Healthcare is broken

We need to get a handle on chronic diseases

Photo by Kelly Sikkema on Unsplash

Where are we now?

If 2020 has taught us anything, it’s the value of good health (both physical and psychological), and the fragility of it.

We made huge progress in many areas of medicine over the last century. We can now expect to live 81 years in the UK for example, that’s 24 years longer than in 1920 (life expectancy of 57).

But, with any massive global change and ‘progression’, there are pros and cons. We live life at a faster pace than ever before, we consume a completely different diet due to mass production, convenience and taste, we sit for longer periods, we’re less active, and many local communities are fizzling out. As a result, environment and lifestyle created conditions are increasing at a rate we haven’t seen before — type 2 diabetes, heart diseases, high blood pressure, cancers, and psychological conditions like depression and anxiety, all on the rise.

I’ve written this article to draw out the path we’re currently on, the solutions available to us, and my view on how to address our chronic disease challenges at scale.

An Unsustainable Approach to Medicine

The world is gradually acknowledging that the way we’ve done medicine for the last century, isn’t compatible with managing health in the modern world. Doctors are still taught to treat diseases which have already occurred. But in reality, most modern illnesses are the result of an accumulation of small, automatic behaviours over a series of months, years, and decades.

Treating chronic (long term) disease after the fact is unsustainable. The annual cost of treating someone with type 2 diabetes is around £5000 per year, that’s nearly 2.5 times as much as treating someone without the condition. And it’s anticipated that if we continue on the same track as we are, 1 in 3 Americans will have type 2 diabetes by 2050. You don’t need an economist to explain that even the richest countries in the world will be crippled by the cost of these treatments at that scale.

On top of the direct costs of treating chronic diseases. We have to consider the secondary effects. They have a huge impact on quality of life, productivity and mental wellbeing, often for decades of someone’s life. In the UK, we can expect to live with disease from 61 years old, on average, however more and more people are developing long term conditions, like type 2 diabetes, in their 30s and 40s.

Photo by Jp Valery on Unsplash

Enough Doom and Gloom…..What’s the solution?

Through addressing lifestyle behaviours, we can significantly change our health outcomes. By improving just a handful of our health behaviours while under 50 (like physical activity, vegetable consumption, alcohol intake) we can increase our disease free lifespan by up to 20 years.

‘By improving just a handful of our health behaviours while under 50, we can increase our disease free lifespan by up to 20 years’

But it’s a challenge to get a 20, 30 or even 40 year old to recognise the importance of making changes early, before the onset of disease. And the process itself is hard while we live in a high paced, stress inducing environment. And of course, ability to change is affected by so many factors, including deprivation.

An effective solution calls for a multi pronged approach….

Better awareness and education:

• Communities and individuals need to be made aware of the facts around what causes chronic diseases. Obesity is the main cause for type 2 diabetes, heart conditions, and 30% cancers, and now we know it significantly increases risk of death from Covid 19 infection too. This information should come through public health, GPs, local councils at a minimum.
• Schools and colleges need to provide clear education about nutrition and physical activity throughout school years.
• Facts on their own are not enough. Personalised information on what to change and how to follow through is just as important.

Government levers:

• Governments will need to raise taxes on the least healthy foods, or in some cases prevent production, to reduce consumption of some foods, in the same way smoking has been addressed. But taxing food and drink is more complex than smoking. We need food to survive, and often people’s options are limited by cost, availability, cooking facilities.
• Benefits systems need to support those in the most deprived communities, with access to healthy foods and facilities to prepare fresh meals.
• Exercise should be encouraged through more government paid for exercise classes, more GP exercise referrals, better local sport facilities, safe cycle paths.
• The introduction of NHS health coaches (to support patients with lifestyle behaviour change) this year is a really interesting interesting step in the right direction.

Medicine:

There are numerous medical approaches to treating or preventing chronic diseases and obesity (a precursor to many of these diseases). Here are a few which will grow significantly over the coming decade:

• Genetic testing for personalised lifestyle recommendations or treatments. We’re learning more about the impact of genes on weight, and chronic disease development. The likes of 23andme will develop more accessible test kits for individuals to understand how their genes impact their outcomes, and what they can do about it.
• Biotech and pharmaceutical companies are in a race to develop new pills and drug concoctions for obesity prevention and disease treatment. For example, PureTech Health have been approved by the FDA for their weight loss capsule which fills up your stomach before meals.
• Bariatric and gastric surgery rates are on the up, but with costs of surgery ranging from £5000-£15000, and risks of serious side effects during or after the procedure, it’s no silver bullet.
• Behaviour change for prevention. Preferable to treating disease or obesity, is preventing it. Costs are lower, and results can be very effective. People diagnosed with type 2 diabetes can even reverse that diagnosis and go into remission through behaviour change alone.

Health Technology:

• Digital technologies can enable solutions (particularly behaviour change solutions) to scale rapidly. They offer personalisation, tracking, and are ‘always on’. Just last month, the UK NICE published new formal guidance, recommending the healthcare commissioning of digital and mobile approaches for behaviour change, based on a mounting base of evidence.
• The big tech giants (Google, Facebook, Apple, Microsoft, Amazon) are all taking steps into the health arena with various evolving focuses, from wearables, to at-home care tools, to tracking apps, to entirely new healthcare services, like Amazon Care.

Photo by Angus Gray on Unsplash

The Future

The current approach, to treat patients after diseases have set in, is going to become completely unsustainable. Successful prevention of chronic disease requires behaviour change, and behaviour change is hard.

We need to make lifestyle behaviour change achievable. We need to make it accessible to millions, if not billions, and we need to act fast.

Within 10 years time, most of us will be supported by a highly intelligent and personalised digital health coach in our pockets, or on our wrists. Emphasis on the word ‘coach’. The digital coaches of the future will be informed by an individual’s genomics, lifestyle, and millions of data points. To make lifestyle changes possible, each individual will be provided with the right information, nudges and rewards, at the right times. And crucially, they will coach how to make gradual, consistent and lasting changes, as opposed to the traditional boom and bust diet approach. We all know that we should eat better and exercise more, but an effective coach helps us to understand exactly which steps to take each day, why to take them, and motivates us to follow through. Without the ‘coach’ element, we’re on our own again.

‘We all know that we should eat better and exercise more, but an effective coach helps us to understand exactly which steps to take each day, why to take them, and motivates us to follow through’

We launched Holly Health to meet this need. Holly Health provides an effective, accessible and scalable digital coach for health behaviour changes (both physical and psychological). We will be ready to operate in clinical environments in 2021. If you’re interested to learn more, please reach out using hello@hollyhealth.io.