Optimising for longterm population health
An early working hypothesis for how we are looking at addressing the root causes of system failure in healthcare.
We’re moving to a world where the science is enabling curative therapies, truly personalised medicine and potentially many more years of healthy living. However, at the same time, nutrition and healthcare systems are increasingly at odds with this trend, at best failing to prioritise healthy outcomes, and at worst actively optimising for near term profit at the direct expense of population health.
Profit and health do not need to be in conflict. Indeed, aligned incentives and simplified systems could be far more profitable and better for the consumer. In this DSV Sector we look across the nutrition– FMCG – healthcare – pharma – insurer ecosystem to explore what products and services can unlock healthier living and move the world towards a more balanced and sustainable model that optimises for lifelong health.
Key areas of system failure
Food, exercise, company and purpose really sit at the core of health but are much harder to quantify and monitise than receptor binding. Community and purpose are particularly challenging as they are shifting rapidly, likely constitute little technical defensibility and sit at the meta level across modern society. This is further compounded by a background system of lobbying and perverse incentives which drive the cost of clearly bad food down and into greater prevalence prevalent.
How can we…
- Increase the appeal of healthy food groups, healthier sugar, salt and fat alternatives that taste equally as good and turning low cost, low nutritional value foods into high value foods?
- Join up food and drug based approaches to treating disease, particularly in diabetes, cardio and auto-immune diseases?
- Optimise community drivers from purpose and stress to peer support?
Early detection and personalised care
A large proportion of disease is curable or at least far more manageable if caught early, yet outside of cancer there’s very little incentive for this to emerge. The doctor doesn’t have time or want the responsibility, the hospital doesn’t want the liability, the payer doesn’t want extra cost this quarter.
How can we…
- Create a dynamic of continuous diagnostics and early diagnosis and long-term consumer owned health optimisation?
- Stratify patients so they receive the optimal intervention the first time, and every time?
- Make the patient truly the informed centre of pre-emptive and responsive care?
Financially enabling a curative approaches and outcome based results
Gene and cell therapies and other advanced therapies will maintain a high price-point for at least the next 20 years as the science becomes increasingly complex and the effective patient groups smaller. This simply won’t work for common diseases under the existing insurer models leaving potential cures in the lab and continuing the treadmill of pills patching up symptoms. As such we must explore new financing mechanisms and enable the supporting operational infrastructure across the healthcare stack.
How can we…
- Create incentives across the clinical and payer stack to make curative therapeutics possible at an R&D level, accessible to all and a more profitable option for incumbents?
Initial Opportunity Areas in need of urgent change
The systems level challenges above cut across many disease areas from cancer to mental health and we will build these out in more detail in time. However there are several disease areas where the current healthcare system fails almost entirely and because of this represent systems that with the right approach could quite rapidly be reworked from the ground up. The first of these that we will look at include:
Population dynamics are changing due to the pressure of attaining financial security, changes in religious beliefs and the realisation that there are probably enough people on this planet. However, our reproductive systems are based on caveman times, how can we move reproductive health into an approach fit for the next 100 years?
How can we…
- Create less intrusive contraception (male and female)?
- Enable egg storage in less harrowing, more effective and lower cost ways?
- Remove the challenges associated with the menopause, period pain and pregnancy complications?
- Improve infant health?
- Eradicate STIs?
Mental health is still treated as something that is largely separate from physical health despite the clear links between exercise, food and mental health, and more importantly the increasingly clear link between the gut, immune system and brain. The desire for quick fixes and complexity of the information presented has created a sledgehammer approach such as massively upregulating a transmitter system such as serotonin or basically knocking people out with ketamine depending on your flavour of depression medication.
We need to move towards better stratification, non-drug and drug-based approaches that consider the brain as a complex network and set of states, in concert with the body, that can be nugged in the right direction.
How can we…
- Stratify mental health disease in a way that creates a significant improvement in treatment?
- Leverage placebo effects, especially in auto-immune conditions?
- Address root causes of stress and anxiety?
- Celebrate and optimise for non-normal brain function rather than medicate?
- Shift to non-drug based approaches or companion programmes that optimise the effects of drugs?
At DSV we publish very early thesis with the aim of starting the conversation and we are at the very beginning of our journey into systems level healthcare. There are likely to be very naive elements in what is covered above and we encourage you to get in touch and work with us on building out a better future.