Interview
„We have to intervene earlier to keep people as healthy as possible“
Bogi Eliasen is Director of Health at the Copenhagen Institute for Futures Studies (CIFS) and works on topics such as genomics, (digital) data and functions and their integration into our future health and care system. In this interview, he reveals why we need to think about health across national borders and talks about the future use of digital biomarkers in medicine.
Bogi Eliasen works in particular on approaches to preventive health and keeping people healthy for as long as possible.
Mr Eliasen, you live and work in Denmark - how does the German healthcare system differ from the Danish one?
In Denmark, we have a tax-financed, centralised system, whereas Germany has an insurance-based, federated and very fragmented system. The hospital reform that is currently being discussed here took place in Denmark 15 years ago - fewer beds, larger hospitals. In this respect, it worked for the time being. However, if we look at the benefits for society as a whole, we see a problem that is not unique to Denmark. Both countries are facing a double demographic challenge: the population is getting older and age-related illnesses are steadily increasing, while at the same time a large number of people are retiring and leaving the labour market - so there are more sick people but fewer workers. This is where we need to start and redefine health as an ongoing process when we make investments and try to make plans. Health is an ongoing process where the challenges and opportunities change, it is not a process with a clear endpoint but rather a never ending ongoing and chaning process.
What role do you think prevention plays in medicine and in the healthcare system as a whole? What is meant by secondary prevention?
The average life expectancy just 150 years ago was 30, whereas nowadays people in many countries live to be 80 on average. If we look at why, it is not just the improvement in medical care, such as the introduction of hospitals. It is mainly factors such as better working conditions, better nutrition etc. that make a difference. People don't get older only because they go to hospital. They oldest mainly get older because they never needed the hospital. And that is crucial to learn that parts of health happen outside of the health systems.
This also means that we have to intervene earlier to keep people as healthy as possible for as long as possible. And this is where secondary prevention comes into play. It's not primarily about more hands – workforce – it's about the point and time at which we apply the expertise we have. This also means that we need to rethink where we invest, because today we are mainly investing in solutions for late-stage in diseases – and not for early-stage in diseases.
“It's not primarily about more hands – workforce – it's about the point and time at which we apply the expertise we have.”
What needs to change in our healthcare system so that it works well in the future?
We must enable access to health - not just to healthcare and medicine, but to a healthy life. This is not about recovery when people are ill, but above all about maintaining health throughout life. This is a change in mentality that needs to take place, from illness to health in all its aspects.
Where do you think the potential of the Bosch Health Campus lies?
I see many opportunities. One of them is that the Bosch Health Campus can contribute to a paradigm shift. Here you really have the opportunity to pursue an interdisciplinary approach. For example, there is the PORT project, which is very similar to our approach to secondary prevention in Denmark. We should push ahead with this. I also see the Bosch Health Campus utilising relevant technology in the healthcare sector – technology that makes the fourth industrial revolution, which is now taking off, possible.
Digitalization as one of the keys to a sustainable healthcare and supply system.
What role does personalised medicine play in the transformation of our healthcare system?
I have had a lot to do with genomics professionally, but it will probably be a different personalisation of medicine in the future - it won't just be about genomics. I call it a new biology where digital biomarkers will play an important role. We will use them to look at our habits in a different way and tailor our behaviour or diet, for example. We will use many more images and imaging techniques and develop intelligent materials such as nanorobots. We will then be able to recognise patterns that emerge from the data we collect. The advantages and health benefits for people will drive this change.
Bogi Eliasen works as Director of Health at the Copenhagen Institute for Futures Studies (CIFS). He was born on the Faroe Islands and lived there until his twenties. Before going to university, he spent two years in Brazil - both periods of his life have greatly influenced his current view of the world. Bogi Eliasen studied political science and international law at Aarhus University in Denmark. He worked for 25 years as a consultant in the political and public sector and for private companies and is a Richard-von-Weizsäcker Fellow at the Robert Bosch Academy. He was the initiator of the Nordic Health 2030 process and was instrumental in initiatives such as FarGen and the Movimiento Salud 2030 (Improving Health in Latin America).
Where should the healthcare system be more sustainable in future?
Sustainability is a very important topic - but it is also important to know exactly what you mean when you talk about it. There is ecological sustainability, but there is also sustainability based on an economically sustainable healthcare system. This means that you should provide a social benefit that is worth at least as much as the resources you use. For example, if we say that we need growth in society in order to be able to help everyone, then this does not necessarily have to be industrial growth. It could also be that by reducing the burden of disease, we have more hands that can do more things. That is also sustainability.
You are co-chair of the supra-regional Health Leaders Network Sciana - how important are such programmes for our healthcare?
Sciana is a leadership programme. Leadership is the part next to technology that I think is very important to move forward with our healthcare challenges. It's about having the courage to make changes. It's about leadership in a new era. The health systems themselves are very different in every country, but 80 per cent of the health challenges around the world are the same. If we want learning health systems that are based on data, we cannot limit this to certain countries - we need to network and exchange within our countries, but also between them. This is where leaders should network with each other.