b e a u t y F O O D

O P e N W O R L DFrom markets defined by boundaries

to markets defined by flowsexpanding global patient populations, internationalized labor

resources, and globalization of biomedical innovation and production will create markets defined by flows of knowledge, human, and capital

resources rather than regional, national, or geographic boundaries.

e C O LO G I e S O F R I S KFrom institutional to individual risk management

as institutions are no longer able or willing to offer risk protection, individuals will have to manage the full range of health-related risks, a task made more challenging given the relationships

between these risks.

D O - I t - y O u R S e L FFrom passive patients to co-creators of health

Whether by choice or by force, individuals will have increasing responsibility for managing their health. they will respond to this

burden of empowerment with three do-it-yourself behaviors — self-agency, self-customization, and self-organization.

a N y t I M e , a N y P L a C e H e a Lt HFrom traditional clinical settings to new points of care

Cost-pressures, the changing role of hospitals, noninstitutionalized care for seniors, and new communication and diagnostic technologies

will expand care settings into the community, the home, and into niches of time and place in the course of daily life.

HeaLtH-aWaRe eNVIRONMeNtSFrom computing to sensemaking

as objects, places, and even humans are embedded with technologies that sense, understand, and act upon their environment, we will gain

the ability to track and monitor our physical, social, and emotional well-being, creating new options for personal health management.

b e t t e R t H a N W e L LFrom therapy and treatment

to enhancement and extensionsSelf-improvement approaches extremes as people experiment with digital, pharmacological, biomechanical, and medical tools to alter,

enhance, and extend their bodies in profoundly different ways, in turn reinventing their bodies, minds, and identities.

Varying cultural expressionsBeauty as a metric for health

••

Cosmetics & surgeryExercise & therapyFood & beveragesVitamins & supplementsCosmeceuticals

•••••

Adorning environmentsNutrition for inside–out beauty

•

•

From professional to individualFrom process to product

••

ON-tHe-GO beauty

Quick indulgencesRetailers as focal pointsLarger markets

•••

Respond to contextOptimize delivery of benefit

••

From stigma to style to rite of passage

•

Overcoming natural talent, capability, or appearanceNew definitions of beauty, aging & life stages

•

•

Fat, sugar, saltObesity brandsMagic ingredients

•••

Consumers experiment with affordable biotech

•

Health-aware kitchensFood maps

•

•

On-the-go foods less nutritious

•

b I O P H a R M a

70% of new drugs are “me too” drugs

•

HumansAnimalsNature

•••

Equal access to results for all participants

•PersonalizationPredictionPrevention

••• eND OF bLOCKbuSteRS

From biological similarities to communities of action

•

bIOCItIZeN

Risk managementSelf-agencySelf-customizationSelf-organization

••••

Rise of targeted therapies•

Therapy & diagnosticsMobile diagnosisFewer adverse effects

•••

PerformanceEnergy balanceAccelerating recovery

•••

eatING WItH a PuRPOSe

InteractomeMetabolome

••

Lab-grown organsCell transplantation

••

Stem-cell researchHuman genomic data

•

•

H e a L t H C a R e M e D I C a L t e C H N O L O G y C O N S u M e R e L e C t R O N I C S I N F O R M a t I O N

Health Care Continues to expandNational health expenditures as a share of GDP

Source: Center for Medicare and Medicaid Services

Growing Market for Medical DevicesValue of US medical device market

Source: Espicom Business Intelligence

GLObaL HeaLtH FOCuSIndiaSingaporeMexico

•••

MeDICaL tOuRISM

Focus on patientsEase of useError reductionOver-the-counter accessibilityRetail price

•••••

INNOVatION FOCuS

MainstreamersAllopathic self-careMaximizingNutritionist

••

••

NaturalistIntegratingHolisticHealthy lifestyle

••••

Makes invisible visibleRedraws risk boundaries Identifies new health commons

•••

NeW CaRtOGRaPHy OF HeaLtH

FinancesCareerAppearance

•••

HealthHome

••

ProductsServicesProviders

•••

Low-cost centers of innovationDiffusion into underserved markets

••

INNOVatION eCOySteMMultiple disciplinesCollaborationGlobal

•••

CHINa & INDIa

RISK PReCISIONEcologicalBehavioralIndividual

•••

Crossover techsHybrid techsData security

•••ReGuLatORy OVeRLOaD

HeaLtH MaNaGeMeNt StRateGIeS

Non-invasive biosensingBody area networksRemote telemonitoringClosed-loop diagnosticsElectronic medical records

•••••

From episodic & clinic-based to continuous monitoring & remote treatment

•

PROGNOStIC tReatMeNt

EmbeddedWearableImplantedAppliances

••••

HomeCommunityRetailers

•••

Top-down & bottom-upNew health decisionsNew sites for intervention

•••

Wireless monitoringModeling of individual baseline valuesPredictive decision-making software

•••

LOCatION OF CaRe SHIFtS

attention enhancement

Collective Intelligence for HealthHealth information sources used in the last 12 months

Source: Institute for the Future, American Lifestyles Survey, 2006

Focus on Personal Health technologiesPercent seeking health benefits when buying house-hold appliances and/or consumer electronics

Source: Institute for the Future, American Lifestyles Survey, 2006

In Search of Health Benefits(Percent that say health benefits are important when they buy household appliances or personal electronic devices)

61%39%Seekhealthbenefits

Source: Institute for the Future, American Lifestyles Survey, 2006.

PaRaDOX OF CHOICe

HeaLtH teCHS GO GLObaL

In the bodyOn the bodyIn place

•••

Electronics become health toolsBiosensors move from developed to developing world

••

More technologiesMore devicesMore health claimsMore risks

••••

Driven by abundant computingImproved decision makingLong-term planning

•••

Self-rationingSelf-diagnosisSelf-treatmentSelf-monitoring

••••

Specialized softwareOnline prayer circlesConcierge doctors

•••

NeW HeaLtH aDVISORS DeVICeS SuPPORt SeLF-MaNaGeMeNt

Elite athletesArtistsExperimental youth

•••Implants & muscle stimulators

Enhanced-vision lensesPerformance prostheticsArtificial muscles

••••

eXtReMe uSeRS aS PIONeeRS

Top–down surveillanceBottom–up sousveillance

••

HeaLtH MONItORING

artificial muscle

PricingOutcomesExperience

•••

Self-regulationProduct reformulationsNew content, new messages

•••

NeW PLatFORMS

PReCISe RISK IDeNtIFICatIONGenomic testingMolecular diagnosticsElectronic medical records

•••

HeaLtH aS FILteR FOR DeCISION MaKIN

G

WorkEntertainmentShoppingFinances

••••

Risk transparencyNew sites for intervention

••

New behaviorsNew interventionsNew toolsPrivacy challenges

••••

Natural vs. artificialGlobal vs. localHealthy vs. unhealthyFood vs. fuel

•••• PeRSONaL HeaLtH teCHNOLOGIeS

Hea

LtH &

eNteRtaINMeNt bLuR

©2006 Institute for the Future. All rights reserved. All brands and trademarks are the property of their respective owners. Reproduction is prohibited without written permission.

New cures for neglected diseasesNew business models

•

•

PeRVaSIVe bIOSeNSING

tRaNSPaReNCy INCReaSeS

eXteNDING SeLF WItH INFORMatION

GeneticBehavioralSocialEnvironmentalEmotional

•••••

ibuyRight

mobile product info

HeaLtH MONItORINGConditioning & mobileFacilitates information exchangeEnables remote treatment

•••

Cost shifting•

uNbuNDLING tHe HOSPItaL

Repair rather than destroy damaged cellsTherapeutic gene sequences under biosensor control

•

•eXteNSIONS at tHe CeLLuLaR LeVeL

LOCa

tION-b

aSeD HeaLtH INFORMatION

Source: http://xdesign.ucsd.edu

eXtReMe eNHaNCeMeNt teCHNOLOGIeS

CONteXt at tHe CeLLuLaR LeVeL

DeMOCRatIZatION OF beauty

eNabLING teCHNOLOGIeS ePIDeMIOLOGIeS OF PLaCe

NeW MODeLS OF CaRe DeLIVeRy

From fun-for-you to good-for-you and better-for-you

•

MyFood PhoneFoodscapes

Food is becoming a central theme in how we think about health, politics, culture, and globalization. this landscape of food trends, consumer identities, ecological niches, and demographic changes constitutes foodscapes.

user-led innovation

the user’s role in shaping markets, research agendas, and innovation is expanding. Whether it’s food, biopharma, or health care, new innovations will be driven by features and values desirable to end-users rather than upstream stakeholders.

Retail health

Greater sensitivity toward ecological determinants of health will broaden perceptions of risk for consumers and opportunities for nontraditional health companies as focus shifts to the inter- relationships between individual behavior, environment, and community well-being.

eco-health literacy

Mobile healthMobile devices are emerging as a platform for delivering health information and supporting consumer health management. they will also be important tools in developing countries and for reaching under-served populations in the united States.

user-generated media and tools that facilitate the creation of collective intelligence will redefine health information and help to provide clarity and credibility in an increasingly fragmented information landscape.

user-generated media

body hackingbody hacking will be the next frontier of self-improvement. Hacking the body in response to physical and cognitive demands of the workplace, the information environment, and the natural environment will give new meaning to eating, taking drugs, fashion, and beauty.

DIy bIOLOGyAmateurs experiment with pharmaceuticals Democratized innovation

•

•

DIy skin culture

CORPORate SOCIaL ReSPONSIbILIty

PeR

SONaL H

eaLtH-INFORMatION eCOLOGy

health tagsas individuals face more responsibility for their own care, they will embrace new models of care delivery. expect innovations such as in-store clinics to open new channels to consumer health markets and enable providers to extend services beyond traditional settings.

CooperationNew social technologies are expanding the human capacity to cooperate and amplify value creation. Cooperation holds important lessons for health and health care as it opens new business models and enhances organizations’ capacity to innovate.

comparison shopping

Re-mission video game

communicating

1990 2000 202019801980

computing

1990

sensing

2000

sensemaking

2020

Sensemaking

Sensing

Communicating

Computing

eXPaNDING DeFINItIONS OF beauty

aNtI-aGING FOCuS

SeLF-aDJuStING PRODuCtS & DeVICeS

bODy aS NeXt FRONtIeR

bODy MODIFICatION

MORe HuMaN DIFFeReNtIatION

before after

aMateuR aGRICuLtuRe

VIRtuOuS CONSuMPtION

Fair-trade coffeeDefines value

••

CONVeNIeNCe tRuMPS HeaLtH

FOOD tRaNSPaReNCy

FOOD INSeCuRIty

FOOD IDeNtIty

INNOVatION DROuGHtbIOPROSPeCtING

tRaNSNatIONaL CLINICaL tRIaLSGeNetIC MeDICINe

ReGeNeRatIVe MeDICINetISSue eNGINeeRING

tHeRaGNOStICS

beyOND tHe “HeaD & SHOuLDeRS

LIFe eXteNSIONbOOMeR FutuRe PROOFING

Ian Wright, asset managementDr. Monia Lziesk, MD PhD Rock Kirsch, 43, entrepreneur

“Forget waiting until I’m 105! I’m seeing the effects today and I feel like a new man.”

“Many of the physicians in the network are also involved in the latest life extension research. Our patients get it first.”

“Why live longer if your resources run out? I work closely

with You+20 doctors and clients to plan

for a rich future.”

Hear actual stories from You+20 doctors, partners, and patients:

OUR SERVICESOUR SERVICES

LOCATIONSLOCATIONS

CONTACT US

0 5 M E D I C A L T E C H N O L O G Y

0 3 B I O P H A R M A 0 4 H E A L T H C A R E

0 6 C O N S U M E R E L E C T R O N I C S

0 7 I N F O R M A T I O N

0 1 B E A U T Y 0 2 F O O D

0 8 B E T T E R T H A N W E L L

IDeNtIty DIetS

PeRSONaL HeaLtH SIMuLatION

www.olay.com

Source: www.time/asia.com

Source: www.myprayercircle.comSource: www.sustainabletable.org

FOCuS ON buILt eNVIRONMeNt

SHIFtING FOOD PORtFOLIOS

tHIR

D-PaRty PayeR tO INDIVIDuaL SeLF-P

ay

Source: IFTF

OPeN-SOuRCe bIOLOGy

Source: www.ischool.berkeley.edu

Source: www.jpl.nasa.gov

buRDeN OF eMPOWeRMeNt

0

1

2

3

4

200519991992

Millions

Source: American Society of Plastic Surgeons, 2005.

Beauty Makeover Culture(Number of cosmetic procedures)

Generation RXAverage prescriptions per person

Source: Greg Critser, Generation RX, 2005

0

5

10

15

200420001993

Growth of Prescription Use

Prescriptions per person

Source: Greg Critser: Generation RX: How Prescription Drugs Are Altering American Lives, Minds, and Bodies, 2005.

Makeover CultureNumber of cosmetic procedures

Source: American Society of Plastic Surgeons, 2005

Seeking Health benefits in FoodPercent of population seeking health benefits in ...

Source: Institute for the Future, American Lifestyle Survey, 2006

0 20 40 60 80 100

Household cleaners

Beauty aids

Personal hygieneproducts

Food

Percent

Food for Health(Health benefits important when purchasing)

Source: Institute for the Future, American Lifestyle Survey, 2006.

0

5

10

15

20

25

2015201020052000

Expanding Health Economy(National health expenditures as a percent of GDP)

Source: centerss for Medicare & Medicaid Services, Office of the Actuary, 2006.

Percent

0

20

40

60

80

100

20112006

Source: Espicom Business Intelligence

Billions of dollars

US Medical Device Market

0 10 20 30 40 50 60

Fitness club

Store display, handout, employee

TV program or infomercial

Family or friends

Doctors

Percent

Expanding Health and Nutrition Information Choices(Percent who used ... in the past months)

Source: Institute for the Future, American Lifestyle Survey, 2006.

F O O D b I O P H a R M a H e a L t H C a R e M e D I C a L t e C H N O L O G y C O N S u M e R e L e C t R O N I C S I N F O R M a t I O N

beauty definitions blend and blur with healthDefinitions of beauty will evolve to reflect diverse perspectives and influ-ences. Beauty and appearance are already widely accepted metrics for health and well-being. But broadening definitions of beauty—and their increased blurring with health—will lead to innovation, as people experi-ment, blending health with different colors, styles, and cultural expres-sions of beauty. “Health and beauty” will be a focal point for user innova-tion as well as for more health economy companies that innovate by blur-ring beauty, food, and biopharma. Innovation will focus on discovering and integrating new technologies and ingredients to derive health benefits.

Risks to beauty interact with risks to healthFor some, beautification focuses on the “head and shoulders.” Others focus on internal work, using food and supplements to beautify. Yet others author new definitions of beauty by adorning the environments in which they live, work, and play. Regardless of the approach, appearing youthful is a key motivator across cultural bounds. Anti-aging benefit, therefore, will remain a critical focus to users and companies alike.

DIy beauty expands user-led innovationAs definitions of beauty and health continue to broaden, three do-it- yourself behaviors will drive user-led innovation in the market. These behaviors are self-agency, self-customization, and self-organization. Self-agency is seen in the way people gather information about products and their ingredients and about themselves and their bodies. Self-customiza-tion is seen in the way people mix and match beauty products and systems to suit individual needs or to define different selves. Self-organization, or the leveraging of collective intelligence in social networks, is seen in the exchange of practices and experiences to find, filter, and make sense of the abundant options in the marketplace.

On-the-go beauty redefines wellnessBeauty care will be delivered in more settings and contexts. The movement of professional quality treatments into the hands of the user will continue, increasing demand for in-home, do-it-yourself, and on-the-go products and experiences. Retail sites will become a focal point for quick indul-gences and on-the-go treatments, making the “spa” experience available to more people, in more places.

Self-adjusting products optimize delivery of health benefitsContext awareness will enable people to monitor themselves and their surroundings, in real time and on a continuous basis. In this world, beauty and health applications will include self-adjusting products that deliver health benefits as context changes and just-in-time personal information that aims to prevent harmful exposure to risks. Even now, beauty compa-nies surpass many traditional technology companies in their ownership of nanotechnology patents. As nano-driven R&D evolves, expect to see beauty products that optimize the delivery of active ingredients and that respond to contextual cues (such as light, particulate levels, and moisture), which trigger different beauty or protective effects.

Makeovers shift to enhancementsExpect more differentiation in what it means to be human as cosmetic surgery and minimally invasive cosmetic treatments move from stigma to style and are lauded as expressions of personal identity, rites of pas-sage, maintenance, and healthy living. Indeed, beauty is quickly moving away from creative expression to include a focus on enhancement, exten-sion, and augmentation. As people employ technology to overcome the constraints of native talent, capability, or appearance, the human body will emerge as the next frontier of user-led innovation. Extreme makeovers are just the beginning. People will author new definitions of everything from beauty and successful aging, to new social advantages and life stages.

blurring identity of food intensifiesThe complexities of the global food chain create food anxieties and desire for virtuous consumption. The effects of this global market will be uneven, creating challenges for fair-trade and organic producers and increasing demand for consumer-friendly food traits such as health benefits. Expect to see substantial blurring between the natural and artificial, the local and global, the healthy and unhealthy. The growing number of options will burden individuals who must then navigate and decipher the true identity and quality of their food choices.

Food insecurities focus on industry practiceFood insecurities will expand beyond safety concerns related to han-dling and production to include the fat, sugar, and salt “wars.” Food is at risk for being labeled the next tobacco. In response, food companies are shifting their brand and product portfolios from fun-for-you to good-for-you and better-for-you foods. On the manufacturing side, food companies will develop so-called magic ingredients—novel fats, sug-ars, and salts that taste and perform as their traditional counterparts, absent their negative health consequences.

Food is fundamental to health The principle factor in diet has shifted away from worries about appearance to concerns over health. As personal health affinities and identities evolve, diets will follow suit. Whether focused on balance and energy, prevention and disease management, or ecology and sustain-ability—food choices will reflect evolving needs and values.

New relationships with agricultureAs biotechnologies become more affordable, engagement with food will likely extend to amateur agriculture. New food production methods will emerge on the fringes and centers of urban environments, creat-ing threats and opportunities related to food choice and food safety. As people are asked to consider the interrelationship between food and the environment, expect debates over the use and production of biofuels.

Mobility and built environment will refocus food debatesAmericans spend nearly half of their total food budget on food away from home and convenience trumps health when people are on-the-go. Regulation exempts the away-from-home food category from labeling mandates. However, new mobile technologies will provide information to individuals at the point of purchase, helping them make better food choices. Health policy discussions will move beyond individual behav-ior and into the built environment, with health campaigns increas-ingly focused on improving health by improving environments such as schools and neighborhoods.

transparency comes to food choicesEmbedded, connected technologies will create health-aware environ-ments in the home that capture personal health information, and pro-vide an interface to manage health. Outside the home, mobile devices will be augmented with digital food maps to facilitate informed decision making in context. Inexpensive diagnostics and the move toward self-management will enable those most engaged to better understand the physiological effects of food and filter the “good” choices from the “bad.” This transparency will shape individual and collective ideas of risk and subsequently define new food and therapeutic communities. As these communities of affinity shift to communities of action, the biocitizen will emerge expressing new preferences and new rights.

body hacking with foodAs diet and nutrition concerns move away from being simply about weight loss and appearance toward improved health and wellness, the shift to enhancement and performance will not be far behind. Already, advances in food science and nutrigenomic fields make it possible to modify food products to increase their performance-enhancing proper-ties and health benefits. People are also learning how to hack their bod-ies with food—to accelerate recovery or optimize physical performance. As more specialized foods enter the marketplace, identities based on food experiences beyond the dietary fads of the present will proliferate.

Open-source biologyAs the costs of innovation rise, many in the pharmaceutical and biotech industries will see the value of open access to intellectual property. This move toward “open-source biology” may spur other profound changes—new cures for neglected diseases in the developing world and new busi-ness models for developing drugs. New demands for biopharma products constructed as public goods will expand and access to these products will become a political issue in a world of networked global biocitizens. This will drive creativity in new business models and clashes over safety, bio-ethics and globalization, and bioprospecting.

Personalization, prediction, and preventionThe future of genetic medicine will be characterized by personalization, prediction, and prevention. The shift will reduce the risk of side effects for patients and provide targeted drugs based on one’s genotype. However, genetic medicine may encounter some roadblocks in clini-cal practice as tensions between race, identity, and genetic therapies raise new ethical issues. As clinical trials become increasingly global, debates over equity and risk will mount as the risk takers in clinical trials demand greater access to the therapies that they helped deliver through participation. The age of blockbuster, one-size-fits-all drugs will close as targeted therapies reach the market.

amateur experimentation enters the life sciencesEngaged consumers are experimenting with life science products. Teens and young adults are experimenting with Ritalin to improve performance in school. Behaviors like this will raise social and ethical issues as ques-tions around which kinds of “enhancers” are deemed legitimate emerge. Amateurs will also impact the innovation process in business. We will see a shift from planned pipelines toward a world where breakthroughs result from emergent and distributed means. New innovation networks will integrate user needs earlier on in the R&D cycle and will depend more heavily on user-led innovation—or direct input from consumers.

therapeutics + Diagnostics = theragnosticsGenetic medicine is a driver in the unbundling of the hospital as risks of adverse events and home- and self-care become the norm. Diagnostics will become less expensive and more mobile. The growth of theragnos-tics will demand greater attention to providers and patients given the divergent markets that therapeutics and diagnostics represent. If therag-nostics prove their value at the bedside, adverse reactions to drugs that result in hospitalization will be prevented and patients will become less sick from toxic therapies such as chemotherapy.

Context awareness at the cellular levelContext awareness will move to the cellular level as the focus of genomic research shifts to developing understanding of the interac-tions of proteins. From the metabolome to the interactome, these efforts will focus on protein–protein interactions and how new drugs can target these interactions as therapies. If the interactome proves to be as useful as its proponents insist, drug-discovery efforts can be better targeted to single pathways to address a variety of cancers and chronic diseases. This work on proteins will also assist scientists in determining which patients will react best to specific cancer therapies. Understanding of the metabolome may also facilitate earlier detection of cancers, such as ovarian cancer.

beyond augmentation to regenerationRegenerative medicine and tissue engineering will give new meaning to replaceable body parts as the application of human genomic data and stem-cell research drive new developments and opportunities for extensions. From genetic therapies and lab-grown organs to cell transplantation and cultured skin grafts, options for medical treatment and better-than-well pursuits are expanding. This trend is not without controversy as playing with our biology will spark debate around what is natural vs. artificial, healthy vs. unhealthy, and moral vs. immoral.

Health economy expands globallyGlobal competition will intensify as markets shift away from being defined by boundaries and local service areas to flows of people, money, ideas, and innovation in a global context. Risk and opportunity will also be reconfigured as a broader perspective on health that spans local, national, international, and global dimensions emerges. As the next decade unfolds, medical tourism will expand with more accredited insti-tutions emerging globally. What’s more, employers and plans will also move in this direction embracing medical tourism selectively as the need to cut costs intensifies. Over time, different markets, domestically and globally, will compete on distinct regional health advantages.

burden of empowerment fragments consumer health marketsDo-it-yourself engagement in health and health care is a response to the increasing burden of empowerment that characterizes the present experience of health care in America. Worldwide institutions that tradi-tionally insured people from risk (such as governments and employers) are no longer willing or capable of offering such risk protection. The end result is that people are turning to the marketplace and networks to mitigate risk. Self-agency, self-customization, and self-organization are the responses to this burden. The result will be continued fragmentation of consumer health markets as health management strategies, rather than demographic proxies or health status, define the market going forward.

Location for care shiftsHealth care will return home and into niches of time and place in the course of daily life. Models for care delivery will also evolve with the desire for convenience taking center stage. Major retailers are already experimenting with in-store health clinics and are defining a niche in the global health economy for routine medical care with added conve-nience. Wireless mobile devices are also evolving into robust platforms for new health and health care interactions.

Health management shifts to the technology infrastructureThe technology infrastructure is quickly evolving, moving from simple computing to sensemaking. Over the next decade, technology infra-structure will move off the desktop and be embedded in environments, objects, and our bodies. Indeed we’ll move to a world in which health management will be outsourced to objects, machines, and even whole environments and settings where we live out our daily lives. Eventually we’ll use personal simulations to see the future consequences of unhealthy behavior in the present. For the health care delivery system, this infrastructure for sensemaking will shape the future design of hospitals and clinical settings, drawing on the infrastructure to cre-ate the smart objects, smart places, and smart structures needed for tomorrow’s “aware” clinical settings.

Health mapping make the invisible visibleDistributed, pervasive sensing data from sensors in the environment will feed digital maps. Using this new cartography of health, individuals and professionals will be able to locate, navigate, and avoid exposure to health risks. Indeed, more environments will become health-aware; coaching users and initiating therapeutic actions on their behalf, based on sophisticated “sensemaking” software.

boomers bring future proofing to health management and more Expect baby boomers to bring a better-than-well sensibility to aging by future proofing many areas of their lives, to age successfully, and bring new meaning to life extension. Opportunities will abound for augment-ing the body—even extending the lifespan—as new products, services, and technologies appear. But as awareness grows about better-than-well pursuits, resistance on the grounds of health risks and offenses to morality will emerge. Going forward, the use of medicine beyond therapy and for the “selfish” pursuit of happiness will infuse health policy and regulation with morality arguments.

New innovation ecosystems emergeIncreasingly complex technology ecosystems involving multiple disci-plines and technology domains will require the collaboration of glob-ally disperse centers of expertise, stimulating flows of financial and intellectual capital, human resources, and entrepreneurial ventures. Emerging economies such as China, India, and Brazil will become low-cost centers for innovation, developing medical technologies that will be initially marketed in developed economies, yet capable of subsidizing diffusion in underserved global markets.

Despite technology’s promise, risks remainMonitoring and sensing technologies will enable more explicit correla-tions between ecological and behavioral causes and individual health effects. While the advent of clinical genomics and molecular medicine herald the arrival of a preventative model of personalized health care, consumer fears over safety, personal data security, and discriminatory risk-pooling will first have to be overcome. A budget-constrained FDA will be challenged to meet the demand for review and certification of new technologies, applications, and categories, resulting in a fragmen-tation of regulatory authority as other national and regional agencies address the need.

Innovation refocuses on patientsInnovation in medical technologies will become more focused on patients, rather than providers or clinicians. While clinical outcomes, length of hospitalization, and recovery times will remain key criteria for successful technologies, ease of use, error reduction, OTC accessibil-ity, and retail price will become more significant as individuals have a greater say in adoption and purchasing decisions.

New models of care delivery Maturation of a number of interrelated technologies, from noninvasive biosensing and body area networks to remote telemonitoring and closed-loop diagnostics will drive a fundamental shift in health care delivery from episodic, clinic-based encounters between physician and patient to continuous monitoring and remote treatment. Ongoing wireless monitor-ing will enable accurate modeling of individual baseline values through-out the day, while predictive decision-making software will adaptively and accurately determine whether a variance in indicators is significant enough to require intervention. Link these technologies with interopera-ble electronic medical records, and diagnosis and treatment will become more portable and less risky.

Shared information creates epidemiologies of placeThe integration of rich flows of environmental data with increasingly diverse streams of detailed personal information will lead to new ways of perceiving and interacting with the external world. One outcome will be to view epidemiology as a continuous or ecological function rather than as a snapshot. Ecological determinants of health will increasingly influence one’s choice of where to live, where to work, and daily rou-tines. Continuous, autonomous health monitoring will engender new perceptions of self in relation to the local community landscape making the conceptual wall between outside and inside increasingly transpar-ent. Environmental and personal health information will also be shared among community members, creating vibrant and ongoing epidemiol-gies of place.

extensions at the cellular levelWhile improvements in orthopedic implants will enable active baby boomers to extend their youthful pursuits well into what was once old age, regenerative medicine will harness the body’s cellular factory to produce therapeutic molecules that seek to repair rather than destroy damaged cells. Therapeutic research will explore the concept of “nano-factories” capable of employing host cell structures and materials to produce therapeutic gene sequences under biosensor control. These efforts will enlist cross-disciplinary collaboration between geneticists, microbiologists, materials scientists, and computational biologists to pioneer proof-of-concept models. In addition to biophysical extensions to the human organism, pervasive sensing, and personal area networks permit individuals to project themselves into social and clinical environ-ments both near and far.

Health devices and biosensors reach global marketsConsumer electronics such as mobile phones will be repurposed as health tools in emerging markets. Low-cost personal health technologies will increase access to medical care in marginalized communities. High-cost products such as biosensors will become increasingly available in developing countries, though not pervasively so. Consumer packaged biosensing in wearable objects and in health-aware environments will be developed, popularized, and then made widely available in resource-rich areas of the world. Personal- and environmental-sensing devices may be used on or in the body, taking form in mobile phones, wear-ables, handheld widgets, implants, and even ingestibles. Other prod-ucts will be designed for “in place” use—installed in homes, cars, and public locales.

unproven technologies could expose people to more risksAlthough many users manage their health under physician’s guidance, many more will experiment without supervision, using clinically valid technologies in unproven, unauthorized, and even prohibited ways. New marketing strategies will emerge to capture the naïve-consumer dol-lar, as public access to clinical tools becomes widespread and faddish. Specialty treatment centers will similarly flourish, offering unorthodox therapies (e.g., cancer vaccines) for patients that have exhausted the value of traditional modalities, or have rejected those delivery systems altogether.

Personal health technologies support self-managementGrowing consumer awareness and new product offerings will enable more self-monitoring, self-diagnosis, self-rationing, and self-treat-ment. Devices will fit into self-management as cost containment and demand push the point-of-care beyond hospitals, clinics, and physician offices’ into the community, home, and on-the-go. Availability of OTC diag-nostics and therapeutics will promote a resurgence of homegrown rem-edies. With nearly three-quarters of the population preferring self-treat-ment to visiting a doctor, personal health technologies that support this preference will be embraced. What’s more, personal health technologies have the potential to give people confidence in their health care decision making, improve adherance to treatment, and sustain health engagement to over time.

Health monitoring will be top down and bottom upHealth awareness will be developed from the top down and the bottom up. Already, technology companies are demonstrating the vision and value of health-aware environments for the aging and chronically ill. Surveillance for health maintenance may be justified in certain con-texts such as cafeteria-based monitoring of school children’s lunches. Surveillance from the bottom up, or sousveillance, is part of this story as communities of action use the same tools to capture information and geocode it to map local patterns of health risk and make them vis-ible to inform policy debate and decisions. With all of this information, we’ll eventually be able to synthesize complex observations to support diagnoses, therapies, and public policy interventions.

extreme users pioneer the better-than-well categoryPeople will seek to make themselves better than well, and extreme users such as elite athletes, artists, and experimental youth will lead the way. For example, elite athletes will take advantage of consumer elec-tronics designed with specialized health functionalities that blur the line between training aid and performance augmentation. Enhanced-vision lenses, performance prosthetics, and solar-powered hearing aids are on the market, and artificial muscles have appeared in the lab. In the future, a spectrum will emerge that ranges from consumer electronics and devices that fit into health care and enhance and support the diabetic through the progression of disease, to devices that are health behavior oriented and fit into activities and the decision making around exercise and nutrition for example, and to a final category of better-than-well for those who seek to be the best humans they can be.

transparency will drive new business modelsInformation flows will be characterized by greater transparency and sophistication in the analyses and aggregation of personal and collec-tive health data. As pricing, effectiveness, and outcomes information become available in greater detail (and to a broader audience), both risks and opportunities will multiply. This transparency will drive the development of new business models that promote more participatory and preventive models of health care. Business models will break free of geographic boundaries—to target populations defined by risk and need, rather than by location or service area. New marketing strate-gies will open new platforms, which enable companies to overcome the limitations of industry boundaries to pursue opportunities in the brand-ing of the global health.

Greater risk precision breaks risk poolsSophisticated risk-management systems and tools such as genomic test-ing, molecular diagnostics, and electronic medical records will enable insurance companies to more precisely identify policyholder risk and the appropriate health providers to reduce risk through intervention. Risk pools will breakdown as increasingly personalized health data enables both payers and providers to disaggregate markets. Patient compliance will be a key metric for all stakeholders, as the cost of non-compliance shifts from provider to consumer. Corporate social responsibility initiatives that focus on health, wellness, the environment, and sustainability will provide signals of credibility and trust to the market and will be welcome additions to a fragmented marketplace.

Collective intelligence as health informationConsumers will leverage the trust in their social networks’ collective intelligence to identify, reduce, and avoid risk. With the proliferation of online information, affinity-based social networks quickly form to guide each other through the complex health maze. Expect more patient-to-patient disease management to emerge. As these communities of interest transform into communities of action, they will exert market influence. Marketing will become more sophisticated as communica-tion strategies address expanding channel choices, do-it-yourself engagement, user-generated media, and new health advisors from concierge doctors and wellness coaches to health management soft-ware and blogs for health communities.

Health information moves into more niches of time and placeHealth information will be accessed anytime, anyplace—driving health concerns and management into more niches of time and place in the course of daily life. Health information will shape everyday decisions such as grocery shopping, eating out, exercise, work life, and social relationships. Technology will further enable this practice, as mobile, continuous health-monitoring and communication systems provide a rich stream of data. Such systems will facilitate the targeted delivery of health care information, advice, and even remote treatment in a wider range of contexts.

Real-time health information targets behavior change and challenges privacyTechnologies enabling remote monitoring and treatment will be used to develop location-based information and messaging. Such technolo-gies integrate real-time data from the broad health ecosystem, with the aim of leveraging teaching moments to change behavior and ultimately reduce unhealthy decisions. This world will challenge notions of pri-vacy, upsetting both consumers and regulators.

Personal health-information ecologies open opportunities for extending the selfEvolving technologies and expanding information flows will give rise to a “personal health-information ecologies” that makes visible many previously invisible health indicators and risks. It will soon be pos-sible to access details about one’s genetic, behavioral, social, and environmental attributes in much the same way we presently access demographic or socioeconomic information. While technologies, man-agement systems, and regulatory structures will be taxed by having to ensure that this wealth of information is used in a way that is equitable and beneficial to individuals and the broader society, this data will open new opportunities for extending the self and perhaps define new sites for intervention beyond the human body.

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bODy aS NeXt FRONtIeR | uSeR-GeNeRateD MeDIa | PeRSONaL HeaLtH teCHNOLOGIeS | eXtReMe uSeRS aS PIONeeRS

What? You started harmlessly enough by wearing a non-invasive glucometer and watching your numbers change after meals, even though you don’t have diabetes. Then you posted your readings online for others to discuss. Now you’re helping to beta test a new diet by eating, observing, and recording. But, you, part of a new phenomenon called “body hacking”? Maybe? But you’re too busy running experi-ments on yourself to read the article.

So What? Adapting to the demands of your so-called life means understanding how your body truly works. Self-improvement goes extreme as “body hackers” experiment on themselves, pioneer new ways to be healthy, and define new ways to be human.

tRaNSPaReNCy INCReaSeS | HeaLtH MONItORING | FOODSCaPeS

What? Fruit? Check. Something sweet? Check. Real-time monitoring of your activities? You might not have a choice. Losing your job meant switching to a new type of health plan, one that sends your grocery purchases back to the provider every time you shop. Some people are even being surveilled voluntarily to get discounts on their insurance. You draw the line at sensors in your refrigerator—if you get the choice.

So What? Extreme cost pressures make it so that we all have more skin the game. Falling off the exercise and nutri-tion program brings financial and health consequences. Expect insurance products to be bundled with carrots and sticks as many of us trade privacy for insurance.

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bIOCItIZeN | eCO-HeaLtH LIteRaCy | uSeR-GeNeRateD MeDIa | NeW CaRtOGRaPHy OF HeaLtH

What? Who says the corporation is always right? Your aug-mented-reality glasses know where you are and what you’re seeing, and they display information relevant to your inter-ests. Some info comes from traditional sources, but much more comes from everyone else, like this warning about the true ecological impact of cheap imported veggies. Any group can have an influential voice, on and off the computer screen, and finding like-minded people is easier than ever.

So What? User practices evolve with the technology infra-structure, and biocitizens everywhere unite. The true identi-ties and practices of companies, brands, and products in the global health economy are revealed—ushering in a new era of transparency generated from the bottom up.

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bODy MODIFICatION | eXPaNDING DeFINItIONS OF HeaLtH | HeaLtH aS FILteR FOR DeCISION MaKING | bOOMeR FutuRe PROOFING

What? Gone are the days of cosmetic procedures done covertly and only in the name of vanity. You know that looking good means feeling good inside and out, so starting a Beauty Savings Account was as much about health and wellness as beauty. The plan covers everything from daily-use preventa-tive products to more expensive, permanent procedures. Your employer even contributes; after all healthy workers get more done.

So What? Definitions of beauty blur with health. As a result, what once looked like beauty now looks like health and health care. Appearance is everything and, as it turns out, a good indicator of overall health and wellness. Thanks to new finan-cial service companies entering the global health economy you’ll be able to save now for what you need later.

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betteR tHaN WeLL | LIFe-eXteNSION | uSeR-LeD INNOVatION | aNtI-aGING FOCuS | eXtReMe eNHaNCeMeNt teCHNOLOGIeS

What? That first gray hair was the last straw. A friend told you about a global health practice built solely around the idea of life extension. They’ve got doctors, researchers, cosmetic surgeons, even financial planners, and now a location in your city. Their goal: adding 20 powerful, beautiful, prosperous years to your life. All you have to do is make a long-term commitment to aging better and living longer. Looks like 80 really is the new 40.

So What? Getting what you want out of health care is now possible by leveraging the best that science and medi-cine have to offer. Doctors become life-extension coaches. Patients become body projects. As long as you can pay, you can stay young and healthy. 03

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HeaLtH-aWaRe eNVIRONMeNtS | bOOMeR FutuRe PROOFING | PeRSONaL HeaLtH teCHNOLOGIeS | RetaIL HeaLtH | DO-It-yOuRSeLF

What? Keeping Mom in her house required some extra eyes, ears, and peace of mind. The new health section of the hardware store sells this health-aware home starter kit, complete with multiple sensors to detect activity, behavior, and overall health status. After only an hour of DIY instal-lation the house is very close to “smart” and you know how Mom is doing 24/7.

So What? Care returns to the home, as the hospital is no longer the locus of health management. Technology turns the places we live, work, and play into health-aware envi-ronments. Our kitchens, workplaces, and even our cars will monitor our health, giving us the information we need to do more ourselves.

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06NeW HeaLtH aDVISORS | LOCatION-baSeD HeaLtH INFORMatION | uSeR-GeNeRateD MeDIa | PeRSONaL HeaLtH teCHNOLOGIeS

What? It’s reassuring to know that you’ll stay supported as you age, like your aunt and uncle are doing. They’ve signed up for a service that facilitates connections between their friends and helps them to make new ones. Groups rely on each other for everything from daily motivation to sharing experiences with new medical procedures.This group even shares their health vitals in real time for an extra level of support.

So What? Health communities proliferate in the global health economy, tapping the collective intelligence in their networks to make better health and health care decisions. Some even go further and function as patient-to-patient dis-ease management programs. By the end of the decade, these communities of interest will turn into communities of action.

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eCOLOGIeS OF RISK | HeaLtH-aWaRe eNVIRONMeNtS | PeRSONaL HeaLtH SIMuLatION | PROGNOStIC tReatMeNt

What? Does skipping that cookie really make a differ-ence? How will my body react to a new drug? Don’t leave these questions to guesses or theory—simulate them! You upgraded to a home supercomputer just so you could run this software, a simulation of your own unique body running 24/7. It helps with long-term planning and immediate decisions, and updates in tune with your blood chemistry. If only it could simulate asking the boss for a raise …

So What? The burden of empowerment eases off as health simulations take the guesswork out of self-management. Thanks to abundant computing power in the home you (and those you trust) will be able to see your future self in the present. Making that lifestyle change could be more compel-ling than ever before.

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Health benefits increasingly define consumer value.

With more responsibility for the cost of their health care, people are turning to the broader marketplace for solutions rather than just the traditional health care delivery system. this trend is accompanied by an expansion of what it means to be healthy, what is considered therapeutic, and what is an appropriate site for intervention or treatment. as we move toward a world of more healthy lifestyles and holistic approaches, in the way we parent, what we eat, how we work, and even how we keep our homes, much of daily life will be viewed through a health lens.

this health lens is what defines the global health economy and is what will fuel innovation and growth in markets for a wide range of products and services not traditionally associated with health or health care, including beauty, food, consumer electronics, retail, travel, and financial services. this trend is most pronounced in the united States but will spread globally as new products, services, and technologies focus on a broad definition of health and spread to other parts of the world over the next decade and beyond.

We have designed this Global Health economy Map of the Decade as your guide to navigating the blurring and expanding boundaries of risk, opportunity, and innovation associated with the global health economy. It describes six big trends and how they play out against seven key markets—beauty, food, biopharma, health care, medical technologies, consumer electronics, and information. It also includes “artifacts from the future”—illustrated scenarios that combine several future trends into a product or service we might see sometime in the coming decade.

MAP OF THE DECADE 2006–2016

SR-1003 | © 2006 Institute for the Future. All rights reserved. All brands and trademarks remain the property of their respective owners. Reproduction is prohibited without written permission.

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