The Have-nots, the Haves, and the Have-mores in Healthcare
Imagine…It is the future. People have been genetically engineered to stop aging after turning 25. But time is the new currency, and people need to pay money to live beyond 25.
Does this scenario sound familiar? That could be because this is the plot of the 2011 movie ‘In Time’, starring Justin Timberlake. It portrays a dystopian world where the rich can become immortal by purchasing time, but the poor struggle to live—literally. As one contemplates such a scenario, it is easy to dismiss the possibility that such a vast economic divide will happen in our ‘real’ future… Or is it?
We live in a world of income inequality. The expression ‘the haves and the have-nots’ has probably been used since the 1700s, but today it might be more apt to say ‘the have-nots, the haves, and the have-mores’—meaning that this inequality has only worsened with time! This problem, as the renowned World Bank economist, Branko Milanovic, argues, also applies to countries, in the sense that a person’s income and global status is determined at their birth, based not only on their parents’ income class, but also on their country of citizenship.
Why does this income inequality matter for healthcare? Poverty affects a person’s ability to access care—or, in the case of most developing countries, access to the best quality care. We are still trying to address these issues; in fact, we are succeeding in doing so, enabled by technological advances such as telehealth, mHealth, and Artificial Intelligence serving remote areas in Africa and China.
But what does the future hold?
The Future Tech Evolution: Affordable to All?
With the fast pace of technological evolution, the realm of healthcare is likely to see advances such as genetic editing, personalized medicine, smart hospitals, smarter cities with tech-enabled public health initiatives, and probably several more.
Will access to these curative technologies be accessible and affordable to all?
The pharma industry prices its prescription drugs at a very high cost, justifying this with the amount of money spent on research and development to develop them, and the high failure rate of potential drug candidates. Given this trend, is it likely that smart hospitals will promise a higher quality of care and faster hospital discharges with better outcomes, but at a higher price than regular hospitals? In the same way, will staying in a smart city be more expensive from an income tax or local tax perspective, because public health initiatives ensure a better quality of life there? Some may argue that insurance companies will benefit from their members availing themselves of high-quality care services, and would therefore be happy to foot the bill. But will insurance companies also increase premiums or co-pays for access to high-quality care?
The Rich and the Others: Current Scenarios
Some of these situations can be very well illustrated with present-day examples: some populations struggle to access basic care, while in contrast the ‘other’ world has access to advanced but expensive treatments to stay not only healthier but to make themselves look even younger. Anti-aging drugs, surgical procedures, and devices are some examples.
Or consider the field of women’s health, where limited access to reproductive health in turn perpetuates the problem of economic inequality. Granted, women’s health has been a neglected area for a very long time, and for a variety of reasons, but this in itself offers a lurid picture of what could happen with technology in the future if this issue is neglected. It is time we stopped to consider this spectrum of women’s health: on the one hand, some women have access to expensive treatments such as laser therapy, Botox, and hormone replacement therapies for the prevention of ageing processes, while other women may not have access even to basic skilled birth care. According to a United Nations Population Fund report, fewer than 20% of the poorest women in Cameroon, Guinea, Niger, and Nigeria have access to skilled birth care.
This scenario puts forwards some rather difficult questions. For instance, does the future offer a similar prospect, where rich people in developed regions could tailor and augment their human bodies to their liking and to enhance their abilities, and could even order synthetic organs (think artificial pancreas) or lab-cultured organs (think stem cell therapy) online, while the poor could lack access to basic drugs? Will we need the Bill and Melinda Gates Foundation to have a team similar to their ‘Neglected Tropical Diseases’ team providing funding in areas like this, where the pharmaceutical industry has not come up with solutions?
The Implications of Neglecting the ‘Health Tech Access Divide’
If the economic divide results in a healthcare access divide, this is likely to create another dimension of the haves versus the have-nots issue. With higher spending capacities, the haves could access better technology, such as bionic rather than regular prostheses, which will give them better capabilities. They could—theoretically and without getting into the ethical and moral considerations—have genetically designed super-babies. They could also avail themselves of deep brain stimulation or other neurological advances to improve their IQ or mental prowess. Those at higher risk of cancers could avail themselves of gene editing technology to prevent cancer occurring, and the list could go on. All this, while the have-nots might have to manage with present-day treatments which fit their budgets! Would not that be a plausible real-world version of the dystopia portrayed in the movie, ‘In Time’?
The economic divide is likely to give rise to another divide between humans—one not based on caste or religion, but this time on how healthy, or how much more physically and perhaps mentally capable, they are. This will further perpetuate the divide, allowing the haves to grow to have-mores, and the have-nots to perhaps shrink to have-nothings! All our current efforts to reduce the income gap and diminish economic inequality will probably be futile by that point.
Are We Creating a ‘Digital Divorce’ in Health Tech?
As we have just started 2018, it is important to think about the implications of these innovations and technology, and the impact that they will have on the future. The Internet may have created equality across the world, but the future of health technology could just do the opposite, creating a digital divide. The real question, as always, is whether we have our priorities right. As a healthcare industry thought leader, watching the industry transform from a slow-moving field into a fast-changing, technology-adopting digital one, I feel responsible for highlighting this issue: are we, healthcare practitioners and thought leaders, moving in the right direction?
In my humble opinion, technological advances must focus on making the benefits of such innovations available to the masses. The mantra of growth by volume might just be a necessity here. Furthermore, the current problems of rising healthcare costs and countries struggling to rein them in could be reproduced in this future scenario, if the benefits are not made available to all at lower costs.
If making innovations globally available to the masses at affordable costs is not made a priority objective, only some innovations will work to improve inequalities in access. The rest will actually aggravate the problem of access, further compounding the basic problem of the income divide. Multiple stakeholders may need to come together, including innovators, manufacturers, payers and governments, to make this possible—perhaps in novel ways and by leveraging unique, unprecedented business models.
