Translator: Robert Tucker Reviewer: Jennifer Becerra
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New lifestyles and technological innovation
can change our health and healthcare.
Why should we change it? Because today there is a phenomenon
which is driven by society, and it is ageing.
Look at the ageing chart, the red section,
that of the 15 to 65 year olds, where here there is a projection from 1990 to 2060.
This segment of the population, the labour force,
the working population, decreases.
It will go down from 67% -- it's 67% today -- to 56%,
and what increases is the right side of the graph,
representing those over 65 years old.
Today, we have about 14% over 65s, but this will become 30%,
so that in 2060, 1 in 3 will be over 65 years old and also the over 80s,
today 5%, i.e. 1 in 20 -- in 2060 it will be more than 1 in 10
who are over 80.
This ageing of the population, what does it matter?
Because, looking at the report, where today there are 4 people working
for every retired person; in 2060 it will be just 2.
If we take old people together with children,
let's call them the old and the young, this figure becomes almost 1 to 1.
This puts a great strain on public finances, on healthcare.
Public healthcare is paid for from the State budget:
today in Italy, public health expenditure is 9.6% of GDP,
but it will become -- this is a European figure -- 12%.
If we look at all spending related to the elderly,
including pensions, today, we are at 23% of GDP
and in 2060 we will arrive at 28%, that is, 1/3 of GDP
will be spent on the elderly.
Here there is an opportunity, and I would like to put it to you:
The opportunity is that the health sector is a sector that will offer new jobs.
We estimate, that at European level, there will be a shortfall
of a million doctors and nurses in 2020.
And the health sector, along with the green economy,
in particular, energy and information technology,
are the three sectors where jobs will increase
and will increase greatly in the coming years.
But for sure we have a problem with the sustainability of the budget.
Let's see how much per capita health spending is growing relative to GDP.
Here we took three reference years: 2007-2009,
it was the time of the crisis, but has not changed much.
The GDP, in red here, per capita decreases: in one single country,
the one in the middle, Poland, there has been a positive GDP,
but per capita health spending grows and grows enormously,
so you understand that there is a gap, because government spending,
that must be paid from the public purse, increases, and GDP decreases.
And this is something that is being watched!
The famous, hated rating agencies look today
at the sustainability of the public finance system.
Currently we are searching for solutions to this problem.
First, if we look at what the causes of mortality are,
where health risks lie, we are able to manage some of them.
Take a look at this graphic for example.
Mad cow disease, that serious agricultural crisis
at the end of the '90s, caused a total of 200 deaths. We eradicated it.
Food poisoning, the well-remembered food poisonings,
which caused tens of thousands of deaths in the '80s
and in the '50s, still cause a certain number of deaths today,
but it is controllable, and something on which we keep a close watch.
What we cannot keep under control, and is the scourge of modern-day society,
are the three risk factors: tobacco, obesity
and excessive alcohol consumption.
Tobacco, today, in Europe,
kills 700,000 people a year. A smoker --
I suspect there are a lot of smokers here, so I'll be very strict with smokers --
not only has a 1 in 2 chance of living
14 years less than a non-smoker, but will spend the last years of his life,
on average between 8 and 12 years, sick, thus creating a problem
not only for himself and his family but also for the public finances,
because it costs, illness caused by tobacco costs.
Obesity is on the rise. What worries most about obesity
is the tendency in children.
Twenty years ago, one child out of ten
was obese or overweight; today it is one in four.
In Europe, there are 22 million children who are obese,
and that number is continuing to increase. And overweight or obese children
will be those who will develop cardiovascular disease,
will develop type II diabetes, which is very much on the rise,
and that's a very expensive disease.
So something has to be done, something's got to change.
How do we change things?
We have to make choices and these choices include those to be made individually.
I say, choose not only to live longer, because what counts
is not only life expectancy. I, as a European woman,
can live to 82, if I lived in Italy it might be 84,
but what counts is the part of my life that I spend in good health
and this is the important indicator. In English they are called
the Healthy Life Years.
They are many, they are not few, they're increasing, 62-63-64,
which means that I'll be spending almost 20 years of my life
not working, not being productive and being a burden on society.
What can we do to change matters? Here's the individual responsibility.
Our health depends on four factors.
About two of them we can do nothing. On two, however, we can act.
The two factors on which we cannot act are our age, and our sex
and DNA, with these we are born. Think, for example, about genetics:
DNA impacts upon between 20% and 40% of the body weight of an individual,
so there's not much to be done.
One can lose weight, but our genetic make-up is also involved.
Consider the natural environment and the socio-economic environment.
The natural environment. If we live in a heavily polluted city
our mortality rate increases 15-20%.
If we are exposed to particulate matter there too we have
a higher rate of disease and even mortality.
Indeed, even our social level counts:
A study was done in England,
looking at life expectancy and years in health
between central London with a high standard of living,
and the eastern suburbs, the poor suburbs,
and it was seen that for every subway stop
life expectancy changes a year.
So these are the factors on which we cannot act.
But there are two factors on which you can act,
for which you hold responsibility. And they are lifestyle
and the healthcare system. Lifestyle depends on four things:
tobacco, alcohol, diet and physical activity.
We can today, with a healthy lifestyle,
prevent many diseases, so that we increase
that part of our life during which we live in health.
One-third of cancers could be prevented by changing lifestyle,
and changing lifestyle not only improves our health,
but also improves the burden we create on the healthcare system.
Let's take a look at price: what does a patient cost
who has diabetes II?
The cost to the healthcare system is 3,000 euros.
How much does cancer treatment cost? I said that a third
of cancers are preventable. It costs 40,000 euros.
How much does a lung transplant for a smoker cost? 200,000 euros.
On the other hand we have costs that are almost zero:
do more exercise, change our diet, quit smoking,
and it is here that, in my opinion, the individual has a great responsibility.
But how do you go about changing your behaviour?
Changing your behaviour is hard, because you see,
I'm increasing your awareness, you already know,
you already know about these things, but today we're taking a look
at what the risk factors are. People can also change their attitude.
For example, today the attitude of society towards smoking
has changed: smoking is no longer trendy, chic, elitist;
smoking makes you feel a little guilty.
But to change our ways,
to go from one behaviour to a lifestyle that is truly different is more difficult.
There is help. Today digital technologies, the Internet,
the famous 5th finger, definitely digital technologies help,
because digital technologies, especially among young people,
influence behaviour. But we can also intervene with standards,
regulations, fiscal measures, incentives.
Let's look at some examples. Regulations. The ban on smoking,
which today exists in ten European countries, including Italy,
on smoking in public places and in the workplace,
has brought about a decrease in heart attacks in Italy of 11%.
From when it was introduced, in successive years, there was found to be
11% fewer heart attacks in Italy,
19% fewer in England.
Raise the tax on cigarettes. A tax increase of 10%
on cigarettes reduces consumption by more or less 6-7%.
Last example. It's very difficult to change diets.
Here the European Commission created a programme
which has been going for some years: the distribution of fruit in schools.
We distribute a portion of fruit to eight million children
throughout Europe and have monitored the consumption of fruit.
And we have seen that these children not only consume fruit at school,
but they also consume it more at home and also become a model
for their companions.
Another example is a campaign,
the information campaign we carried out
that is called: "Ex-smokers are Unstoppable".
Why? Firstly, 70% of smokers start to smoke
before they're 18, and there society can have an influence.
So we decided to act on the population band
of 25 to 35, when people begin to think,
begin to know more, become more aware
and perhaps change their behaviour and above all for once send out
a positive message: stop smoking,
you'll be better for it and stay better for it,
do more sport, you will be stronger, and richer, because you will spend less.
To go with this campaign there is a digital platform, an e-Coach,
to follow smokers, stay with them, and try to get them to succeed in giving up.
So, these are lifestyle matters, but I said to you that there were
two factors upon which we can act: our lifestyle and the healthcare system.
Let's see what we can do for the health system.
Today, healthcare, the way in which medicine is delivered to patients,
is changing, the digital revolution has entered into society
and is also entering into healthcare.
In English it's called e-Health. In Italian "sanità elettronica", e-sanità.
What does that mean? It means we are also introducing the new technology
and digital platforms into healthcare,
with essentially four objectives.
The first: to manage information better. If we manage information better
on the sick, care and treatments, we can compare,
see which treatments are more effective.
Second, we can integrate, better coordinate the various levels of care,
GP level, hospital level and specialist centre level.
We can take care of the chronically ill outside of our hospitals,
keep people out of hospital.
Fourth, we can ensure access to care even in remote areas,
in places a long way away, the mountains, in the country.
And there is evidence that an e-Health system definitely lowers costs
and renders the health system more efficient.
I'll give you two examples. First, this example of telemedicine,
which, today, is carried out in 9 regions of Europe,
of which the leader is Venice, and has been in use for some years,
where they have practically connected the individual,
that is the patient, with the doctor,
with primary care, with the hospital specialist,
with aftercare, thus to have, firstly to have all the information
managed by a central system and above all to be also able
to keep a check on the patient remotely, a monitoring system,
an alert system and this is a system that lowers cost.
Another case. "Il mio cuore" ["My Heart"]. This is a project that has been going
in 33 countries, including the US and even in some parts of Italy,
where some sufferers of chronic illnesses,
significantly cardiovascular disease or respiratory ones, asthma, diabetes,
are given intelligent biomedical devices to measure parameters,
measure respiration, pressure, heart rate, blood pressure,
even do an electrocardiogram, all with intelligent tools,
which can be a shirt, a bed, apparatus, apps.
Today there are apps for your smartphone. But now, pay attention,
because I'm saying to you that I'm asking for your help too.
Because it means that the patient acts for his own health.
It is no longer just the traditional patient-doctor relationship
where the patient's a passive participant. The patient, first of all, must learn,
but must also become co-manager of his own health,
and certainly there is a choice,
we authorities certainly have to push the new technologies
needed for e-Health, but also the citizen must be ready to accept them.
So in conclusion, we certainly have a problem with an ageing demographic.
This ageing of the population creates a burden on public finances,
the healthcare system being public, which is extremely heavy.
Europe is the only place in the world where healthcare is a right,
it is written into the Treaty. Universal access to good quality care
for a European citizen, is a right,
so we want to see this right work.
For it to work we have to make the health system sustainable.
To make it sustainable we have to make the individual responsible:
the individual must adopt a better lifestyle, a healthier one,
to prevent disease. And we need to push innovation
into the health system, because innovation helps to reduce costs.
With this, I want to repeat, your choices matter,
your responsibility matters
and I hope I've succeeded in getting that across to you.