Failing States of health – How broader collaboration can bring us closer to the future of health


While the COVID-19 pandemic has seen some countries respond well to the ongoing health crisis for their own populations, it has also – despite decades of increasing and accelerating globalisation – shown how quickly countries can turn inwards. As countries around the world entered states of emergency and enacted extraordinary measures to contain the spread of COVID-19, they have in many instances also reverted to a ‘city-state’ logic, strictly limiting their attention within their borders and not daring to opt into common solutions that very likely would have been better, which will be discussed in more detail at the HIMSS & Health 2.0 European Digital Event in September.

Disappointingly, our leaders and international political institutions have both failed to stand together and provide strong frameworks for collaboration throughout the COVID-19 crisis, while other organisations and actors like businesses and researchers have in many ways worked to intensify and deepen cross-border collaboration. As we look cautiously to the end of the first wave of the crisis in some parts of the world, we must consider how sustainable these cross-border relationships are, who can and should take the lead in defending and cultivating them, and what benefits they can provide for the future of healthcare – particularly in relation to the emerging personalised health paradigm. Given the recent experience, the notion that states will lead this charge may be met with a degree of scepticism. 

The nation state as a ‘work in progress’

We should have in mind that the nation state and the Westphalian – i.e., nation state – system are social constructs that can be dated back to the 1648 Peace of Westphalia, but in reality only begin to manifest as we know them today in the wake of World War II with decolonisation and the establishment of the United Nations. This is to say that the constructs we expect so much of are quite new and not very stable. 

The pandemic suggests that the fragile system of fragmented nation states may not be equipped to handle a world that is becoming exponentially more connected. A rethinking of this system, especially as it relates to health, is overdue.

We know that as a global community we need to deliver on a better vision for healthcare in the wake of COVID-19. Doing this will require a great deal of adaptive and transformative thinking – to the extent that we need to consider if it is not states, but certain non-state actors, organisations and citizens that are best equipped to develop the framework for this vision, with the states instead playing a supporting role further down the line.

Affirming health as a global challenge and the 90/10 model 

A crucial step in delivering on a better vision for health is building a global consensus around the notion that health is indeed a global challenge for which we are all responsible, not simply an obligation of individual nation states that often lack the capacity to deliver adequate care on a national and local level. A practical point of departure in this effort could be reaffirming and expanding the mandate of UN Sustainable Development Goal 3, which aims to ensure healthy lives and promote wellbeing for all at all ages. By leveraging an existing global consensus with lessons from COVID-19, proactive leaders can help propel a more robust, global vision for health that emphasises equity, outcomes, and evidence-based decision making instead of vague guarantees and legislative or regulatory benchmarks. By encouraging and empowering leaders and decision-makers outside of the state, the close cross-border collaboration that is fundamental to achieving SDG 3 may be within reach sooner than we think.

To clarify, this is not to say that states cannot or will not be crucial to the improvement of health in the long-term. While states have struggled to work adaptively and collaboratively in the midst of the pandemic, it is clear that states are drawing much-needed lessons from the harrowing experience of the past few months. Although more diverse constellations of actors and organisations have shown an ability to work more flexibly throughout the crisis – perhaps because they are not nearly as encumbered by slow and complicated political processes – than states and state institutions, states can still play an invaluable role as conveners and agenda setters if the sufficient institutional learning takes place in the wake of the crisis.

At the same time, taking a broader global approach to health that welcomes a more diverse swathe of private contributors should also entail a stronger commitment to supporting developments that are useful for and accessible by the vast majority of people, not just the wealthiest segments of the population. This approach is what we at the Copenhagen Institute for Futures Studies have termed the ‘90/10 logic’, a mindset that advocates investing in and developing solutions that can improve health outcomes and wellbeing for all, including the other 90% of the population rather than just the top 10%. Supporting solutions that emphasise equality, equity and utility is another area to which states can contribute as regulators.

The Humanome: The fruit of cross-border collaboration in personalised health

At the Copenhagen Institute for Futures Studies, we have been continuously monitoring challenges, opportunities, and developments in the ongoing transition towards more personalised and preventive approaches to health and healthcare. On this basis, we have also envisioned what increased cross-border collaboration in health could produce in the future. At CIFS, we have developed a concept known as the ‘Humanome’ together with other Nordic stakesholders in Nordic Health 2030, in which we propose as an ideal model for personalised health, and which will be explored in greater depth at the HIMSS & Health 2.0 European Digital Event.

The Humanome (see illustration below) is a concept that gives a holistic picture of an individual’s health. It is based on data from both public and private sector sources, which all influence personal health. These data fall into different categories of conditions and influences on health and are to a varying degree fixed or changeable. Some of the data span over multiple categories, illustrated by the gradients in the model. ​ 

The Humanome requires a transformative new way of approaching health and how we work together. Some conditions that are needed to realise the Humanome are increased trust, interoperable standards, cross-border collaboration, dynamic data models, and an emphasis on prevention as service on the path towards better quality of life and wellbeing.

The outermost layer of the Humanome is the ‘data control and contracts’ category, which has to do with how data is handled by individuals, public and private institutions and actors, as well as the infrastructures that allow for the storage and transfer, and sharing of data. The building represents the hospital and established health system which holds medical records containing all the traditional clinical, biobank, health records and relevant data on health production. ​ ​

As a tool for organising and identifying relationships and patterns in health-relevant information, the Humanome qualifies people to make informed decisions and enables conscious interactions regarding their health based on real-time, real-world data over their lifespan.

​As the Humanome is founded on and, indeed, entirely dependent upon cross-border collaboration, dynamic sharing of information, new kinds of public-private partnerships, and a preventive health mindset, it is a model that is built for a world in which the burden of disease is becoming more diversified and in which health both transcends national borders and is increasingly individualised. The Humanome is, therefore, a model for the future of health.

Hear more from HIMSS Future50 leader, Bogi Eliasen, at the HIMSS & Health 2.0 European Digital Event taking place 7-11 September 2020.

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