Health care 2.0

aalto_university_magazine_02_healthcare_photo_Miina_Savolainen.jpgAn ageing population, reducing tax revenues and a shortage of nursing staff are some of the dark clouds that are casting shadows on the outlook for public health care. Researchers, who predict a rosier future, are putting their faith on a revolution in medical technology as well as on a fundamental change in the service system.

1. How will health care change by the year 2030?

2. How will future society care for the growing elderly population?

3. What ethical questions will be associated with health care two decades from now?

Academy Professor Risto Ilmoniemi:

1. "In the future, it will be easier to map genes, evaluate an individual's susceptibility to different illnesses and undertake preventative action. The significance of health promotion measures will increase as the share of the working population decreases. People will have to take more responsibility for their own health, and new food products with health effects as well as addiction-fighting medicines will enter the market. By 2030, technology will enable us to make more precise diagnoses and better treatment decisions. We will be able to produce more detailed images of the brain, enabling us to observe its functioning in real-time. There will be more and more personal, portable sensors as well as diagnosis, treatment and aid tools. Artificial intelligence systems will make diagnoses and provide treatment instructions on the basis of measuring sensors, web-stored patient data and other patient-provided information without the patient ever having to visit a health care centre or hospital.

Pharmaceuticals will be complemented by electrical and magnetic stimulation treatments that cause less side-effects and can be targeted more precisely. Such experimental therapies have already been applied in the treatment of depression, pain, migraine and tinnitus. Games, which aim to promote the functionality and learning ability of the brain, are also becoming increasingly common. Information systems and logistics must also develop. We need to adopt the methods, which are familiar from the world of industry, to enhance the effectiveness of operations, reduce medical errors as well as to ensure that nurses are left sufficient time for patient contact."

2. "New technologies should liberate people from the machine, allowing them to spend more time with other persons. Staff numbers may well reduce, but each employee should have more time to devote to patients than they do at present. I hate to use the word robot in this context, but new kinds of machines could be introduced to provide support for work with the elderly. After all, machines that do the dishes or vacuum clean automatically already exist. Robots should not, however, replace interpersonal relationships."

3. "New types of ethical questions will arise. Boosting neural performance with pharmaceuticals, electrical stimulation or games, for example, may not always be risk-free. It may be that, in 2030, society will be debating to what extent it is permissible to manipulate healthy people. Society can probably not afford to offer the full range of available diagnostics or treatments to everybody. The requirement of transparency will in all likelihood force health care providers to engage in deeper debate regarding the principles of prioritisation. Also, while the developed world enjoys access to improved health care, we should consider how technology could serve those less fortunate than us as well. The biggest health problems will continue to plague the third world in the 2030s, too."

Risto Ilmoniemi works at the Department of Biomedical Engineering and Computational Science at the School of Science. He is one of the world's leading experts on MEG and TMS methods, which are used in brain research. During his Academy Professorship, which commenced at the beginning of the year, Ilmoniemi and his research group will develop high-tech imaging systems and apply these methods to brain research.

Project Manager Antti Autio:

1. "The health care service system is facing major changes. Preservation of the welfare state will require us to focus and implement more extensive regional totalities. The search is already on for models with which to combine basic health care and specialised medical treatments. The key to resolving personnel shortages is more effective resource allocation, rehabilitation and the utilisation of the patient's own resources. In a modern hospital, patients will participate in their own treatment and the input of, for example, relatives will help promote recovery and distribute the burden.

In Finland, nurses with college degrees perform routine tasks – such as serve food and make beds – that are in Holland, for example, delegated to employees with some training in hotel work. In future, Finnish hospitals will be able to use people with less training, allowing nursing professionals to concentrate on more demanding tasks. A radical change that is invisible to the patient involves the funding and organisation of the system. The traditional system will have to be dismantled, but, in the best case, the availability of services will improve."

2. "We don't have adequate resources for medicalisation-oriented geriatric care, in which the elderly can reside in the wards of health centres for up to several years. The existing, expensive system must be done away with. In 2030, the elderly will live at home and services will be within rollator-assisted walking distance. Senior citizens will make decisions for themselves and their personal resources will be taken into use. Ward capacity will be utilised for at most month-long rehabilitation spells.

Future pensioners will not settle for what has been on offer to the generations who experienced the war years. A much higher standard will be demanded of services and equipment. Multifunctional city blocks will be designed in a way that places everyday services close to families and the elderly. Neighbourhood shops will make a return and new service models that support communality will emerge. Personalised home-care services will be nearby, but they are only utilised when needed. City blocks will support different forms of housing and subsidies will be available for the housing needs of low-income senior citizens. These solutions may appear expensive at first, but the goal is to keep overall costs manageable instead of scrutinising individual price tags. Such apartment blocks would be challenging for investors, making it essential that developers and municipal authorities cooperate closely in the planning stage."

3. "People will have more responsibility for their personal health in the future. They will participate in the upkeep of their own physical wellbeing, although I don't expect any more additional taxes to be directed at smokers, for example. How people spend their autumn years and the rights an individual is given with regards to the ending of his or her own life will be significant issues of debate. This debate should not extend to the issue of cost. Another question that needs to be pondered is the purchasing of additional time through the application of pharmaceuticals in terminal-stage patients. We must determine whether or not this is a socially supported basic right. Although, on the other hand, it is hard to see how the securing of such treatment at the patient's own cost could be forbidden. The system should not treat people differently based on their wealth."

Architect Antti Autio serves as a project manager at the School of Science BIT Research Centre's Healthcare Engineering, Management and Architecture Institute. He is currently working on a PhD thesis, which examines hospital architecture. He has also contributed to the drafting of the winning proposal in the international Healthcare 2025 service system design competition.

Professor Andy Miah:

1. "The biggest influence on health care will be genetic data – information about people's potential health risks that will inform the way in which people lead their lives and how health care strategies are delivered. We will find a growing commercial supermarket of genetic tests, which will claim to reveal simply health-related information, but which will undoubtedly be construed as lifestyle information. Sequencing individual genomes will make preventive therapy a lot more possible. Integration of digital technology will mean that we take more responsibility for our own treatment and sometimes bypass official medical care. As well, there will be more online and mobile services to monitor our own health. Much of this will take place through voluntary self-surveillance performed with the aid of nanosized devices."

2. "In 20 years, I will be close to the age that counts to be part of the ageing population. My day-to-day needs will be met by intelligent systems that talk to each other. It will get rid of the things that I'd rather not do, so I can concentrate my depleting energy on the things that I really care about. My medicine cabinet will inform my personal physician when I am low on medication and the pills will be delivered automatically. A nurse may schedule a virtual visit in my calendar. This connectivity doesn't mean that I'm alone. Far from it. I will be weaved into a web of friends and family in different parts of the world and we'll be able to continually share our lives through the web."

3. "The biggest moral decision in association with health care is how far society is prepared to go in pursuit of a good life. The end goals of health care lead us to a situation where we make people better than well. The more we pursue the alleviation of health-related functioning, the more we will become superhuman. We see steps in this direction through vaccinations and other technologies that improve our resilience, but, as we do so, we become transhuman, characterized by a biological blueprint that is greatly different from previous generations. If societies decide to pursue life's endless continuation, the ethical dilemma will be to ensure that this takes place in a way that promotes social justice and equality. It won't make sense for such technology to be available for only the rich. People who perform labour-intensive jobs require more resilience than office workers. As the choices become widespread, they will become affordable to all. We will have to give up on essentialist definitions of what it means to be human, as this concept will be shaped more by what technology can allow us to change about our biology, than by characteristics brought about by evolution."

Andy Miah, BA, MPhil, PhD, is director of the Creative Futures Research Centre at the University of the West of Scotland. Part futurologist, part philosopher, his work has grown to encompass all aspects of the way technology impacts on people. Professor Miah gave a lecture at Aalto University in January.

The original article is published in Finnish in Aalto University Magazine 02. Text by Sabina Mäki. Edited in English by Ned Coogan.

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