世界经济论坛-第四次工业革命中的健康与医疗保健：2016-2018年健康与医疗未来全球未来委员会（英文）-2019.5-45页.pdf

Insight ReportHealth and Healthcare in the Fourth Industrial RevolutionGlobal Future Council on the Future of Health and Healthcare 2016-2018April 2019World Economic Forum91-93 route de la CapiteCH-1223 Cologny/GenevaSwitzerlandTel.:+41(0)22 869 1212Fax:+41(0)22 786 2744Email:contactweforum.orgwww.weforum.org 2019 World Economic Forum.All rights reserved.No part of this publication may be reproduced or transmitted in any form or by any means,including photocopying and recording,or by any information storage and retrieval system.3Global Future Council on the Future of Health and HealthcareExecutive SummaryForewordIntroductionMedical Breakthroughs in BiotechnologyGenetic EngineeringRegenerative Medicine and Stem Cells:Improving and Restoring HomeostasisImmunotherapyPrecision MedicineSome DefinitionsHistorical Perspectives of Precision MedicineExamples of Precision Medicine in PracticeChallenges,Limitations and Promises of Precision MedicineEnhancing Human Health for Improved WellnessNanotechnologyMedical Things and the Internet of ThingsAnalytics and Computing for Improved Diagnostics,Payments and Information SharingArtificial IntelligenceBig DataCase Study:Big Data for Rational CareBlockchainVirtual/Augmented RealityModern Machines and Healthcare3D PrintingRoboticsDronesPolicy and Governance:Adjusting Society to Rapid Changes in the Health and Healthcare EcosystemAccess and AffordabilityWorkforceRegulationEthics,Equity and Social ConsiderationsNorms,Standards,Responsible ConductData Ownership,Privacy and SharingBiosecurity and biosafetyCybersecurityConclusion Acknowledgements Endnotes578991218202021212425252527272929323233333333343434343435353536373840Contents4Global Future Council on the Future of Health and HealthcareFigure 0:What is driving innovations in health and healthcare?Table 1:Successes and promises in genetic engineeringTable 2A:Clinical applications of ex-vivo gene therapiesTable 2B:Clinical applications of in-vivo gene therapiesFigure 1:A brief history of the use of live cell-based therapies in medicineTable 3:Successes and promises in regenerative medicineTable 4:Other applications of regenerative medicineFigure 2:Strategies to expand the potential of regenerative medicineTable 5:Successes and promises in immunotherapyTable 6:Precision Medicine in practiceTable 7:More examples of Precision Medicine applications across medicineFigure 3:Applications of nanotechnology in medicine Table 8:Internet-of-things applications in health and healthcareTable 9:Artificial intelligence applications in health and healthcareFigure 4:Developing a model for rational care based on individual patient outcome tracking and treatment decisions Table 10:Applications of drones in health and healthcare 691112131316171822232526273033Table of Figures5Global Future Council on the Future of Health and HealthcareExecutive SummaryThe World Economic Forum Global Future Council(GFC)on the Future of Health and Healthcare comprises expert stakeholders representing the public and private healthcare sectors.For the 2016-2018 mandate,members of the GFC worked together to provide insights on how the evolution of global health and healthcare will affect us all in the decades to come,including through the implementation of the Fourth Industrial Revolution.It is now well recognized that the misalignment of all stakeholders resides at the core of health sector underperformance.This is largely due to narrow competing objectives(silos versus different incentives),power asymmetries(North versus South,advanced versus emerging economies)and cooperation failures among other things.However,these challenges will have to be addressed collectively as health-and healthcare-related issues have become some of the most prominent preoccupations for people across the globe and generations.First and foremost is the pressing issue of seeking sustainability:from our ageing demographics(by 2050,one fifth of the global population will be over 60 and two thirds of babies born today could live to 100)to the increasing burden of non-communicable chronic diseases(NCDs),which already represent 75%of healthcare expenses,while the rising cost of healthcare will contribute to an overall direct and indirect loss of$47 trillion for the worlds gross domestic product by 2030.Second,the acceleration of science and discovery with,for example,the cost of genome sequencing falling below$1,000,and over 100,000 new drugs in the pipeline,some of which have already had a profound impact in developing cures,particularly in cancer,but are increasingly associated with unaffordable costs.For example,recent approved cell therapy costs well over$1 million for one treatment for a single patient.Third,the progress in technology spanning the digitalization of health and healthcare to social media,internet of things(IoT),wearables,sensors,big data,artificial intelligence(AI),augmented reality(AR),nanotechnology,robotics and 3D printing,which together will radically transform society,increasing interconnectivity and breaking the structures of healthcare systems.The 2016-2018 Global Future Council on the Future of Health and Healthcare examined how these advances in discovery and clinical sciences,data science and technology and their convergence are paving the way for exciting new developments.Specific examples of breakthroughs include genetic engineering especially genome editing regenerative biology and medicine,tissue engineering,cancer genomics and immunotherapy,precision medicine,microbiome,optical imaging,optogenetics and brain machine interface technology.In addition,the surge of data science with big data analytics,digital technologies and AI will have a transformative impact on health and medicine.If the aforementioned achieve their potential,we will see transformative effects across all aspects of health and healthcare.Indeed,certain advances will go beyond transforming disease treatment and prevention;they will effectively offer a cure for some diseases.For example,gene-editing technologies have the potential to cure genetic diseases,such as sickle cell disease and cystic fibrosis.Germline editing has the potential to cure diseases with permanent intergenerational changes,while somatic genome editing can treat,control and possibly cure acquired diseases.Advances in precision medicine can guide healthcare decisions towards the most effective treatment for a given patient or subset of patients.Furthermore,precision medicine holds great promise for prevention and public health,particularly by identifying predisposed or high-risk patients for specific conditions and diseases that could be readily prevented with early detection,appropriate screening or through lifestyles changes.Though healthcare is somewhat behind when it comes to big data compared with other sectors or industries,it certainly is catching up with massive information generated.Healthcare data captured in real-time can generate new knowledge and evidence to better understand patterns of health and disease.The access to real-world evidence will play a critical role in the development of a system in which,“science,informatics,incentives and culture are aligned for continuous improvement and innovation,with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience1”.6Global Future Council on the Future of Health and HealthcareThe integration of big data,analytics,new technology and connectivity inside and outside clinical encounters,coupled with payer activity and cost,pharmaceutical and medical products R&D data,and patient behaviour,will help us better predict the outcome of diseases as well as drivers of health,including social determinants which are often underappreciated.In the future,two fundamental shifts will reshape the healthcare industry.First,healthcare will be delivered as a seamless continuum of care,away from the clinic-centred point of care model and with a greater focus on prevention and early intervention.Second,health and healthcare delivery will focus on each person within their own ecosystem,with a greater impact from people or patients themselves,often referred to as the consumerization of healthcare.Telehealth technologies will enable patients to send personal information to providers who can remotely diagnose health problems;IoT and other technologies will enable real-time monitoring;and technologies such as apps and wearables will help promote healthy behaviours and enable sustained behaviour modification.Finally,AI is likely to transform all areas of health and medicine towards clinical decision-making.Across systems,the integration of these approaches will serve as a foundation for value-based care approaches and value-based payment models,focusing on improving individual outcome while optimizing the cost of care per patient.Improving care outcome through rationalization at the point of care will help reduce redundancies and waste,estimated at up to a third of the current total spend for healthcare.This will improve outcome and efficiency of healthcare delivery,while controlling costs and keeping innovation at the centre of future health and healthcare enterprise.Despite the mounting challenges facing health and healthcare delivery,our council was able to provide promising insights and perspectives,thanks to all its members collective expertise.The combined advances in discovery and clinical sciences,data science and technology and their convergence through the Fourth Industrial Revolution,are paving the way for unprecedented changes,which will profoundly transform health and healthcare to become much more connected,efficient,preemptive,precise,democratized and affordable.Not only will this improve the health of individuals,it will also reduce imbalances across geographies while boosting economies and spurring employment,a key factor in the wellness and health of society.Digitalization of health and healthcareRapid evolution of science and medicineUnsustainable rise of costsBy 2020,it is estimated that the volume of medical knowledge will be doubling every 73 days.Genome mapping now costs less than USD 1000More than 15000 drugs are in the pipeline in 2018,with over a third targeting cancerNew processes for drug developmentBy 2050,20%of the global population will be aged over 60Yet,at least half of the worlds population cannot obtain essential health services.800 million people spend at least 10%of their household budgets on health expenses;For almost 100 million people these expenses are high enough to push them into extreme poverty.By 2040,the world will spend around USD 25 trillion every year on healthcareSpending more does not necessarily achieve better health results,or higher life expectanciesFor example,the US spends more than five times as much per person as Estonia,yet both countries have similar life expectancies.Over 318,00 health apps are now available(double from just two years ago)on top app stores worldwide with more than 200 health apps being added each day.The integration of data will enable a system biology approach to prevention,disease surveillance,early detection,and interventionAppsWearablesBig data and analyticsSocial MediaTechnological advances being leveraged in health and healthcareArtificial IntelligenceBig Data and AnalyticsVirtual and augmented realityNanotechnologiesModern machines(robotics,drones,3D-printing)Exciting developments in:Precision medicineImmunotherapyMicrobiologyGenetic engineeringRegenerative medicineOlder PopulationHigher CostsInequality of AccessFigure 0:What is driving innovations in health and healthcare?7Global Future Council on the Future of Health and HealthcareForewordSociety is in the midst of transformative changes.Klaus Schwab,in his book,The Fourth Industrial Revolution,notes that we are at the beginning of a revolution that is fundamentally changing the way we live,work and relate to one another.The scope of the Fourth Industrial Revolution is broad and is characterized by a fusion of technologies across physical,digital and biological domains.It is disrupting almost every sector and industry in every country and creating massive change in a non-linear way at unprecedented speed.Indeed,the Fourth Industrial Revolution is transforming health and medicine due to the lightning-speed advances in genomics,genetic engineering,synthetic biology,nanotechnology,data science,AI,robotics,to name just a few.These scientific and technological advances promise to yield breakthrough diagnosis and therapies including precision medicine and medical cures.Medical and technological breakthroughs and advances will transform health and healthcare to become much more connected,precise and democratized,with significantly improved human outcomes.At the same time,innovations and technologies inevitably carry risks and raise important questions.For instance,rising healthcare spending and the unaffordability of treatments are already a global challenge,and there are concerns that expensive new treatments and technologies will only exacerbate these trends.Technology may deepen healthcare inequalities by perpetuating existing biases in research results based on data that might lack diversity of gender,race and age.Health professions will need to acquire new knowledge and skills to utilize new technologies and adapt to changing modes of care delivery.To comprehend the scope of scientific and technological breakthroughs and their potential impact,the 2016-2018 Global Future Council on the Future of Health and Healthcare2 prepared this report to serve as a key resource in understanding the effect of the Fourth Industrial revolution on health and medicine.Through a series of case studies,it seeks to characterize how this revolution in health and healthcare will affect us in the coming decades and to discuss the societal implications and governance of key emerging technologies related to health and healthcare.Our hope is to promote understanding of these groundbreaking technologies,identify the challenges they will bring,raise awareness and stimulate dialogue,and drive collaboration between policy-makers and innovators.We,the Co-Chairs of the 2016-2018 council,and a co-lead author,were privileged to work with the members of the council who have provided important insights and dedicated significant time to completing this report.Without the contributions of all these individuals,this report would not have been possible.Andre Goy,Council Co-Chair;Chairman and Executive Director;Chief of Lymphoma,John Theurer Cancer Center,Hackensack University Medical CenterSania Nishtar,Council Co-Chair;Founder and President,HeartfileVictor J.Dzau,Council Member and Co-Lead Author;President,US National Academy of Medicine8Global Future Council on the Future of Health and HealthcareIntroductionBy 2050,the world will be home to 10 billion people,and two in five of these people will be aged 60 or over,including 434