Underpinning discussions at this Aspen Seminar for Leaders session devoted to the future of healthcare was the acknowledgement that major advances in research and the boost in diagnostic capabilities ensured by Big Data are shifting the development of medicine in the direction of personalized treatments, which are characterized by a stronger focus on prevention.
With this in mind, it was deemed necessary to consider not only the importance of the genome, but also of all those individual behaviors and environmental conditions that have an impact on the epigenome (that is, the set of processes that enable the instructions contained in the genome to be read in the right tissues at the appropriate time), resulting in appreciable variations in survival curves, and, in particular, those for survival in good health.
It was observed, moreover, that the increased life expectancy witnessed in recent decades has not been matched by a commensurate extension of healthy life years. Medicine today aims to change the gradual decline in quality of life to ensure a prolonged life that is as free as possible of chronic diseases. The objective, alongside increasing the wellbeing of older patients, is to improve the sustainability of the health system, much of the spending of which is currently focused on treating chronic diseases in elderly patients.
The participants highlighted that significant benefits for the economic and social system can also be gained through educating people on healthy lifestyles and prevention. This was held up as the most cost-effective way, in the medium term, of preventing the aging of the population from having serious consequences on the viability of a welfare system that is already engaged in rationalizing services through increased waiting lists.
It was remarked, however, that investment in education and prevention in Italy would still appear to be of an inadequate level to change the health paradigm. This was attributed primarily to a certain inertia within the health system, whose managerial cadres seem insufficiently aware of the importance of prevention. In addition, there is also a degree of market resistance, since promoting awareness of healthier lifestyles will unquestionably entail a significant change in consumption as well as in food production and distribution chains. It was noted, moreover, that developments in the last fifty years have led to rapid changes in lifestyles, and have – in addition to increasing people’s material wellbeing – also introduced major health risks.
There was thus a perceived need to improve lifestyle awareness, a process which it was felt should become a priority at government level, with efforts made to overcome cultural and budgetary obstacles. As regards the latter, it was highlighted that education spending continues to be counted as current expenditure and not as investment. The participants urged that special attention also needs to be paid to providing care for and raising awareness among new residents of Italy from different countries and cultures.
Given this scenario, it was suggested that technology – starting with Big Data analytics – could play a pivotal role. Italy, while boasting a health system with extensive coverage of the population, and hence, one that is well-placed to collect large amounts of data, has not proved capable of capturing a clear and distinct picture of the state of the nation’s health. The participants pointed to the regionalization of the system and difficulties in communication between the various regions as presenting the main obstacle. Removing this hurdle will – it was argued – require a boost in monitoring capacity and policymakers to be held accountable for their healthcare decisions.
Even so, the policy challenges involved were viewed as not inconsiderable. On the one hand, new technologies – when applied to the health of individuals – raise serious ethical as well as privacy questions. On the other, it is necessary to find new ways of ensuring the sustainability of the healthcare system, while maintaining its accessibility and geographic coverage, factors which to date have assured Italy’s placement among those countries where life expectancy has increased the most. It was suggested that, in order to achieve this goal, the crucial challenge is to resolve the mismatch between the temporal horizons of politicians and the timespan of policies. Indeed, by way of a concluding remark, it was stressed that only a long-term perspective (one that unfortunately is often clouded by the prospect of elections) can ensure that citizens will have access to the major medical advances of the future.