Life, Learning & Living, before the eventuality of Disease, Decay & Death?

Health is a very personal subject that takes public proportions when it is affected by conditions that are controlled by larger environmental factors that an individual is placed in. It needs to be recognized that the three essential conditions that impact health are:

1. Hereditary Conditions: These are conditions inherited from biological parents.
2. Congenital Conditions: These are conditions acquired during fetal development of a pregnancy and can be of genetic nature or acquired through external factors by the mother and transmitted during pregnancy.  
3. Lifestyle Conditions: These are external conditions that are acquired by the human system as a factor of the lifestyle.

The process of public health should be concerned with all the three conditions in its attempt to manage a healthy society in a democracy. Coordinating between governments, research institutions and the universe of healthcare ecosystems in native countries to impact the lives of individuals positively.

Public Health entities need to collaborate with Private Health entities; guiding the Standards, Principles, Policies and Procedures that help manage and shape healthy outcomes. This is a very critical cog in the wheel of governance and most of the world now realizes its importance because of the Covid-19 crisis we face. Whether it is the World Health Organization (WHO) or the respective government health ministries and the affiliated Public Health Institutions such as the Center for Disease Control (CDC) in the US or the Indian Council for Medical Research (ICMR) that rarely come into public discourse. 

It is unfortunate in this modern era, even in the most advanced of economies, we are fighting great inequities of life? It has been now discovered that during the Covid - 19 crisis, African Americans in the USA have been more impacted than caucasians. A simple factor without going too deep an analysis here is a socio economic one; where a section of the society such as African Americans and Latinos are susceptible to greater infections because a they live in poor environmental conditions, make poor diet and lifestyle choices because of their socio-economic status and yet form a majority in the front line workforce that caters to essential services because of their educational backgrounds. This bias brings into sharp focus just human diversity which is in poor light. How does one even start fathoming the other diversities of life and bringing them to the equation of creating an equitable society?

The above illustration published by the World Health Organization (WHO) shows the Public Health expenditures of both India and US going up. But that is not reflective of the ground realities showing preparedness for a greater public health regime, is there? In the US, issues such as overweight and obesity, mental health, physical activity and nutrition, tobacco and substance use, environmental quality, HIV/AIDS, immunization and access to healthcare show no significant signs of improvement. In India, in addition to still fighting traditional problems such as malaria, typhoid, polio and measles, the system continues to reactively fight infectious diseases such as chikungunya, NIPAH, SARS/MARS, H1N1 and pandemic influenza, among others.

When humans get infected, it’s not because the virus is ‘wily’ or ‘devious,’ adjectives applied to this complicated pathogen. Humans get infected, quite often, simply because they have put themselves in some virus’s way.

The Circle of Life

Like most public institutions, Public Health is also run as a bureaucracy with outdated structures, synergies and systems. In the context of a modern world that is glocal (Global and Local at the same time), it becomes necessary that the public health institutions modernize as well. Otherwise, the great scientists and researchers they employ will only be defending administrations rather than advancing science and technology for the greater good of humanity. 

Public Health Institutions should be at the center of healthcare innovation in. However they are not connected to the four C’s - Concept, Culture, Capabilities and Configuration to address this dire need of the modern world. 

In essence, while the Covid - 19 pandemic is still looming large on societies, it is critical for Public Health Institutions to renew their organizations to become an effective part of every government and global administration. Whether it is this pandemic or any anticipated future one, they need to be equipped with the four T’s that form the very infrastructure around which they operate to proactively prevent future economic disasters and loss of life due to health crisis rather than reactively create toothless defenses against an already dominant enemy. 

The Public Health Institutions should be digitally transformed connecting all the five layers of Strategic Operations, Leadership, Culture, Resilience and Skills.

Their processes must be renewed to the relevance of the modern realities of digital economy and Society 5.0. And they need to become a pivotal agency to prevent the occurrence of future pandemics and in the process, preparing the populace to be collaborating without the distress of the current lockdowns. There is really no alternative to this transformation taking root now while concurrently attending to getting things with the mistakes incurred in the initial phase of this pandemic.

The only sure way to move out of the current crisis is to establish a continuous process that connects the 4T’s: Trace, Track, Test and Treat. The invention of vaccines, the trials of drug cocktails and the analysis, diagnosis, treatment and prognosis can all fit into this process. It must be emphasized that this data that emerges from the process cannot be episodic but rather a continuous cycle of an individual’s life. This lifecycle data of an individual that will also be owned by the individual when provided access for specific events / transactions that refer to the four steps of Track, Trace, Test and Treat will provide a comprehensive closure to understanding the status quo with the the current crisis. At the same time, this will also become the source of understanding future occurrences of health threats that can be responsively managed.

We are at a strategic inflection point to either progress to a next generation healthcare ecosystem or regress further into an abyss of reactive response to health threats that will plunge life itself to greater levels of disruption and disaster.

The driver is Digital Health Record

The terminology of Digital Health Record (DHR) has to first of all become a commonly interpreted term. It cannot be employed for Patient Data that a Physician or a Hospital owns episodically at the time of treating patients for specific conditions. Essentially, this is data consisting of the tests and investigations performed by various specialists, each owning the data while a patient is treated for a specific condition. Nowhere is the correlation made beyond the symptoms and treatments of specific conditions. Medicine on the other hand is evolving to understand the importance of the connectedness of the physiological and psychological aspects of an individual and addressing health more personally and holistically.

On the other hand, the very foundation of science and technology research, based on raising funding, is competitive in nature. There is plenty of evidence on the humongous amount of wastage incurred by precious talent in the pursuit of cures that is discretely driven while a collaborative approach could be more productive and priceless in terms of value for the society. Wouldn't it be more relevant in a globally mobile world for research to be open, science rather than medicine driven and funding is based on globally open and inclusive collaboration?

The Digital Health Record (DHR) is ideally the record of an individual’s health that includes the Physiology, Biology and Psychology of the individual from birth to death; referencing the conditions of heredity, congenital and acquired.

This Digital Health Record (DHR) data can organically become centric to Public Health, Private Healthcare Ecosystem, Research & Development (R&D), Pharmaceutical and Medical Equipment & Accessories manufacturing and distribution. In such a situation, there is both the certainty of impacting life generating and life saving innovations that stay connected in the realm of life rather than the limited orbit of Pharma and Medicine. 

There is no denying the opportunities with Digital Health Record (DHR) but the number of impediments to such data not being in place are:

1. The vested interests of the medical community who monopolize such power.
2. The reshaping of research and its funding. 
3. Whether at all it is possible for the incumbents to generate and build data from birth.
4. The security around the data ownership and the sharing of the data for collaboration.
5. The willingness of the individuals to participate and contribute to the creation of the Digital Health Record (DHR). 

For any concept that is disruptively innovative in nature, there is always going to be resistance. Arguments including density, accessibility, usability, feasibility and sustainability will come to the fore. Cost and capability will follow. Passions will swing for and against the need for innovation. Human insecurity will be hard at work added to the debt at multiple levels; strategic, technological and financial.

And yet, in the healthcare space, we are cornered and have no more room to maneuver. It is a matter of just how much worse it can get. Any innovation in the healthcare ecosystem will need to start with a Digital Health Record (DHR) that can be owned by the individual during their lifetime.   

Wealth can only be useful when one gets to live healthy. 

The path to Innovation

It must become quite clear for any individual with a thinking capacity that the institution of both Public and Private Health are in dire need of Innovation. They are currently barely surviving on decades old ideas and practices and need a fresh narrative, processes, technology, infrastructure and structure to become relevant in modern time. This will be a movement with a narrative driven by the advancement of Science & Technology that sees opportunities for human growth through health that is a composite of Mental, Physical and Emotional. And it shouldn’t be very difficult to follow that such a composite approach which is radically different from the past needs a narrative to see health as “Life, Learning & Living; before the eventual Disease, Decay and Death”. One that raises the Quality of Life to a higher threshold of capability.  

The path to successful innovation is a three step process of Education, Ownership and Commitment. Where Value is the narrative that runs across; taking people from Innocence through awareness, understanding, definition, competence and eventually to excellence. Where people from hearing about a concept go on to trying it themselves and from thereon become advocates to institutionalizing the concept based on their own great engagement and experience. 

And the journey of Innovation itself is a continuous one; from Innocence to Excellence as the above illustration shows. Every innovation, whether it is Mind to Market / an Invention to Innovation Cycle and Time to Market / Innovation to Improvisation cycle has a limited shelf life. The essence of innovation is not just in these cycles running faster and more efficiently but in the renewal of it; that sets and accomplishes a higher threshold of capability and value delivery. 

In the modern world, all innovation happens in an open environment that is shared and collaborated upon. Technology facilitates the operation of a platform for innovation to be carried out securely using digital identity management that is role based; connecting an ecosystem globally. There is no organizational entity better funded and with a better motive than the Public Health organizations that can fund this innovation platform and deliver its manage to fuse public and private health for a risk assured world that can thrive responsibly.

As the above illustration shows, the platform matches the individual Personal Healthcare with Professional Practice Management of the healthcare ecosystem. Institutional Care with the integrated health management needs of wellness and medicine. The platform becomes the source of all prescriptions and payments and bringing to bear the promise of telemedicine and reducing the friction and of healthcare insurance. At the other end, such a platform becoming the source and means for research and development including clinical trials management in the drug discovery and development process, scientific research on health and development of vaccines, medication and medical technology manufacturing. As the above illustration indicates, such as digital healthcare platform can only be sponsored by the Public Health Agencies in the respective countries and connected to the World Health Organization and its universe of Customers on one end and the Healthcare ecosystem in each country with the individual at the center.

This proposal when implemented will eliminate several conflicts of interests:

1. The issue of owning the data by the individual without compromise to any agencies.
2. The funding of the platform to be built, managed and maintained becomes a non-issue as a fraction of the cost of the Public Health Services to Standardize, Regulate, Set Guidelines, Policies and Procedures can be addressed digitally. 
3. The conflicts in the ecosystem and resistance to the Transformation / Change will be mandated when a scientific rather than a commercial view drives the healthcare ecosystem.
4. Socio-economic disparities will be reduced making healthcare accessible for everyone as a matter of right. 
5. There could be a direct link between the Revenue earned from taxes and a cess collected in the process for health insurance that could make for an ability to manage Public and Private health with a proactive approach to wellness rather than an emphasis on disease; leaving each industry player to innovate and compete from a higher threshold of capability.

Reform and Renewal Matters

A reform and a renewal of Public Health Services is urgently warranted and needed. One that is relevant to the modern society because the future of a healthy society depends on it. It was way back in 2017 that Bill Gates wondered aloud how we would deal with an airborne virus pandemic. This was against the background of how America had dealt with ebola, SARS and H1N1, not too distant in the past.

The above illustration presents a picture of the growth of the healthcare services market that is based on commerce. The true value in there would be to reduce the expenditure while substantially increasing the quality of life that can be measured by mortality rates, disease prevention, reduction in drug pricing, decreased substance abuse and improvement in hygiene and sanitation standards.  

The Public health system is an institution that attracts a lot of government and private funding. And these funds need to be put to optimum use. From a credibility standpoint, this agency would be best suited to fund and manage a digital healthcare platform that addresses the need for improving the quality of life through health. In the process, it will also be able to impartially solve the many inequities that plague the delivery of healthcare globally. It would be the ideal institution to bring about an aggregation of data currently to make the process of Trace, Track, Test and Treat seamlessly intelligent. Which incidentally would be the launchpad for cutting the creation of digital health record into manageable chunks and proving the value coursing from 

• Conceptualization: That would reduce the time to normalcy from the Covid-19 pandemic and showing the way to prevent future pandemics globally. 
• Engineering: Putting together a globally coordinated program that feeds from Individual Digital Health Record to find Health Solutions that can bring upon succor to those suffering from deadly disease and prevent them in the next generations. At the same time, connect the globe, connecting the dots, shaping healthcare outcomes that are responsive and not reactive. 
• Industrialization: Bringing uniform healthcare processes that allow for humanity to adapt to a higher quality of living and thereby reducing the inequities of life that indirectly increase health risks globally.
• Commercialization: Reducing the tremendous costs of healthcare while allowing Science & Technology to focus on outcomes that are People Centric rather than business and commerce centric. 

Perhaps an institution can invest in a small example anywhere in the world; be it India, Africa or the US. And start with creating a small ecosystem creation to prove the concept. This white paper has been written with an intent to set a dialog and create the necessary scaffolds of an eventually global platform and create early positive outcomes that can then be evangelized on a global scale. 

Health is personal as a rule and there can be no exceptions

It is not possible to seek funding for such programs from private funding sources because of their vested interests in commerce driven healthcare and medicine. The individuals globally are not in a position to fund this platform by subscription at a time when they face a sever economic recession. It is the philanthropic or public health institutions who need to pave the way for creating a healthier society. There is no better time than now, when one can prove a solution out of a crisis and innovate to create a better future. The bottom line however to any innovation in healthcare is, an individual's digital health record which is a realtime live data feed from birth to death.