How will healthcare evolve in future urban cities?
As appeared in August's issue of Monocle
Tomorrow's health centres will bear little semblance to the hospitals we have today. In fact, they will look and function more like a "lifestyle hub", where the focus is on a holistic lifestyle and rejuvenation is the preferred medicine. In this round of the Singapore Sessions, we speak with thought leaders from diverse industries to find out what the future of urban healthcare will be.
The Session
Click on the sessionists to find out more about their perspectives or read the full session.
Klavs Hyttel — Your local hospital will be transformed by the increased centralization and specialisation, due to the need to maximise the concentration and use of expert skills and expensive medico-technical equipment.
Eventually, it may be replaced by a new hospital outside the dense urban areas, a place where you will go to get the best possible treatment when necessary - but only then!
This leaves a physical and mental distance - a 'void' that will put increased focus on the urban integrated health centre "around the corner": The fine balance between the convenience of proximity and the security of excellence only the super-hospital can provide.
But your local urban health centre will also get larger and much more multi-disciplinary. Increased challenges in recruiting the best personnel make bigger clusters and professional communities much more attractive, and this will change the landscape of medical services: There will be fewer small clinics - the 'village doctor' will be a dying breed. Instead, the continuous breaking down of traditional professional boundaries will mean that your health centre can do new things, integrating treatment, education and community services in new ways.
Health centres will on one hand be able to treat more complex cases, as the development in surgical techniques continues, meaning that open surgery will be almost non-existent within five years, and you will be able to walk home after most interventions. On the other hand, the rise of 'pervasive medicine' will mean that fewer patients actually need to show in person, as medication and monitoring can be handled online, and ultimately intelligent textiles in your clothes may keep watch over your condition instead of a nurse. As the number of chronic patients is rising, this will have a huge influence on the daily routines of the health centre.
It will mean that prevention will become an equal focus of your personal profile at the health centre, for example providing diet counselling, help to quit tobacco, personalized physical exercise etc, but also intervening proactively to prevent psychiatric cases or dementia, and to ensure rapid rehabilitation. Since short term 'hospitalization' will also be possible at larger health centres, for example as a transition from hospital treatment to returning home, you may find that breaking a leg becomes your opportunity to lose weight, or quit smoking.
The physical location of health centres even today is an opportunity to initiate change in the socio-urban context, and will be used widely to introduce workplaces in mono-functional housing districts or community activities in bland urban districts. Literally bringing the cure closer to the symptoms, this means that the physical boundaries of the health centre will also be blurred: Treatments and counselling can extend well into your private sphere or working environment, and ultimately you may find yourself being cured and being at work at the same time.
Finally, your health centre will not look like it used to. Already today there is a strong drive to move away from the typical institutional look - which may make you sick from even looking at it - and replacing it with bright and friendly spaces full of art to provide a deliberate counterpoint to the functional aesthetics of the clinic. However, so far surfaces have always been dictated by hygiene and cleaning performance, resulting in 'faux' decors of poor material quality. This will change, as it turns out that natural materials can perform just as well with much higher value, durability and sustainability, and your health centre will become like your home or hotel room.
Yes
NoAbout the sessionist
Klavs Hyttel
Partner and Architect
CF Møller Architects
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Nerio Alessandri — People are more and more aware that being healthy is not only about having a session at the gym, but it's about choosing to follow a lifestyle encompassing their life and having an impact on how they eat, on how they move and on how they spend their free time.
That's why the future health centre will be a lot more than a gym, it will be a lifestyle hub supporting, educating and guiding people toward movement and healthy lifestyle at home, at work and in free time. People won't go to the gym because they want to work out on a treadmill or a chest press, but they will go to the gym because they have a goal in mind: to lose weight, to improve mind and body wellbeing, to look better, to improve sport performance, etc. The future gym will become a real consulting centre providing tailor made training programs, but also education, networking services, remote services, etc.
I expect future health clubs being connected to people's doctors and providing specific treatments, since for many illnesses such as cardiovascular diseases or diabetes, it has been proved that exercise is a real medicine. I also expect people calling their health club to get advice on how to cook their dinner or where to go on holiday. This will have a strong impact in the club design and layout, in staff required skills, in the networking systems and technologies. Going back to the health centre facility, I believe we will find less and less "fitness supermarkets" catering every user in the same space and with the same offer; health clubs will be targeting specific population groups by designing different areas to provide the right atmosphere, design and training programs for different people with different aspirations. Sustainability will be another key issue for the future club, since it is not possible to talk about people's health without considering the environment: at Technogym we are developing a system to turn the energy produced by people's movement on the equipment into 100% clean electricity.
About the sessionist
Nerio Alessandri
President and Founder
Technogym
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Andreas Wieser — The urban health-centre of the future will be more of a holistic partner for people, helping them to achieve very wide-ranging goals in the regeneration and fulfilment of their everyday lives, rather than a place for treatment.
We currently have a very body centred understanding of health, with a focus on sport and physical fitness, but this is changing rapidly to a fuller understanding that brings psychology into play. New fields like psychosomatics and psychoneuroimmunology will boom and healthcare will focus on the person in their entireness. Energy medicine and information medicine, or even spiritual medicine, will be the fields of the future. Health will also be seen as an almost philosophical expression of the urban dream, and with more time pressures people will look to qualified partners to advise on all aspects of healthy life.
Urban healthcare will rely on an interdisciplinary team of networked experts who have to work with linked diagnosis, detoxification and empowerment of their clients. Modern academic medicine and complementary medicine will work intermingled in diagnosis and therapy.
Ageing populations will no longer tolerate such a dramatic decrease in their standards of living with age, and intelligent life-coaching and other health services (exercise, mobility and diet) will give enhanced mobility and well being for longer. There will be a lot more focus on Life Balance (not only the physical level, but also psychological, emotional and spiritual dimension have to be considered) and this will be done through heath centres as well as remotely via internet based advisers.
About the sessionist
Andreas Wieser
Managing Director and Partner
Health Centre Lanserhof
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Yong Ying-I — The growth of cities presents new challenges to accessibility to healthcare. With busier lifestyles and space being at a premium, healthcare services and wellness promotion must be brought to urban residents.
With growing evidence that many diseases can be kept at bay through preventive strategies, the onus is on individuals to be responsible for managing their diets, exercising frequently and undergoing regular health checks. In this manner, individuals can improve their long-term health, detect and address chronic conditions early, and reduce their need for emergency care services. To cater to time-pressed urban residents, health-promoting activities will be incorporated into schools, workplaces and the community. Trusted web portals will also provide health and medical information and enable people to find healthcare services and wellness activities that are convenient for them to access.
Healthcare facilities will be decentralised. Instead of healthcare being centred on hospitals, routine procedures like day surgeries and diagnostic services will be offered in satellite facilities near where people live. All healthcare providers will be connected electronically so that healthcare professionals can access medical records across providers, facilitating patients' care transitions.
Nurses and other trained members of the care team will visit patients in their homes and tele-consult with one another and the patients' doctors remotely, through mobile phones, tablet computers and internet-connected televisions. Individuals too will be able to use such tele-medicine facilities to communicate with their doctors and nurse educators. This will improve in particular the management of elderly and less mobile patients who have a variety of chronic diseases, enabling them to receive good, affordable care without having to visit their doctors frequently.
With these new possibilities, effective integration between health promotion and a range of healthcare providers is the key to success. Within Singapore, the Ministry of Health is working with all parties on a holistic strategy to integrate care, ranging from developing preventive care services and health education, to investing in infrastructure and a national electronic health record system, to manpower development and deployment of healthcare workers and encouraging new business models for sustainable healthcare services. We aim to create a healthcare system that is truly seamless, accessible and affordable for all.
About the sessionist
Yong Ying-I
Permanent Secretary
Ministry of Health for Singapore
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