The Future of Health 2018

Biomedical Research and Data Strategy (Panel 1)

• Economic Impact of Health: Advances in health and medical research account for up to 50% of all economic growth over the past two centuries.
• 21st Century Cures Act:
  • Enacted nearly 18 months prior to the conference with strong bipartisan support.
  • Provided $2 billion in guaranteed funding over five years and an additional $1 billion appropriated in the subsequent budget year ($3 billion total).
  • Reduced regulatory barriers ("red tape") and enabled new data sharing requirements for NIH-funded research.
  • Increased funding stability for early-stage investigators, reversing a trend of squeezed opportunities since 2003.
• The "All of Us" Research Program:
  • An unprecedented national initiative to recruit 1 million participants for a longitudinal cohort study.
  • Utilizes electronic health records, genomic sequencing (costing < $1,000), and wearable sensor data.
  • Currently in beta testing with 42,000 enrolled participants across 100+ sites.
  • Focuses on holistic health factors (diet, exercise) rather than just disease, aiming to reduce bias by ensuring 50%+ of participants are from traditionally underrepresented groups.
• Data Interoperability:
  • Despite widespread adoption of electronic health records, systems remain "clunky" and non-interoperable.
  • Dr. Collins emphasized the need for standardized data collection to enable large-scale, real-world evidence generation.
• Opioid Crisis Response:
  • Congress is developing comprehensive legislation to address the crisis beyond the initial $2 billion in state funding provided by the Cures Act.
  • Focus areas include researching non-addictive pain medications, investigating pill dumping, and implementing true mental health parity.
• Public Engagement:
  • Beta testing revealed a 50% participation rate across all demographics, driven by altruism and the assurance of data return (personal health/genomic data) to participants.
  • Privacy concerns persist regarding data security, though participants accepted risks due to end-to-end encryption and partner-level involvement in study design.
• Global Collaboration:
  • International projects (e.g., HapMap, Microbiome Project, UK Biobank) now involve over 18 million participants.
  • The U.S. aims to lead in establishing data standards for cross-border meta-analyses.

Human Capital and Economic Prosperity (Panel 2)

• World Bank Human Capital Index:
  • The World Bank plans to launch a global ranking (1–180) of countries based on health and education outcomes.
  • The ranking aims to create political pressure on leaders to invest in "no-regret" investments: broadband, clean energy, and human capital.
  • Metrics combine "learning-adjusted years of schooling" with health outcomes (e.g., child stunting rates) to predict economic growth.
  • Target audiences include G20 leaders, credit rating agencies (to influence sovereign bond costs), and business investors.
• Economic Shifts and Risks:
  • Global manufacturing is shifting toward automation (e.g., robotics in Bangladesh garment factories), closing the traditional path for low-skilled labor absorption in developing nations.
  • Without significant investment in human capital, developing nations risk fragility, conflict, and mass migration to developed regions.
  • By 2025, near-universal broadband access will increase middle-class aspirations globally, necessitating skills aligned with a technology-driven economy.
• Private and Philanthropic Capital:
  • With global government spending tightening, private donors and foundations are filling vacuums in health and infrastructure.
  • U.S. charitable giving reached an estimated $390 billion in 2016; the World Bank is increasing annual lending to $8 billion.
  • Investment in community health yields $7–$10 in economic value for every dollar spent.
• Food Systems and Health:
  • A major risk involves 2–3 billion people moving from $2/day to $10–$20/day income, potentially replicating the U.S. model of high processed-food consumption and obesity.
  • Obesity currently costs the U.S. $1.5 trillion annually; projections suggest similar costs for China and other emerging economies.
  • Private sector is shifting toward alternative protein sources and sustainable food systems to prevent non-communicable diseases.
• Inequality and Early Development:
  • Stunting and malnutrition in early childhood (e.g., 45% stunting in Pakistan) directly correlate with future earnings inability.
  • Disparities exist even within developed nations; a child born in Detroit has early-life health outcomes roughly one-third of a child in a suburb.
• Philanthropic Strategy:
  • High returns on investment come from supporting young scientists and early education (e.g., coding and robotics in Singapore schools at age six).
  • The Rockefeller Foundation and other foundations are shifting focus to "science-based community health" and resilience rather than just emergency aid.
• Future Outlook:
  • The "Human Capital Project" seeks to change the mentality of finance ministers from waiting for donations to proactively investing in health and education as drivers of sovereignty and stability.
  • Global market capitalism must be restructured to ensure all populations have a role in the future economy to prevent systemic instability.