I can’t see the demand for health care ever falling.
Through biological research we’re diagnosing more, and sooner, and also treating more. We’re also living for longer, which means more diseases seeing as so many are age-related. We’re not even living well, which means more lifestyle-related diseases. The keyword is ‘more’. There are more and more reasons to demand more and more health care.
Health care is also getting more expensive (another ‘more’). People think it’s because of ageing populations. In fact, health care is getting more expensive because the industry is charging more. Health care is more expensive because health care has decided to be more expensive.
When I was the Physician Editor of TEDMED I thought I was going to see examples of how we’ll cope with this unstoppable growth in demand. But of the 1600 nominations I reviewed for the stage programme only three offered any promise. What the three were doesn’t matter. What matters is the state of thinking and innovation in health care.
Given the colossal size of the problem why are our ideas so small?
In early 2013 I set about trying to understand this. I spoke to as many people as possible and shared what I learnt through a blog. I saw it as an ’exploration’ because it seemed clear to me that no one has all the answers. Some people think they do and yet their wisdom is based only on theory. That’s not enough for me; I want to see working examples in the messiness of the real world.
Fast forward to today and I have learnt a lot (including the need to keep learning). A physician leader told me unequivocally that health care doesn’t have the answers. A nurse told me patients see their diseases differently to health care professionals. A community activist told me that health care professionals often fail to understand how their advice runs counter to people's cultures.
There’s a disconnect between the health care system and the people it purports to serve. At the heart of this disconnect is the definition of health. The health care system has a clear, bio-medical definition that revolves around sickness. Treating it is the job of health care, preventing it is the job of public health. All sickness must be responded to. And yet in a world of chronic diseases – diseases that may become fatal in the long-term but are more nuisances in the day-to-day – they don’t necessarily sign-up to this bio-medical view of, and absolutist approach to, health.
I learnt that people can feel healthy despite the presence of disease. And I learnt this was because they have a broader definition of health. Their definition encompasses things like safety, physical functioning, financial security, emotional security, nourishing relationships, and a sense of control over one’s life. People balance their bio-medical health with their own definition of health.
I’ve become interested in how people and communities can pursue their own definition of health. Some of the people I have spoken with agreed to meet, to share their work, expose their struggles, and seek guidance from one another. This meeting lay the foundations for the Creating Health Collaborative, a community of entrepreneurs and intrapreneurs working individually to understand and create health as defined by people and communities (or ‘beyond the lens of health care’, as we say).
People ask me what the Collaborative is. Is it a think tank? A form of academia? Something for policy advocacy? The truth is I don’t know. All I know is that we need to deepen our thinking in health and I prefer that to be driven by real-world practice rather than abstract pontificating. Ultimately the Collaborative is about exploring through prototyping. If we can understand how to create ‘health beyond the lens of health care’ we may be able to establish a counterforce to the growing demand for care.
It’s not going to be easy but the time for small ideas has passed.