Socializing Health

Today’s health systems were designed under very different demographic, logistical, social and clinical variables. The increase in life expectancy, for example, is forcing us to move toward healthcare that will need to respond effectively and sustainably to the growing demand for noncommunicable diseases (NCDs). And it will have to do so under strong financial pressure, as well as under the no less significant pressure of an increasingly educated and demanding public, which has, by and large, embraced technology.

Diabetes, the great epidemic we were talking about before COVID-19, is one of the greatest health challenges of the 21st century and a threat to the sustainability of health systems around the world and in Latin America in particular, owing to its high prevalence and the shortcomings of public health systems. For example, Mexico has the highest DM prevalence of all OECD countries, affecting more than 15 percent of the population (OECD, 2017).

The management of diabetes, and care for chronic diseases in general, remains inefficient, poorly taught, analogue, face-to-face and labor-intensive.

The technology that could solve part of the problem is already available, but we have been attempting to transform health systems for years, with scant success. It is only now, with the global health crisis caused by COVID-19, that we have opened the floodgates to innovation, collaboration and the massive adoption of digital technology to address the current situation.

So, what now?

In a "post-COVID world", patients need to be guaranteed:

• Access to care
• Access to information
• Access to treatment (medicines and devices)

And all this with minimum mobility and maximum efficiency for the system.

All this requires a totally different health model. But do we have the capacity to transform our health systems? Are we on time to do so? I am talking about technological infrastructure, the re-engineering of processes, the training of medical personnel, adapting the regulatory framework, overcoming administrative bureaucracy and fitting into the political agenda.

I am making a deliberate association between the health system and the public health system, assuming that there are more agents in the “game,” but betting on the notion that the guarantee of universal healthcare and scale can only be assumed by the public sector. An administration should be open to public-private collaboration in order make the innovation needed possible, and at the necessary speed. And it must be truly believed that putting patients at the center of care means endowing them with the ability to make decisions and organizing services around them, and not the other way around.

Returning to diabetes, its treatment is based mainly on data management and on the patients' own decisions about their lifestyle. If we depend so much on them, let's play that card to the fullest.

In the region, healthcare expenditure related to diabetes is estimated at between US$45 million and US$77 million, and this is expected to increase to US$130 million by 2040 (forecasts before the COVID-19 pandemic). We also know that 70 percent of expenditure is due to complications. These are problems that can be avoided with good metabolic control.

Diabetes, and the entire metabolic syndrome spectrum, is going to become an increasingly pressing public health priority, and if we want to accelerate the response, we need to put the solution in the hands of patients:

1. Turning technology into “digital” therapy (which we already have)
2. Socializing this technology

In other words: Digitalizing diabetes and socializing the technology that allows it.

Technological advances, attitudinal shifts and the ubiquity of personal devices open a new door to facilitating better diabetes self-management: let's put the doctor in the patient's pocket thanks to smart apps that generate personalized insights from data, universally and openly collected from devices, whatever their origin.

This will allow each patient to become a consumer node and generator of digital information. For example, carrying their medical history with them and sharing it wherever they go, thus breaking down the silos of the system.

Nodes of an infrastructure from which we do not have to actively seek data, rather data is collected automatically to provide a decision-making support system for both patients and professionals.

An infrastructure to which a specific public or private healthcare provider can be connected, in line with its degree of digital readiness.

A platform on which different stakeholders (caregivers, payers, retailers, pharma industry, researchers, etc.) can design new user-based services by generating patient-centric value chains to ensure:

• Access to care
• Access to information
• Access to treatment (medicines and devices)