Scaling Health Designs Globally: How To Not Get Lost in Translation
Replicating isn’t the same as scaling
Have you heard about the time when Pepsi launched in China with the campaign “Pepsi Brings You Back to Life,” which translated locally as “Pepsi Brings You Back From the Grave”? This is just one of many examples of brands not conducting appropriate research or prototyping and then getting lost in translation as they roll out across the globe. Languages are different, needs are different, context is different.
In order for Austin to be a model health city, we must not only effectively and efficiently affect health outcomes here, but also enable the model to learn from and adapt to the unique conditions of other communities, so that it’s validated and relevant anywhere. It’s important for us to actively learn from and even design health solutions for communities with different circumstances who are working to fix many of the same health challenges.
Last week the Design Institute for Health and Dell Med hosted a delegation from Singapore’s National University Health System (NUHS) and Ministry of Health (MOH), and we learned a lot about our shared missions and also each other’s unique conditions and therefore unique opportunities to redesign health. As Dr. John Wong, CEO of NUHS said, we “learned shamelessly.”
First things first: a shared health mission…
Austin, Texas and the city-state and island country of Singapore? We actually have a lot in common. We have a similar unemployment rate (about 2.5%) and rising health care costs (though Singapore’s health costs are only about 5% of the GDP vs. about 20% in the US). Importantly, with one of the fastest aging populations in the world and with similar rates of chronic disease, the NUHS is shifting from hospital based care to community based care, from quality to value, and from healthcare to health. Sound familiar?
…But in a different context
Unsurprisingly, the context in which Singaporeans get and stay well is quite different from Austin.
Singaporeans are 76% ethnically Chinese, 15% Malaysian and 7.5% Indian compared to Austin that’s 50% non-Hispanic White, 35% Latino, 8% African American and 6% Asian. Singapore is able to track and study its population, through the pervasive use of a unique identification number from birth through death. This means that Singapore has access to longitudinal data (even pre-conception maternal health data) for a population that is ethnically complementary to Austin. They are uncovering health differences for a population that is underrepresented in western health studies.
Unlike Austin’s youthful population (with a median age 31.8), Singapore’s population is rapidly aging (with a median age of 40.5), which is the challenge that most other US cities are facing. Singapore acknowledges their population will mimic Japan’s in 12 years, and are therefore innovating especially (and appropriately) in primary care and community settings, trying to get in front of the “silver tsunami.”
2. System Levers
Because Singapore is a benevolent authoritarian regime, it has more variables it can directly control in an attempt to understand and affect health determinants and influencers. For example, Singapore encourages individuals to take responsibility for their health and health care costs through mandatory savings plans for routine care but also directly controls the costs and is a payer of last resort. Just a couple weeks ago, Singapore announced that it would be consolidating all health and social services for seniors under the MOH, meaning that the NUHS now has the resources and the authority to act on social determinants of health and therefore to deliver health, not just health care. 82% of Singaporeans live in public housing, and new campuses that better integrate health are being planned. Singapore even attempts to influence racial harmony, from mandating housing integration and celebrating its interracial marriage rate (20% vs. 15% in the US) to disallowing negative comments about another race or religion.
The effect of these (and other) system levers on Singapore’s population is that Singapore remains one of the most trusted countries in the world. Contrast that to trust in the US government, which is at a historic low. Trust for governmental institutions, including healthcare, amongst underserved populations in Austin is also low for many reasons, including historic discrimination and current inequities and bias. This leads to individual workarounds that may actually harm care, such as when “Melissa,” whom we met in Austin, insisted on speaking a language with which she was less comfortable with a bilingual healthcare provider, because she thought she would be believed more. As the most economically segregated city in the country, Austin is still feeling the impact of historic segregation laws, and we have long way to go to repair and build trust, especially amongst historically underserved communities.
Potential Collaboration Opportunities
We see many potential collaborations with Singapore, with the aim of evolving a model of value-based care (note: Singapore refers to it as value-driven outcomes) that can work beyond Austin (and Singapore). I’ll leave you with a few provocations for those collaborations and would love to hear what excites you.
How might we combine Dell Med’s value-based care experience with NUHS’ rich longitudinal data and access to study outcomes more accurately and comprehensively?
How might we leverage Singapore’s authority, resources and venue to better understand how to assess social determinants?
How might we learn from our two extremes of trusted environments? Can we learn more about what breaks and what builds trust to create health solutions that are better received? What are the characteristics of Singaporean trust and who exhibits that in Austin and therefore could be a potential (but perhaps unusual) vehicle for care delivery or prevention?