BHCT’s
December
Newsletter
To end the year in style, BHCT is pleased to present its last newsletter.
We won’t talk about Covid neither critique the crisis management but retain from Covid that a simple virus was able to accelerate BHCT’s triple world wide shift. A step backwards is now unlikely as Covid’s management rushed :
– Delivering time for caregivers for essential care.
– Inviting citizens to take responsibility individually and collectively.
– Operating patients’ triage due to lack of material and human resources.
– Controlling the allocation of resources.
– Recurring to a massive use of data processing technologies and AI.
These arguments had been previously anticipated by BHCT when discussing the ambulatory, preventive and competence shift, needed to contribute to more sustainability. Therefore, Covid is an excellent opportunity for BHCT to re-examine the issue, not by looking backwards, but by integrating the new realities into a completely redesigned #BHCT22 event. Facing a fait accompli requires from stakeholders an exercice of collective intelligence in order to take advantage of what the virus has been able to bring to the health care sector.
WITH THE COLLABORATION OF
What will we do during this incoming year ?
After two years of health uncertainty, the world wants 2022 to be the year of the end of a pandemic that continues to dividere et impera.
A micro-enemy which was able to remind humanity of its vulnerability more effectively than climate change, terrorism, or social inequality.
The importance of equitable and sustainable access to healthcare has thus become a visible priority and supported by all of us.
Money will not enough to make it. To its credit, Covid has demonstrated that without the motivation and solidarity of stakeholders, sustainable and accessible healthcare policies are doomed to failure in the medium term.
In 2022, BHCT resumes its original thinking, based on a citizen governing his good health, supported in his journey by different stakeholder, whether they are caregivers, economic or political ones.
A successful health care policy based on citizen involvement requires that the thorny problem of active collaboration between stakeholders in support of the citizen be solved beforehand. A wish that some people like to claim is only utopia, but what if it’s not?
Welcome to #BHCT22
After a period of incertitude, #BHCT22 received a complete home staging.
The purpose of #BHCT20, which unfortunately couldn’t take place, will remain but #BHCT22 will change its organization with a round table concept spread over one year to answer to the necessary health and safety restrictions.
In February 2022 BHCT will launch an online inquiry with four themes that will be discussed in May 2022 for a live statement.
In April 2022, BHCT will organize a walking cocktail to communicate the results of the inquiry and the questions that will be addressed during the round tables.
In May 2022, BHCT will hold four exclusive round tables to explore how Covid has speeded up BHCT’s triple world wide shift (3WWS) regarding the withhold questions with live statement by the end of the evening.
In Septembre 2022, BHCT will invite its active members and those who contributed to make this event a success, to a glass of friendship in order to meet our exclusive guests, who will be progressively presented on our social medias until May 2022.
Four tables, one statement
First table : The Wealth sector as a role player
The first table will focus on how the wealth sector intends to play a more active role within the next years in public health. Selling tests in food stores, operating vaccines in pharmacies or giving heath advices in private companies… Private actors are demanding parties to take over some missions from certified healthcare providers. Are those actors welcome in a still conservative healthcare sector which sees big tech, big pharma, retailers, or food industries as having no or few added value in public health?
Second table : Health Citizenship
The second table refers to health citizenship. The covid crise shows that taking the right individual or collective healthcare decisions is not as easy as one might think. Nevertheless, questions surfaced concerning citizens’ accountability in terms of social acceptance, care accessibility and financial contribution. What about unhealthy lifestyles or predective genetics? Should we expect similar reflections about a health pass reserving access to affordable healthcare for citizens who are ready to take care of own health ?
Third table : The role of caregivers vs. chronic diseases
The third round table will question the role of caregivers and especially physicians in daily management of chronic diseases and patient follow up. In classical hospital-centric models, caregivers are considered as being the first choice to coach citizens for their daily health. Administrative, financial & time pressure however, have conducted caregivers to forget about this important mission pushing citizens towards other solutions. A red carpet for tech companies offering individual health planning for daily management of chronic diseases with the best customer experience acquired through years of market research. As comes along, citizens will turn to those same partners for minor health issues driven by affordability, accessibility and comfort those players can provide easily.
Fourth table : health tracing and social control
The fourth table will be about cost control, citizen health tracing and more prevention as main levers to achieve greater sustainability but which also imply the social control of our health habits. During the pandemic, society has rather easily accepted and actively participated in tracing. Will the introduction of this system remain? Friend or foe? Next to the cost control, the search for new funds remains important more than ever as the pandemic has led to an unexpected gap between state income and expenses. Moreover, quantum AI and the potential of improved management in all branches of (healthcare) systems seems to be a new source of operational excellence with financial benefits.
Dr. Sam Ward interviews Frederik Leloup & Karolien Haese
Karolien Haese
Chairwoman - BHCT
1. In the search for more sustainable models of the healthcare system, the trend is towards the measurement of performance in relation to KPIs whose values are fixed based on satisfaction averages according to a specific and fixed objective, generally the result of a ratio of scientific excellence/cost. What do you think about it?
F. Leloup: As an International Executive MBA faculty member I regularly invite future leaders to question themselves about the notion of leadership, especially in its controlling aspect, source of the domination power . This patriarchal approach to economics is also reflected in health care. Measuring to control, because «it is said» that we only know how to manage what is measurable and controllable is, in my opinion, an ineptitude for those who are interested in something other than the established balance of power and therefore the maintenance of the status quo that preserves it. Of course, the objective is to achieve a predictive ideal, whether it is a benefit for an investor, an improvement in health for a patient, or to meet the budget for a government.
Far be it from me to question that principle. However, I often dare to express the idea that an ideal is never fixed and that many parameters can influence it at any time. Success is not achieved by controlling performance but by piloting it with all the agility required by the particular case we are addressing. The essential role of the leader will then be to involve stakeholders in this need to adapt to the objectives set. This does not mean the loss of control of the situation. On the contrary, it means taking an interest in it with all the intelligence and energy
available.
K. Haese: I can only join Frederik and I would even say that the management of the pandemic is an excellent example of what it means to have to regularly adapt one’s objectives while having to reassure the main stakeholders. The biggest problem in managing the inconceivable is right leadership being the ability to reassure citizens facing the unknown.
2. What does “piloting the performance” mean to you?
F. Leloup: A few years ago, the economic world started a major shift, gradually abandoning the power of domination establishing control as the main tool of management in favor of a power of service, source of authentic leadership detached from the occupied social function.
Are we not all invited to assume this response-ability, this power of service in all our life roles, whatever our rank? In the medical world, this shift is taking place right now. Health keeps being seen as a problem to be solved once it arises. Despite an innovative discourse based on prevention and citizen empowerment in taking charge of one’s own health, the overall approach remains fundamentally paternalistic, in all its nobility and limits.
In doing so, the caregiver locks himself in a system which, of course, is likely to reassure him provisionally but which in reality reduces his freedom of action.
Such a constraint could only worsen with control algorithms designed to measure their performance and that of healthcare institutions as if the caregiver were just a simple performer waiting for his report card. Such an approach will only help the quality of care and cost control if the doctor manages to involve his patient in the treatment deemed adequate. However, without the time and space required, it is impossible to control health performance and the third-party payers may have to opt for other incentive or punitive methods of the stubborn citizen. A form of social contract which Europe has abandoned from a long time.
Far be it from me to question that principle. However, I often dare to express the idea that an ideal is never fixed and that many parameters can influence it at any time. Success is not achieved by controlling performance but by piloting it with all the agility required. The leader’s difficulty will then be to reassure the stakeholders in the need to adapt the objectives which does not mean loss of control of the situation.
K. Haese: In the BHCT approach, the citizen is actually seen as a pilot of his own route of care, and this since birth.
However, if he is not taught to drive, his individual performance in terms of preserving and/or improving his health capital will necessarily be affected. The citizen must therefore be able to count on several stakeholders in his health journey. Health education obviously plays a primary role, but other actors, not necessarily health care providers, can play key roles in helping citizens achieve their care route. In case of illness, the citizen must be able to count on more experienced instructors; not to take away from him steering wheel, as the caregivers had been taught him until now, but by helping him drive in exceptional conditions, which may be life-threatening for him. Moving from a pilot role to a co-pilot is not an easy exercise, especially on slippery terrain. However, the main savings will be made with a participative citizen, aware of his or her state of health and aware of what he or she wants and can achieve as a level of performance.
3. The Covid crisis has exacerbated calls for behavioral freedom. Do you think it is productive for the sustainability of the system?
F. Leloup: What makes human beings complex in a democratic environment is their freedom of behavior.
Frederik Leloup
Board Member - BHCT
The answer is not configurable as would be an observation of a set of caged mice facing a given situation, except if we put humanity in a closed and sanitized box, to confine it. Covid reminded that the diktat is difficult and only works on a temporary basis and under penalty. A sustainable health care system cannot be based on a paradigm that forces caregivers, in the name of performance and cost/benefit ratio limited to a small number of measurable parameters, to act as the police for their patients, monitoring or otherwise denouncing their behavior. It would take away medicine’s main raison d’être, that is to accompany the patient towards a better balance, in the absence of a perfect one.
K. Haese: The stricter the laws, the more discipline there will be, that’s a fact. The human being ends up giving in, more out of concern for losing his comfort than out of fear. However, this principle has its limits. The human being is a fundamentally social and supportive being and, in the long run, a behavioral dictatorship will not hold. Secondly, even under dictatorship, the cost of a controlled society is, on the long term base, higher than a society that calls for measured citizen accountability.
Unlike Covid, a fundamental reform of a health care system is not a matter of urgency but a matter of continuity and conviction. The whole point is to start somewhere by daring to question the existing achievements.
4. Last question, Frederic, you stated that the future is more difficult to anticipate than to create, what do you mean by that?
F. Leloup: In the entrepreneurial, economic, social or cultural world, the greatest successes stem from incongruous experimentation. A theory of wandering to which we wrongly attribute a pejorative connotation especially in the medical world. To wander, to try, to experience what has not been programmed is yet what has made progress possible. Innovation is the result of an experiment. It is not a process that is decreed. To the green washing is added today the innovation washing. The enlightened leader sees the desirable world to which he wishes to belong. His commitment can only create it.
In the quest for a more sustainable health care system, innovation must not only think in terms of technical progress. It means daring to question a pattern of operation that is part of a balance of forces where qualification and title decide who is right or wrong. Such an environment is destructive to the citizen awakening essential to sustainability and to the emergence of a desirable world.
Karolien Haese and Frederic Leloup for BHCT, interview by Dr. Ward
BHCT x The Women’s Art Gala for Children
During 2021, BHCT had the pleasure of meeting the world of art and health.
The ASBL Art for Life, originally founded to coordinate the gala dinner of the association «Sauvez Mon Enfant», took advantage of the pandemic to transform its one-time project into a long-term project to promote art and good causes.
The founders wish to adopt a mixed approach, by allowing artists to promote and sell their works in the best conditions, through the commitment of benefit-sharing for charitable projects selected by a godmother committee.
The Women’s Art Gala for Children will open on May 1, with a vintage car rally that will lead art lovers to the Bruno Lussato Foundation, graciously provided, where the works of women’s artists will be exhibited for sale. In the meantime, the collection through social media using innovation for solidarity.
The exhibition will remain open to all for a period of 15 days before the works selected for the gala dinner auction are moved to Sophie Cauvin’s studio. A magical and inspiring venue that will host the final auction on Thursday, May 19.
Karolien Haese & Giovanni Briganti
AI for Health, beyond the device
When I answered positively to Dr. Giovanni Briganti’s invitation to join the think group AI4Belgium, my biggest question was undoubtedly what will be different regarding dozens of similar projects.
There is something very paradoxical when it comes to AI in-depth reflection. AI changes our world in a profound way with a tremendous speed while real change needs time.
Coping with this reality, think-groups are rapidly overwhelmed with ethical and legal questions each time AI implementation transforms existing processes replacing some human missions with machines.
To answer those questions, the easiest and most comfortable way is to consider AI as a simple tool, unable to think ethically or understand what accountability means in decision making.
However, such an approach is not grounded in reality.
A recent experience carried out by the University of Oxford showed how a generative AI structure with 530 billions parameters is able to participate in a conference with humans to discuss Ethical issues and isolate itself from human judgment*.
Thereby, AI tools already broadly work on autonomous bases, following more and more complex artificial neural network schemes without any human intervention or correction. If we dare to face the truth, we have to admit that AI is nothing more than a brain in progress.
Therefore, it would be a lure to believe humans will entirely preserve control on artificial decision-making algorithms. Global Ethical and legal frames based on the explainability principles, which should be included in the learning processes, may help to address the human concerns of hegemony but will not offer any guaranty.
Consequently, legal and ethical frames should evolve constantly with the degree of maturity of AI until humanity is ready to reconsider the question of a legal capacity assigned to the machines. Regarding this issue, it is always a pleasure to discuss with Dr. Giovanni Briganti** as we both agree that the rapid development of artificial neural networks technics will go beyond an AI as a simple tool.
Artificial and human intelligence will have to learn how to coexist within ethical and legal frames which are still hard to imagine as never humans have faced the situation of a self-created emerging intelligence able to exceed their own one, at least in some specific skills.
According Dr Briganti, using AI in healthcare asks, in fact, for very simple guidelines which could be easily integrated in self-learning schemes. With AI tools, the relationship between the man and the machine fundamentally changed as the used tools are not passive but may think autonomously. The biggest challenge will, therefore, remain trust. By asking algorithms for self-evaluation and explainability and confront it to a human judgment, frames will be easier to set.
Until then, AI in healthcare will principally promote itself as a tool to improve measurable performances of :
– the overall quality of care
– quality of life at work for healthcare professionals
– of healthcare institutions
– innovation in research and development
– the management processes in public health.
It is a fact that more than in any other area, the performance of AI tools is measured in fields as research, diagnosis, connected health, pharmacovigilance… and those measurements are widely used, by multiple stakeholders, to convince third parties about the potentials of AI in healthcare.
This is also the reason why, over the last years, healthcare became a main experiential zone to measure the balance between human fears and fascination regarding the use of AI in autonomous decision-making, hasten the sector to speed up with answering ethical and legal issued related to data use, accountability, and mission shifts.
But solving those questions in an agile and flexible way will ask for some resilience to machine’s autonomy which has not been reached so far.
Did you know?
In 1951 WHO adopted the first ‘International Sanitary Regulations’.
In 1969, after the Hong-Kong flu killing between one and four million people, the WHO reviewed its ISR and adopted a first active collaboration treaty to monitor and control six infectious diseases, obliging member stated to notify the WHO in case those diseases occur on their territory:
– cholera,
– plague,
– yellow fever,
– smallpox,
– relapsing fever
– typhus
In 1995, the resurgence over the last ten years of infectious diseases as plague and cholera as well as the emergence of new diseases as AIDS and Ebola conducted the 48th World Health Assembly to call for the revision of the Regulations. However, no important change was brought to regulation until SARS-Cov19.
In 2005, the World Health Assembly adopted a complete reviewed International Health Regulation. Major changes lay in :
- No more limitation concerning the scope or nature of concerned diseases;
“By not limiting the application of the IHR (2005) to specific diseases, it is intended that the Regulations will maintain their relevance for years to come even in the face of the continued evolution of diseases and of their transmission factors”
- Notification made by other persons than official country notification is possible;
“Authorizing WHO to take into consideration unofficial reports of public health events and to obtain verification from States”
- Evaluation of the risk of spreading due to cross-border travels and trade.
“The State shall use the algorithm provided by WHO to assess risk of international spread, If considerable, to notify this ‘Public Health Emergency of International Concern”
Nevertheless, WHO still cannot constraint members States to adopt obligatory sanitarian measures, keeping this international organization in its weakness.
SARS-COV 2 conducted also the EU commission to a deeper reflection concerning public health in the EU, edictating EU4Health 2021-2027 – a vision for a healthier European Union | Public Health (europa.eu)
“EU4Health is the EU’s ambitious response to COVID-19. The pandemic has a major impact on patients, medical and healthcare staff, and health systems in Europe. The new EU4Health programme will go beyond crisis response to address healthcare systems’ resilience.
EU4Health, established by Regulation (EU) 2021/522, will provide funding to eligible entities, health organisations and NGOs from EU countries, or non-EU countries associated to the programme”
Education sexuelle & droits humains – International Innovation Award UNESCO
ESSM Fellow and Director of BHCT, Dr Sam Ward will have the privilege of presenting the UNESCO Sexual Health & Human Rights chair’s International Prize for Innovation in Human Sexual Health and Education on January 14, in Paris.
For several years, Dr. Sam Ward has been able to appreciate the added value of combining health, innovation and human rights in his role as Medical Director of BHCT.
BHCT will also actively collaborate to promote innovation for health education by hosting a MOOC introduction on online communication to promote sexual health.
The education of citizens to their own health through new digital tools has been, since its foundation, an important pillar for BHCT that defends a health care philosophy based on financial, intellectual and quality accessibility to health for all.
Sam Ward
Medical Director - BHCT
Furthermore, it is with great pleasure that BHCT has agreed to join the team of Professor Thierry Troussier to illustrate, through a comic strip, the importance of citizens’ awareness to sexual health.
The topic is even more of interest as the debate on sexual violence against women is far from being closed. Preventing it also involves the collective awareness that physical integrity is a right down to its most intimate part, sexuality.
