Do communities hold the secret to revolutionising healthcare?

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Medicine has been overhauled by a century-long boom in scientific advances. So why are people getting sicker? A new movement names community as the long-neglected ingredient for successful healthcare.

Ever since penicillin was discovered in 1928, the medical industry has been rising in leaps and bounds. Global life expectancy more than doubled from 1900 to 2015 and vaccinations, insulin and surgical advancements all played a role. Today, scientific communities are caught up in giddy apprehension for an even brighter future thanks to tech. Some say 3D printing, artificial intelligence and genetic mapping will pave the way to a glorious new era for human health.

There is one small problem with this optimism, say the critics: the inconvenient fact that people are now getting sicker. In the West, obesity is becoming more common and that’s undoing some advancements made by technology and drugs. Diabetes, heart disease and even certain cancers are becoming more prevalent. We are living longer but spending more years unwell – and that’s a conundrum AI and 3D printing doesn’t have an answer for.

Pritpal Tamber is one such critic – an independent researcher who funds his work by consulting and speaking with international bureau Speakers Corner. Pritpal is concerned with bridging the gap between communities and medicine and he has some big predictions for the future of healthcare.

“It’s pretty clear that the days of big hospitals are numbered,” says Pritpal as he explains the findings of his research. Pritpal believes healthcare interventions would see more success if they were done with communities rather than to them. “The kinds of conditions we’re getting now require changes in social context more than more hospitals,” he says.

Since 2013, Pritpal has been investigating attitudes about health – among real communities, as well as medical professionals. He found a huge divide: communities have different perceptions and priorities, which affects how they respond to medical intervention.

“It’s clear to me that health care’s priorities are not the same as many communities’, and we do not have mechanisms to find, and build from, the middle ground. This is, I believe, partly why many communities are getting sicker,” Pritpal theorises.

So, Pritpal looks for community-oriented practitioners operating from that middle ground and attempts to identify shared principles that sector professionals can learn from. He believes this is better than focusing on tech – especially for low-income communities. “Tech is always over-sold,” Pritpal cautions. “And when it underwhelms, it’s rebranded by tech entrepreneurs and management consultancies as a way to pull the wool over our eyes.”

“Health IT was a huge failure – and an expensive one,” says Pritpal. Google Health was the most infamous brand to flop way back in 2011, and its creator said the failure was due to the platform’s lack of social credentials. In other words, it was useless at engaging with communities.

Pritpal is sceptical about the rebrand of health IT to digital health, despite some recent successes. “We’re now being sold the potential of artificial intelligence but I suspect it’ll underwhelm as its predecessors have.

“Health and care are complex topics and trying to apply AI lessons from Fast-Moving Consumer Goods and the like is largely pointless, if not irresponsible. Tech also has the potential to further disadvantage disadvantaged communities. It’s a dangerous tool.”

Strong words, then, but they aren’t without basis – digital health trackers like Fitbits have largely remained a middle-class obsession. Lower-income communities simply don’t engage in the same way, says Pritpal.

“It’s increasingly clear that we cannot rely solely on the provision of ‘services’ to help people stay healthy and recover from sickness. Individuals and communities need to participate too.

“But we need to be careful in assuming middle class, university-educated notions of participation. That demographic tends to understand the importance of participation – which requires agency, the ability to make purposeful choices. Many others do not.

“It’s important that any attempt to foster greater civic participation has a deep understanding of what agency is, how it might be fostered, and what barriers to its fostering might exist. Without that, we’ll only widen the inequity already growing too large in society.”

Pritpal says professionals should put people back at the centre of what they do. “Medicine has become an industrial machine that is brilliant at finding new things and trying to treat them,” he explains. “The problem is that, while that’s an amazing growth model for the sector, it’s not coupled with a growth in value for people. Just because we can label something with a diagnosis doesn’t mean that we can or should treat it  – or even label it.”

He predicts that there will be a growing backlash against the medical industry if it fails to create social value – which could be achieved by wedding medicine with social care. He also urges developing nations to learn from failures in the USA and Europe.

“Crudely, Europe is both ageing and getting fatter,” Pritpal surmises. The problem for ageing populations is that “social care does not scale well because it is such a labour-intensive industry.”

With obesity, many conditions can be treated. But, “we’re not very good at it because they’re at the mercy of people’s social context more than the quality of their health care.”

These problems are rooted in lack of community integration – and they make healthcare spending less efficient. Pritpal says this is why Europe is facing “a bottomless pit” for financing health and social care. Innovations simply can’t keep up.

Slowly but surely, providers are beginning to understand the importance of integrating health and social care. The NHS plans to recruit 600 mental health social workers by 2024, for instance. But, there is still a long way to go before healthcare is seen as a collaborative, localised effort rather than a medical assembly line.

One factor that could slow down progress – for good reasons – are the benefits of a top-down approach. After all, the steady rise of obesity may be linked to how modern farming techniques shape the immune system – and that’s not something communities can tackle alone. Likewise, community health can’t manage the food industry’s sugar problem. But, it may hold the secret to making people happy and well – which, from penicillin to robotic surgery, has always been at the heart of medical innovation.

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