Health Is Wealth!

Without health it is difficult to have fun, pleasure, wealth, freedom and drive for reason and responsibility. At times in pursuit of above mentioned things we lose our focus on health and lose health! This is true at individual and country level.

Which country has the best health care system?
Does spending more on healthcare ensure better health?
What is the optimum funding for healthcare?
How health is a linear and non-linear function?

The above questions require research and data collection and analysis. And it will always be a work in progress. Three articles published in Lancet throw some light and make us ponder on health.

Wealth But Not Health In USA The article speaks about the now well known fact that US spends more on health care per person than other G7 countries.
Americans especially American women are having declining health for 30 years.  Americans fare badly not only at life span but also at infant mortality, low birth weight, injuries and homicides, teenage pregnancies and sexually transmitted infections, drug-related deaths!, obesity, diabetes and heart disease, chronic lung disease, HIV/AIDS prevalence.  The data if segregated according to region and economic level will be more revealing about the disparity in health condition.
I suspect there is a great inequality in health care access and outcome within US. This despite the fact that US spends 18% of its GDP on health. The leading European countries range between 9.5 to 12 %. And they have better metrics to show. One thing which i dare to conclude without digging into the data  is that probably the level of inequality is less as of today. It will be interesting to note the metrics 5 and 10 years from now as austerity measures get implemented.

Cuba spends on healthcare and has results to show for it also.

What are the lessons for other countries? What model should one follow? How should the government intervene or give incentives for better health. This especially true for young nations like India and China which will have its major population moving above 50 years in coming decade or two.

The Lancet article mentions the following remedies for US.

"Why are Americans at a health disadvantage compared with those in other countries? The fragmented US health-care system, and, in particular, poor access to health care and to primary care, are partly to blame. Lack of insurance, or inadequate insurance, restricts access to health care for many Americans. But the system is not the only problem. Unhealthy behaviours abound in the USA, particularly overeating, drug abuse, and other risk-taking activities such as not wearing motorcycle helmets, drinking and driving, and using firearms. Social and economic conditions in the USA contribute to high incomes for some, but to high poverty and income inequality for others, and to low standards of education. Welfare safety nets are not as robust as they are in other countries. Moreover, cities in the USA are often built around car use, which discourages physical activity and contributes to obesity."

Also it seeks implementation of National Prevention Strategy.

The report mentions the following things:

The Strategy’s seven Priorities are designed to improve health and 
wellness for the entire U.S. population, including those groups 
disproportionately affected by disease and injury. 
• Tobacco Free Living
• Preventing Drug Abuse and Excessive Alcohol Use 
• Healthy Eating
• Active Living
• Injury and Violence Free Living
• Reproductive and Sexual Health
• Mental and Emotional Well-Being


My opinion:

1. Behaviors are difficult to change. People who fight fires are normally the heroes and not the one's who prevent fires! We need to glorify fire prev-enters.
2. Corporate's, government, schools, colleges should stress on healthy living. Incentives and recognition should be given to healthy people. Ideal Blood pressure individuals in different age groups, Best Glycemic control in a particular quarter, Best Aerobic capacity person, etc etc.
3. Role of viruses in causing infections, chronic diseases and cancers should be highlighted. Vaccinations should be explained.

We need not have to wait to implement these strategies in Emerging Countries. Every nation stands to benefit by rewarding healthy living.

Other articles to read:
1. Guardian
2. UC Atlas
3. PBS Newshour-How US Compares

A slightly different view!

So what are you going to do to stay healthy?

Building & Managing Products For Emerging Markets-Healthcare Specific

INDIA-BANGALORE
One good thing leads to another.Thanks to Eventbrite.

 On Saturday attended a talk on "Building & Managing Products For Emerging Markets", by Ravi Kaushik.  Ravi Kaushik is the Global Product Manager-Director at Wipro GE Healthcare. He presently is focusing on Maternal and Infant Division. Under this they have come out with a Lullaby Warmer. The whole iterative process in bringing out this product and tailoring to India was discussed in detail. The challenges from price sensitivity to recommendations by end user were all part of the discussion. The effort of around 4 years with  inputs from various sources collected meticulously has resulted in world class product at Indian price! This product is now exported to developed countries also. Ravi highlighted the learning with fair bit of anecdotes, analogues and personal nuggets. Few examples-how the bottom of the pyramid varies from country to country, ice-berg pyramid.

 The audience was entrepreneurs, Nokiaites, few techies and other product leadership institute students (I am limited in my knowledge about the participants).
 The way the cell phones have penetrated the market was also part of discussion. Also it was highlighted that certain quality issues are a must in few companies which the competitors may not be adhering to. The Nokia person mentioned that each Nokia handset has to go through a Radiation emission test and this adds to cost of each set by 8$. Now we are not sure whether the local cell phone handset manufacturers test their phones or not! If it is not mandatory or not required by law, will companies be doing it voluntarily?

The event was organized by Institute of Product Leadership and Adaptive Marketing.

It is sad to note that there is no licenses or certificates  required to enter the healthcare devices market. Anybody can produce warmers, ECG machines etc and sell them. The story goes that an influential Diary Owner entered the baby warmer market, sold around 800 odd units and now is back in diary business!

Few learnings;
1. The corporate world/MNC's do take lot of pain to understand sector like healthcare through primary and secondary research but there are still lot of gaps.

2. Healthcare has complex behavioral patterns influenced by economic and other considerations. The end consumer may be  a doctor, hospital, government or the patient ! Each one presents an unique challenge in terms of market, penetration and scalability.

3. Out of pocket expenditure is the prevalent mode of healthcare expenditure in the larger part of the country. They are ready to go in debt and pay if they are convinced of the value. How the value is communicated or demonstrated is the key! The behavior of doctors and how they look at products is something which is not universally known, studied or accepted. The laws of economics also work on them!

4. Lack of FDA kind of approval in healthcare devices leaves the field wide open for all kind of jugaad!

5. Indian market pushes everyone to innovate and offer the best price. The sad or unfortunate part is the "push" is not always from the end consumer or beneficial to the end consumer.

6. Specific to warmers or products related to infants and maternal care, the lower birth rate areas will have greater market for these products. This may seem paradoxical. One may think that the areas with high infant mortality rate should be the first to have products aimed at reducing infant mortality rate! That is true provide it is funded through government. Low birth rate goes hand in hand with literacy and greater economic freedom. This makes investing in the 'precious' child a must.

7. Healthcare requires manufacturing, services, consultancy and educational support! What i mean is that manufacturing, services, consultancy and education specific to healthcare are very much in need.

Bubbles in Research, Education and Healthcare

Few years back we witnessed the housing bubble coming to an end. Its effects are still being felt. The internet bubble in 2000-2001 led to the creation of infrastructure.Japanese are still to recover from the bubble which ended in 1989.  There have been numerous bubbles and busts in history documented. Also considered as business cycle this is considered by some as inevitable and also beneficial. The governments try their best to avoid this as it brings the survival of the fittest to a very crude form! We are yet to learn the art of growing without creating bubbles. Trade, economics and financial market have made their contribution and we need to be thankful to them. In the new era we will have to learn the art of creating mini bubbles from which survival is easier and the pain is short lived.
The latest making the rounds is education bubble and healthcare bubble  in US. It will be interesting to see if there is a bubble, and when it will burst. Can we anticipate the consequences of this bubble burst?
There are lot of countries in the world which would aspire to have a bubble in their education and healthcare sector!
Similarly can scientific research suffer from bubbles? The link is to an article which predicted something like that in 2010 http://chronicle.com/article/Will-the-Biomedical-Research/124981/ Bubbles predicted too early have limited impact on the behavior of people.
It is happening with respect to NIH funds. What will be the impact and when the impact will happen are questions which require more analysis and some speculative work. Does the nature of certain research demand that they have bubbles. Without the failures we would not have had our successes? How do i calculate the return on investment of Human Genome Project? What time frame should one be looking at?
Researchers do have fiscal responsibility. But how does one define it?

Similar thoughts can be expressed about healthcare. Solutions can be varied but difficult to implement as they require behavioral changes. Most behavioral changes happen because of pain or right incentives provided at the inflection point. What incentives can be provided to hospitals, doctors, pharmaceutical industry and patients to contain the so called emerging bubble?

The bubble in education will create bonded laborers new era. There are efforts to prevent this.

Why is it so difficult to learn from bubbles in other sectors? Why is it difficult to contain bubbles after having recognized their formation?
Does nature operate through bubbles?

"Unbridled growth in any sector acts as cancer to the ecosystem called life" Pruning either by nature or by humans, if they can, reduce malignant insults.