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Social Determinants – the KEY to solving current pressures on Health Systems


Standardization, personalization, and digitalization

This article co-authored by Michael T. Modic MD, and Luis Lasalvia, MD, MIB, makes an essential point that healthcare can learn valuable lessons from other industries like manufacturing, retail, banking, and hotels. The three critical aspects of standardisation, personification, and digitalization to be learned from these industries are all “bull’s eye hits.”

Some burden of “diseases” fits into the predictable category – the relationship between cause, treatment, and impact are well known (e.g., hip replacement). Here the standardisation on BEST practice needs to be relentlessly pursued. The standardisation of predictable treatments remains an area of wastage due to ongoing variations in many current healthcare practices globally.  

Other diseases fit into a category where “we have seen this before, and our treatment responses have had mixed results.” Here there is some degree of trial and error, starting with what has been done before. Here, the mindset has to be trying a range of good practices or “empirical medicine.” Here digitalized data can make a big difference to save time and guesswork in the understanding causes and treatment responses.  

Increasingly, we are confronting illness and conditions that we are unfamiliar with both in the communicable diseases (the early stage of the Ebola outbreak) as well as chronic, lifestyle, life-ling conditions. (especially with an ageing population and people living longer with more years in ill health). The causes initially will not be unknown, existing treatment has minimal impact, and new treatment will take time to develop. Here we are in the realms of “intuitive medicine” where the appropriate responses

are likely to cut across other determinants of health. Advanced analytics on digitized data from across many sectors will be needed to come up with such new and broader responses. 


Personalised medicine which is already making a dramatic impact, can only accelerate with exponential advances and convergence of technology, life science, and engineering. Future healthcare services will be “closer, smaller, earlier, and personalised” as life science advances in disciplines such as genomic screening, editing, and related therapies become mainstream and replace or augment a broad range of current surgery, drug, and radiation treatments. 

 The disruption here will be significant on many health organisations and systems, especially those that continue to build large hospitals that have little or no flexibility to do anything but perpetuate current way health services are delivered. 


Social determinants – the key to solving current pressure on health systems 

The burden of disease on health systems has shifted to chronic, lifestyle, and life- long illness and conditions. Current health system services no matter how vigorous and innovative is fighting a losing battle against this changing burden of diseases. Increasing crippling pressures felt by many health systems bear witness to this losing battle.  

The root cause of these chronic, lifestyles and life-long illness and conditions lies in a complex interplay of genes, behaviours, lifestyle choices, societal environments, and cultural practices. Without addressing these broader determinants, merely investing in more healthcare services is continuing with the ambulance at the bottom of the cliff. The need for a more comprehensive social determinants approach is well known but remains outside the grasps of many health systems.  

There is no question that healthcare needs new partners who can contribute to these social determinants. New entrants are emerging in recent times and are starting to pick up pace in making their presence felt in healthcare. Some of these new entrants can potentially be part of the comprehensive social determinants approach. 


New entrants 

The convergence of healthcare with other sectors such as retail, housing, energy, transport, and food is increasing by the day. Big moves by the eCommerce giants, retail, insurance, housing, engineering, and food industry players into healthcare are emerging and expanding daily. Amazon, JP Morgan Chase, Berkshire Hattaway, Ikea, Best Buy, Alibaba, Walmart, CVS, Tencent, Cyberdyne, Panasonic, are some examples of non-traditional health organisations entering the global USD7 trillion market. For the time being new entrants’ health investments are primarily in diagnostic, primary care, smart devices for wellness monitoring, robotic aids. New entrants will move towards core treatment and rehabilitation services 

To successfully do that they will be looking to partner with health organisations with share vision and agenda for change.  

The unfortunate reality is that some current healthcare organisations and systems will resist these new entrants. They know they have to adopt these changes but struggle with the tyranny and gravitational pull of maintaining status quo. 


New visionary leadership 

The article towards the end makes a very crucial point for successful implementation. New visionary leadership is required if healthcare is to tackle the spiralling fiscal and service pressures and achieve that through partnerships with new entrants.  

Developing, mentoring, and coaching “future leaders that we need” to lead a relevant, sustainable, and equitable 21st-century healthcare holds the key to this healthcare turnaround. Leaders that embrace ambiguity, openness, teamwork, diversity, constant learning, preferably with a small ego, comfortable with a continuous and rapidly changing environment, and with the courage and conviction to inform by but not be shackled by history. 


Be part of this meaningful agenda 

The authors have added their voices to this crucial agenda of “what will the future of healthcare look like.” Lend your voice to this discussion by sharing your comments as well as re-sharing this post and the article. 



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Chai 。仁材 Chuah 蔡
is the founder of Health System Transformation Limited. A New Zealand Company, he started after he finished up as the Director-General of Health
and Chief Executive of the New Zealand Ministry of Health on February 2018.

He is the first Asian to be appointed as Chief Executive in the New Zealand public service. His previous roles included the National Director
of the National Health Board, Chief Executive of a District Health Board, Chief Financial Officer, and Chief Operating Manager in public health institutions in New Zealand

His focus is currently writing, speaking, sharing, and advising on:
1. future of healthcare
2. leaders we need
3. better care for our seniors (elderly)

He currently also provides mentoring and coaching for up and coming leaders, especially in healthcare.

In his free time, he enjoys travelling with his wife, spending time with his adult children, and a brand new granddaughter. He also enjoys pottering around his garden and developing hs newfound hobby of drawing


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