.
"There's a reason Greece and Italy are failing, economically," Dishman, said, adding that large percentages of those countries' doctors and nurses, especially in primary care, are retiring. Meanwhile, entitlements to the older generation, "who are expecting all-you-can eat medicine, which they've kind of gotten used to," are placing an unsustainable strain on those nations' economies. The math just doesn't work out.
"The U.S. can look at what's going on in the rest of the world and see it as a harbinger of what's to come here," he said.
Unfortunately, "the reason why I'm nervous about the U.S. in terms of global competitiveness, really is sort of the great technology industry," he said. "We've been fighting at Intel for years trying to get the NIH and the VC community to focus on global aging."
In Europe, "they passed the healthy aging partnership [the European Innovation Partnership on Active and Healthy Ageing] years ago," said Dishman. "They're working on transnational licensure of doctors and nurses so care can go anywhere a senior goes in Europe. They're building a broadband infrastructure that's ready for multi-party, high-res videoconferencing to the home. And they've invested more than a billion Euros to catalyze small and medium-sized companies to work in this space."
Alas, so far, at least, "there's nothing like that in the States. Not even close. And now you have China that's done the same. Australia that's doing the same. And it's like the rest of the world has woken up to global aging, but the U.S. has its head in the sand."
Our failure is on two fronts, he said. First, "we're not building the infrastructure to keep up with our own older people that are going to double and then double again in 50 years. Second, "we're not going to be the leader in intellectual property and services that are going to be farmed out to the other two billion people on the planet."
We're poised on the precipice of some major and world-changing demographic shifts, but the U.S. is lagging. "We don't have enough medical informaticists," said Dishman. "We don't have enough engineers who are trained in these bioengineering sciences. We don't have a regulatory climate that facilitates this kind of R&D.
"It's time to wake up to global aging in the United States."