Ogilvy's 2010 report on the future of healthcare reflects on significant advancements by 2015, such as the integration of cloud-based electronic health records and the rise of consumer wearable technology that empowers patients to self-monitor their health. By 2020, the report envisions even smarter homes and systems promoting preventive health through genetic profiling and enhanced patient engagement via technology. Despite optimism about technological advances, the report stresses the importance of public education and communication for sustainable healthcare improvement beyond 2020.

2. Back in 2010, Ogilvy produced the following report
on the future of our Healthcare system with a
10-year horizon. Five years down the line, we can
now take the opportunity to reflect to see how close
their interpretation of early signals of technical and
social changes, are to becoming reality. In 2015,
we can already see clear motions of change.
Clinical IT systems, traditionally once only
updated by healthcare professionals, are now
being continually updated via cloud-based
electronic health records (EHRs) that integrate with
multiple third party devices. Patients can access
their own EHR, and update it with their own real-
time data collected from wearable technology.
This wave of a new generation of consumer wearable
technologies are activating patients and encouraging
them to self-monitor and self-manage. Through this
technology, people are analysing their own body’s
vital signs and making informed decisions to
make their lives better.
Our homes have become smarter, and we are
already starting to live amongst an intricate
network of physical objects that connect
with each other; our weighing scales are
communicating with our smartphones to monitor our
weight, our intelligent heating systems, accessed
and monitored by carers remotely on their smart
phones, are keeping our vulnerable loved-ones warm.
Accessing your GP surgery is becoming easier –
virtual consultations and online triage are allowing
greater access to see a trained healthcare
professional, whenever, and wherever you are.
Robotic surgery is already being used in many
hospitals, gaining popularity as a less traumatic and
minimally invasive alternative to traditional surgery.
There are now programmes gathering and
interpreting the data needed to develop precision
medicine – the genetic codes of tens of thousands of
people are already being sequenced to understand
the links between our genes and our health, allowing
us to create bespoke therapies and predict who will
become ill.
As we approach 2020, what will likely happen
in the next five years? There is certainly a direction
of travel in combining advances in technology with
the use of behavioural insights to unlock efficiencies
and improvements in care. The explosion of social
innovation we are already seeing in our everyday
lives will begin to alter how people are involved in
looking after themselves and others through social
prescribing and patient activation. Supermarkets
will likely be unlocking the valuable data they
mine from existing loyalty cards, to direct us to
products suitable for our medical conditions.
The home will become even smarter, and devices
will be able to proactively challenge and change
our behaviour, monitoring our adherence to
medication as an example. With the recent outbreak
of Ebola, it also seems highly likely that geolocation
services on our smartphones/wearable technology
will be able to alert us to high risk infectious areas
in future epidemics.
For the other portends of the future from 2010,
we will need to take a realistic look beyond 2020.
Healthcare systems are struggling – investment in
the power of engaging people and improving our
knowledge and understanding will be the most
powerful tools to keep it sustainable. There will of
course always be advances in technology,
medicines and systems but heavy public funding
investment might take longer to procure for some of
these 2020 visions; brain-computer interfaces,
growing our own limbs and true personalised
polypharmacy based on our genetic makeup will
come one day, we might just need to extend our
horizons a little further.
Claire Oatway
Chief Operating Officer
Tim Bray
GP Partner & Research Lead
20 November, 2015

3. 2
Introduction & overview

4. 3
This map shows 8 ‘zones’ of health engagement from a psychosocial, or health
psychology, perspective. For any particular aspect of our health, we are likely to ‘move’
through several of these zones as we experience and process symptoms, outcomes and
information made available to us.

5. It is rather straightforward to present a
fantastical, idealistic image of the future.
But our intention here is to combine the
‘what if?’ with the trends that we at Ogilvy
already see: a vision of thoughts and ideas
that we believe will be achieved over the
next 10 years. We have dramatised this
vision as 20 scenarios of what our
digitally-driven healthcare might look like
in 2020, hence 202020 VISION; how all of
us will be engaging with our own health
and the health of our family and friends in
the year 2020.
Predicting the future is not an easy business:
“This telephone has too many
shortcomings… as a means of
communication… the device is inherently
of no value”
Western Union internal memo, 1876
“Everything that can be invented has been
invented.”
Charles H. Duell, US Patent Office, 1899
“I think there is a world market for maybe
five computers”
Thomas Watson, Chairman of IBM, 1943
4

6. “There is no reason for any individual to have a computer
in their home”
Ken Olsen, President and Founder of Digital Equipment
Corporation 1977
What we know for sure is that everything that can be invented
has not been invented.
A HUMAN PERSPECTIVE
What we also know is that health is a human business and so
we have approached 202020 VISION from a human,
‘biopsychosocial’ perspective. As Osler, a great nineteenth
century expert in internal medicine noted: “The good
physician treats the disease but the great physician treats the
patient who has the disease”.
So what is a ‘biopsychosocial’ approach? It looks at the
interaction of our biological processes with our thoughts,
feelings, beliefs, behaviours and their social context. It is
common sense and an empirical fact that social and
psychological factors affect health; yet it is by no means
universally accepted.
In our view, technology, particularly that which has driven
social media, already has had a profound impact on the
psychosocial context of health and healthcare. And this will
continue at an accelerating pace up to and beyond 2020.
5

7. We have mapped a psychosocial context into 8 ‘zones’ of
health engagement and have presented our 20 ideas for 2020
as they could relate to these zones. We have pursued this
approach to remind us all that a focus on technology alone is
naïve.
We believe that the tipping point of future progress will be the
widespread acceptance and adoption of ‘cloud-based’
electronic health histories (EHH), also commonly referred to as
electronic health records (EHR) or electronic medical records
(EMR), accessed at any time, any place, anywhere, through
personal multi-functional devices (PMFDs), the ‘smartphones’
of 2020. This for us is a must, it is the ‘digital glue’ that will
allow technological advances to interact with our bodies and
our lifestyles, that change and evolve throughout our lives.
INTERVENTION ACROSS 8 HEALTH
ENGAGEMENT ZONES
By 2020 ‘preventive health’ (zone A) will have become big
business for industries that were once on the fringes. Genetic
profiling will have gained widespread acceptance helped by
(health insurer) incentives to prevent disease progression.
There will be further incentives to participate in screening for
conditions that have been identified as risks. All of this will be
easy and much of it carried out on our personal multi-
functional devices (PMFDs) – the ‘smartphones’ of 2020.
6

8. Crucial to public acceptance of these advances will be highly
targeted communication campaigns demonstrating the ease
of testing / screening and comparing and contrasting the
benefits of early, pre-clinical intervention, versus the effect of
delayed treatment.
Leading companies within the food industry will have
embraced the regulatory challenges associated with
evidence-based preventive health and we envisage
partnerships and alliances with the pharmaceutical industry.
Some indulgences in 2020 are likely to have both
psychological and physiological benefits… and many
consumers will be happy to pay a premium for these
pleasures.
When it comes to ‘perceiving & interpreting symptoms’ (zone
B) and ‘responding to symptoms’ (zone C), technology will
provide enhanced personal monitoring of our bodies at a pre-
symptomatic level via miniature implants that will feed this
information to our ‘cloud-based’ electronic health histories.
Diagnostic algorithms will then help us interpret our
symptoms and help guide our responses.
Our subjective, emotional representations will be enhanced by
data collected from our biological processes, enabling some
decisions to be automatically made for us. ‘Self care’ (zone D)
will take on a whole new dimension.
Such data will be power. Today’s online patient groups will
become increasingly influential patient co-operatives as their
7

9. access to automatic, anonymised members’ data is sought
after. And at the same time, every item that we purchase is
likely to have a health value attached to it, driven by global
supermarket chains, that will aggregate data and use this to
increase market share through wide-ranging health offerings.
The ‘professional consultation’ (zone E) will have been
transformed in part through virtual interactions. Doctors’
‘visits’ will be more focused and patients' expectations better
managed. Both virtual and real interactions will be enhanced
by tailored outputs, many of which will include videographic
simulations that model an individual's future health, depicting
the consequences of decisions and behaviours. The impact of
this powerful imagery on our responses to healthcare
recommendations cannot be underestimated.
When engaging with ‘hospitalisation & surgery’ (zone F), we
will start to see a hi-tech, hi-touch polarisation of health
provision. Human judgement and involvement in some
procedures will be verging on the obsolete with advances in
imaging and robotics.
We predict global health providers will have partnered with
leading brands in the hospitality business to create a
substantial health tourism industry that leverages the benefits
of psychological nourishment on recovery. We will also
witness a whole new era in medicine: advances in tissue and
8

10. organ regeneration for both therapeutic and cosmetic
purposes.
‘Long-term care’ (zone G) will become increasingly important
as we continue to live longer, afflicted by chronic disease. We
will, however, see a transformation in how we engage in this
care. Assisted by genetic profiling and electronic health
histories, we will see personalised polypharmacy, with
individually tailored dosing. And many of our medicines will
transmit data to confirm when they have been taken and how
they are working with the body. A number of medicines will be
replaced by gene therapy.
And finally, within ‘terminal care’ (zone H), we will see the use
of mind-reading technology that is already available, applied
to help people better realise their very final wishes.
COMMUNICATION IS KEY
If we are to effect the true potential that ‘technology promises
health’, we need to remind ourselves that we are not
machines but idiosyncratic human beings, with hopes and
fears, stimulated and shaped by the media, family and friends.
Public and individual patient communication will be the key to
unlocking the benefits of new technologies.
To achieve this we must all keep in mind:
9

11. • Technology in itself is not a panacea; it needs to be adopted
and incorporated into our everyday behaviour.
• Technology will give us tools to do a lot more, but the
information that these tools will gather must be
communicated and interpreted effectively to change
behaviour.
• Information is ineffective if we don't understand it in the
context of our everyday lives, and information overload will
have to be managed. To cut through the ‘clutter’,
information will increasingly need to be communicated
through storytelling and information visualisation
(infographics), whereby it is portrayed in ways that tell visual
stories. The provision of information / knowledge /
understanding will become an art and a science.
• New technologies to map and track individuals’ attitudes
and behaviour will allow us to create the right message
with the right tone in the right place at the right time.
• General health prevention messaging, that we often switch-
off to today, will speak to us as individuals, tailored to the
specific lives we lead.
• Relative risk will need to be considered. Risk will need to be
put into perspective and communicated responsibly to
avoid the unnecessary fear that is a barrier to health
improvement. Highly-targeted, persistent, positive
10

12. messaging will be needed to help overcome fear and
embarrassment.
• Although health is a serious matter, we don’t always have to
take ourselves seriously when it comes to health
communication. Gaming for example, is already a proven,
highly valuable, communication tool that effects behavioural
change as well.
At Ogilvy, our responsibility is to help the broader public and
individual patients embrace technologies that are being
invested in by the healthcare industry. We have already
established strong partnerships with innovators in
communication and interactive technologies and we have
started to bring together advances in medicine with those in
communication and interaction.
Moving forward, we envisage working with all players, existing
and emerging within the healthcare industry. By embracing
behavioural medicine, science and technology, we aspire to
maximise economic and societal benefit, thereby realising a
healthier future.
11

13. 12
Eight health
engagement zones

14. This map shows 8 ‘zones’ of health engagement from a psychosocial, or health
psychology, perspective. For any particular aspect of our health, we are likely to ‘move’
through several of these zones as we experience and process symptoms, outcomes and
information made available to us.
13

15. There are essentially two kinds of preventive
health – activities that promote better health
(taking exercise, a varied diet, drinking in
moderation, not smoking); and actions that
help detect disease (self-examination,
participation in screening).
All sorts of factors predict whether we will
engage in preventive health activities
including our age, sex, class, ethnicity and
personality, the extent to which we believe we
are susceptible to an illness and the
perceived threat of a disease. We are also
influenced by the media or by friends and
family as well as by the benefits or barriers to
taking part. So, we may know that a
sedentary lifestyle lowers life expectancy, and
contributes to the development of various
chronic diseases. And we may have heard
that diets high in salt or fat are bad for us but
many of us still find it difficult to exercise and
eat properly.
Similarly, many of us are aware of the benefits
of self-examination, particularly in the early
detection of certain types of cancer. But still
Zone A PREVENTIVE HEALTH
14
A

16. some of us don’t practise these simple techniques for various
reasons, including fear, embarrassment, lack of confidence or
simple forgetfulness. We also need to volunteer to be
screened by experts with better knowledge and technology
and studies show that even if we do attend for an initial
screening, as many as half of us may not go back.
For some of us, the fear of being ‘found to be ill’ is so strong
that it has a negative effect on our attending a screening
programme.
Education has been shown to help with certain groups –
research shows that women who receive educational
programmes are 2–3 times more likely to participate in
screening than those who don't receive the programme.
An invitation to participate in a screening programme may
cause us to worry and become anxious, possibly because of a
fear that the invitation itself implies the presence of the illness
being screened. Those who find it difficult to balance these
anxieties can become hypochondriacs or hyper-resistant to
medical intervention.
Even receiving good news can make some of us anxious.
Perhaps we feel we are just putting off the inevitable. For
example with certain types of cancer that we know we may be
vulnerable to, the result only shows that we haven't got the
15

17. disease – yet. And while we may feel relieved at finding we
don't have a serious condition, we may also feel angry at the
distress caused by the process.
Although our knowledge of preventive measures and
availability of screening for new conditions will continue to
increase over our lifetimes, the uptake of preventive health will
continue to vary depending upon the demographic, social and
personality factors of the individual.
16

18. Often, we only engage with our own health
when we experience symptoms and many
symptoms are so short-lived that they pass
before we have time to think much about
them. Symptoms are essentially the changes
in our body brought about by disease. We
may notice changes in bodily functions,
emissions and / or sensations ourselves while
other changes, such as those in our
appearance or behaviour, may be noticed by
our family and friends. We can however feel ill
without having an identifiable disease, and
we can have a disease without feeling ill, and
although some diseases have clearly defined
symptoms, many involve a subjective
interpretation of our body's response –
feeling “sick”, tired, or pain for example.
We all practice `self-regulation' when it comes
to our health. We view illness as an unstable
state and we work towards re-establishing
the status quo by appraising, interpreting and
responding based on what we know. We
learn about health and illness in the same
way that we learn about everything else:
through our own and others' experiences.
Zone B PERCIEVING & INTERPRETING
SYMPTOMS
17
B

19. These experiences and our understanding of medical
knowledge shape our `illness beliefs' and profoundly shape
the way we perceive and interpret symptoms.
Saying this, symptom perception and interpretation are
influenced by a number of factors:
Attention – we are more likely to be aware of and report
symptoms when we are under-stimulated by our environment
Culture – shapes our expectations and assumptions about
health
Gender – women report more symptoms and illnesses than
men
Personality – if we're self-aware, we'll have a tendency to
focus on our feelings and reactions and therefore symptoms
Context and identity – our perceptions of the symptoms we
experience are dependent on our social identities: we have
multiple social identities based on the contexts of our lives
and our relationships with others
Stress and mood – if we're stressed we may believe we are
more vulnerable to illness and so attend more closely to
changes. We may also experience stress-related physiological
changes (such as increased heart rate) and interpret these as
symptoms of illness. If we're in a positive mood we consider
ourselves healthier
18

20. Prior experience – We attribute new symptoms to previously
diagnosed chronic conditions or with the ageing process.
So when we experience symptoms we usually try to work out
why we feel like we do. Essentially we are trying to solve a
problem and our approach will be based on the symptoms
that we perceive represent a particular illness. If all the
symptoms we experience relate closely to the beliefs and
representations we hold for a disease, we are likely to
interpret the symptoms as indicating this disease. But while
we all experience symptoms, we're all quite different in the
way that we act upon them.
19

21. The way we respond to symptoms varies
widely. Whereas some of us may seek a
doctor's attention immediately, others might
turn to over-the-counter remedies for the
same symptoms or wait and see if the
symptoms subside or get worse. There are, in
short, different pathways to health.
Our symptoms provoke an emotional
representation (such as fear, anxiety, negative
mood) that guides our coping responses. We
may seek advice from family, friends and
colleagues (our lay referral system) and
increasingly go online. This provides a ‘peer
assessment’ of our symptoms, helps us label
them, and crucially, helps us decide whether
and when to go to the pharmacy for a ‘self-
care’ remedy, (see Health Engagement Zone
D) or visit our doctor.
While advice from family, friends and
colleagues frequently incorporates rumour
and gossip, it can provide all-important (if
sometimes misguided) reassurance but, if
their views are incongruent with our own, it is
our views that tend to predominate. However,
Zone C RESPONDING TO SYMPTOMS
20
C

22. after seeking advice from peers, fear of disease and
awareness of mortality still means that many of us put off
seeking help.
Research has investigated some of the personality traits,
lifestyle attributes and demographics that affect our approach
to responding to symptoms. Some of us are described as
‘Severe Sufferers’. We take our illnesses seriously, fuss,
pamper ourselves and keep trying new and different products.
We tend to be younger, have children and are relatively well
educated. But we are more likely to be anxious people and
believe that we suffer more severely. Others among us are
described as ‘Active Medicators’. We are on the same side of
the motivational spectrum as ‘Severe Sufferers’ and tend to
use medication to relieve every ache and pain. We are
emotionally adjusted to the demands of our active lives and
are typically of average income and education.
On the opposite side of the motivational spectrum are those
of us described as ‘The Hypochondriacs’. We have a deep
concern over our health and have more conservative attitudes
towards medication. We see possible dangers in the frequent
use of medication, tend to be concerned over side effects and
are afraid of medication with new ingredients and extra
potency. We are strongly oriented toward medical authority,
21

23. seeking guidance in treatment. We tend to be older, not as
well educated and more of us are female than male.
Also on this opposite side of the motivational spectrum, but
even more so, are the ‘Practicalists’. If we're in this group we
tend to accept illness and its discomforts as a part of life,
without fuss and pampering and we are the least concerned.
We use medication as a last resort and tend to be older, well
educated, and emotionally the most stable.
22

24. Self-care in response to symptoms of illness
is extremely common. According to at least
three separate studies, we don't see a doctor
for between 70% and 90% of illness
episodes and if we do see a doctor many of
us will have ‘treated’ ourselves beforehand.
Self-care is often our initial response to
illness, one sometimes encouraged by
governments and other authorities
(particularly in the current economic climate).
In one study, over 80% of adults investigated
had used at least one over-the-counter (OTC)
medication in response to symptoms that
were later diagnosed as colorectal cancer.
For older people among us, self-care takes
on a special significance – although we are
more likely to see our doctor for physical
checks when we are older, we will not
necessarily see him or her every time we
experience symptoms – despite the fact that
we are more likely to suffer from chronic
conditions. When we consider our symptoms
to be serious however, because of the length
of time we have experienced them or how
Zone D SELF CARE
23
D

25. much pain and dysfunction they cause, we are as likely as our
younger counterparts to shift from self-care to professional
care.
Opening up about our health issues to family, friends and / or
colleagues can be beneficial to outcomes. It can help us to
identify when self-care has run its course and thus lead to a
more speedy consultation with healthcare professionals.
Women are more open in these discussions than men, who
are also widely believed to engage less with their peers
regarding health issues, especially those deemed to be
personally embarrassing.
The number of self-help groups that now exist has grown over
the past 50 years. Members seek help not just for education
but also for a shared experience, especially a shared
misfortune. Overall, these groups can be classified as follows
on the basis of why people join them:
• Physical problems
• Emotional problems
• Relatives of those with physical, emotional or addiction
problems
• Family problems
• Addiction problems
24

26. • Social problems (e.g. sexual non-conformity, one-parent
families, life changes, social isolation)
• Women's groups
• Ethnic minority groups
An important aim of these groups is to inform and refer as well
as to provide counsel and / or advice. Therapeutic services
under professional guidance and mutual supportive activities
are also common.
25

27. The greater the number of symptoms we
perceive and the greater our health concerns,
the more likely we are to seek professional
help. Furthermore, we are more likely to
consult with a healthcare professional if we
believe the outcome will be effective.
Generally, we speak to female practitioners
more than male and share more personal and
medical information with them although this
depends on our gender, social class and age,
as well as the nature of the problem (i.e. how
intimate or potentially embarrassing it is).
As patients we need to be aware of the
importance of understanding and managing
our expectations from a professional
consultation. Our consultation agenda may
be closely related to the immediate threats
we perceive, such as continuing pain or how
treatment will impact our lives. If we are
anxious or stressed, or if we feel unfamiliar
with the information being discussed, the
outcome of the consultation can be affected
significantly and we may not acquire the
understanding that we need. Research
suggests that some of us may lack the
Zone E PROFESSIONAL MEDICAL
CONSULTATION
26
E

28. confidence to challenge what we perceive to be an educated
and successful healthcare practitioner.
Research has also shown that the most important
expectations to be met from a consultation were
‘understanding and explanation’ of the condition, ‘emotional
support’ and ‘getting information’.
Other studies have shown that patients who feel more unwell
and worried or have a high incidence of anxiety and
depression or no paid work, show a stronger preference for
good communication. Middle aged patients are more likely
than older patients to want good communication. This may be
because older individuals are used to the traditional approach
of the doctor having all the authority in the consultation and
being a figure who is above them in the hierarchy of the
interaction. None of these studies show counter-intuitive
results except for the fact that many patients seem to rate
good communication skills over diagnostic ability.
Our doctor’s agenda in the consultation is likely to be more
closely linked to understanding the severity of illness and
developing a treatment plan. His or her use of common sense
language and avoidance of technical or medical jargon can
help our understanding significantly. In cancer diagnoses, for
example, most of us will have little understanding of terms like
‘median survival’ or ‘good prognosis’.
27

29. Understanding the differences between the agendas of both
patients and practitioners enables us to address each other’s
concerns and ensure that we both leave having disclosed and
acquired all the information necessary for progress to be
made.
28

30. Hospitalisation and surgery continue to be
central features of medical care in developed
countries. Some of us will undergo diagnosis
and / or therapy and then leave without an
overnight stay (outpatients), while others will
stay overnight or for several weeks or months
(inpatients). The trend in recent years has
been for inpatient stays to be as short as
possible with an increasing number of
procedures now being carried out on an
outpatient basis. This is partly driven by cost
but also by evidence that shorter hospital
stays are not associated with poorer
outcomes.
Although the goal of hospitalisation is to
improve health and wellbeing, for the vast
majority of us there are a number of negative
consequences.
Hospitalisation can be a stressful experience:
there is a loss of privacy, independence and
control. We can find ourselves in close
proximity with other patients we don't know
and frequently in intimate contact with
healthcare providers, sometimes being
Zone F HOSPITALISATION & SURGERY
29
F

31. treated as though we are neither mindfully present nor a
person. Suddenly we can no longer choose when to eat and
sleep, when to read or bathe. We are subsumed by the
hospital regime and can become confused by its structure,
procedures and terminology.
For some of us, hospital restrictions may be therapeutically
desirable and offer freedom from responsibility and an
opportunity to focus on recovery. But for others there is
concern over the obligations left behind unfulfilled and limited
visiting hours, a lack of opportunity to engage with `real' world
people and restrictions on TV and radio can be less than
desirable. And these restrictions may not be conducive to
recovery. In the absence of external stimuli we may spend
more time focusing our attention on symptoms that may or
may not contribute to our illness and as a result become more
anxious. We may also experience anxiety over the diagnosis,
prognosis and the influence of the illness on our life and worry
about the treatment regime and the probability of its success.
As a consequence we can become distressed and even
angry. One researcher has commented that some patients
may relieve this anger with “petty acts of mutiny such as
making passes at nurses, drinking in one's room, smoking
against medical advice and wandering up and down the
wards and corridors”.
30

32. Evidence suggests that high levels of anxiety and stress
predict poorer outcomes. This has led to interventions to
promote recovery particularly from surgery as well as to
reduce anticipatory nausea and vomiting associated with
chemotherapy. These interventions are most notably to
provide more information and provide cognitive-behavioural
therapy. They are effective to varying degrees in reducing the
stress associated with hospitalisation and may operate via
effects on the immune system and / or by promoting ‘well’
behaviours (or reducing ‘unwell’ or maladaptive behaviours).
31

33. How we cope and adjust to long-term,
chronic illnesses such as asthma and
diabetes differs from how we cope with
short-term illnesses such as ‘flu’.
Coping methods that we may find to be
effective in the short-term, can be ineffective,
if not completely inappropriate, to long-term
treatment.
Long-term coping and adjustment to illness
can be significantly impacted by whether our
outlook is generally positive or negative as
well as whether we engage with friends and
family for support. The optimists among us
tend to interpret situations in a positive light
and have a fighting spirit (e.g. “I am
determined to beat this disease”) with
expectations of favourable results. This has
been shown to be associated with improved
outcomes and long-term survival among
breast cancer patients. On the other hand,
pessimists have feelings of hopelessness and
helplessness (e.g. “I feel there is nothing I can
do to help myself”), associated with poorer
outcomes. These differences in outcomes
could be related to resistance to stress.
Zone G LONG-TERM CARE
32
G

34. Studies indicate that optimists are much more resistant than
pessimists and concentrate on problem-focused coping
aimed at solving the problem and doing something about it.
They plan, take direct action and screen out particular
activities. They are also more likely to seek social support –
the advice and help of friends and others. This can have a
significant impact on our recovery and quality of life – a strong
social support network can increase adherence to treatment,
limit distress, facilitate better coping with stressful events and
ultimately increase survival.
In contrast, pessimists tend to give up on goals with which
stress interferes and cope with stress in an emotion-focused
way. This can involve denial or positive reinterpretation of
events.
Treatment adherence is a critical component of long-term care
and involves not only taking the right medicines at the right
time but adherence to appointments, programmes that
support lifestyle changes and psychosocial interventions.
As few as one in four of us follow medication instructions
properly, half of us are likely to discontinue our medication
before we are supposed to, and up to one in every three of us
make medication errors in ways that may endanger our health.
The longer we need to take prescribed medications, the more
likely it is that non-adherence will occur. This is compounded
33

35. when treatment involves multiple aspects including
medication, self-monitoring and lifestyle change. In fact,
studies have identified 20 factors behind non-adherence, and
contrary to popular assumptions, research has failed to
demonstrate consistent associations between adherence and
personality, gender, education, socio-demographic status,
marital status, religion or ethnic background.
It is not surprising that adherence to treatment leads to a
better outcome. What is perhaps surprising are studies which
show better outcomes for adherers, compared to non-
adherers, even when the treatment is a placebo!
34

36. Although many people may go to hospital or
a hospice at the final stage of their disease
when their carers can no longer provide the
necessary physical or medical care that they
need, the majority of care up to that point
occurs at home.
Hospices aim to provide an optimal quality of
life for us and our families as death
approaches, attempting to make us pain-free,
minimising our experience of distress, and
helping us to maintain as much dignity and
control as possible. The intention is also for
us to maintain relationships with our loved
ones in a caring and compassionate
environment.
Many hospices or nursing homes also aim to
create a feeling of independence for us, to
alleviate our feeling of being a `burden' upon
our carers, encouraging us to continue to live
our lives without feeling inhibited.
If we are facing death as a result of a long-
standing illness, issues such as ‘a good
death’ and ‘dying with dignity’ become
crucial.
Zone H TERMINAL CARE
35
H

37. Solutions must be implemented that will empower us to
control the circumstances surrounding our death in a dignified
manner.
As well as social, medical and emotional support, those in the
final stage of illness often need financial and informational
support. Many feel the need to ‘put their life in order’. Some
want to be involved in their remembrance services, or set up
trust funds, legacies or memorials. Many have spiritual needs
irrespective of whether they are a believer, agnostic or an
atheist. Many die as they lived, but all want the process to be
as psychological and physically comfortable as possible.
The role of family and friends is often crucial in a person’s final
days. Death remains a taboo subject and there are often
numerous powerful emotions in the last stages of a person's
life. One that is most difficult to deal with, is anger. There may
be anger at God, their family and the whole injustice of the
world. Grieving relatives can suffer similar feelings as well as
the anxiety and depression of grief. Hence the importance of
professional help.
Research has shown that conventional therapies have limited
application to the sick and the dying. Much like healthcare
provided throughout one’s life, effective communication with
the patient and family are critical. The provision of information,
36

38. predictions and prognosis can all have a significant influence
on future behaviour and potentially on treatment and illness
outcomes. From the patient and the family's perspective,
difficult questions need to be asked, each requiring sensitivity
and honesty. From that of the health professional, a judgment
call is required regarding the capability of people to
understand and manage the information they are requesting.
37

39. 38
20 big ideas in
health to connect
with 2020

40. 39

41. Personal futuring
40
1“
”
BY 2020ADVANCED
GENETIC PROFILINGWILL
BE COMMONPLACE

42. Testing for cholesterol, blood sugar and birth defects is
already the norm. However, we are now on the brink of a
major step forward on this evolutionary journey: by 2020
advanced genetic profiling will be commonplace. And while
cures may still elude us, identification of the future diseases
for which we are at risk will allow us to screen for these
conditions specifically and adopt preventative lifestyle
changes and treatment regimes. Health insurers, genetic
profiling service providers and diagnostics manufacturers
will flood our personal devices offering incentives including
conditional access to latest treatments and lower premiums.
Outdoor electronic billboards will promote the benefits of
preventive intervention comparing those who have been
41

43. profiled and have made decisions accordingly, and those who
haven't. And of course, our personal genetic profiles will be
integrated into our ‘cloud-based’ electronic
health histories (formerly known as
electronic health records).
As well as support from friends and family,
the role of health professionals will be
pivotal in helping us make sense of complex
information about our future to understand relative
risk, the benefits of screening and early intervention.
We will see a new breed of patient groups, with health
professional input, dedicated to specific genetic aberrations,
their tests and early interventions. The focus will be on the
rational and emotional benefits of earliest possible
intervention.
The more we know about disease the better our prediction will
be about the future of our own and others health and
longevity. However, because (nearly) all diseases are
determined by multiple factors no prediction or
prognosis is ever completely error free: we
speak in terms of probabilities. We inherit
potential not certainty and we can intervene at
all stages so we will still live with uncertainty.
Individual reactions to our own health vary greatly:
some of us repress and ignore advice and warning signs;
others act immediately. Some of us react from our hearts;
42

44. others their head. Some societies encourage agency, mastery
and control: others help people accept their fate.
Relatively few people will discover that they are predisposed
to incurable, degenerative diseases. Testing will indicate
conditions that are potentially manageable through early
lifestyle intervention, and possibly the introduction of
preventative medication and most people will simply do what
they can to live as well as possible for as long as possible.
43

45. Pocket health check
44
2 “
”
THISWILL MAKE IT POSSIBLE
TO RECOGNISE DISEASE
ONSET EVEN EARLIER

46. Medical diagnostics are rapidly evolving and we are already
seeing faster and earlier recognition of disease driven by
much higher levels of diagnostic sensitivity. Continuous
advances in ‘laboratory miniaturisation’ such as DNA
microarray and lab-on-a-chip systems for example, will open
the doors to tests currently conducted in a laboratory, being
carried out at home using our PMFDs. This will make it
possible to recognise disease onset even earlier and results
will be available within minutes or hours rather than days or
weeks, more cost effectively with significantly more accuracy,
in more people. Increasingly high resolution cameras in our
2020 PMFDs, supported by imaging algorithms will also
facilitate remote observational screening at home, with or
without a physician on the other side of the lens.
45

47. The challenge in 2020 will continue to be about the willingness
of people to participate in screening. While ‘health rewards’
and incentives may help, the big carrot will be the prospect of
earlier intervention leading to better disease management and
in some cases a cure as opposed to curtailment.
Everybody accepts that prevention is better than cure, but
just as some people don’t want to know the sex of their
unborn child, some prefer not to know the
future of their own health, however cheap,
easy and convenient it is to monitor.
Screening allows for better management but
it is not always totally accurate and
press stories about false positives
and negatives have a big impact on those volunteering. Lots
of factors determine the frequency with which a person
attends for screening or uses a pocket measure: their
personality, health beliefs, medical history, friends and
family. As screening becomes more common, cheaper
and more reliable it will be the norm rather than
the exception. It may even become mandatory
in certain countries or particular organisations
to be screened for very specific illnesses,
which will cause political uproar. Importantly,
if we can do the screening ourselves we can
keep the results confidential, thus
reducing fear of embarrassment and
social stigma.
46

48. It pays to be healthy
47
ADVERTISERSWILL KNOWAN
INDIVIDUAL CONSUMER’S
BEHAVIOURABSOLUTELYAND
IN EXHAUSTIVE DETAIL3 “
”

49. Cross-analysis of people's lifestyle behaviours offers
insights and opportunities to promote healthy lifestyle
options. Partnerships between financial institutions,
health insurers and pharmaceutical companies for
example opens up the possibility of tracking users and
encouraging them to make decisions that will benefit
both the individual and companies alike.
Welcome to a world where customer data is instantly
available and deals and money saving promotions can be
targeted accordingly. In this world, health-promoting
options can be offered. And, the more health conscious
options an individual makes, the more rewards they
receive.
48

50. Knowing real world behavioural patterns of consumers and
being able to tailor promotional messaging in real time is the
nirvana of the marketing industry. A future of tracking
individuals’ locations and activities through facial recognition,
GPS and retina / fingerprint scanning will open the door to
highly targeted advertising.
Advertisers will know an individual consumer’s behaviour
absolutely and in exhaustive detail. This information will be
analysed to deliver relevant and targeted messaging via a
range of digital media.
People know about but don’t always follow guidelines (e.g.
calorie intake, exercise, alcohol intake), often because they
are unrealistic and unachievable. People can be incentivised
to be healthier e.g. pounds for pounds, in taxes; but our
responses to incentives differ. Extrinsic motivation (by
objective rewards) can backfire: intrinsic motivation (for the
love of the activity) is always better. Targeted marketing has
always been carried out by manufacturers and advertisers. We
have used psychographics to segment people according to
their lifestyle and there is much more data available now to
help us do this. Health messaging can be targeted to sound
more positive, i.e. healthy hedonism, but the problem for most
societies is that it is the middle-class, educated and more
healthy people who attend to the messages, follow them, and
pay for them whilst most of those who need to follow them,
do not.
49

51. Infectious disease swarms
50
THE BENEFITS OFTRADING
THEIR PERSONAL DATA FOR
TECHNOLOGICALLY-
ENHANCED PROTECTION
4 “
”

52. We have already entered an age of location-based services,
GPS tracking and various topographical-based
‘mashups’ (data combinations). And, as Google FluTrends
highlights, using vast amounts of individual data to detect
patterns has massive potential for mapping infectious disease
outbreaks.
In 2020, people’s PMFDs (personal multi-functional devices)
will contain their health & lifestyle histories, enabling
authorities to track their behaviours and identify the potential
spread of disease. Media hype can cause a frenzy of anxiety
about the potential dangers of infectious disease, as we have
seen with SARS, Swine Flu and Avian Flu. The ability to
accurately map and identify outbreaks will be invaluable in
51

53. either allaying or justifying public concern. Media-driven mass
panic seen today will be mitigated to a degree, by the tracking
technologies of 2020. But all of this will only happen if people
understand the benefits of trading their personal data for
technologically-enhanced protection. This will have to be
addressed through public education campaigns
that people believe and trust. In 2020 such
campaigns will be ‘authored’ by co-operatives
that will most likely be driven by highly
influential social groups as well as leading
consumer brands.
Increased levels of information for individuals
and their families should help prevent
exposure to potential illness and provide peace of mind.
Awareness of an infectious disease outbreak at the children's
school, a potential holiday destination, the local sports centre
or the local restaurant could dramatically impact an
individual's decision-making. Stirred up by the media this may
lead to mass panics, which politicians will have to
address.
However this also leads to a phenomenon known
as ‘modern health worries’: concerns about how
aspects of modernity influence health such as
contamination of food or various types of
environmental pollution. People also worry about
bio-terrorism and genetically modified foods;
52

54. about cell phone and overhead cables. Although knowledge is
power, there are two issues to be managed here: first, when
you're powerless to adjust behaviour even when knowledge
indicates you should; second, if information lacks perspective
and leads to forms of mass hysteria.
53

55. One statin burger coming up!
54
INDULGENCES OF
2020WILL BE
CLINICALLY
PROVENTO BE
GOOD FOR US...
5 “

56. Restaurants and other food service companies are positioning
themselves more and more as lower-fat, better-tasting,
calorie-reducing health crusaders for the masses. We all know
that closer inspection of the menu of ingredients for some,
might argue otherwise. But by 2020 much of this will have
changed. The food industry will have embraced the regulatory
challenges the pharmaceutical industry currently face and will
incorporate clinically proven health benefits in their brands.
And through alliance and / or acquisition, the pharmaceutical
industry will be exploring foods and beverages as vehicles for
delivering preventive medication so that selected indulgences
of 2020 will be clinically proven to be good for us both
physiologically and psychologically. When stepping into a
multi-national fast food chain or arranging the weekly shop,
55

57. online people's choices will be proactively
influenced by their dietary and medical
histories as well as their future health
requirements.
Affecting behaviour change among
individuals who either do not
understand or care about the impact
bad lifestyle decisions have on their
health is one of the most difficult
issues facing the healthcare industry.
Many factors are involved as we see
in the models of behavioural
medicine. Making health decisions
easier for people and rewarding them for
good behaviour may provide a way to
reach ‘hard-to-convert’ people. Thus
it has been proposed to pay people
to give up smoking or lose weight
for example. Ultimately, it is hoped
this saves money for the healthcare
funders. Providing people with more
information about their diet and
health state is a good way for
individuals to monitor and
consequently change their
behaviour. Funders can attempt all
sorts of strategies to encourage and
56

58. discourage various forms of behaviour. This could include
legislation banning advertising for certain extremely unhealthy
products and providing tax relief for food manufacturers and
retailers who interface with individuals’ health records and
respond with tailored, health-supporting, products and
services.
57

59. It’s what’s inside that counts
58
..MONITOR OUR
BODIES’VITAL
READINGSVIA
MINIATURE..
IMPLANTS
6 “
”

60. Continual measurement of the body’s vital signs is crucial to
effective management of illness (or potential illness). As some
people with heart conditions know, technology already exists
that can monitor the heart and even shock it back into life
should anything go awry.
By 2020 we will be able to monitor our bodies' vital readings
via a miniature RFID (Radio Frequency Identification) implant.
Data will be captured, transmitted and stored within our
‘cloud-based’ electronic health histories and just as with
today's home security systems, different packages will be
available for different levels of observation to identify
asymptomatic changes in the body that would otherwise go
unnoticed. This technology will be used to create instant
59

61. medical alerts, monitor
adherence, measure the
effectiveness of our medication
and create data for broader
research methodology, taking self
regulation to a whole new level.
We have long known the benefit of
monitoring our physiology. The whole concept of biofeedback
has been very popular and successful for helping people
monitor their stress levels and reactions. We like to receive
feedback on our progress and moreover, feedback changes
behaviour. However, it is more effective if it is specific, reliable,
easy to access and easy to interpret.
The question for many people is what the feedback means
and what they can do about it: even if an individual knows
that their blood pressure is suddenly up, they may not
necessarily understand why, and more importantly, what they
should do.
And as we have seen with smartphones, it may become a
fashion statement to show off your monitoring device, in
which case social approval for being health conscious could
help people focus on how they should respond. Saying this,
many of the responses in the future are likely to be
automatically generated.
60

62. Talking medicine cabinet
61
..THE BATHROOM
CABINET..WILL
TAKE ONAWHOLE
NEW ROLE
7 “
”

63. In addition to our PMFDs (personal multi-functional devices),
the bathroom cabinet (and other digital display devices of the
future) will take on a whole new role. Feedback loops could
provide them with information to advise us on what we should
do about any signs and symptoms. Likewise, the fridge could
advise us on what to eat depending on health status.
Information and action alerts will be created in part by generic
clinical algorithms. But they will also be fine tuned, or
personalised, based on self-selected and automatically
generated (anonymous) recommendations from family, friends
and colleagues (lay referral system). We will be helping one
another to help ourselves.
62

64. Continual communication of health
messaging for some, could be very
supportive, acting as an aide-memoire for
their medication especially if they suffer
from conditions requiring continual
monitoring and intervention such as
diabetes.
It may seem like having a ‘live-in’
doctor, which may be particularly
useful when dealing with an
‘embarrassing issue’. Devices such as
‘SatNav’ mean that people have become
used to machines talking to them
although we do like to choose the voice: male
versus female, nationality of accent, tone
(friendly versus strict).
But the continual bombardment of messaging
and intrusion into everyday life could become
tiresome and / or overwhelming. It could be
like ‘big brother’ or ‘little brother’ is
watching us, if not managed carefully.
Digital display devices will give directions
or suggestions for action, rather than simply
provide information, and these will need to be
followed correctly, to avoid potentially serious
implications. It will be very important to get
63

65. the tone and timing right if people are to
respond positively to the recommended
courses of actions, provided by the
technology of tomorrow.
64

66. The age of auto-triage
65
DIAGNOSTICALGORITHMS
WILL INTERACTWITHA
PERSON’S...ELECTRONIC
HEALTH HISTORY
8“
”

67. For many of us, once we have decided we need to respond
to symptoms, our engagement with healthcare services can
be associated with waiting and worrying. As anyone who
has visited their local Emergency Room in the past few
years can tell you, triage resources are strained and the
pre-screening of patients takes longer than most would
consider necessary. In 2020 the use of technology will
counter this. Upon arrival, touch-screen questionnaires will
be individually tailored based on our existing electronic
health histories. That is, of course, if this information hasn't
already been automatically transmitted from home or in the
car beforehand.
66

68. Triage investigation and analysis will be conducted behind the
scenes, without the need for human interaction. Diagnostic
algorithms will interact with a person’s ‘cloud-based’
electronic health history (EHH), genetic profile and feelings to
enable instant assessment and, in turn, faster assignment of
their treatment priority.
Many of us have learnt very happily to do things with
machines that previously would have been done by people:
e.g. check-out at supermarkets, check-in at airports. It is
perceived as quick and reliable. And the idea of prioritising the
most needy is generally accepted. But it is a different matter
for many when considering who has access to their medical
data: their doctor, their family, their employer and most of all
themselves. Concerns about the security of these data will
need to be allayed.
The idea that people could be automatically ‘checked-in’ to a
virtual clinician when at home, or anywhere for that matter is
attractive except that health issues are highly emotional.
Some people will always prefer to have the emotional
reassurance of a doctor that they could both see and hear
right from the very beginning, as opposed to interaction with a
machine.
67

69. Get a check-up before you check-out
68
EVERY ITEMTHAT IS
PURCHASEDWILL HAVE
A‘HEALTHVALUE’
ATTACHEDTO IT
9“
”

70. Supermarkets are so much more than a place to do your
weekly shop. The list of offerings for the consumer in just one
building is mindboggling – petrol, electronics, mobile phones,
insurance, credit cards, travel agents, restaurants, clothing,
pharmacy, photo, furniture… oh, and you can even buy your
weekly groceries. And, this is all available 24 hours a day.
As such, supermarkets’ pharmacy offering is sure to increase
and expand. In 2020, supermarkets will not only fulfil
prescriptions and sell over the counter (OTC) remedies, they
will become comprehensive centres of health services.
This will be driven by what we buy, what we eat and what we
do. Every item that is purchased will have a ‘health value’
attached to it and this data will be collected at the point of
69

71. sale and merged with activity and food
consumption data from our personal
multifunction devices (enabled by
advances in visual recognition).
As such, the retailing giants of 2020 will
proactively and pre-emptively engage us in
self-health consumption, all at the right price of
course.
We are used to frequent traveller miles and other points
systems and if the incentives are right, there is no reason why
people wouldn’t respond to health points. For example we
may get more points for `lower fat' versions of some products.
Given human nature, if these did become a reality, some
people may start buying them for others
rather than themselves: knowing whether
people actually consume / use the products
they buy will be essential.
There are already debates about large
corporations having more power over people's
lives, being motivated by profit, and what they may
do with ‘personal information’. In order for such organisations
to act as ‘health guardians’, new levels of trust will have to be
built, communicated and maintained.
70

72. Patients really like me
71
...PATIENT CO-OPERATIVES
WILL BE PRESENT
THEMSELVESAS LIFESTYLE
BRANDS
10“
”

73. PatientsLikeMe.com – a social networking health site that
enables its members to share treatment and symptom
information in order to track and to learn from real-world
outcomes – is the flagship of the online movement for patients
to share information and experiences.
In 2020 a multitude of patient co-operatives will present
themselves as lifestyle brands, competing with one another
for our personal health experiences and data. Some co-
operatives will be open to everyone with the same disease,
while others will have specific membership criteria for
example based on genetic profile, illness attitude and
experience: not just any patients with the same disease,
‘patients really like me’.
72

74. These co-operatives will compete to sell our data (in an
anonymous format) to pharmaceutical and other healthcare
companies to enhance member benefits and their own brand
profile. Mass data collection via RFID (radio frequency
identification) devices and PMFDs (personal multi-functional
devices) will provide information that will dramatically increase
our understanding of variations between, and within, diseases
and their patient populations. It will also aid significant
advancements in medical care by revolutionising clinical
research in prescription and OTC medicine with an overall
shift in power towards patients.
People who are interested in helping others change their
health-related behaviours say the same
thing: “Make a realistic plan, start small, change one
behaviour at a time, but most of all, involve a ‘buddy’ and ask
for support from those who care about you.”
Patient support groups have grown exponentially over the
past decade. They have different functions, dependent largely
on their membership: they can have a political function to
lobby authorities; they can have an educational function to
help others understand their illness and be more sympathetic
to sufferers and their families.
The most important function of these groups is to provide
emotional, informational, technical and even financial support
to others with the same problem. This has always been known
to be a very powerful factor in healing and helping people feel
73

75. that they are really understood. Groups that harness digital
technology to progress beyond offering contacts ‘similar to
me’ to those ‘really like me’ will help people regain a positive
social identity, reducing the feeling of isolation and minority
status.
74

76. You have to see it to believe it
75
...COMPUTER-GENERATED
VIDEO FEATURINGTHE
PATIENTASTHE‘STAR’...
11“
”

77. Communicating the impact of a diagnosed disease
can be challenging and patients often
underestimate their condition. Diabetes, for
example, can often be asymptomatic but if
uncontrolled can lead to severe complications such
as cardiovascular disease, blindness and
amputations.
In 2020, patients are likely to walk away from their
doctor's office (or close their browser window) and
within a very short time be able to view a detailed
description of the impact of their condition
presented as a video documentary. Physicians will
have instructed software to access large databases
76

78. to quickly assemble a portfolio of information that provides
patients with a ‘commonsense understanding’ of their
condition. The use of computer-generated video featuring the
patient as the ‘star’ will depict outcomes for them with and
without lifestyle and medical interventions.
Seeing their future selves living out their predicted lifestyle,
vividly on screen, will help drive home the gravitas of their
situation and affect behaviour.
Although we remember best what we have read, rather than
heard or seen, the power of imagery can have a very dramatic
effect on behaviour. Using words and pictures together to help
people understand the impact of their disease and its
potential future consequences can drive patients to better
make decisions about their health. It can reduce the ‘it
cannot / will not happen to me’ syndrome.
Beyond static visualisation, video can present dramatic
emotional drivers aimed at behaviour change. Charities have
always known this. The challenge will be to use digital
technology to bring to life future scenarios that are perceived
to be real, not make-believe, that empower rather than
frighten, so that people will actually apply the message and
adopt recommended health behaviours.
77

79. Home and (far) away
78
...MINIMALLY INVASIVE
AND NON-INVASIVE
PROCEDURESAT HOME...
12 “
”

80. Overburden on staff, diagnostic services, hospital beds and
other resources indicate a need for a dramatic change in the
way healthcare systems manage patients. Given the
increasing range of self-assessment and self-treatment
technologies, an increasing amount of specialist consultation
and hospital care may soon be possible at home.
The technology of 2020 – that allows continual update of
electronic health histories, virtual consultations, easier
analysis of the body's vital signs and adherence tracking – will
enable healthcare professionals to treat patients remotely. We
will see a growth in community nursing which will support
minimally invasive and non-invasive procedures at home:
already camera-in-a-pill technology is replacing traditional
79

81. approaches to in-hospital
endoscopy and developments in this
area are likely to enable more
examinations and interventions at
home, perhaps even without assistive
nursing support.
Hospitals have the staff and technology
to cope well with emergencies and
unexpected events, but the institutional
nature of these facilities can mean that
various groups are not well catered for: some people
particularly dislike mixed wards, or restrictions on various
religious practices.
For most people home is where
the heart and health is. We say we
go home to retreat to a place of
familiarity, security and support. And home
births are popular despite certain difficulties.
People have always wanted home visits by their doctor
particularly in dealing with very personal, potentially
embarrassing issues. This is because hospitals can be
depressing places for some people: the clinical environment,
the impersonal nature of things; the institutional rules and
regulations, the changes in personal habits.
Hospitals will need to embrace technology holistically. While
emergency and critical care will continue to be served best in
80

82. these environments where wide-ranging expertise is
immediately on hand, a thorough re-appraisal of the provision
of non-critical care will deliver cost-efficiencies and desired
health outcomes at home. For this to happen, tomorrow's
doctors will need to be trained now on how to interact with
technology itself and with their patients via this technology.
81

83. Dominelle Bay:Welcome to Dominican
Republic’s premier women’s health resort
82
...SURGICAL INTERVENTION
WITHIN OASES OF
PSYCHOLOGICAL
NOURISHMENT
13 “
”

84. Some consider healthcare in the developed world to be
overpriced and under-resourced. Many health systems around
the world struggle to reduce waiting
lists for important treatment and
surgery. Therefore patients, and some
providers, are increasingly looking for
alternative methods of treatment.
We've all read of people going to
developing nations for cheaper
healthcare and receiving high quality
and efficient treatment. This trend is
set to continue and by 2020 could be
considered part of a normal treatment routine. Several global
health providers will have partnered with or acquired leading
hotel chains to target premium patients with offers of surgical
intervention within oases of psychological
nourishment. Earlier detection of disease
will broaden the window for effective
surgical intervention making advance
planning a reality. For some patients,
hospital stays will actually become longer
as they take the opportunity to recharge
their minds, away from the stresses of
day-to-day life. Still in intimate contact
with their family & friends through state-
of-the-art technology, they will actually get better and feel
better more quickly.
83

85. Healing and recovery are as much
about the mind as the body: a
healthy body is found in a healthy
mind. Exotic locations that
incorporate relaxation and
pampering may better facilitate
physical healing and enterprises
that provide all sorts of ‘alternative’
therapies may have particularly
powerful placebo effects.
Health tourism is driven by three
things: waiting lists, costs of
treatment and individual wealth.
Wealthier people from the developing
world come to the developed for
diagnosis and specialist treatments,
while many in the developed world go
to developing world countries for things
like plastic surgery or advanced
dentistry.
Such inequalities associated with health
tourism are unlikely to disappear. But
broad adoption should not only have a
positive impact on the individual but
release valuable resources for those
unable to afford it.
84

86. Grow your own body
85
...WE ONLY HAVETO REFLECT
ONWHATAMPHIBIANSARE
CAPABLE OF
14“
”

87. Over recent years the ability for scientists to artificially grow
cells, tissue and bone by using existing human samples has
brought both praise and scepticism in equal measure.
As this area of research continues to move forward, the
potential for use in human medicine is almost overwhelming.
Between now and 2020 we will have moved beyond the fields
of skin and bone replacement to regeneration in life-
threatening and life-restricting diseases including cancer,
cardiac infarcts, diabetes, kidney failure, liver failure and
neurodegenerative illnesses.
The prospect of amputees, burn victims, diabetics, and even
those seeking cosmetic improvements being able to amend
their bodies to any desired form, is both frightening and
86

88. exciting. Numerous processes still have to be
perfected to reach the goal of breeding whole
organs or parts of the human body, but we
only have to reflect on what amphibians are
capable of, to consider this a probability
rather than a mere possibility.
Organ donation is a very tricky issue and
one that can carry a lot of anxiety for the
donor, the recipient and the families of all
those concerned. Furthermore, there are
many cultural and religious issues concerning
organ donation and transplantation.
For people in situations where a ‘required match’ could have
been found it will eradicate the problems of rejection and
the side effects associated with immunosuppressive
therapy. But more significantly, it could mean that
fewer people have to suffer from a shortage of
donor organs and tissues.
Tissue and organ regeneration has the potential
to eliminate many of the anxieties and issues
currently associated with donation and
transplantation, but will introduce new worries of its own
among patients and their families. Healthcare
professionals will of course endeavour to manage these, but
initially, won’t have a significant track record to draw from.
87

89. Robodocs
88
...HUMAN JUDGEMENTAND
INVOLVEMENT..WILL
BECOME MINIMAL
15“
”

90. Surgeons increasingly rely on modern technology and
advanced macro and micro anatomical imaging to augment
their skills, thereby improving patient outcomes. Utilisation of
technology can be lifesaving and can alleviate certain stresses
and concerns for the surgical team, the patient and the
healthcare system.
Robotics will develop to the point where the need for human
judgement and involvement in many routine procedures will
become minimal. Some hospitals and clinics will establish
bespoke facilities focussing on high throughput, highly
automated imaging and minimally invasive, robotic surgical
interventions. The lure of automation and associated cost
89

91. savings will change the mix
of professional assistance in
favour of nursing support.
While patients won’t quite be
performing basic surgical
procedures at home by 2020, we will
see a reduction, but not eradication, of human
intervention in many cases.
Today, we drive cars designed by robots, we ‘fly by wire’ and
we travel in trains that do not have drivers. Yet despite the
sophistication of machines many people want them monitored
by humans so that automated decisions can be over-ridden,
even though man is liable to make
many systematic errors however bright
and well trained.
Already, robotic-assisted surgical procedures
have been shown to reduce the duration of
hospital stays and patient surveys suggest that this
approach is chosen because of greater expectations of
decreased morbidity, improved outcomes and less pain.
But whilst medical care is about accurate diagnosis and
effective treatment, which computers and robots are
increasingly capable of, it is also about empathy and
understanding – the emotional ‘add on’ that sets humans
apart. Man will always have a role to play in healthcare
90

92. provision. In the specific case of robotic intervention,
identifying and meeting the needs of patients who need
support through tailored preoperative communication, family
counselling and postoperative support groups will become
key themes in the future.
91

93. One pill for every ill
92
...UNIQUELY PERSONALISED
PRESCRIPTIONS..DELIVERED
TO OUR DOOR,OVERNIGHT
16 “
”

94. Many people with multiple conditions and chronic disease
have to take numerous pills to manage their health.
Pharmaceutical companies have spent a significant portion of
R&D funds researching combinations of drugs that are
commonly taken concurrently as part of a treatment regime.
The aim is to reduce the pill burden for individuals so that they
may only have to take one pill daily, which in turn, can help
increase adherence and improve outcomes.
But, the way our bodies process drugs can vary from one
individual to another. By 2020, the days of `standard'
prescriptions being fulfilled by a local pharmacist will be
increasingly replaced by personalised polypharmacy, which
will be precisely tailored to our genetic profile and how we as
93

95. individuals (not population averages), metabolise drugs
differently. Repeat prescriptions
will be automatically
generated and adjusted
according to our
response and
adherence data,
unless a physician
intervenes of course.
This could be centrally
processed at regional
fulfilment centres and our
uniquely personalised prescriptions, delivered to our door,
overnight.
Non-adherence, that can be exacerbated by a
high daily pill burden, causes
prolonged suffering, extra visits
to the doctor, longer recovery
time and avoidable
hospitalisation – it is costly to
both the patient and the
profession.
Suboptimal dosage can also cause
prolonged suffering and present an
unnecessary demand on the healthcare system.
Tailoring dosage, making it easier for the patient to take their
prescribed medication will help, but this is not the only factor
94

96. of importance in encouraging adherence. People tend to
follow their doctors’ orders more when they believe it is the
appropriate course; they understand and are able to
undertake the actions; they are not impeded in their course of
action and they are able to monitor their progress.
Personalised polypharmacy will need to be supported by
personalised digital interventions that address these factors to
realise its full potential
95

97. Intelligent meds
96
THISTECHNOLOGYWILL
NOT IN ITSELF IMPROVE
ADHERENCE
17 “
”

98. We already have pills that contain a microchip to check
information about the patient’s body. The ‘chip-in-a-pill’
system takes measurements from within the body. When
the pill comes into contact with stomach acid, it generates
an electronic signal that communicates with a body patch.
This data is then remotely forwarded to a central database
and is accessible via mobile devices.
This technology will become cheaper and more feasible
over the next decade, enabling enormous advances in
monitoring. But it will not in itself improve adherence. By
2020 leaders in this and similar technologies will also have
invested heavily in patient segmentation and behavioural
medicine. They will be providing PMFD (personal multi-
97

99. functional device) programmes, addressing the 20 factors
affecting adherence, based on the collated behaviours and
experiences of patients at similar life stages, with similar
lifestyles and similar health attitudes.
Currently there are various ways of assessing whether
patients are taking their medication, from pill counts using
mechanical devices through to blood and urine tests. But
these can be both inaccurate and costly respectively. We also
know that between one third and a half of patients do not
comply with medical advice when it comes to taking
medicine, but when questioned, they often say they do so in
order to please their doctor: reported behaviour differs from
their actual behaviour.
Knowing a patient's
adherence precisely will
require a change in the
nature of the
‘conversations’ healthcare
institutions and healthcare professionals have with their
patients. There will be a need to identify and understand
individual reasons for non-adherence in a tone that is
sympathetic not condescending. This in turn implies a focus
on the ‘language’ of the interaction that will best support
future behavioural change. And there will be a need to follow
this with behavioural counselling to address these reasons.
Not all healthcare professionals are adequately equipped in
this, nor are healthcare administrators.
98

100. A game of life and death
99
...GAMESWILL HAVE BEEN
CREATED...INCORPORATING
REAL LIFE PATIENT DATA
AND BEHAVIOUR
18
“
”

101. Throughout our entire lives we learn by playing, and games
can be the most enjoyable (and some might argue, the most
effective) way of teaching good behaviour, structure and
knowledge.
To that end, games can increase adherence and teach people
about diseases. In fact, this has already been proven through
a number of studies.
As evidenced by social gaming and new easier-to-use gaming
consoles, games are an activity for the masses. This trend is
set to continue and fun, educational gaming will be tailored to
specific patient populations and at-risk groups.
By 2020 games will have been created for many chronic
disease communities incorporating real life patient data and
100

102. behaviour. Patients within these
communities will bond with and learn from
one another through social gameplay.
They will devise strategies as part of this
gameplay and if they live these out in real
life they will achieve higher status.
Leading players achieving expert patient
status will gain additional credits for
coaching others to play the game better.
And so the line between patients’ virtual
worlds and real lives will blur as online
activity favourably impacts offline
behaviour and health outcomes.
Gameplay teaches about knowledge
and dexterity and reaction times. It
also teaches about others and
how we compare to others. We
know that electronic games can
be addictive, provide excitement,
and a sense of achievement.
Thus, through these mechanisms,
they can provide feedback on
one's progress. They can allow
people to enter a fantasy world
and to experiment: they can allow
for automated, unconscious
101

103. behaviour change and learning.
Saying this, gaming is unfortunately burdened with
misconceptions that aren't conducive to its deployment in
healthcare e.g. ‘computer games are mostly played by young
men’; ‘virtual worlds are not for serious matters’.
The challenge with gaming therefore, is perhaps less about
acceptance by patients and more about acceptance by the
healthcare professionals. The latter is important not only in
terms of deploying gaming in healthcare, but in developing
meaningful healthcare games that will require collaboration
between experts in health and experts in gameplay.
102

104. Feel better with designer genes
103
GENETIC SCREENING OF
SOMATIC MUTATIONS IN
TUMOURSWILL BECOMEA
STANDARD DIAGNOSTICTEST...
19“
”

105. Genetic testing
and modification
provides enormous potential
for the medical community. Because
of its accuracy, gene therapy in cancer
treatment specifically destroys tumour cells without
damaging normal, healthy tissue. Improvements in
DNA sequencing technology will mean that genetic
screening of somatic mutations in tumours will become a
standard diagnostic test, thus enabling tailored, targeted
therapy to be administered. In non-cancerous diseases,
somatic gene therapy works by introducing one or more
genes into the diseased cells to inactivate or replace a
mutated gene causing the disease. Unfortunately the effects
of somatic gene therapy are short-lived because most cells
die and are replaced by new ones, with the mutated gene,
which means repeated treatments are necessary to maintain
therapeutic effect.
The potential of gene therapy is enormous, but the results to
date are somewhat limited. By 2020, not only will we be able
to identify many of the genetic faults and deficiencies behind
today’s life-threatening and life-limiting diseases, but gene
therapies will also be available to deliver ‘patient-friendly’
treatments.
The more we understand medical genetics the greater the
opportunity to identify and correct errors that create disease.
Gene therapy can offer hope where none existed before, but it
104

106. is important that patients and their families understand what is
wrong with their genes and the consequences of electing to
have or not have gene therapy. Long-term, repeat treatments
can be very stressful for the individual primarily, but also for
the family: they can mean time off work, hospital visits, and
stress.
With gene therapy, there is the worry of side-effects (as with
any treatment) and the possible dangers associated with any
experimental therapy. But already there is also great optimism.
All of this needs to be carefully managed so that people’s
expectations are realistic. This means understanding
probabilities and the likelihood of success or failure, and we
know how challenging communication of these can be.
105

107. The power of the mind
106
USINGTHE POWER OFTHEIR
THOUGHTS...
20“ ”

108. As the power of modern computing grows alongside our
understanding of the human brain, we are on the brink of seeing
technology transform terminal care. The development of brain-
computer interfaces is already taking gaming to the next level
by enabling players to interact by the power of thought.
Similarly, ‘The Multimodal Brain Orchestra’ has demonstrated
how a `conductor' can control an orchestra by thought alone.
This technology holds great promise for the development of
interactive care environments where terminally ill patients with
limited mobility or strength have the option to control their
surroundings, easily interact with others, both near and far away
and provide themselves with mental stimulation. In 2020, brain-
computer interfaces will be used to allow patients to control a
107

109. range of interactive devices from their bed. Using the power of
their thoughts they will be able to select movies, communicate
with their friends and family, control their personal finances
and even take a relaxing simulated break abroad. Clearly,
terminal care may always be a daunting experience, however,
this technology has the potential to give patients greater
control and peace of mind.
There is nothing quite as depressing for people as to lose
control and feel helplessly dependent on other people,
particularly strangers. This is particularly difficult if one is in
pain or nearing the end of life. Worse is the problem of not
being able to communicate clearly ones hopes, wishes and
thoughts to family and friends.
People ‘medicate’ with music and with memories. We know
the power of social support to improve a person's morale
which improves all aspects of their physical state. Work with
quadraplegics has shown how providing some way of
communicating makes all the difference to the quality of their
lives, and those looking after them.
Most want to talk not only to friends and families, but also to
professionals. People in terminal care want to get ‘their affairs
in order’. This involves not only messages to loved ones, but
also monetary and related issues they want to resolve before
they die. Things need to be said, and clearly. Also, particularly
with family, there may be emotional issues and long ignored
108

110. problems that many are most eager to settle. Giving them a
way of doing this can substantially improve their quality of life.
109
Conceived & created by:
David Davenport-Firth, Enrique Alda,
James Robertson, John Green, Sarah Gordon,
Claudia Calvo, Francis Martinez, José M Gallego
© 2010 Ogilvy CommonHealth Worldwide
© 2014 iBook Edition