Is it time to revisit the trade-off between health and privacy?

Much improved medical interventions, public sanitation and publicly funded healthcare were crucial to reduce the mortality rate. Today, less children die, and an increased healthcare expenditure has aided people with a disease or disability to enjoy a longer life. Developing countries had the biggest gain in life expectancy over the past decades, while developed countries followed a pattern of diminishing life expectancy returns on additional healthcare expenditures.

For China, back in 1980, when over half of its 1 billion population were still living in extreme poverty on less than 1 USD per day, the average life expectancy was 66,8 years. Fifty years later, 10 more years were added to reach 76,6 years today. It took Western countries about the same time to reach this target by the end of last century. The big difference is that from the 1950s onwards, the GDP per capita of Western countries was at least 5 times higher than that of China and healthcare spending over 10 times more per capita. Under the current ‘Healthy China 2030’ plan, China aims to reach the life expectancy of 79 years - the same as in the US today - by 2030. If China achieves this target, they would have done it in half the time the United States needed with less than 10% of the healthcare expenditure cost per person. If we were to extrapolate this trend, Chinese will soon live longer than us. So, what could be their secret towards longevity?

5000 years of practice

Many western health practitioners claim Traditional Chinese Medicine (TCM) is unscientific as it lacks well-defined, well-tested causes to explain a disease state and evidence that a drug works. A popular Chinese saying counters this argument by stating that “excellence is from experience” and TCM is based on 5,000 years of practice and experiences. President Xi Jinping strongly supports TCM with a national strategy that provides universal access to the practice now and a booming TCM industry by 2030. With such support from Beijing, it is no surprise that TCM was used in combination with Western medicine to treat COVID-19 patients in China. While Chinese doctors claim TCM has been most effective to prevent and treat the disease, Western experts warn that there is no good evidence for TCM, its use is unjustified and potentially harmful. Chinese patients trust their heritage as much as science, navigating between the two parallel worlds of medicine, exploring either or both options.

The Chinese mindset towards health is seen as a state of balance between physical, social and super-natural environment. Healthcare in China is seen from the internal state of the body as a whole, whereas Western medicine approaches it mostly from external forces on a body part. Chinese medicine aims to restore harmony of the body’s ecosystem by use of acupuncture, herbs and food to recover and sustain health. Chinese medicine is by default a personalized medicine tailored upon the needs and symptoms of the patient. It then adjusts the ingredients upon further examination of a patient’s response to the treatment. Western medicine is nowadays also evolving from a ‘one-size-fits-all' paradigm to tailor medicine and patient management to each person’s molecular or cellular level. From immunology to gene therapies, the same advanced Western personalized procedures are used in the West as in China as this revolution fits completely the Chinese view of traditional personal healthcare. China’s cultural past embraces and reinforces the medical possibilities of tomorrow.

Longevity becomes a choice

More important than comparing Western with Chinese medicine, is that in China the body gets checked on a regular basis. This routine check-up by examination of one’s appearance or its tongue became part of the culture often done quickly by friends, family or colleagues. It is similar to how a farmer predicts bad weather by looking at the behavior of the animals he knows so well. Talking about farmers, as China is still a very rural population, the bulk of a farmer’s wealth often resides in the handful of cows or pigs they own. The health of their livestock is almost as important as their own health. Most of them try to get each animal insured, but how do insurance companies know which cow or pig is sick or died, and whether the farmer is telling the truth? Chinese tech firms therefore lately have been making the country’s farms a living laboratory of how AI is used to improve insurance claims and monitor livestock health to raise productivity. The Chinese insurer PingAn has deployed a bovine and porcine face recognition app to help China’s 300 million farmers to collect and upload photos of their animals on a constant basis to the cloud. As such, the farmer can not only keep their animals healthy longer, but he has now easy access to financing to buy more livestock. Companies like Alibaba, JD.com and Tencent created smart agriculture platforms to help farmers monitor animals in real time to detect symptoms like breathing difficulties, lethargy, pregnancy and much more. Each animal has its own data file, which includes age, weight, breed, exercise frequency and feeding habits, often a good indicator of an animal’s health.

Now imagine the same for people. With livestock, you don’t need the pigs’ consent to deploy face recognition – not in China or Europe; but for humans that might raise privacy concerns. This said, the story here is that constant health monitoring technology is already been deployed on large scale in China, just not yet on humans. I guess Chinese will be quick to become the guineapigs of this new age of health monitoring on scale when a technology company gives them the ‘buy with 1 click’ option to live longer or die sooner in full secrecy. The inequality gap between who can afford better healthcare and who not as we have in the States today, could evolve to an inequality gap between those with poor health and those with better genes. How can a society provide a more inclusive healthcare system?

Healthcare is a digital journey

If we want to evolve from sick care to health care in future, new technologies can’t only help us create better pills, vaccines or treatments, but also collect and compute data to provide our real-time health status. Today, easily accessible inexpensive wearable technologies like the Apple watch can measure with the highest accuracy what took state-of-the-art MedTech companies a decade to research and develop. 2020 saw a fast growth of China’s wearable devices market, where the biggest producers worldwide are Chinese pleasing the tech-savvy Chinese consumers who scramble to embrace the gadgets to make life more convenient. For those who can’t afford the wearables, the company PingAn Good Doctor built one-minute clinics to reach half a billion Chinese in the rural areas and smaller towns of China.

Their 24/7 compact 3-square meter mini-booths include a Virtual ‘AI Doctor,’ to collect data on patients with instruments, after which a human doctors provides diagnoses and medical advice by video-conference. A connected vending machine containing 100 categories of common drugs is available or medication can be delivered to your home in 30 minutes. The real value-proposition is that you can do a regular one-minute check-up any time at almost no cost, as easy as brushing your teeth.

A Chinese company taking this to the next level is iCarbonX. Just like Good Doctor, in their mini-clinics they too measure vital signs (blood pressure, body temperature, heart and respiration rate), but combine that data with internal biological data (DNA, molecular omnics, medical records) as well as behavior and social data (from health wearables and social media) to offer a 360-degree picture of a person’s health at any given moment. This company wants the world of healthcare to move from sick care to predictive healthcare by looking at diseases as a build-up over time. By capturing data and signals early on, we should be able to prevent diseases to occur instead of having to treat them. iCarbonX in this way is creating a data scientific version of TCM. They want to try and map out anyone’s digital life, to enable us to perform healthcare management and make smarter daily life choices to more easily prevent chronic diseases from happening. Think of iCarbonX as your daily guide of a health journey showing you the likely outcomes of any life choice you make. The choice for the patients of the future will be whether we want to travel as a group as we do today, or become an individual explorer of our own health map?

Who do we trust with our data?

In our current healthcare system, we gather data of patients mostly when someone visits the hospital or a doctor’s office. In this sick care model, protecting data is less challenging as the data is limited in time and volume. It gives us a sense of security that our data is safe with people who took the Hippocratic Oath to preserve the patients’ privacy. As we now progress from sick care treatment to healthcare management, we will require a constant flow of personal health data to be taken, stored, managed, computed and cross-referenced somewhere. It won’t be the hospitals and doctors who will be managing our data anymore, but instead technology companies with the best data management and security skills. But can we trust these tech companies? A fast-growing number consumers are accepting this fact already when they buy smartwatches, track their own fitness data, manage their health with apps, discuss health issues online, search for treatment advice on Google, or get their genome data from 23andMe. It almost feels perverse that consumers trust Google, Apple and individual doctors, but distrust the institutions that are overregulated to keep our data safe: insurers, big pharma, banks and governments. The reason is simple: Doctor Google is giving us more in return for our data, seemingly for free

This is where China is very different. Chinese trust their government and regulated industry more than private companies and doctors. Chinese have more faith their data will be safe with the nation’s institutions as well as the big tech like Tencent or Alibaba who are being closely watched by Beijing as they are the actors to censor the internet in China. In a way, one could say that China’s tech giants have become the experts in protecting all online data. It is also an illusion to think that Chinese people or companies do not care about protecting personal data, or that no data protection laws exist in China. Every Chinese is by law the owner of their own data as in Europe with GDPR, and China’s cybersecurity law prohibits from using anyone’s data without their consent. Technology companies in China appreciate the risk probably more than their Western counterparts as the Chinese government is not joking around when a breach happens like we witnessed with Facebook in 2018. In China, the government fulfils the role as guardian of people’s wellbeing, where in the West we rely more on institutions to protect citizens. China’s fast recovery from the pandemic reinforced the trust Chinese have in the government. People in China believe more than ever that their leaders care about everyone’s health; and Xi Jinping is seen as the Confucian patriarch who runs the country as if it were his own family. Despite what we may read about China, trust in China’s top leaders seems at an ever high. As for the rest of the World, Trump has tarnished the image of our global institutions, and it will take quite some time for Biden to regain the prestige these institutions once had. As good data governance and trust in the guardians is becoming the condition for healthcare to take a leap into personal health management, China seems to have a better chance to make a difference in how long people will live.

Good cop/bad cop

The interesting paradox is that the West is trusting Chinese private companies like Huawei less as they have alleged links with the government, which for many Chinese enterprises is true as China is pushing for more public-private partnership (PPP) business models. Yet, it’s the same PPP model that enables many entities like governments, hospitals, technology companies, insurers, employers, wellness centers to all work closely together and share health data on unified platforms. Data platforms which are now being secured by blockchain technologies to verify the origin and authenticity of the data. This unveils another challenge of the West to implement a technology like blockchain, as we can’t get all stakeholders on board easily. Who would have thought that a strong centralized power like China would be needed to make a decentralized blockchain model work well?

That strong central power in Beijing worries the West, as we can easily envision China in becoming a biosecurity state. This dystopian image of China got more real recently by the mandatory QR tracing app that hundreds of millions of Chinese have to use to maintain their freedom of mobility in the cities. China’s digital infrastructure is clearly in place, and during the coronavirus outbreak, Chinese plainly put their health ahead of privacy concerns.

In the West we debate about the harm any privacy invasion can cause; while in China they debate more what the benefits are of giving up some privacy. Can we use drones to check people’s backyards in lockdown is the debate here, while in China, the debate is how to use drones to deliver groceries to people in remote areas and disinfect public areas faster? In my view, the biggest challenge to resolve in the West is how to change our thinking from risk to opportunity and benefit, especially during a crisis. What can consumers get in return when they share private data to those who police and regulate our cities. In China, after a few months of sharing health QR data, 1,4 billion Chinese got their freedom back, while the West is still mostly in semi-lock-downs after 9 months. The benefits are self-explanatory.

My experience is that Chinese companies, institutions and governments are simply better at showing consumers what the benefits of sharing their data is, and despite our dystopian view of China’s system, most citizens see their government primarily as ‘good police’.

We need more actual, real-life and historical data to get better healthcare; and as long as citizens feel that sharing more data is beneficial to their health or wallet, they will entrust their data with those who handle it with care and give them the most convenience. What we will see in future is that consumers will demand companies and institutions to use our data and advanced technology to regulate and create better societies. China is often portraited by Western media as invasive bad-cop surveillance state, and seldom do we read about the much more impactful Chinese good-police applications using the same AI or Big Data technologies. In my book China’s New Normal, I shared many examples of how local governments and tech companies work closely together on applications on large scale to improve social problems, poverty, mobility, environment, education and health.

China’s depicted threat of government involvement with tech giants functions often as a strength because together they make more of a societal difference. My personal experience is that the trade-off Chinese consumers make to share their data with public-private entities is usually more appealing than for consumers in the West. If we entrust our government and feel they are accountable to give us real value in return for our personal data, sharing health data will become like paying taxes. Keeping people healthier longer is in the benefit of our government as much as it is in ours. Chinese will have fewer issues to pay data-taxes to the government, as over the past 40 years most of their lives have improved drastically thanks in large part to the guidance of Beijing. Isn’t the biggest value we can get from our government to enjoy a longer, healthier life?