FREEDOM AND SAFETY
My mother died of Covid-19 at the age of 91. She was recovering from surgery in an assisted-living facility in Durham, North Carolina. While she had previously been healthy, the virus aggressively invaded her body, and her doctors soon told us there was nothing they could do. We were allowed one brief compassion visit. My sisters and I suited up in head-to-toe PPE to be with my mother for 20 minutes. She was unresponsive, but I hope she knew we were there. She passed away a few days later.
My family’s heartbreak is not unique. We share it with more than 200,000 American families. In communities of color, this heartbreak is not even uncommon. Discrimination, lack of access to health care, and poverty all increase the risks for Black and brown people. In my own Black, mostly working-class family, almost everyone has a friend or in-law who has died from Covid.
But this heartbreak is avoidable. While coronavirus has proven devastating around the world, it has taken a particularly deadly toll on the United States. Our elected leaders bear much responsibility for this, but our deeply flawed health system is also to blame.
A system that prioritizes top-notch healthcare for a small number of people rather than prevention and quality care for everyone will never perform well in a public health crisis. The US spent $3.6 trillion on health care in 2018, but Americans live shorter, sicker lives than people in many other wealthy countries that spend a fraction of what we do. We also have glaring health inequities that leave Black, brown, and Indigenous people, and folks who live in under-resourced rural areas, with greater health threats and lower life expectancies.
Covid has alerted us to a pressing need: It’s time to design a future for US health that’s centered on people.
Systems change is a big but worthy endeavor. Changing a system means anticipating what it might have to deal with in the next 20, 50, or 100 years. FORESIGHT, a nationwide health initiative I help lead, recently released a scan of many health trends and emergent issues. They include the increased prevalence of technologies like AI, gene editing, and digital fabrication. The future will also hold recurring pandemics, climate crises, and shifting racial demographics.
We brought a diverse group of people together to review these trends and emergent issues and develop scenarios of what the future could look like. These scenarios aren’t intended to be predictions, rather they’re supposed to kickstart a collective imagining of how today’s trends and technologies could influence the future.
One future finds the “pandemics of the 2020s” have driven many city dwellers to leave their hectic lives and settle in self-selected kinship groups called Eco-Hubs. These Hubs offer access to a better quality of life, shared and local ownership, slow growth, and environmental sustainability. Collaboration with government and corporations gives Hub residents access to advanced technologies, including education robots that serve youth and well-being robots that fill health needs. People living in Hubs both fear and rely on city cultures and big manufacturing and agriculture systems; their relationship with the outside world is always delicate.
Another scenario explores swapping out economic benchmarks like GDP for people-centric benchmarks measuring human well-being. Here, viewing the costs and benefits of our system through a different lens incentivizes stronger public health, housing, and education systems. In a particularly automated future, in which corporations have become collectives, health care includes on-demand services linked to health data from sensors in watches; drones deliver medicine; and health is more strongly connected to food and land with a Food-Land-Health partnership between large food companies and family farmers.
In a darker scenario, environmental breakdown forces people to leave southern and coastal regions for colder, midwestern areas. Climate migrants and community “long timers” satisfy growing populations by farming vertically, mass producing food, and creating inexpensive housing with 3D printing. But a growing gap between haves and have-nots threatens to destroy this system as tensions rise and resources become scarce.
In the strange year that has been 2020, we are already seeing a glimpse of the future right here in the present. We can imagine how dramatically this year’s developments will transform our health and well-being in coming decades.
Real systems change calls for true collaboration - not shouting each other down - and who does the collaborating makes all the difference. If we leave everything to the people who traditionally hold power - leaders from business, politics, and beyond - it will not get the job done. If everyday people do not recognize their own priorities for health and well-being in our system, it will only cause disconnect, distrust, and frustration. And as we have seen over and over in our streets this summer, frustrations can easily boil over.
When we don’t plan for change with an eye toward the future and people at the center, we miss opportunities. Consider the conundrum of texting and healthcare. Americans sent over two trillion texts in 2019. Most health consumers would prefer to get information - reminders about vaccines or answers to simple medical questions - over text. But texting, which is a mature technology at this point, is regulated by out-of-date laws. As a result, our system remains stuck in the 1980s and patients cannot use text to access essential health information.
Real systems change requires that we shake things up and bring everyone to the table to talk about the future, especially people who have traditionally been left out. As a health technology CEO, I know there will be a seat for me. But my nephew who drives a bus in New York City and fears Covid should also have a seat. My cousin who does not trust a future vaccine for the virus - she should have a place too. The uninsured immigrant who cannot find a Spanish-speaking doctor - pull up a chair for him. We can collect the wisdom of everyday people and harness it to empower business, nonprofit, and civic leaders to create meaningful change.
Covid-19 is a wake-up call. Let’s use it as an opportunity to put people - our nephews, cousins, and friends - at the center of our future health system.