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QUALITY: Personal health ecologies as the future of DSM.

I spent a day last week at IFTF’s meeting on Personal Health Ecologies. These are my notes, so use these as provocation material rather than a finished argument. But something important is slowly going on here, and health care wonks and industry players should be aware.

As you know I have some affection and connection for IFTF. Their research lately has veered away from the health care system per se and is looking more at health as a lens for commerce–that is looking at the potential businesses to support consumers living their lives with a health focus. They call these personal health ecologies–more about them on page 10 of this report. The crowd at the meeting was not just the traditional health plans/pharma/services types but also financial services companies, software companies, hardware, consumer goods vendors and anyone else looking to learn more about consumers.

One major part of the research this year is looking at the behaviors of the chronically ill. Businesses are getting interested in figuring out these groups as there will be more and more of them in the future. Today’s meeting looks at the chronically ill, and how they manage their own health ecology. This doesn’t just mean their interactions with the “health care system” (plans, doctors, hospitals) but also with their relationships (family and friends), their connection with products, with technology and where they care for their health. To do this IFTF did a whole bunch of ethnographic research, following people around at home, at work and in their daily lives just managing their disease. This is all pretty intangible stuff for a business, but it’s basic research that is important for developing products and services.

So what are they looking at? Diabetes, obesity….

Rod had a “fun” scenario looking at obesity. Interestingly as Generation Y gets fatter, their rate of health spending will increase much faster (maybe in their 30s as opposed to in their late 40s). What might be evidence of this scenario? The key question is at what point will obesity and physical inactivity overtake smoking as the leading cause of preventable death. As obesity and diabetes increases there’s much more focus on obesity and prevention amongst men and children, rather than just Weight watchers as a place for women concerned about looking good.

In terms of business opportunities, there’s a lot of invisible work in tracking and managing disease–so there’s a huge opportunity for routinizing their information management and automatic data capture at home–same as in the hospital (80% of nurses work is recording data and that’s slowly being captured and recorded automatically). Also having to interpret the results of the data, which are not intuitive to the patients.

There’s a real problem for chronically ill people. They get on and off their regimens because they can’t stay there. We need something to make the treatment less miserable than the disease.

So what were the companies at the conference doing to help the chronically ill? Three examples at the meeting:

  • Intel is trying to wire the home. They realize that health doesn’t live on the desktop, so how does Intel get into it? They have test houses out with RFID sensors everywhere and devices networked together, and even biometric devices that can be in the bloodstream. They’re also trying to develop mote-based sensors.
  • Abbott, in its diabetes division has a wireless sensor implanted into the skin sending continuous a wireless data stream to a glucose meter on the belt, called the Freestyle Navigator.
  • Health Hero has a new version of the Health Buddy out which is now both text and voice operated, and can be connected to devices like digital scales.

In many ways the potential success of this is linked to pay-for-performance or more likely some form of pay for outcomes. This is (maybe) going to drive the adoption of disease management techniques in Medcare populations, and may move some of the techniques Health Hero and others are using into the mainstream of health care delivery. We’ll see, but it’s a long transition from where we are now.

Meanwhile, the conference moved onto a riveting session about wider issues of how to change the wider patterns that cause obesity and diabetes, and made me feel very fat! What might stop this trend? Stanford Prof Christopher Gardner tells us that its the Mediterranean plant-based diet rather than the typical American diet….but how to make people change? (Here’s more on his techniques). At the moment we focus on people changing but in fact you can change the way people eat by packaging–but that’s been used so far to make people eat more. Chris recommends “Food Politics” and “Fast Food Nation” as great books that have far more impact than any moralizing professor suggesting a diet. But Susan Foerster from the California “5 a day” campaign (State of California Health dept) shows that financially there is no way to marketing-wise fight the fast-food monolith. Something like $50bn is spent on food advertising (none on veggies) versus under $400m of PSAs. The result = obesity. (Did you know there were 66 spoonfuls of sugar in a 7-11 Super Big Gulp?) And this runs to other political decisions — $72 per capita spent on roads compared to 0.55c spent on pedestrian walkways. Also limited access to fresh produce in poorer areas.

This is all depressing stuff. My view is that the cost of obesity is massive but the marketing is all pushing this one way–to more obesity and more chronic disease. The only way to break this is to divide the corporations who are paying for the costs of obesity from the food companies who are making money from it. But that’s a long way away from our current medical culture. So my bet is on more obesity and more diabetes. Interesting stuff.

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