SmartHEALTH – WHERE TO NEXT?
ANDREW TURNBULL | DIRECTOR AT SCOTT CARVER
The application of smart technologies that harvest real time data will inform active living policy, investment and place design. Society is at a tipping point where smartHEALTH will place new obligations on the individual to actively minimise their critical care burden through programmed preventative health.
CONTEXT – A REALITY CHECK
A statistic at age 53. I suffered a heart attack forcing lifestyle changes. Surgery (acute care), a 6 week structured hospital recovery program, a 12 month Health Provider program, medication and E-health monitoring are the basis of my Health Plan and a personal commitment to physical activity evidenced by my smart watch. In return, I am able to negotiate with my health providers based upon real time data.
My health data is shared weekly to my medical team and health insurer. No longer an excuse for inactivity or poor lifestyle, I am tethered to my smart device as part of a preventative health program.
As a design professional, this life event has given me direct insight into how technology will inform and track my life choices. An activity target of 7.5km walking with 10,000+ steps a day cannot be achieved without a commitment to a proactive exercise program. Trading car travel for a walk to the bus stop, a walk at lunchtime, a gym session and an evening walk in my local community are the new regime.
Additionally, this new activity program became a new-found opportunity to engage with my community. And quite frankly, the streets are in disrepair; there is a lack of infrastructure to support programmed active living for all ages and our parks and open spaces are under increased demand from suburban intensification.
This realisation leads to the question: How will live data smartHealth technologies inform government priorities and realise macro and micro investment into inclusive urban environments? Our health epidemic has been building for decades. New incentivised delivery models are urgently required to reform policy, the food industry, heath care and investment models. Technology is an integral part of our daily life providing data as a tradable commodity. It is time that we used health data to evidence and advocate for community investment and not corporate profit:
“Our sedentary, car dependent lifestyles are significant contributing factors to the prevalence of preventable health issues. Development practices have contributed to these problems by often giving priority to cars (vehicular movement) rather than encouraging people to walk, cycle and use public transport” (Health Places and Spaces 2009).
THE HEALTH EQUATION =
Many factors contribute to increased health costs: our population is growing and aging. Every Australian age strata are receiving more expensive medical services per person and accessing them more frequently .
Combined Australian Government expenditure into critical care infrastructure, Medicare, Pharmaceutical Benefits Scheme [PBS], research and NGO funding exceeds 10% of the Federal Budget expenditure. This is an unsustainable proposition costing the Australian Economy an estimated $30B per annum in direct heath cost and loss of productivity.
If the economic rationale is true, that a $1 investment in preventative health will deliver a $10 cost saving to society.
What could be achieved with a $3B investment retrofit of our urban environs to promote and deliver community centric active living?
The cost of health care is a challenge for government and the individual alike. It is rising faster than inflation at approximately 6% per annum in Australia. The forward trajectory will place increasing preventative health responsibility on the individual.
“Perhaps the most compelling reason for taking a deeper interest in what Healthy Places & Spaces has to offer comes from evidence about human health and financial costs of preventable disease/illness”  (Health Places and Spaces 2009).
Seventy percent of Australians will be diagnosed with a chronic illness - the majority of which are preventable. Heart disease is the single leading cause of deaths and impacts 1:6 Australians. High blood pressure, high cholesterol, smoking, obesity, physical inactivity, diabetes and stress are modifiable behavioural and bio medical factors that contribute significantly to the health care burden. Preventable health and physical inactivity must be the focus of society. This is a global health epidemic.
Improvements in walking and cycling environment have the potential to increase the value of residential and retail properties . Global case studies and research strongly supports that walking and cycling, combined with good public transport networks, stimulates local economies, increases property values and is essential to the success of revitalisation strategies. Engaged and inclusive communities support human health and well-being.
Our urban landscapes are a critical part of our urban fabric. They support food production, environmental bio diversity, recreation; fitness and physical activity, movement networks and are a place for social interaction and cultural engagement. Macro planning allocates in the order of 40% land use to environmental | open space [15%], street and transit networks [25%].
Urban population growth and intensification is placing unprecedented pressure on land availability, both greenfield and urban infill. Government and development industry focus on optimising the development yield, supported by car dependency, is eroding the quantum of private recreational, productive and environmental landscapes.
This is especially true of suburban residential intensification with the conversion of detached housing lots into multi residential product. Reduced lot size and increased development footprint effectively reduces the available private open space 80% per capita replaced by a token offer of a balcony terrace and communal open space that is not conducive the physical activity. Increased population density places unprecedented demand for limited public and natural landscapes – an unsustainable proposition.
The erosion of accessible green space is counter to the investment into active living and promotion of physical activity. Investment into outdoor fitness & community programs for all ages and compulsory acquisition of land dedicated for active green space amenity are interventions that can deliver immediate benefit.
How well are we achieving active living priorities that deliver positive change in our suburbs, work places and cities? Healthy Places & Spaces – A national guide to designing places for healthy living – establishes core design principles to plan health communities.
Active transport – integrated active transport modes
Aesthetics – attractiveness of place
Connectivity – streets, open spaces and places
Environments for all people – inclusive
Mixed density – diversity
Mixed land use – complementary uses
Parks and open space – recreation, lifestyle, bio diversity, sustainability and production
Safety and surveillance – reduce crime and support human well-being
Social inclusion – engaged community
Supporting infrastructure - amenity
Presently, a barrier to urban retrofitting and investment into active living infrastructure is the significant public and private sector costs. But what is the real cost to society if we do not re priorities forward investment?
New community-centric models need to be evolved for financing, management and supported programs. There is much to learn from global case studies that research and implement tangible micro programs that significantly empower the community promoting physical activity and human well-being.
FITNESS & PROGRAMMED PHYSICAL ACTIVITY
Australians of all age groups are becoming more inactive. The level of participation is very much influenced by age profile, gender and disposable income. It is estimated that 1:5 Australians are engaged in a physical activity once a week. Participation in organised fitness drops sharply after 35 years of age.
Walking represents the highest physical activity participation rate at 19% followed by organised sports, including gyms, at 17%, noting that for the later the 5 to 34 demographic profile are the majority users.
An aging population will place increased demands on our health resources. Retrofitting our suburbs to support aging in place, community transport and non sport active living choice focussed on physical exercise is a strategic investment with enormous upside benefit to society.
The 2017 Active Living Research Annual Conference brings together 30 disciplines to advance knowledge and action around active communities. The theme ‘Active Living across the Life Span’, places emphasis on the importance of promoting physical activity through-out the life course, from childhood through mature adulthood, for optimal health and quality of life.
“We love the idea of creating spaces in public to engage the elderly. The value of these for the exercise, but the key is not a gym, not a retirement home, but outside” Manuel Francisco Martin
A TIME FOR ACTION
Individual evidence based smartHEALTH data will certainly influence forward directions in the health space empowering communities to apply political pressure to ensure appropriate investment into their communities. Incentivised health - government and private sector - is critical for individual behavioural change where the individual will be an active participant and accountable.
“Many of the current burdens on our national health system are caused by diseases and conditions that could have easily been prevented by simply adopting healthier lifestyle choices” 
Technology is part of our everyday life. Smart watch and fit-bit technology allows for individual geo tracking, data collection and health monitoring. E-Health, tele-health monitoring and smartHEALTH will be the new language.
Will there be a shift in health profiling focused on a personal plan and evidenced by real time data? A new paradigm.
issue 03. autumn 2017