This way healthcare can be different

Dirk Van de Poel, along with co-authors Herman Toch and Ann Maes, delves into these and various other questions in his latest book, "Zo kan Zorg Anders." (This way healthcare can be different)

Based on five conceptual frameworks or 'routes', they offer decision-makers in the healthcare sector a comprehensive view of the future. At Bopro, Dirk is a transition manager with a great deal of experience in future-oriented real estate projects in the healthcare sector. Today we interviewed him about his book.

Dirk, you are quite critical for our current healthcare system. Was such a book necessary as a type of eye-opener?

Dirk: Well, in any case, we see that the current healthcare system is coming under serious pressure. This has multiple causes: demographic reasons, the recent pandemic, increasing staff shortages, etc.

At the same time, there is a growing question as to whether the basic principles of this system are still adapted to today's society. The current healthcare system is one of ‘Cure & Care’. We treat an illness or a problem when it occurs. This way of thinking has obviously taken us very far in the medical field, yet we see that it is coming up to its limits.

In order to prevent our healthcare system from bursting at the seams, we believe it is important to work on a paradigm shift similar to those we see in areas such as climate and mobility. In our opinion, you can no longer take the subject of ‘healthcare’ seriously without looking at a broader picture of health and technology.

This includes elements such as nutrition, road safety, smoking, air quality, and sustainability but also AI, care robots, wearables, and all types of smart products.

Can you explain, in a nutshell, what exactly the five routes in your book stand for?

Dirk: For starters, these different routes have a number of common elements. For example, they all have to take sustainability into account and all five are constantly challenged by technological innovation. We call these two elements the evolving norms. They are decisive in every transition, whether it concerns mobility, the agricultural sector, or healthcare.

The first route we describe is that of the Health Collective. This route still allows room for the Care & Cure principle but moves the focus entirely to health-centered thinking. We will organize everything to promote collective health. A practical example of this is whether we should still allow a McDonald's branch to be built in close proximity to a school. Followers of the Health Collective will try to combat this with regulations. In this strive towards collective health, we see new players pop up, new partnerships, and new ecosystems.

There was also an ethical aspect to this Collective Health route if I'm not mistaken.

Dirk: Indeed, we see today that people are living longer and longer, but also that the proportion of years in which they need extensive care is increasing. Within this route, it is therefore argued that those 'unhealthy' years should not be unnecessarily extended, certainly not against the will of the patient. Here we are entering the discourse of euthanasia and a ‘completed life’.

The second route seems to go one step further when it comes to the implementation of technology.

Dirk: That is the radically preventive route. We are indeed taking this one step further. This movement assumes that we should never get sick again through technological innovations. Existing examples of this range from the permanent monitoring of blood pressure with an app to tinkering with DNA to eliminate certain diseases a priori.

Data becomes a catalyst in the strive toward an ever-healthier future. The more we share our data, the more preventive we can act. Because of this focus on prevention over curing, followers of this route predict that laboratories will in the future make up a larger share of our lives than the classic general practice.

Another example, one with which we have experience at Bopro, is the Digital Twin. We will make a digital copy of a building to foresee and avoid problems in the construction phase. Now we can also apply this to people in the form of a virtual avatar. Here we will digitally reconstruct all known characteristics of a person, including DNA. This way problems can be spotted in advance and the effect of interventions or even dietary adjustments can then be tested virtually. These evolutions are already underway and are fully driven by innovation.

We also see all kinds of ethical issues bubbling up here, not in the least about the ownership of this data, and we can also simply ask ourselves the question: 'Do we really want this?'. On the other hand, we also have to realize that in most cases technological innovation does not wait for our answer.

An even more extreme paradigm in terms of technology implementation is that of transhumanism. Forget about sickness and health, for transhumanist healthcare should revolve around the survival of the species. Transhumanists strive to make the human species more adaptable to its environment through implanted technology.

We already know a number of friendly applications for this, such as pacemakers and prostheses. But transhumanists go further and want to push humanity beyond the current perception of 'healthy'. And then we think in terms of stronger, more intelligent, longer lifespan, etc. The ultimate dream within this movement is to create a kind of Homo Deus. An eternally living human with almost divine powers.

The last routes rather revolve around the organization of the transition.

Dirk: That's right, this is a crucial question with many implications. Today most transitions of the dominant system are seen on an axis between the government and the market. But here we see other system dynamics pop up. Roughly speaking, we are talking about a bottom-up or a top-down transition

In the entrepreneurial ecosystem, the transition is driven from the bottom up. By small businesses, co-ops, decentralized, open source, and bottom-up. On the other hand, you have the organizing ecosystem in which large companies and the government implement the change top-down. This can happen in both an authoritarian and democratic way.

The distinction between these two is important in terms of data collection, among other things. Those who own the data can steer the system. This can happen for good or for worse.

Now can you tell us how this relates to the work we do at Bopro?

Dirk: When you invest in real estate, you don’t invest for the next 5 years. You invest for the long term with a perspective on multiple decennia. Therefore it’s important to have an understanding of which transition dynamics impact our future. In the elderly care sector for example the words: ‘Healthier, more self, longer at home, and more digital’ indicate the expectations of coming generations.

And while in our book we don’t say the future will be exactly like this or like that. We do give an easy-to-read understanding of the current streams of thought around the future of healthcare.

Understanding these paradigms allows us to see how current healthcare real estate developments can be made future-proof for coming transitions. Modularity quite often plays a crucial role in this process.