Promoting Health

Are We Asking the Wrong Questions About Investing in Child Health?

By: Scott Orsey

Are we missing the mark when it comes to how we best invest in children’s health? Perhaps a futuristic look at the transportation sector may hold relevant and innovative solutions to transforming healthcare.

I recently had the opportunity to listen to Tony Seba deliver inspiring and motivating remarks at a conference. Tony is a futurist who is famous in some circles for predicting the disruption of our automobile culture. His rationale is fascinating. He discusses the convergence of a number of technologies including batteries, electric vehicles, autonomous driving, solar energy and ride hailing services. His prediction for 2030 is that the vast majority (somewhere like 80 percent) of all passenger vehicle miles will be through what he calls “transportation as a service” (TAAS), where people will opt to pay $100 a month for transportation subscriptions over purchasing vehicles. This, in turn, will dramatically reduce the need for parking lots and the number of personally owned vehicles will decline.

How does he make this claim? He bases his argument in his studies of disruptive technologies and innovation adoption. This transformation, he posits, is possible due to predictable technological advancements – advancements like Moore’s law that show computer processor speeds double every two years. Similar trends, like the relentless reduction in battery costs, are predictable and facilitate these new products and services.

Seba’s thought provoking presentation made me reflect. What if we are asking the wrong investment questions in health?

Watch a version of Tony Seba’s talk here.

In community child health circles, we have a wicked problem. We know that interventions addressing social needs demonstrably improve health outcomes and ultimately reduce the cost of our health system. Because we know this, we want to install programs that address these concerns, but our society doesn’t do a good job of funding these interventions so they are not universally accessible. How do we pay for them? That’s a sticky challenge.

To the casual observer, there could be a business case here somewhere. We could tally up the intervention costs and compare them to the benefits. Performing the right mathematical calculations, this information would produce an estimate of Return on Investment (ROI). If the ROI is high enough, then we can make the case to invest in the intervention and reap the rewards sometime in the future.

There are health conditions where this analysis has already been performed, and ROI is decidedly positive. Asthma interventions, for example, have been proven again and again to be less expensive than the alternative of children missing school, parents missing work, and sufferers seeking the emergency department when experiencing an acute attack. There are other conditions with positive ROI where the outcomes are not realized in short-term cost savings, but are spread over a long time as improved health and well-being. Good nutrition interventions – avoiding obesity, diabetes and heart conditions – are good examples. There are still other conditions with positive ROI where the benefits are in some domain completely unrelated to healthcare. For example, consider how early interventions regarding behavioral concerns might impact costs in such domains as education or juvenile justice.

Is calculating the ROI on these interventions answering the best investment question?

What if once we calculate the costs, we instead use them as the benchmark against which to compare competing approaches? If an approach can disrupt this cost model in the same way that long lasting, autonomous, electric, ride hailing vehicles can disrupt the current individually owned, consumer vehicle market, then that, certainly, would be worthy of our investment!

So what does it take to successfully raise a healthy, happy and well child? We know the determinants that contribute: genetics, environment, behaviors, and healthcare.  Perhaps we should look at the rate of technological advancements in each of these to identify opportunities for disruption.  What is the convergence of these technologies that will transform the status quo?

Let’s tackle the domains one at a time:

Genetics:

We know that genetics plays an important role in health and well-being. We have evidence that some children who grow up within adverse conditions become healthy and successful adults just as there are examples of children who grow up in healthy environments that have non-optimal outcomes. While medical science has made great strides in identifying genetic predisposition to the most chronic and complex health conditions, might it also be able to identify those with less severe genetic predisposition to the influence of other health determinants? The costs of genetic testing and the accompanying big-data technology are dropping incredibly fast. Perhaps we are just a few years from when we can reliably identify these markers.

Environment:

It’s been over five decades since Lyndon B. Johnson first declared the war on poverty, yet we are no closer today to winning that war than we were back then. This fact is humbling and hints that we are unlikely to improve the environmental conditions for all through the traditional approaches we are taking. However, we know that the environment is important to health and well-being because of how it triggers response within the body. Chemical toxins inhibit natural biology. Toxic stress inhibits neuron growth. We’ve already seen explosive advancement and adoption of wearables and implants. Might new technology be capable of monitoring our body’s response to better fine tune interventions? Could it be possible to identify the moment that an adverse experience or environmental exposure occurs?

Behavior:

Just as certain behaviors put us at risk for chronic medical conditions, behaviors play a big role in children’s long-term health and well-being. We know that children who experience multiple traumatic events grow up to be less healthy and earn less as adults than children who don’t. We also know that a caregiver can provide a buffer to mitigate the impact of trauma. Adults need this knowledge and connection to others to be successful parents. We already have technology embedded in our mobile phones to stay connected and link to nearly any piece of information we need. Might this same technology be capable of nudging us to modify our behaviors in real time to improve the outcomes for our children?

Healthcare:

Quality healthcare delivery is incredibly important, and in those areas that we traditionally think of as “health”, such as complex or chronic conditions, we have an amazing system in place. The next frontier will be to expand our definition of healthcare delivery to include linkage to other sectors that have been shown to strengthen children’s well-being. This is so-called population health, where care not only includes those services delivered in a traditional health care setting, but also includes those that are available in the community where people live, work, learn and play. These services exist today, but are generally inaccessible, too expensive or inefficiently applied to reach all who might benefit. Might our system become more integrated?

From my vantage, it’s not far-fetched to imagine ten-fold improvements and cost reductions in each of these domains in the very near future. When these converge, disruption is a certainty.

Like Tony Seba’s TAAS, we would achieve Health as a Service (HAAS). This would differ from our current transactional health delivery system in important ways. It would be on-demand, comprehensive and extend far beyond the traditional definition of healthcare. It would identify needs and concerns upstream and would deliver near-immediate feedback or intervention. It would be highly personalized, making it far less intrusive to our daily lives than the more bluntly applied interventions of today.

Our efforts will be embedded in a system that is so much more efficient and targeted in the future, that asking our original ROI question would become moot. We might be better off asking where we can invest in innovations that promise to transform the way we approach our health.

Scott Orsey, is the associate director of operations, business strategy and institutional engagement for Connecticut Children’s Office for Community Child Health.

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