Anders Ekholm is one of DigitalWell Arena's coaches - the only one with the addition "provocateur". His ideas for transforming the welfare system are based on breaking with the "concrete solutions" of the 20th century, seriously creating an infrastructure for data and realizing that better public health is largely created outside of healthcare.
Anders Ekholm sits on DigitalWell Arena's advisory board, and some have probably met him as a lecturer at various conferences and events. In his role as coach and provocateur within the arena, he will contribute thoughts that challenge the path choices in the transformation to the health society of the future.
The title provocateur can be debated, but for a man who has analyzed welfare data in basically all ministries since the 1980s and has long spoken about the need for change, it is no big deal. Anders Ekholm says that during his time as head of analysis at the Ministry of Social Affairs, he was once named "general practitioners' enemy number one".
- I wrote a report about primary care disappearing and gradually becoming something else, or rather that the health centers are disappearing. There will be more home care, more telecare or perhaps a lab at the bus station that will be closer to the residents, says Anders Ekholm, who, not least during the Corona crisis, received support for his forecast.
Want to break with concrete solutions
It is his belief that the "concrete solutions" of the 20th century, where we could build away social problems with concrete to, among other things, gain access to clean water, sewage and better housing, have now done their job.
- If you look at the UN's Human Development Index, we are at the top, we are at 95 out of 100. It really can't get any better, so you can say that the 20th century welfare project is complete, even if there is a need for renovation. We haven't really understood this, but we think that we should solve the problems of the present and the future in the same way: centralize, create rules and throw money at the problems, says Anders Ekholm.
The new challenges are the complex societal problems. For example, gang crime, the climate issue or unequal health between different groups.
- Elderly care is a clear example. There are departments within the same building, which may have a common manager, where year after year one department works very well and the other year after year works very badly. All the traditional control signals and models are identical, but the result will be completely different. It is a typical example of a complex system. What you have to do then is self-organize the systems, so that they can solve these things themselves, be clearer in the goal description and follow up the results in real time, says Anders Ekholm.
10,000 employees – but no managers
He highlights the Dutch home service company Buurtzorg as a successful real-life example. Buurtzorg has been voted the country's best employer several years in a row, they have the most satisfied users and the lowest cost per measure. Despite 10,000 employees, there are no managers, each work group of around 12 people is self-governing and hires new employees themselves. IT functions act as a support in everyday life.
"As soon as an IT minister is appointed, they start talking about broadband expansion, so they are still in the digging stage."
A similar line of reasoning is repeated about health care, where Anders Ekholm says that there is data to support that small and medium-sized hospitals are the most efficient. At the same time, he thinks that the concept of health linked to our lifestyles and how we can more actively avoid visiting healthcare is at least as interesting.
- During the 20th century, in terms of average life expectancy, healthcare progress only accounted for ten percent, the rest is clean water and sewage, reduced accidents, better environments and housing. All these concrete solutions. Today it is a little more, it is thought perhaps that 25 to 35 percent of health is improved by healthcare, but no more. When we talk about health, it is life in general – eating and exercise habits, having a job, a meaningful everyday life and access to beautiful environments – that matters.
Data that makes the individual visible
Anders Ekholm believes that a more data-driven and individualized view of health is also absolutely crucial to moving forward. But then we have to start collecting data about the collective in order to also be able to draw conclusions about individuals.
- We need to make measures that are much more individual-centred, then we need to have data per individual, so we start from this 20th century thinking when it comes to population averages, where you think that a fever is over 37 degrees. Now, funnily enough, people's body temperature is starting to drop. But without having measured what temperature you have as healthy, we cannot answer the question when exactly you have a fever, the healthcare system only measures when people are sick.
Here, our laws and regulations also pose a challenge. In some other countries it is assumed that the collection of medical data is okay, for example in Estonia where you have to actively say no to be exempt. In Sweden, you are instead required to give your consent, even though, according to Anders Ekholm, there is a "skyrocketing acceptance".
- The legislation is actually the inverse of what people think, it is extremely problematic. For example, we do not think that acquaintances, neighbors and work colleagues should find out things of a gossip nature such as your income. At the same time, you can easily find out what people earn online. But if in a region you would like to have income data to check the combination of socio-economics and lab values, to put in measures at the individual level, you will not get income data at the individual level from SCB. You can use data for gossip but not to improve the world, which is bizarre.
Infrastructure that requires content
Anders Ekholm wants to see a new, digital infrastructure for welfare. He makes an analogy with the industrial era, where the state's expansion of the railway laid the foundation for the export of iron ore and timber - and our present prosperity.
Now the question is just as much about what we must and are allowed to transport.
- As soon as an IT minister is appointed, they start talking about broadband expansion, so they are still in the digging stage. And it's clear that it's needed, if we're going to have healthcare out in every single cabin in the forest, we have to have an infrastructure, so it's not an unimportant issue. But we have to push things online too.
Anders Ekholm points out that, on the whole, the Swedish healthcare system is one of the best in the world. The key question for the future is how we are going to cope with our current healthcare consumption, when the proportion of people of working age is decreasing while the proportion of the elderly is increasing. Here, Anders Ekholm believes that the lack of innovation and the use of non-clinical technology is a challenge.
Old technology became controversial
He thinks the debate that has been around, for example, online doctor services (at least before Corona) is telling.
- But what have you done? Well, introduced the 90s technology of video calling. 30 years after it was invented, it came to healthcare. It is a good example that our ability to us non-clinical technology is poor.
Anders Ekholm also talks about how in Canada they started analyzing data on patients who often came to the emergency room with diffuse symptoms, and that they then found other ways to help them.
- It's a lot about precision, because care is reactive. So they did a lot of examinations without remembering that the patient was here just now and drawing some conclusions from the visit pattern, it costs a lot of money. The lack of precision is unimaginably expensive, if you need four, five or ten visits to get the right diagnosis.
Satellite image of our road choices
Even when Anders Ekholm zooms out a bit, and talks about the value of beautiful environments, he can quickly find data that supports the reasoning. For example, via a Danish study that showed how the availability of greenery in residential areas affects the risk of mental illness, or how we choose our walking routes.
- If you follow the GPS data and see how people walk, it is very clear that they take the beautiful roads, avoid the ugly motorways and industrial areas and even take detours. Here you are prepared to incur a time cost to take a detour. There are so many things we need to think about in order to address health, the healthcare system does not have much control over our health.
Facts: Anders Ekholm
- Missions in DigitalWell Arena: Coach, provocateur and one of the members of DigitalWell Arena's advisory board.
- Other missions: Senior advisor for the Institute for Future Studies, chairman of Greater Stockholm's diabetes association and member of DIGG - the Danish authority for digital management - advisory body.
- Background: Since the 1980s, has had various assignments at the Ministry of Finance, the Ministry of Labor and the Ministry of Education and was head of analysis at the Ministry of Social Affairs.
