Over the course of history, the ability to learn from the past, act in the present and try to predict the future has always been of significant value and advantage to both individuals and society at large.
Future predictors in forms of so-called ‘megatrends’ represent our formal knowledge of the likely future. They are characterized by three traits: a time horizon of between 10 and 15 years, a wide range and a great impact (Copenhagen Institute of Future Studies, 2017). Megatrends depict concrete changes in society (e.g., economy, environment, technological and social advances) that will in general bear upon the way in which we communicate with each other, move across and consume resources from planet Earth (Kleiner, Art & Powell, Juliette, 2017),and due to the scope of these changes, they tend to influence each other, as well as all aspects of society.
Megatrends help us to plan on both micro and macro level of society and to prepare for handling the immediate future of 10-15 years to come, by putting necessary adaptive mechanisms in place before a change occurs and/ or takes hold of the different sectors in society, such as healthcare.
In the following, some of the most important megatrends will be exemplified. These are drawn from primary and secondary research in connection with a recent publication on five trending themes in the Danish healthcare sector 2025 (Syddansk Sundhedsinnovation, 2018a).
By 2025, it is expected that non-communicable diseases (NCDs), such as cardiovascular diseases, diabetes, respiratory diseases and different forms of cancer, are going to rise significantly. In addition, mental health issues and injuries, especially in the oldest-old, are going to be more pronounced in the years to come. Especially NCDs and mental illnesses often turn into chronic conditions attached with a long-term care plan that in many cases encompasses multiple diseases and conditions as time passes (Frølich, Olesen, & Kristensen, 2017; WHO, 2017).
In recent reports, WHO forecasts a rising chronic disease burden in especially low-income countries which is partly due to the increased average life expectancy at birth. In high-, middle- and low-income countries, NCDs already make up more than 80% of the healthcare burden. WHO (2011) predicts the following statistics:
“By 2030, non-communicable [chronic] diseases are projected to account for more than one-half of the disease burden in low-income countries and more than three-fourths in middle-income countries. Infectious and parasitic diseases will account for 30 percent and 10 percent, respectively, in low- and middle-income countries. Among the 60-and-over population, non-communicable diseases already account for more than 87 percent of the burden in low-, middle-, and high-income countries.” (World Health Organization, National Institute on Aging, National Institutes of Health, & U.S. Department of Health and Human Services, 2011)
Infectious and acute, communicable diseases will become more easily detectable and manageable. Likewise, chronic diseases will be more common and more complex and difficult to prevent and treat. Long-term treatment success often depends on more than the immediate and right mixture of drugs, but on patients’ health patterns, existing support system, personal needs and experiences, all of which can make care plans more challenging (Syddansk Sundhedsinnovation, 2018c).
Both the World Health Organisation (WHO) and large software companies have realized the shift in disease burden towards more complexity, chronicity and co-morbidities, also called an epidemiologic transition (for further information on the term, please see: World Health Organization et al., 2011).
As a feature of this transition, James (2016) describes the relationship between aging and disease burden with the term ‘longevity revolution’:
Niall McDonagh, Health ATU Director for Western Europe at Microsoft, sums up ageing, chronic disease burden and limited budgets as the three factors that play a major role in the overall challenge that the healthcare sector will face:
In literature, these types of diseases are often a result of a combination of factors such as genetics, physiology, environment and behaviour. Especially behaviour connected to lifestyle choices which can influence the actual prevention of illness and promotion of health, such as physical exercise, diet, tobacco and alcohol use, is often complex and resistant to change. Whereas old age and frailty seem imperative and impossible to circumvent as life passes, environmental hazards and ‘unhealthy’ lifestyle choices present definite enabling but also avoidable factors in a growing global population that has (multiple) chronic diseases and co-morbidities.
Towards the year 2025, research and development in Denmark and abroad will therefore need to focus on all of the above mentioned risk factors including genetics, physiology, environment and behaviour, the last of which still has to gain momentum, in order to optimise society towards citizens with healthy, long lives. Regarding this James (2016) contemplates:
In the coming years, current generations will learn to live with chronic diseases such as dementia, asthma, and forms of cancer (which will slowly become chronic, treatment-intensive disorders) and manage these much more effectively. But what this tendency towards co-morbidities, complexity and chronicity in diseases will also do is that, it will let societies re-examine how their existing social, cultural and economic structures might possibly dis- or enable strong physical and mental health (Copenhagen Institute of Future Studies, 2017; Frølich et al., 2017).
In the Danish context, a study conducted in 2013 (Danske Regioner, 2015) documented that 1% of the population accounted for 30% of the overall governments paid hospital expenses, and that 10% accounted for 75% of the expenses. While these figures may appear startling, they are widely reported as the result of citizens with multiple and often chronic diagnosis. Some studies suggest that 33% of the Danish population have multiple diagnosis, 29% have one, and 38% have none (Frølich et al., 2017, p. 28). In other words, more than 50 % of citizens with a diagnosis have oftentimes more than one. It is therefore no surprise, that citizens with complex health issues are already accounting for a significant portion of the total healthcare budget, and that with increasing life expectancy, this number is projected to increase with it. As such, the healthcare system today is in need of being organized in a way which takes into account that some 50% of patients find themselves in a situation where they are in contact with possibly several different wards at the same hospital, as well as with their general practitioner and municipal services.
The world is getting older. As advances in Smart Health Technology, medicine and Prehabilitation continue to provide clinicians and citizens with tools and knowledge on how to live healthier and intervene intelligently, the mean global age is rising; and the years we live longer, we also live healthier and more active.
In parallel to this shift in population proportions, the old age dependency ratio – i.e. the ratio between the elderly, retired (>65 years) and the younger, economically active (20-64 years) citizens – will rise in the coming years. By 2050 it is projected that globally there is going to be on average 3.5 working citizen between 20-64 years globally, and 3.2 working citizen between 20-64 years in all major regions except Africa who will have to economically support 1 elderly citizen above the age of 65 (United Nations, 2015, pp. 6/7). Compared to this, in 1950 there was a much lower ratio of 16 to 1 on average (Hondrich, 2007, pp.96-98).
According to Erik Jylling (2017) from the Danish Regions the old age dependency ratio in Denmark will be even lower compared to the global average:
Having more elderly, frail citizens, who are in need of care and support, in parallel with less younger economically active citizens who can offer the needed support, means an enormous organisational and financial pressure on the health care systems in low-, middle- and high-income countries alike (United Nations, 2015; World Health Organization et al., 2011).
Medical science is developing new methods and cures that enable people to live a longer life, and make it possible for people to manage their individual (multiple) diseases while living ‘fully’. So indeed, there will be a lot of elderly who are active and aging healthily but, by time there will also be many of them – the older they get – who are in need of assistance and 24-hours care services. Predictions about demographics though state, that there will be less people to provide, in terms of paying taxes to the system and in terms of professions/ labour force within the care sector.
By 2025 the world will not only face an imminent shift in demographics worldwide, but also trends and changes in societal structures (e.g. family and urban structure, polarization, globalization) and disease burden (e.g. multiple chronic rather than infectious/ acute diseases), a declining labour force in the healthcare sector and immense technological advances, all of which will intensify the pressure on health systems and ask for new directions in the delivery of healthcare (Munk Christiansen, Goul Andersen, Gregersen, & Frandsen, 2012).
In Denmark, the population is estimated to reach 6,2 million by 2040, meaning that it will have grown by half a million citizens in a quarter of a century; most of whom will be expected to live in cities (United Nations, 2017).
Table 1: Population growth in Denmark until 2040 (United Nations, 2017).
Since research and development in medicine and related disciplines are developing successful programs and procedures, to prevent, detect and treat diseases, life expectancy at birth is increasing and mortality rate is falling, especially in the developing world. As seen in Table 2, both the Danish and global life expectancy is increasing, and in addition a lower mortality rate are significantly contributing to a population growth where there is a larger proportion of elderly and oldest-old citizens present (Sundheds- og Ældreministeriet et al., 2018; United Nations, 2015, 2017).
In Denmark we are in parallel experiencing a shortage of staff, a growing elderly and often frail population with co-morbidities, and a declining younger and economically active population to finance the costs of care/ the public healthcare. Peder Jest (2017), the director of Odense University Hospital, offers his view on the demographic challenge and necessary self-management of one’s health:
We also experience that the society is increasingly connected in terms of local, centralized living – as urban areas are being built which connect distant parts of the city and which attract families, singles, older and younger people alike. This infrastructure enables easy networking and knowledge gathering/sharing between people from different backgrounds and with different experiences on a local scale. Urbanisation is further driven by a political discourse that emphasizes the pressing issue of sustainability and circular economies.
In the future healthcare sector, citizens and patients are going to take advantage of the possibilities that urban infrastructures give. On the other hand there is going to be citizens who choose to live in the countryside. This might cause a clash between the city and countryside in that access to healthcare and options available might be distributed unequally. Since greater overall access to care options and health information and a closer and larger community network often mean greater knowledge and a stronger voice in one’s care path towards a healthy old age, it could clearly leave citizens choosing to live ‘differently’ and further away from the urbanized infrastructures at a major disadvantage.
The healthcare sector has to keep this potential inequality in mind and draw on solutions that could overcome this barrier.
Due to the demographic composition, centralized urban infrastructures, and global connectedness, we are going to meet more and more people with different lifestyles and ways of approaching everyday circumstances. Such a gradually increasing fragmentation of behaviours and needs, of people from all walks of life, be it high-ranking politicians, business professionals, or family members and neighbours living on the same street, will become even more pronounced over the next decade. In a similar vein, we are beginning to see family structures and relationship entities change, and in parallel, views on what is acceptable in terms of e.g., morphing and patchy constellations of these; which means that long-standing traditions and authorities – meaning who says what and how something is supposed to be – are taken into questioning.
For the Danish healthcare sector, this increasing fragmentation and polarization in society means that health behaviour, access and needs are going to be very diverse and detached from each other. Consequently, healthcare institutions will meet difficulties to stratify their citizens and patients, to actually be able to target each member, distinguished by socioeconomic background, skills and geography, of a certain group. There will also be ‘niche’ groups that will have a very specific knowledge and behavioural pattern, for the healthcare sector to be sensible and inclusive of.
In terms of family constellations and in particular, a declining number of larger family networks, the healthcare sector will see the importance of the surrounding community and community action as well as alterative living arrangements (e.g., of younger and older people) and technology to assist in healthcare in urban and rural districts.
We are looking at a future in which a rapid, abundant growth in all branches of production and development of new solutions and technologies is taking place. Acceleration and in particular, accelerated technological growth will influence the way in which society and thereby each individual moves (mobility), interacts (communication) and consumes (energy/ ecological footprint) (Kleiner, Art & Powell, Juliette, 2017).
Besides more knowledge being easily accessible and sharable, more products and services will be produced and consumed, and more efficient forms of transportation will be readily available. Society already exhibits signs of and actively shapes this megatrend, in terms of shifting relationships, jobs or homes at an accelerated pace.
As more solutions and technologies become a reality at an accelerating pace (World Economic Forum, 2016), the healthcare sector has to be open and ready to choose from, test and implement these in order to potentially optimize their processes. It is also important to look ‘outside of the box’ and re-think healthcare services in terms of the health consumers’/ citizens’ demands and ways of moving, interacting and consuming in the market (Syddansk Sundhedsinnovation, 2018b, 2018c). Due to both increased economic growth and accelerated production and consumption, citizens will strive for the ‘ultimate and best’ option – which can stretch from medical treatment over to alternative therapy and courses in mindfulness.
In the future we will also meet a society in which each individual will strive to live and make decisions about life according to what fits to individual prevailing circumstances, which are oftentimes changing from one moment to the other. An individual’s consumption patterns will largely depend on what is instantly available and suits best and most optimal, right here and right now. Our striving for constant optimization and feedback as well as instant gratification will have almost no boundaries in the future. At the same time, the ability to concentrate, to engross one’s mind and suspend one’s needs, will be much less prevalent in citizens of 2025.
All healthcare professionals will have to meet and accommodate individual preferences and needs at any given time – even foresee these before are actually being uttered. They will have to take measures on how to comply with a need for constant optimisation, best options available – independent of boundaries of e.g., institution, knowledge and geography –, feedback and instant gratification once a healthcare plan is being laid out, adjusted and actually met.
Signposts such as global citizenship, sharing economy, easy information access and distribution and more are hinting at a much more democratic future as well. Power seems to become more distributed and lay within the hands of the citizens in a globalized world.
Democratisation is the actual process of a society moving from a more authoritarian to a democratic regime. It is “a transformation process in which equality, access and transparency are strengthened. Much democratisation is about responsibility, decentralisation, empowerment and openness” (Copenhagen Institute of Future Studies, 2017). Yet, the term is just as much used to describe our desire to be informed and involved in and exercise direct influence on issues that personally impact us, so that political measures, initiatives and re-organisation of processes make sense and give value to specifically our everyday lives.
In a more democratic and less authoritarian healthcare sector, patients and citizens will have access to knowledge and willingness to take part in shaping their healthcare plan. Health knowledge that either has been documented or claimed as being reliable e.g., on social media and the internet will be easily available and challenge the doctor-patient/ healthcare professional-citizen relationship. Traditional roles will be defied and responsibilities rearranged, to a point at which collaboration, professional guidance and co-responsibility appear as common key goals. The dichotomous relationship between doctors, nurses and other health professionals on the one hand and the self-reliant patients on the other is shifting towards one where the patients have greater co-responsibility and the health professionals less authority and a counselling role. At the same time, patients will connect with other patients to a greater extent and compare stories, treatments and solutions with each other in person and in online networks and communities, in order to be able to navigate in and contribute to a new paradigm in the Danish healthcare sector (BBC Radio 4, n.d.; Darzi, 2015).