Zuckerberg San Francisco General Hospital on Wednesday, Dec. 5, 2018. (Kevin N. Hume/S.F. Examiner)

Health care needs to be “disrupted,” but not in the way startups think

By Shannon Brownlee, Benjamin F. Miller, and Vikas Saini

To Silicon Valley entrepreneurs, health care is a sector ripe for disruption. They’re not wrong, given skyrocketing health care spending that’s yielding diminishing returns on health. From high-tech fitness trackers to genome sequencing and pill delivery services, the number of health care startups has exploded. In 2018, investors poured more than $8 billion into digital health startups, up from $5.7 billion invested the year before on the promise of shaking up health care, and innovating our way to better health.

Yet despite all the money and ingenuity going into these ventures, there’s not much evidence that they will actually make people healthier.

The trouble with these apps is two-fold. First, developers have bought into a dominant, but false paradigm: that using technology to track various medical biomarkers, like weight and heart rate and number of steps taken per day, will lead to better health for the individual. That hasn’t worked out.

For example, genomic sequencing has not been shown to improve behavior; wearable fitness trackers don’t actually help people lose weight; and personalized health plans rarely provide information about diet and exercise that patients don’t already know.

The other false assumption that developers make is that focusing on individual behavior will add up to better health for the community as a whole and can bring down health care costs.

While it’s certainly the case that part of an individual’s health is a result of behavior, such as smoking and exercise habits, those habits in turn are affected by a set of socioeconomic factors, which together with environmental conditions affect how long we live, our mental well-being, and a host of other health outcomes. If you want a long, healthy life, make sure you can find a steady job, good education, nutritious food and clean water, stable housing, and a safe family environment.

Unfortunately, these and multiple of other vital community conditions which determine health, are out of reach for millions of Californians, and ironically, their effect is no more apparent than in the Bay Area and Silicon Valley. The region contains some of the healthiest counties, but also the most significant racial health disparities in all of California. San Jose has one of the highest levels of income inequality of any metropolitan area in the country. Housing affordability in Silicon Valley is squeezing out teachers and firefighters. Over the past two years, the homeless population in San Jose increased by about 30 percent, from 7,394 to 9,706. Even within the tech industry itself, social conditions are leading to burnout and serious mental health issues, threatening the well-being of the workforce.

More significantly, the state’s ability to have an impact on these community conditions is being squeezed by rising health care spending, which is crowding out and misdirecting attention and resources. Part of that rising spending can be attributed to cost of medical technology. The net effect is that over the last decade, the ratio of spending on community conditions to health care has declined. According to a recent report, in 2007 California spent $1.22 on environmental protections, public health and social services for every $1 spent on health care; by 2018, California only spent 0.68 on these community conditions for every $1 spent on health care.

If Silicon Valley really wants to disrupt the health care sector in a way that has the most impact on people’s health, it needs to bake an understanding of community conditions into whatever ideas they put forward. There is an enormous opportunity for truly disruptive tech innovation, but it needs to do more than activate individuals. It needs to change the dynamic of their social networks in brand new ways. Finding the right business model will be a challenge, but that’s what innovators were born to do.

Vikas Saini, MD is a cardiologist and president of the Lown Institute. Shannon Brownlee is senior vice president of the Lown Institute. Benjamin F. Miller is chief strategy officer for Well Being Trust, a California-based national foundation.

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