Draft of Speech for United Nations Rio + 20 Pre-Conference
Stanford University Campus, 2/3/2012
By Eric Dishman
I am very honored to be here today on behalf of Intel Corporation and our joint venture with GE, Care Innovations, to help celebrate the 20-year anniversary of the Rio conference and to help plan for the next 20 years of sustainable development and innovation. I realized as I prepared for today that my own career as a social scientist in high tech, focused on home health and independent living, has paralleled those 20 years. In fact, it was the summer of 1992 while working for Paul Allen, the co-founder of Microsoft, at his think-tank in Silicon Valley when I designed my first remote patient monitoring prototype to help monitor the heart rate and blood pressure of seniors who found it too challenging to get to a doctor’s office for a check-up. What was vision back then is a much-needed reality today. If you take only one message away from my comments here this morning, it should be this: if we are to develop sustainable, worldwide healthcare systems, we must build a workforce, a business model, and a technology infrastructure to take healthcare home.
For a moment, I ask you to visualize in your imagination the oldest person you have ever known. It could be a parent, a grandparent, a neighbor, a former boss. Just capture their image in your mind, when they were at their oldest. What did they look like? Their clothes? Their hair? (Or lack thereof?) What surprised you about what they could still do at their age? And what depressed you that they had lost? Now look around this auditorium and imagine a fifth of the people here sharing the same looks, needs, and capabilities of that oldest person you can remember. Now you will begin to have a sense, thanks to so many advances in healthcare, agriculture, and technology, that we have a “longevity challenge” ahead of us. It is most striking when you realize that back in 1950, there were only 3000 centenarians on our planet but, by 2050, demographers believe there will be more than 6 million people over age 100! It is, indeed, a swiftly graying planet.
The Rio conference in 1992 served as a wakeup call about Global Warming and helped to energize innovation and investment in climate change sciences and industries. But Global Aging, by comparison and with every bit as much impact on our global economy and lifestyle as Global Warming, has received inadequate attention and investment. Thus, Intel, a company whose history and heart is about trying to solve big, audacious societal challenges through computing, started about 12 years ago to study Global Aging. Over this time, our social scientists, engineers, and designers have observed over 1000 elderly households and 250 care facilities in 20 countries. This body of work has helped to fuel everything from new products and businesses like those in Care Innovations to policy work in the U.S. and the European Union to our current work with China on “Age Friendly Cities” as they strive to move 90% of their care for older people to the home by 2020.
As part of that fieldwork, almost a decade ago, I spent time studying rural villages throughout Europe to try to figure out how to deliver healthcare to those resource-limited communities. In one town in particular, the local leader—sort of the unofficial mayor—drove me out a few miles from the center of the town to show me an empty lot that he and others in the community were attempting to buy to build a hospital. He proclaimed to me: “If you have a hospital, then you have arrived as a community…you have made it!” They were doing everything from bake sale fund raisers to major capital campaigns to try to build a hospital for their isolated region.
About a year ago, I checked in on their “progress,” and it was a sad story. The unofficial mayor had died of emphysema, and the group of investors in that community had never been able to raise the money for such an expensive endeavor as a hospital. They had lost their down-payment money (and, in some cases, their retirement nest eggs) in the midst of the financial mayhem of the European debt crisis. And the lot, to this day, sits empty, with nothing but a gravel parking lot and bushes and trees poking up through a lone, crumbling sidewalk to nowhere. Perhaps most tragic to me is the lost decade—two decades, really, from when they had first started—of having no care available for the local people of that town in the interim.
Herein lies some of the thinking about healthcare development that I want to try to “un-do” today. The notion of a hospital as a symbol of “having arrived”—of economic and technological progress—is not surprising, but also not very healthy in the long run. I ask you to consider the idea that real progress—truly successful innovation—would be to use hospitals only as a last resort and to build out a 21st century healthcare infrastructure that shifts care to the home and community, that focuses more on prevention and early detection, and that is accessible and affordable for everyone. As a global society, we need to accept the idea that the hospital as the end goal—as the marker of medical progress—no longer fits our needs. In the midst of Global Aging, a hospital-centric model must somehow begin to give way to a home-centric model for the future.
So how might we begin to get there—how do we begin to take healthcare home? I’m somewhat notorious at Intel for coming up with alliterative phrases, and today will be no different. As you break out into workgroups this afternoon at the conference—and as you prepare your national strategies back home for the Rio conference in June—I urge you to think about the following “3Cs”: Connectivity, Careforce, and Community.
By “connectivity,” I mean many of the connection technologies already discussed here at the conference today. In particular, how do we insure we build a broadband infrastructure that is ready for 21st century healthcare delivery all the way to the home? So many countries are rightfully investing in fiber or wireless of many types and flavors, but they have done little to define requirements for the kinds of healthcare needs we will have in a graying world. We can’t let digital movies and music be the only source for driving our requirements for broadband networks. Healthcare requirements—for a virtual visit with a doctor, vital signs capture from the home, a sensor network for helping to prevent falls, a security solution that protects patient data from the bedside to “the cloud” and all points between—should also be part of the mix. We must come to ask: Do we have the right speed, security, network redundancy, packet prioritization, and other capabilities to make the home a plausible, affordable, and safe node of care?
Connectivity technologies and innovations for a 21st century healthcare “grid” abound. For example, Intel has recently worked with doctors and officials in Mexico to build a solution called “Medicina a Distancia” to bring hospital quality expertise to remote and rural parts of the country. I know many of you here have been working on similar telehealth initiatives to bring the access and expertise of the city to rural areas, which is an amazing beginning. But we still treat such telehealth encounters as the exception to a face-to-face visit instead of the norm. We have to make the face-to-face visit the rare exception. And to do so, we have to carry the “last mile” of that connection all the way to the patient’s home, workplace, and community for some rather creative applications that drive prevention, wellness, behavior change, and adherence to a care plan.
For example, years ago, researchers in Intel Labs in Ireland took off-the-shelf GPS technologies and an internet connection to prototype an online service that allowed senior citizens who still could drive their cars to share their weekly routing information online with frail, home-bound seniors who could no longer drive. Pretty soon, they were carpooling and sharing rides all around town, getting people out of the house, and offloading the local healthcare authorities who didn’t have time or money to check in on each homebound elder. The connective power of the internet can unleash amazing social support systems that we have only begun to tap into as a society; we must leverage this connectivity if we are to give everyone access to high quality care.
The “second C” I ask you to think about is what I call “careforce.” That is, how do we use information and communication technologies to help skill-shift care to increasingly informed and empowered patients, friends, neighbors, and community health workers? In the era of Global Aging, we simply cannot train enough doctors and nurses to catch up with the demographic realities of the age wave, so we must come up with creative ways to better leverage the family caregivers and community workers who already provide the bulk of daily care anyway. Online training and time banking tools for volunteers, social support networks, decision support tools…all of these can be key enablers for a 21st century careforce that must learn to assist and complement the hard work of increasingly scarce doctors, nurses, and highly trained medical specialists.
To help achieve this end, we recently launched the “Intel Skoool Healthcare Education Platform” for multimedia content and assessment on mobile computers in Sri Lanka. This program seeks to expand and to give technology training to 1 million healthcare workers in developing countries by 2015. This will also entail delivering basic electronic health records to children in 5000 schools by that same year. Furthermore, Intel social scientists have continued to study “team based care models” around the world to help figure out what new tools and workflow training is needed to do virtual, coordinated care between general practice doctors, nurses, medical assistants, volunteer community health workers, and patients themselves. We believe developing a tech-savvy careforce—and the coordination tools to support them—is crucial for a sustainable healthcare system in the long run.
The third and final “C” I ask you to consider is “community.” I opened this talk with the call to “take healthcare home.” While I sometimes mean specifically building care capacity in the actual homes of citizens—and that is certainly a focus for our Care Innovations joint venture—I also more broadly mean that we have to move beyond hospital-and-clinic-centric models to home-and-community-centric models. In short, we must learn how to place-shift care to these more inexpensive, accessible settings—for diagnosis, treatment, and prevention. And we must learn how to design buildings and neighborhoods where care-at-home is a priority, instead of an after-thought or a panicked, expensive retrofit for our parents’ homes after they have already become ill or injured.
This may involve putting a telehealth unit—like our Care Innovations “Guide” technology—into the actual homes of chronic disease patients, who can remotely collect their vital signs, get just-in-time video coaching or content, or hear reminders for medication and other behavioral supports. Or it may mean using a health kiosk at the workplace or library or grocery store for a quick checkup, instead of an often un-necessary, expensive pilgrimage to the clinic. Our social science team has been studying models like the Veteran’s Administration Home-Base Primary Care program in the U.S. and various “hospital at home” models in Europe to understand just how much care can safely and effectively be done in the home. As a result, we have come to believe that each nation should be exploring how to achieve the goal of shifting at least 50% of care done in hospitals or clinics today to the home or community by 2020, as a starting point for building a sustainable healthcare economy!
These 3Cs provoke us to ask questions—and to challenge long-standing assumptions—about who delivers care, where it gets done, and how it is funded. And they ignite possibilities for connectivity and computing technologies that we have only begun to explore. In no way do I mean to suggest that we should become “anti hospital” or that clinics and hospitals will go away completely. But we should build and use fewer of them—so that we reduce our dependency on those expensive settings that require more and more of society’s resources to maintain. And we should focus our energy and investment, instead, on building out this “healthcare grid” to the home and community, thus offloading our overburdened mainframe medical systems. At an individual level, these questions can also help us to think about how each of us might reduce our “clinical footprint”—much as we have our carbon footprint—by taking ownership of our own health, wellness, and prevention in a proactive way to reduce our impact on the medical system.
Thanks to the ripples of innovation and policy change coming out of Rio 20 years ago, all of us in this room now know “Global Warming” as a megatrend to contend with. We all now know that there is an international race to be at the front of the pack for developing “green technologies” and “green jobs.” And we now know that, in many cases, developing countries may well leap ahead of developed countries in innovating eco-technology because they do not have the “old way of doing things” to maintain and defend. Their historical lack becomes their potential future gain.
I suggest to you that Global Aging is no less urgent or impactful than Global Warming—it is the other inconvenient truth which has been too long ignored or glosses over. Longevity is a societal “success catastrophe” that requires new thinking and new investment by all of us. Thus, perhaps together, here today, we can move towards making Rio 2012 the beginning of the wakeup call for Global Aging. So too, developing economies may well achieve a 21st century healthcare system faster than the developed world because there is no old, hospital-centric way of delivering care to protect. Many of you have the chance to move straight to a home-and-community-based care model. I hope these 3Cs help you to think about that possibility. I hope they help ignite your country’s efforts to develop “gray technologies” and “gray jobs” to address the global needs of the more than two billion people aged 60 and above who will share this planet—who will inhabit this room with us—in the not so distant future of 2050.
So, in closing…let’s have no more empty lots waiting for enough cash to build the mega hospital complex that says our community “has arrived.” Let’s use the widely available, increasingly affordable connection technologies that are already here in our midst to build a new kind of healthcare system—a 21st century healthcare grid—that is available and affordable for everyone….in their workplaces, their communities, and their homes. Let’s build a society in which aging-in-place—in which independence—is a reality, even for those who celebrate more than 100 birthdays.
Thank you. And I look forward to joining you in the breakout sessions and in this noble human endeavor!