 Well, good afternoon. Such a quiet and attentive group. Either that or you're just plain exhausted after what I'm sure has been a long day. But we intend to keep you very much interested in the panel that's about to kick off. I'm Francis Collins. I'm the director of the National Institutes of Health in the United States. And it's my privilege to serve as the moderator of this panel on shaping the future of health with a very distinguished group of five panelists. This is part of the global challenge on the future of health, which is a theme of the 2016 World Economic Forum with, I think, no less than 35 dialogues focused on health more than I think has ever happened in Davos. And I've been coming to this meeting for almost 20 years. So it's wonderful to see this kind of focus. And this is a session where we're going to particularly look at the future of health as it relates to what we're going to do about the 9.7 billion people that we estimate will be living on this planet in 2050. Are we ready for that in terms of the health concerns? Only 20% of health outcomes depend on the healthcare sector. Most of the rest depend on the environment, on individual choices, on public policies. And we particularly want to focus in this session on what we could do collectively across many different sectors in order to improve the likelihood that more of those 9.7 billion people will be able to live full lives and not cut down by disease. And that means we're going to be talking about health promotion and disease prevention and what things could be done in order to maximize that. Now, some might say, well, all we have to do is give people the information about what it is that promotes health and everything will be fine. I don't think this audience is naive enough to think that that's the answer. I wish that we could say that all of us and all of those other people are rational actors in every space. We know that doesn't necessarily apply. And even in circumstances where resources are actually fairly plentiful, people make bad decisions about their health. And while we don't want to turn into big brothers or nanny states, we do want to come up with ways to encourage health decisions to be the easy decision and not the hard one. And that's one of the things we might be talking about in the course of this conversation. So I briefly just introduced myself. Let me now introduce the panelists. And after I have done so, I'm going to ask each of them to speak for just three minutes about a perspective that they would like to share with you and with the other panelists on this topic. After that, we'll get engaged in a bit of a conversation amongst the panel, which I will try to stimulate. And then after a bit, we will throw this open to you, the audience. So please be thinking about things that you would like to raise as far as questions to this distinguished group. And somewhere near the end, I will try to have the panelists give you some summary of what it was that was most important that they take away from the conversation we've had as part of this session. So let me do the introductions and very briefly because you have materials about these folks in your packet. But starting on nearest to me, Olivier Brandecourt is the Chief Executive Officer of Santa Fe and France. He's a physician. He's been CEO since April of 2015. His specialty is in infectious diseases and tropical medicine, including focus on malaria research. He spent two years in Congo as a doctor before moving into pharmaceutical industry at Pfizer, at Bayer, and now at Santa Fe. Next in the line here is Edith Shippers, the Minister of Health, Welfare, and Sport of the Netherlands. She has been a member of the House of Representatives since 2003 when she was first elected. And her role is particularly important because, as you know, Netherlands as the presidency of the Council of the European Union and her role, therefore, since October 2010 as Minister of Health, Welfare, and Sport is particularly relevant to our conversation today. Next, Paul Bulke. He is the Chief Executive Officer of Nestle. Here in Switzerland, he has a degree in commercial engineering. He's been with Nestle since 1979 and has been CEO since 2008. Nestle, as you may know, is the world's largest nutrition health and wellness company, and no doubt he will have a lot to say about the nutritional aspects of health. Next, Franz van Houten, who is the Chief Executive Officer and Chairman of Royal Phillips here in the Netherlands, where he has been since 1986. He has also played the role of improving their view in health. Phillips, as you may know, is an electronics company but now very much a health company. And it has a stated goal of improving three billion lives per year by 2025. And finally, on the end, Riza Lavizo-Mori, who is the Chief Executive Officer and President of the Robert Wood Johnson Foundation. She's a physician with specialty in geriatrics and also has an MBA. She has been President and CEO of RWJ since 2003. RWJ is a private foundation working to build a culture of health. So those are the introductions. I thought we might in the order that makes some sort of plausible sense, although this could be a little bit random. I might start with Riza to say from your perspective, as the head of a foundation that looks at this whole question of health and a culture of health, what would you like to share with this group? First of all, I think we need to acknowledge why health is so important. It has been raised many times at this conference. Health is really essential to having a healthy, resilient economy and population. So we start there and then at our foundation, we like to say that health really exists where we live, learn, work, and play. And so in order to achieve health, we have to think more broadly than the healthcare system or disease states and acknowledge that where people live, whether they have access to open spaces, whether they have access to healthy food and opportunities to be physically active are as important or more important to being able to achieve a healthy state and certainly a healthy population. So let me try to be a little bit provocative and focus on what business leaders might do in order to increase the health of populations and, if you will, do good and do well. So three quick examples. The first is Disney. Certainly a place where we like to go and play. And a few years ago, many of you may know that they voluntarily changed the default on their kids' meals at all of their theme parks. So instead of getting sugar-sweetened beverages and French fries, you would get water, low-fat milk, and vegetables as part of the meal. When they evaluated this a few years later, they found satisfaction among the parents was extremely high, calories were reduced by 21%, sodium was reduced, and it didn't have any impact on their ability to sell meals at the theme park. So where you play, changing the default can make a big difference in the ability for people to have access to healthy food. Second example, many of you from the U.S. know that CVS Health in 2014 decided to stop selling tobacco products in all of their retail stores. At the time, they were worried that they were going to take a $2 billion hit to revenues. And what they found is they did take a hit to revenues, but their stock price went up. And a year and a half later, when they evaluated the impact of this decision, they found that in the states where they have more than 15% market share, the percentage of cigarettes sold went down, average smoker bought five less packs of cigarettes, and in fact their sales of nicotine replacement products went up. And then the third example really quickly is one that involves leaders from across the food chain who looked in 2012 at whether or not they could take empty calories, if you will, out of the food supply and committed to take 1.5 trillion calories out of the food supply. This was 16 companies ranging from PepsiCo to Coca-Cola and General Mills, many others, Kraft. And after about a year and a half, they had taken 6.4 trillion calories out. So three examples of where corporate leadership, business leadership was able to restructure the ecosystem, if you will, so people were better able to make healthy choices. Great, thanks a lot. Risa, well, you just brought up nutrition, so let me turn to Paul Volcker at Nestle. Risa, we were also one of them. Yeah, I knew as soon as I started naming names, I was going to get in trouble. But I'm sure you didn't mention so that I could mention. So gracious. Not only a few thoughts, maybe not into the link, but first of all, I must say, there's now for a few years that we here in Dalville speak about health. And that actually also nutrition is part of that discussion. We have also the governance meetings where we have the healthcare sector. And I remember the first time Nestle was sitting on the table everybody was saying, what are they doing here? But if you think nutrition and actually the Chinese, I have said that before, the Chinese, they say it very well, the best medicine is food. They see, when we speak about healthcare, normally we wear, and that has changed, we wear talking about sick care. And now, and you mentioned that before, let's talk about in use of health, not therapeutic health. And health is, actually health is not a disease. And that's why you have to really as a society to look in how can we keep, in the business case if you want, the economical value, but also the wellness value of a healthy society is tremendous. How can we keep health? And actually by going about that equation, nutrition starts to be very pretty much part of that equation. Because good nutrition versus malnutrition or over calories or et cetera is tremendously linked with a healthy society. And there everybody has to play its part, but starts be that awareness. Also that the population understands the importance of nutrition in its own life, that we educate people so that they can make the healthy choices, the healthy lifestyle choices, that companies like ours take their responsibility too and deliver nutrition in the right way. And there we have made major strides, there is more to be done. So the responsibility, but first of all understanding the relationship between good nutrition and health and how actually good nutrition can be induce health, create health and keep health over time. That's one. Then the complementarity of the health care or the sick care systems with nutrition. A treatment when you have to recover from an intervention or something, health can actually accelerate or secure medical interventions is also to be explored. Actually there's not a lot of that happening yet. Just an example, if we can do adaptive nutrition for somebody who has got an intervention, he'll shorten, he stay in hospital. That is a tremendous, I would say, positive push into lower health care costs. The health care costs in the world are going through the roof, we know that. Specifically in the western world, in North America closing in to 20%. The health care systems are being built up in the developing world. 75% of the world population is building health or thinking together with the middle class building up, thinking about health care systems. They're never going to be able to afford the systems we have. So what is the answer there? And we should explore together these dimensions. So I would say also, health is local. We can speak globally. But at the end of the day, we speak about nutrition. Then you start to localize dramatically health and health status. Each country has another challenge to answer. So we can speak globally. But at the end of the day, and you mentioned that only the health care system has 20% of that equation, 80% is more or less local. And their nutrition is definitely a very, very important factor. So these are few thoughts. Great. Thanks very much, Paul. Let me turn next to Olivier Brandecourt to talk about some of the technologies and other interventions that are coming out of pharmaceutical companies that might play a role here in prevention. Thank you, Colin. So the task is very clear, right? We have to provide health care and health security to 10 billion people. And I like to be a little bit blue sky and talk about 20, 30 or 20, even 50 here. It's going to be a mongest task and require a lot of coordination between multiple stakeholders, of course. The cost of it, we wouldn't be able to afford if we were using the same system as today. So what could be the system which will allow us to get there? It has to be based, and it's a concept which has been emerging at the NIH just before Dr. Collins several years ago by Eliezer Rooney of the four P's. So the medicine of the future, in order to allow us to use preventive medicine in order to prevent cost, has to be preventive. It has to be participatory. It has to be personalized, and it has to be predictive. And if you put the four together, you eventually can get there if we're lucky. So let me talk about the first two P's where our industry can participate. Predictive is based on a huge level of data. And of course the computational technology to analyze it and come up with predictive models. Where is the data coming from? It's going probably to come from very similarly to we had with the Framingham study. Ongoing prospective study where patients would be very well known and whose genetic material or genetic map would be very well understood as it would be connected with a lot of different clips and we would know exactly what they are doing in terms of activities all day long. And by assembling that material you can eventually predict based on that genetic material what would be the risk. Therefore risk drives potential prevention. Now in terms of the second P which has to do with prevention that's where our industry can collaborate and come up with new technology. So the immune system is the best tool for prevention. We know that for a long time and we are using it today very effectively for infectious diseases in the developed world and now more and more in the developing world and that has helped us to tackle very significant infections. We can go one step further and get to in the next 10 or 20 years with universal flu vaccine for instance. We just put out at Sanofi the Dange fever vaccine and maybe in 2050 Dange fever would be eradicated from the surface of the earth and that would be great. But we can think about vaccine one step further again looking at NDCs and especially because they represent such a very heavy burden on the cost of health care. I think diabetes plus cardiovascular plus Alzheimer's represent about 75% of the entire cost of the developed country health systems. It is possible to imagine that in 2050 we would have a vaccine against Alzheimer's. We tested one, not we, but the industry has and we got into serious side effects but today you can send antibodies across the blood-brain barrier connect to what is responsible for Alzheimer's beta-amyloid protein and you can extract that and get your brain rid of that protein. So by doing exactly the opposite and injecting fragment of that protein you can eventually elicit antibodies which would do the job. So that's one example of a potential situation in 30 or 35 years from now. Then you get into a different type of prevention beyond vaccine. It's prevention of diseases which are driven by multiple genes. They are way too complex to be related only to a couple of genes. Diabetes, for instance, type 2 diabetes is one of those examples. It's triggered by, we think, about 200 genes. So what type of prevention do we have there? Very different. It can't be vaccine. It would have to be education. It would have to be connected devices. So that's what I wanted to put on the table. Prevention is a solution as long as we have very good predictive model and you can imagine a world in 2050 where we would have tackle very serious diseases. Great. Thanks very much. Talking about technology, let me turn to Franz Van Houten from Philips. Thank you. Well, it's then maybe our job to make that futuristic world of Olivier happen. A lot at Davos is being talked about about population health. How do we change and improve the health of a population? And then people talk about analytics and data. That's all right and that's all important and necessary because you can identify cohorts of people that need a certain approach and treatment. But what we should not overlook is that we actually need to reach these people. Because they will only get better if we touch their lives and somehow make their lives better. And we talk about the consumerization of health and this is where people take accountability for their health. The sheer fact that we need to say that already means that it is not easy to influence people's health and lifestyle and accountability. And you come to a very complex system where you need to think about the incentives and disincentives that drive behavior, education, know-how, systems that work against each other. Let's face it, the payer system and the healthcare providers they are not all collaborating in the same way. And it is a passive system versus a proactive system. We wait until somebody gets sick and then we cure them rather than reaching out in a preventative way. I think this is more the territory of the Ministry of Health of course where we all need to realize that there are environmental conditions to be influenced before we can get major breakthroughs on healthy lifestyles. Now technology will certainly play a role in this and we are dedicated, dedicating Philips to be a health tech company to do this, both in the world of health care, professional health care and in the world of consumer health. And we would like not to oppose these worlds but to bridge them. We think we need to get an integration of these worlds where the health care professional becomes the health care coach, proactive and the consumer actually takes accountability for their own health. Enabling consumers to measure and then to monitor and manage their health and where we also motivate them on their health is a world that is entirely possible and technology is available. We have the sensor technology that people can wear on their bodies. We can measure full continuously in the cloud. We can do algorithms to provide feedback. And if we would couple that to education and incentive systems I'm sure we can have a major impact. It will require money streams to be perhaps redirected to facilitate some of these preventative care programs to be financed because what stands in the way of adoption is partly also money. We don't want to wait for all of that. Every small step is one. And at Philips we said, OK, if people like their fries maybe we can do deep frying without fat. Small step for mankind but still a major leap, right? So if we get kids to brush their teeth well dental hygiene is very important and will have major consequences down the road for one's health. So we have used gamification technology to help kids brush their teeth well. And now it becomes fun to brush your teeth. That's good. So I'm sure that let's say using technologies like gamification and online data and feedback mechanisms will start to influence people. I do want to warn against the world of gadgetry because I think it will need to be based on real clinical insights and proof and consumers need to know that what they do will have an impact and can be trusted. So gimmicky stuff that doesn't work actually sets us back. So I'm all in favor of applying some rigor and regulation around what we do in providing health coaching but I am very hopeful of what can come out of it. And as I said in the beginning I see the health professionals to be the health coach and in the connected world, in an online world. I'm sure we can support much greater populations than today where people have to take an appointment, go to the doctor's office. But then maybe this is also to the minister can we then also change the reimbursement rules where patients do not have to go to the doctor's physician's office because otherwise the doctor doesn't get reimbursed. So to foster innovation in the world of health I think we need to take the disincentives away, take some of the old rules away and start pushing in the right direction. I think it's going to be fascinating and doesn't have to take 30 years. Great, thank you. So minister of health, welfare and sport, many people seem to be pointing to you. Like what can we do here in terms of government policies to enhance a good outcome? I'm not a minister of education. I think education is very important in this field. But I'm a minister of health, so for the healthcare system. A minister of sport for exercising and sport and I'm responsible for healthy food and food safety. So I think a lot of things come together that are really important because if you're a minister of sport, exercise is incredible important for a healthy lifestyle. Not only to exercise in sports but also how do you design your building? Is the stairs in the middle or is the elevator in the middle? We have in our office now desk bikes so we don't sit all day on our chair but we can also exercise a little bit behind our desk. We have meetings where we stand. We have in Holland of course as a cycling country, we have a cycling pass. That's very important because exercise is not that one hour or half an hour a day. Maybe a week. It's much more. It's to exercise through the day. So I think that's the first major point. Secondly of course food is a major point and if you say food is the best medicine that gives a big responsibility. That we make healthy food the easy choice. And in this presidency of the EU we organize a conference where we try to find roadmap to action how to reformulate our food. Because our food if I want to live healthy and I choose my food from the supermarket I eat too much salt, too much saturated fat and maybe even too much calories. But if you want to lower this salt and you really want to keep the taste so it can't be done in one year. But we can make a program how to make your food healthier. And there we need really the industry, restaurants, catering and supermarkets. So in Holland we work together at a round table and we make a whole roadmap for Holland but we are one part of a big internal market. So I really have an aim to make this roadmap for Europe. Thirdly I think these new technologies will have a big impact on whole healthcare but especially also on the prevention part. Because you see that all this education and all this healthy lifestyle you see that there is a big gap between highly educated people and low educated people in Holland. The gap of life expectancy is six years. And we don't have the biggest gap in the world. But six years already. How to make the easy choice, the healthy life more attractive. How to make it more understandable. And there we have these new technologies who can help brushing your teeth. Or gaming. So all kinds of gaming, new situations where you really can help people to exercise or even exercise with dementia in an institute with gaming. And this is really, there is a whole world we can explore. So I think this new technology will help also in this prevention for so far. And eHealth is in reimbursement in the Netherlands. You don't have to have a face-to-face contact. You can also get your eHealth reimbursed by the way. By the way, well very good. Wonderful comments from all five of you. I guess just to pick up on a number of the things that were put forward it doesn't seem as if we have a lack of ideas about ways to influence healthy behaviors whether they're behavioral modifications or whether they're structural changes in the environment or biomedical interventions or policy changes. But it doesn't always seem that we have the strongest evidence to know which of those are actually working. And good intentions of course sometimes aren't sufficient to result in good outcomes and the plural of anecdotes is still not data. And we've certainly seen circumstances where things that made a lot of sense ultimately didn't turn out to provide improved outcomes. And so what we really ought to insist on I would think whether it's testing out the latest wearable sensor and I'm wearing a couple of them because I wanted to see if they agreed and they don't which tells me that somebody's not right here. We really ought to have a system for generating that kind of evidence in real world and to figure out then how to implement the things that work and maybe not the things that don't. And of course payers are very interested in that kind of evidence as well they should be. Olivier you mentioned sort of the importance of prospective studies where you might have the chance to do some of that evidence collection. Can you say a little bit more about how we might be doing a better job of that even as we are having all these great aspirations but maybe we aren't exactly sure whether we're on the right path or not. Well again it's not going to be only prospective ongoing study with healthy subjects. When I'm saying that I'm referring to a study which is well known in the industry which is called Baseline where for 10 years a segment of 10,000 people will be followed and because it would have started healthy you would be able to detect the emergence of pathology during those 10 years and therefore the predictive model would become very, very granular but the data would come from electronic medical records from many, many of course databases. So bottom line is we need to get down to very precise predictive model which each individual would basically own with either her healthcare professional and would drive behaviors including eating healthy and exercising and many different things but sometimes being fully aware that the risk of a much serious disease is actually in the genetic map and make sure that you have the appropriate behavior and intervention in order to avoid a very big cost to the system later on and just one example to finish that is as to do with diabetes we're not very successful in educating diabetes patients and we try for decades and 50% of the diabetic population type 2 is still not at goal so you deal with that, of course you reinforce the education and the healthy behaviors but at the same time technology can help you to control absolutely perfectly the glucose level of those patients and I see some people from Novartis in the audience right you can have lengths measuring your glucose level you need to have two of course because otherwise the FDA will not allow the pump to eventually inject you need two measures but you could have a complete control 24-7 of your glycemia through technology today or if it's not today it's tomorrow or 10 years from now so that's a very good example where technology can actually drive costs down significantly and your point is well taken that we should be careful not to assume that the strategy that works for one person as far as improving their health outcomes is necessarily going to work for another we all have different approaches and this personalizing of the enterprise is probably critical if we're going to see maximum benefit what about mental health we haven't said a whole lot about that I don't know if any of you would like to weigh in what with given the enormous weight that mental health carries in terms of human experience on the individuals on families in terms of economic costs are there's places there that we haven't explored sufficiently that we ought to be paying more attention to I don't know Riza if you want to weigh in from RWJ's perspective well I think such a big topic and obviously one that carries a tremendous burden but one of the areas that I think we haven't looked at enough and bears more investigation is the role that toxic stress plays in leading to mental illness and problems particularly in low resource communities but increasingly around the world where we have people that are living with daily trauma they're living in situations where they have violence as a regular part of their lives so I guess my point is that at the same time we're looking at the treatment of behavioral health and mental health issues we've also got to focus some resources on those early causes that we don't study enough in order to understand the impact that they're going to have 10 or 15 years from now and certainly we are not designing the care that we provide with the lens of how to make sure that those people that are in regular traumatic situations are getting the care that they need. Let me ask about sustainability of these kinds of interventions because I think that's a big concern for people who have tried to impose or introduce various means of encouraging healthy behaviors I understand that the number of people who actually once they've acquired a wearable sensor wear it for more than a week or two is a minority and most sort of get bored with it quickly France from your perspective where you have a big investment in this space what do we need to do to sort of face up to that issue that it's not just a short term we're looking at, we're trying to look at long term and we need to obviously start as early as possible to change health behaviors before it's too late You recall that I made the distinction between gadgets and real solutions and when you measure you also need to monitor and you need to motivate I use the 3M model that we use at Philips the feedback loop back into a cloud environment and where the incentive or the payment and reimbursement is tied to the adherence is important I can give various examples I mean if you are diagnosed with sleep apnea and you are on a CPAP device that costs money and if your insurance reimburses that then I think it is fair to say we also expect that the machine is being used properly now many patients do that because it really helps them but now we have created a connected CPAP machine where we on a daily basis measure the use we measure the oxygen saturation we measure heart rate we measure sleep adherence we give feedback the day after here's what happened to you the last 24 hours but we can also provide data back to the provider or the insurance company like this patient is no longer using it or therefore in terms of accountability taking accountability of your own health something has to happen and I envisaged these kind of solutions now you may say well that's big brother watching you no I mean you get a service you sign up for a service and the adherence to the service is part of it so I think that's a kind of a world where we need to go to and I see most patients opt into that because they get a better service and they are not there to actually see the benefit there's a bit of a stick but there's also a carrot Paul you said that these people taking care of themselves having these monitoring devices they have over two weeks and all it's linked to something fundamental that there's health at the end of the day what is the value of health perceived value of health you value it really when you lose it but as long as you have it you feel everything is okay and that's something fundamental and I think when we say also the self-responsibility of the individual towards his health it's something that I feel in society has to be increased dramatically it goes even beyond health the self-responsibility in society has to be increased that's basic education to a certain extent too and I think somewhere in society we that's philosophy now but somewhere in society we have to yeah the government is going to care for you but the first thing is you care for yourself and that is an obligation and we should as a society to drive that more and stronger and that is linked with fundamental as I said education and that starts very young and that sounds like very idyllic but that is fundamental and also nutrition healthy diets it's true that we have to do our part we have to deliver food satisfaction because people like to eat and they like food but we have to do it and build science and R&D that we are investing quite heavily also in our company is to give that calories out and salt and all that and we're doing major strides we have to see and bring that further but that's not going to compensate for unhealthy lifestyles for unhealthy diets and so and there that has to be complementary and I think it's fundamental it's a fundamental question not only for health for other reasons too for other dimensions in society too self-responsibility as an individual in society and we should as a society actually force that saying you have to be responsible for yourself first in the first place and so my government has a role to play there too because sometimes you feel governments or politicians they want to protect you say I don't think I'm going to do it for you you see which are things like labelling and all that you cannot tax yourself to glory you have to install a little bit more fundamental responsibility in society So at points taken individual responsibility is necessary but is it sufficient I think evidence would say it often is not and let me ask minister shippers in terms of tobacco we have not talked about tobacco yet and we need to as the most significant cause of premature death and morbidity that ought to be preventable and yet we are still far from having succeeded in that battle obviously a rational actor presented with the evidence about the harm of tobacco would never start smoking and if they did would stop immediately but we know that that has not worked despite sharing the information so various other entities obviously can be called upon to help but governments are one of them from your perspective what more should we be doing about this very preventable cause of millions and millions of deaths I think this is a very difficult topic because in the end people decide themselves that they eat unhealthy, they drink too much or they smoke and as a government you can make laws, you don't smoke in public buildings but you can smoke at home you can smoke so in the end I think education is really important and I can't underline that enough but it's not enough of course it's heavily taxed the taxes are already quite heavy you can always try to do more but then you get also illegal import so you see that we hired the age on which you can drink alcohol in the Netherlands we made it from 16 to 18 but we see that you get young people not to drink anymore in cafes because it's illegal but they smoke haruana or they use ecstasy but if you look closely you see that in people themselves they try to be healthy or not I can't understand that people take these ecstasy pills, it's a blue pill you have no idea what's in it and we have incidents on a regular basis but still they take the pills so it's very tough to have a healthy lifestyle to promote it of course you can have taxes you can make your food healthier you can make the healthy choice easier to exercise to have a safe environment a healthy environment but still I don't know what it is with people we're talking about all of ourselves here in an ideas lab yesterday we talked about addictions and how one of the most really diabolical aspect of addiction is that it takes this opportunity of being a rational actor and completely erases that and so to expect somebody to just will themselves out of that kind of behavior flies in the face of everything we're learning about brain neurochemistry so you have to prevent them from starting exactly because when they already started is very tough to stop indeed and you can't just sort of count on the individual to be able to do that without some help I'm going to open this up now to questions from the audience I assume there are roving microphones around here somewhere if you have a question identify yourself please and if you want to pose it to one member of the panel say so otherwise we'll figure out who's best positioned to weigh in questions right here thank you my name is Khaled Falah minister of health Saudi Arabia and my question to Mr. Brandy Court Olivier is about the speed of development of new technologies and specially new pharmaceutical products I mean I got excited hearing about immunization against some of these diseases but then you say 2050 we see this acceleration of new product development in other areas like IT what is it in pharma and healthcare in general that is making it a slower although the solutions may be identified the time to market is so long what can be done about it yeah so the 2050 I used is because I'm next to the head of the NIH so I didn't want to say anything which would be scientifically completely crazy I just I just wanted to be a little bit blue sky and you know kind of paint a world the world of 2050 and how we can you know tackle some of those very heavy diseases I was describing the length of development has not not to be prolonged recently including with those new technologies we just put a very targeted technology on the market for cardiovascular diseases PCSK9 technology the first revolution where the statins they completely change the way we are doing cardiovascular medicine I think that new technology is so targeted bringing the bad cholesterol so low now to such a level that they are approximately the levels you are born with right and families with that level genetically because you have mutation of that genes the dying of course but they're never dying of any cardiovascular incident so that we developed that molecule in a matter of you know a few years probably seven eight years so that has not been extended however you can always think that it would have to be accelerated and frankly the answer is in the hands of the regulatory agencies right because they are dictating the rules I have a question I see one back here Norbert Rudinschman from Bain and we have been working with the World Economic Forum on this topic of health and I just want to highlight one other point you know which I think is important in terms of the urgency of getting something moving we have looked at the data and if we don't do nothing in terms of the noncommunicable diseases things are going to turn really sick very very soon and you know if we were just to wait till twenty nine you know we actually would face I would say a tsunami which is as important from the financial perspective as five times the financial crisis so the question actually would be you know how do we get movement going and how do we address the urgency that's there based on the tsunami of noncommunicable diseases which are coming and perhaps that's something Lisa to you or also to you in terms of consumerization and how do we make health I would say sexy in a positive sense well I think one of the key issues is we can't take this on sort of one silo at a time it really is going to take a systems approach starting with developing a shared value for what we mean about health and having that be much broader than as was referenced earlier sickness care secondly I think and it's been mentioned here health really happens in the context of communities and so having a community based approach whether it's a state a county a a larger region is going to be critical and we've talked a lot about integration of the various systems of care whether it's data used to do that integration old fashioned ways of creating greater communication and coordination particularly for people as they get older and have more than one noncommunicable disease and then finally leadership so I think unless we really look at it from a comprehensive approach it's unlikely that we're going to solve the problem with the urgency that we have to solve the problem. I agree with all of that I would add one thing you're still talking about consumers and consumers need to be addressed in a compelling way so rules are not necessarily helping but marketing can right so I mentioned gamification but we should also mention role modeling and especially in the communities and now that cost money I mean of course as business we will do it as part of our propositions but to get a society to evaluate health in a different way I would advocate for a change program and a change program that includes the role of the communities and role models and so on and so on and that will cost money right and I don't totally agree with the 20 80 percent rule because it is difficult to grab the 80 but the 20 percent is a big bill right it's trillions and I applaud the U.S. government for experimenting with redirecting some money for example under the this program to get health care professionals to engage in preventative care programs in the community now that's all trial and error and learning fine but I do think we need to start these programs and find out what works and find out what doesn't work and then scale them up I think we need to stop the financing of some of these programs a bit more because otherwise it's stock only and we don't get enough action. Very fast because we always speak about health like there's only one dimension society there's so many different societies and countries and situations and non-communal diseases are actually exploding in societies where there is malnutrition and so what a lot of things happening already speak for what I know but the micro fortification in these countries and we know the mappings there is so much to be done we for example can use the products that we already sell or have present in these markets and fortify them we do that by the rate of 200 billion portions in the last year only for my company but then we are also part of a industry and we are influencing doing that in the industry too and consumer goods forum is one of them where we have one pillar only four pillars we have one pillar is health and how we as an industry together with retail can bring that and I think these impacts are dramatic you see we can map that then also the results and you see also sometimes say no you should first measure the impact you do what is obvious first and then you see after time and there you touch a lot of lives and very positive education also education we speak about self responsibility and we know and but we have programs with children about nutrition in rural areas and we touching my company alone has touched over the last years 10 million children already children are motivators of adults they go home and look and it's going to be hard work and what we have to do is consistency over time you have to hammer that's education everybody who has children know what I mean but you have to go on and on and on and you have to use you see also what we do in many of these countries we go with projects and then we leave you have to make sure that you stay and companies like mine we are there for more than 100 years already so we use that consistency in time so the western world is one thing there's so much that you can dramatically change in the developing world also and that's where we're looking at too so just that note Thanks question here Yes. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. Dr. than anywhere else. I think the overall annual bill is about 100 billion, right? Not doing the educational piece not integrated, right? The best algorithm in term of distribution of drug and insulin and cost, on average, 20 billion. So right there, we think that for such a very specific epidemics, interventions, relatively simple, not waiting for the integrated health of the 2030 or 2050 would save 20 billion. And a big piece is due to behaviors which are not responding to education. So my question to the minister is, are we eventually considering policies, especially in countries where you have universal coverage, which would penalize fine people who don't have the appropriate behaviors? Because they are so costly to the overall system. But of course, that triggers a second question, which is, what type of policy are you putting behind health care data privacy? And the two have to go together. But I think they are fundamental. If we wanted to tackle the huge health care cost, we would have to be much more directive with patients and healthy individuals. But I'm not sure policy side would automatically follow. Let's hear what the minister has to say. So I think we need to look at the money streams. This is an area that's very difficult to tackle in most countries. Most money goes to curative care, volume driven, not outcome based. So in the end, some money will need to be made available for preventative care programs, outcome based. So nobody says that we should get money for just an effort. Should be results oriented as a public policy. Now, let's experiment with that, but let's make a move. So I know I was an ass, but can I weigh in? Everybody wants this one. I think investing in early childhood, in not only the health of children, 0 to 5 years, but also their social, emotional learning and their education. I think that there's good data that suggests that the return on investment across both health, education, and overall productivity at age 25, the return on investment is somewhere 1 to 7. So to add to what we might put our resources in where there's been a delay in action. Right. We should let the minister respond to the query that was posed. Please. If you look at health care systems like in the Netherlands, you see that everybody pays according to their income. And you see that lifestyle and bad eating is a lower income, has higher, they eat worse, they have a worse lifestyle. There's a lot of improvement possible. If I will make penalties for this group, they already don't pay for their own insurance. They are subsidized. So we have to subsidize them more to pay their penalty. I don't think this is the way. I think the way is much is very difficult because why is it so difficult? We have several programs in Holland that are quite successful, but they take a lot of energy. You have to be with a long breath. You have to take the children and their mothers and buy their mothers, the whole family, to education programs about food, but also to exercise. And these programs are quite successful. You see that obesity is lowering in these neighborhoods, low-income neighborhoods. So it's very successful. But we have to stay there. And you know that when you have elections in the next government and they say, we have a whole different program. So, and it takes a lot of energy because it's much more easy to make a program on paper and put it in the paper box of a house. And you say, okay, I've done my work to have them to take a whole community in a different lifestyle is possible, but it costs a lot of energy. Thank you. I think we have time for one more question, and then we're going to have a lightning round of summaries. Yes. Thank you, Dr. Collins. You asked the question. One second. Oh, sorry. Stan Bergman, I'm the CEO of Henry Shine with the largest provider of dental, medical, and vet products to office-based practitioners. You asked about mental health. You mentioned tobacco. And I was just wondering if the panel, and I think probably everyone on this panel may have an opinion on oral care. There are 3.1 billion people in the world that suffer from caries. And if there is a way to reduce caries, I think in the end it would improve health in general. There are many studies that have been published specifically in the last five or six years directing the correlation between oral care and health care in general. So I think practically everyone on the panel would, in one way, have an answer, because I think most people on this panel are involved in one way or another in the oral care arena. Responses? Well, I violently agree. And I think, actually, oral care has come a long way, right? I mean, we can be still negative that there are all these people that have caries, but it is an environment where by collaboration between health professionals and education, we have come quite far. So I think let's just continue now. And again, that's another example where intervention of multiple components, including fluoride in the water, has made a huge difference that wouldn't necessarily have happened just because we told kids to brush their teeth and they didn't necessarily. But maybe, minister, there's also a social divide on oral hygiene. Is there? I think there is, yes. We have, for children, it's in our universal coverage. But although you can go for free to a dentist, you see that certain groups don't go with their children. So that's not only a financial question. It's also, is it in your culture? Is it in your system to go every year? And education, we come back at education, yes. So we have only an hour, unfortunately, to discuss a topic that could occupy many days and has many weeks, many years. But it's been, I think, very useful having the chance to hear from all of you. Let me just quickly ask, before we break up, that each of you give me 30 seconds of sort of what do you think is the most important message that you would want this audience to hear from your perspective about how to shape the future of health. Maybe we'll just go in order here, starting with you, Olivier. Well, I put forward the concept of the four P in medicine for the future. And I think, interestingly, the most challenging is not data capture. It's not the pharma industry developing very sophisticated technology is in fact to change the behavior of people in order to drive that prevention, which will itself drive the reduction in cost. Thank you. Minister. I think most important is to work together. You can pinpoint the industry doesn't do this, and the government doesn't do that. But I think that you're most successful if you work together and you, everybody keeps his own responsibility. But by working together, I think the outcome is much more than if you do it on your own. I'll say it. From my side, just reiterating what I said, that it's good to feel that nutritionist starts to be much more explicitly part of the health equation, and not only in normal day-by-day food, but also that we are working in that investing in how to know and understand better how nutrients interact with the human body. That's new science. And you think about the microbiome and so on. So I'm seeing that we start to have more of that, it would say, acceptance of that equation is a good thing to feel. That's great to answer. Well, we live in a digital age. Every consumer wears a computer. That's called a mobile phone. And the ability to provide measurements and feedback in there by influencing and confronting people with their own behavior, I think, is much more possible now than ever before. So let's use all that technology and confront people and help them change their lifestyle. And I think we can be a little bit optimistic then. Riza? I think it's going to take us recognizing that this is going to take a culture change and one where we recognize that individual responsibility is critical, but so is creating the kind of environment where we put health decisions in with all the other critical decisions we make, and particularly for people who don't see health as what they usually do, like architects who design the buildings that can either be healthy or not. So I think everybody can appreciate the multiple components of this discussion and the multiple actors that need to get together in an integrated way if we're going to actually solve what could be an enormous challenge, as was pointed out by a question, the tsunami that we are facing of non-communicable diseases, whether that's tobacco-related or physical and activity-related or diet-related or abusive substances like alcohol, we have a huge challenge in front of us. Where better than the World Economic Forum to take that on? Please join me in thanking a wonderful panel. Thank you.