Come again?

KEEPING UP WITH THE JETSONS Rev 2 Compact version.

If you’ve been around the block a few times, you’ll remember the Jetsons.  If you haven't, here's your primer.   The Jetsons was a cartoon series set in 2062. It debuted  in 1962 and Rosie was the Jetsons’ robot-maid. She controlled the chaos in George, Jane, Judy, Elroy and even the family dog’s orbit.  A reject from U-Rent A Maid, Rosie was a humanoid robot, an assistive device with a frilly apron and a huge heart. Rewind to 2014 and we’re already living in an assisted world – far earlier than the Jetsons predicted. From remotes and smart phones all the way to driverless cars, the robo-genie is out of the bottle. 

The question is, will this robo-boost benefit our older generations? Will it make the next generation of older people independent or isolated? In the UK over 50% of over 75 year olds who live alone say their TV is their main company. A further 17% reported they have contact with another person less than once a week. It’s hardly surprising that neuroscientists have found higher levels of epinephrine, the stress hormone, in the morning urine of  “lonely people”. Rent-a-Maid Rosie had a heart… it begs the question, could a relationship with a machine be better than nothing, or no one, at all?

It’s not a huge concern at this juncture – but it ought to be. 

There are concerns: fears about inauthentic relationships, particularly with respect to end of life care.  Our acceptance of introducing human-like but not actually human helpers might qualify as an infringement on personal dignity. So, the next step should be targeted attention on specialized ‘bots that will be able to assist and care for older adults.  They are already successfully aiding the medical industry and this could be a logical next step.

The business of robotic engineering and the business of caring do represent two distinct cultures needing to comfortably co-exist. Since 2000, pioneering surgical procedures using robotic arms and a surgeon operating from a console have allowed dexterity beyond what’s humanly possible. A recent study showed that trained physicians were outperformed in diagnostic accuracy when pitted against artificial intelligence algorithms by a staggering 41.9%. Add to this the dual bonus of tremor reduction and faster recovery times for patients – there’s not much to dislike about these robots!  Plus, it’s common knowledge that most people never do any rehab exercises after they leave the hospital or physio appointment. But wait… this won’t be a problem anymore. We can have virtual avatars carrying out routine checks on patients, as well as advising them on proper technique! Even better, these "relational agents" are at the forefront of medication management, "watching" patients take the right meds. 

Fifteen years ago, an entertainment robot pet, AIBO, was brought to market by Sony. Research was conducted in Japan on its use in a care home for dementia patients. AIBO was regarded as a total success in terms of increased communication with patients, as well as performing duties better than a real animal with respect to… ahem… cleanliness issues. Success notwithstanding, AIBO was discontinued in 2006 and customer support ended last year. Hmmm. Now, Toyota is working on a full range of HSR, Human Support Robots. There is a Robot Era project in full swing in Tuscany and Sweden. All three projects support independent living for older people. 

Older people without cognitive decline have high demands for a high quality of life. They need help with basic functions including cleaning and shopping, which robots of the future will be able to perform, but human intervention will continue to be fundamental. The extent to which robotic innovations will assist or replace humans in the future remains unknown – as are the long term costs, but will the reduction in human labour be seen as a worth the expense?  After all, what if a robot IS capable of caring behaviour: are they so different from a well-trained carer, a taught actor who expresses compassion and concern as part of their job? How comparatively artificial is empathy imbued by human designers in a dutiful robot?

In the meantime, no one can predict their own ageing fate. Ageing is not a homogeneous process and care needs are highly personal and fluctuating. Normal function is lost unevenly and inequitably, not suddenly and over the course of a lifetime. Sophisticated assistive care is, at present, available to the few: the deep pocketed and participants in optimum conditions, in controlled settings. Until sufficient interest, improved access and affordability gaps are closed, solutions loom just out of reach. Boomers, like me, are watching their own ageing parents and wondering. The boundaries of what is achievable to enable independent living are being pushed and we all want that.

Get a move on Rosie.

For more information, the BioCentre on Ethics held a teleconference on the Use Of Robotics and the Care of Older Persons on April 11, 2014, Deborah was a panelist. Link to the audio and full report: http://www.bioethics.ac.uk/news/Teleconference-on-robotics-and-the-older-person-
Deborah Gale

Keeping up with the Jetsons. LONG VERSION

Last week, the BioCentre on Ethics hosted a teleconference on the Use of Robotics in the Care of Older People. I was on a panel with Dr Walter Greenleaf from Stanford University and Dr Amanda Sharkey from the University of Sheffield.

We teamed up to discuss whether robotic assistive devices are more likely to empower independent living or intensify isolation. We barely scratched the surface. Dr Greenleaf opened the conversation reminding us that at the same time as we are facing the acute problems of caring for ageing populations, we are already living in an assisted world. He advocated for immediate action in the form of targeted, solution oriented efforts and user-led ie older person involvement in the design process. Unless actual users can be involved in all elements of design, we will be unable to stay far enough ahead of the predicted, large-scale physical and neurodegenerative inevitability's. Dr Sharkey also acknowledged the predictable expansion of robotic options, in all domains of care, but cautioned against the inherent risks, particularly with respect to end of life care.  Our overenthusiastic acceptance of introducing human-like but not actually human helpers could qualify as an infringement of personal dignity, in our older years. The subtext to our exchange of viewpoints, as academics observing these developments, was on ethical isolation amidst this burgeoning robotic innovation. Worthy of note, the concept of robo-ethics is a mere 13 years old.

STATE OF PLAY

The fact is, the robo-genie is way out of the bottle and robotic intervention is already occurring in every dimension of modern life. What's needed is targeted attention on the actual application of robots to provide assistance and care for older adults. Despite the robotic inventing taking place in specialized, well-funded labs and the growing awareness that the planet is ageing, a serious lack of consumer ready solutions remains. Robotics for older people isn’t core to any business plans of the relevant players in this market. This is relevant because we live in a commercially driven world.

Clearly, the business of robotic engineering and the business of caring represent two distinct cultures that need to comfortably coexist and these cultures are already intersecting.  Since 2000, amazingly complex surgical procedures using robotic arms and a surgeon operating from a console have allowed for enhanced dexterity and more refined movements than were ever humanly possible . Add to this the dual bonus of tremor reduction and faster recovery times for patients and there is not much not to like about these robots!  Next, it is well documented that most people never do any rehab exercises after they leave the hospital or physio appointment. There are now virtual avatars carrying out routine checks to see that patients are actually doing their exercises and advising them on proper technique. 

These "relational agents" are also at the forefront of medication management, "watching" patients take the right meds, at the right time. This is hugely beneficial, given that 50% of the people to whom 146M are dispensed in the US daily are never taken, at a cost of some $2.9B annually. In addition, diagnostic and pharmaceutical errors result in 700K drug emergencies every year. This translates to sunk costs to the pharmaceutical industry of £180B. Big Pharma flag bearer or not, this is material. Another recent study shows that AI, artificial intelligence algorithms, outperform trained physicians in terms of diagnostic accuracy by 41.9%. In these examples, there is proven synergy when artificial intelligence and robotic engineering are combined with humans and we leverage all the new technological tools at our disposal. The nagging question, then, is will these interactions alter the users: surgeons, carers and the cared for's basic understanding of themselves and if so, at what cost?

INAUTHENTIC RELATIONSHIPS

There is something called the Turing Test that robots can take. It's a test for intelligence which requires that a human being should be able to distinguish the machine from another human being by using the replies to the questions put to both. Many studies have shown a natural disposition of people (especially, older people and children) to accept life-like robots readily as peers, despite the fact that they are machines. This opens up the debate to concerns over inauthentic relationships.

Over ten years ago, research was conducted on an entertainment robot animal. AIBO was being used for treating severely demented people in a care home in Japan (Tamura et al., 2004).  The conclusion was that the AIBO was an effective rehabilitation tool, providing positive outcomes to patients. In addition, AIBO was observed to avoid any potential danger or injury to the patient and because it was not a real animal, cleanliness was more easily maintained. AIBO was also attributed with the most positive outcomes, when the AIBO was dressed. Apparently, the introduction of humanoid characteristics and demonstrating their usefulness in predictable environments, not situations requiring intuition or spontaneity, is the implicit driver of good tech for older persons.

Similarly, a "welfare robot", in the form of a robotic seal called Paro has also shown beneficial effects on people with dementia. A landmark Danish study aims to professionalise the use of Paro by certifying professional caretakers in their use of the robotic seal. The objective is to determine the extent to which new technology can support care home residents’ independence, communication and needs for stimulation. So does the robotic seal give care staff more time for social contacts with other residents, thereby enhance the well-being of both parties or  is this actually a clever distraction, further limiting personal contact?

LONELINESS

And what about loneliness? In the UK, it is estimated that over 50% of over 75 year olds who report living alone, say their TV is their main company and 17% report that they only have contact with a person, less than once a week. If you are being cared for by social services, your carer may not even speak the same language as you do and can only spend, on average, about 15 minutes, per day, per visit.

This makes it hardly surprising that neuroscientists have found higher levels of epinephrine, the stress hormone, in the morning urine of  “lonely people”.  Their research also showed that “loneliness” – subjective social isolation – alters the basic process of DNA transcription. We know that gene expression also disrupts perception, behavior and physiology. Loneliness burrows deep and can become a trap that reinforces isolation. On the positive side, loneliness and possibly depression have both been observed to be relieved using AIBO or Paro and in much the same way as a communication technology such as Skype works to create connectedness in people without cognitive deficiencies.

The bottom line is this, when you introduce a robotic assistive device into the mix you need user led design. Because older people respond differently to any technology than do designers or technology saturated children, they need to be included in any R&D effort. Worthy of mention, the prototypical designer of anything from F1 to a toilet seat is a 38 -year-old-white-male. What do you suppose they would rather be working on?

ANWERS

Is there an answer? In the case of people with dementia or other psychopathologies, are we deceiving them? If a robot is capable of impressive caring behaviour, is that wrong? Are carers who are good actors and exhibit impressive caring behaviour any different? In the same way that the carer may die, the robot may fail. Is one disappointment bigger than the other, in the mind of the cared for? Is there a distinction? Is artificial empathy, imbued by human designers fundamentally wrong? For that matter, is first person subjective experience or at best, realistic conscious like behaviour, necessary for caring? I think not. However, human intervention in terms of monitoring will for the foreseeable future, continue to be important.

Meanwhile, in all of the popular and stunningly poignant TED talks by Henry Evans and Hugh Herr or other equally important personal technology news, we see enthusiastic people fully dedicated to reengaging with the human race. These are the fortunate survivors, all living new lives and au fait with their biomechanically engineered prosthesis and body surrogate robots. Some of these come with $400K price tags, clearly out of reach for most, but they also inspire great hope. These are  authentic but they should not be confused or compared with the radically different experience of ageing.

With ageing, function is lost unevenly and inequitably, not suddenly and over the course of a lifetime. The application of robots in care of older adults is uncharted territory. The needs of an ageing citizenry are no less immediate or urgent but are unlikely to be perceived in the same way as the otherwise disabled group. The extent to which robotic innovations will assist or replace humans is yet unknown and the long term costs of such care are also unknowable.

The ultimate goal of human-robot interaction in the care of older people is to enable communication with real users in real-world environments. We need to start training a new generation, combining specialists from both ends of the age spectrum with specialist knowledge about technology and of actual ageing. Currently, there are serious gaps in the linkages between product and the population they are intended to serve (Hudson, 2014).

At present, the boomers are watching their own ageing parents and worrying. We see the centenarians, clutching their birthday greetings from the Queen and delight  to see them being adequately celebrated, obviously cared for. There is no hint of fear, no whiff of loss of control, no suggestion of isolation, loneliness or neglect.  They also illuminate that the benefits of ageing are far from equitably distributed. This has further philosophical and spiritual implications for the broad definition of caring and even categories of the notion of “elder abuse”, be it inflicted by man or machine.

By definition, these issues are intricate, vital, and incalculable. This is as true today as it was for the 1962 Jetsons and their indefatigible robot house-maid, when Rosie the Robot got burned into our boomer memory banks. She was a reject, an outdated model from U-Rent A Maid. The Jetson's only ran for 24 episodes but in that brief time, it fired our imaginations. Despite the fact that Rosie was past her sell by date, she ran the house while simultaneously dispensing wisdom, parental advice and discipline. If having a robot like Rosie, who understands where the older person is located in the home, provide them with whatever help they want or need and provide companionship, can this be so wrong?

Ageing is not a homogeneous process, care needs are highly personal and fluctuating, while eventual decline is undeniable. This debate only serves to underscore the first world nature of this problem. Older people without cognitive decline have high demands for a high quality of life. They need help with basic functions including cleaning, washing and shopping that robots of the future will be able to perform. Integrating technology with existing health and social care services makes intuitive sense but it represents such an ambitious undertaking it is barely conceivable. Meanwhile, sophisticated assistive care is, at present, available to the few: the deep pocketed and participants in optimum conditions, in controlled settings. Until sufficient interest, improved access and affordability gaps are closed, solutions loom just out of reach (Hudson, 2014).  But this also represents a yawning ethical issue and it's racing to the fore. As such, it is rightly under exploration. 
Get a move on Rosie.

Deborah Gale

For more information, the BioCentre on Ethics held a teleconference on the Use Of Robotics and the Care of Older Persons on April 11, 2014, Deborah was a panelist. Link to the audio and full report: http://www.bioethics.ac.uk/news/Teleconference-on-robotics-and-the-older-person-

HUDSON, R. B. 2014. Aging and Technology: The Promise and the Paradox. Public Policy & Aging Report, 24, 3-5.

JOHNSTON, S. 2014, Aging2.0 Flipboard. Accessed: 23 March 2014. http://flip.it/dDQpo 

TAMURA, T., YONEMITSU, S., ITOH, A., OIKAWA, D., KAWAKAMI, A., HIGASHI, Y., FUJIMOOTO, T. & NAKAJIMA, K. 2004. Is an Entertainment Robot Useful in the Care of Elderly People With Severe Dementia? The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 59, M83-M85.

In Search of A Second Act....

The boomers and their encore careers are taking off, at speed.

When 45% of the US population will be over 50 next year (2015) and when this demographic consistently demonstrates the highest rate of successful (still in business after 5 years) and sustainable (as in “green”) entrepreneurial activities, it is not a fluke.

Before Washington shut down for the latest blast of Mother Nature’s interference, an exceptional joint senate hearing of the Small Business & Entrepreneurship/Aging Committees took place. Having considered all the expert witness testimony, Senators Nelson (R) ME and O’Neill (D) FL characterized the hearing as  "an eye opener" and "tremendous". 

Hopefully, this signifies progress. The Stanford Center on Poverty and Inequality recently reported that the long-term unemployment rate for men and for women is nearing the all time high for the period since 2000. Even since the Great Recession of 2008-9, the economy is still not delivering enough jobs and a full recovery is unlikely without major labor market reform and intervention. Encore entrepreneurship for seniors represents the way forward. The hearing was held with the following key participants and an SRO audience.

Federal Government representatives:

Senator Nelson (D) FL, chairman, Special Committee on Aging

Senator Collins (R) ME, Ranking Member, Special Committee on Aging

Senator Landrieu (D) LA, outgoing Chair, Small Business and Entrepreneurship committee

Senator Risch  (R) Idaho, Ranking Member Small Business and Entrepreneurship committee

Senator Scott (R) SC

Senator Casey (D) PA

Expert testimony by:

Tamika Montgomery, SBA (Small Business Administration) associate administrator

Kenneth Yancey, SCORE Association (Small Business Consultant) president

Conchy Bretos, CEO of MIA  Senior Living Solutions activist based in Miami

Elizabeth Isele, co- founder of SEW (Senior Entrepreneurship Works) and eProvStudio.com

Dr Greg O’Neill, Director of the National Academy on an Aging Society

In opening comments, the significant degree of misunderstanding surrounding senior entrepreneurship was confirmed. Senator Collins admitted that before getting involved with this issue, she had no idea that more older people were starting businesses than younger people. In fact, between 1996-2010, nearly 40% of new businesses were started by those aged 55-64, compared to 26% started by those 20-34.

Senator Landrieu (D) LA, outgoing committee chair, commented that the term “encore entrepreneur” is apt because the combination of being wiser, calmer and older allows seniors another chance to think, to dream and to build great businesses.  

As the baby boomers age and their numbers grow, it is therefore essential to create appropriate structures and facilitate senior entrepreneurship. This hearing sought to understand the barriers to senior entrepreneurship, in order to remove them.

Biggest impediments to expanding opportunities for senior entrepreneurship:

1.     Capital constraints

a. Tamika Montgomery, Small Business Administration Entrepreneurial Development associate  administrator reported that accessing capital is the biggest challenge.  Identifying where resources exist is not always straightforward. Seniors don’t know what is available. SBA volunteers are there to identify, guide and assist entrepreneurs to appropriate resources.

b.   Ken Yancey, SCORE is in partnership with the SBA. He said that less than 10% of SCORE clients were successful at getting bank financing. The majority self fund from savings. He emphasized he was not supporting borrowing from 401K’s or retirement savings to bootstrap entrepreneurship. He sees scope for micro lending for seniors.

c.   Conchy Bretos, MIA, indicated that typically seniors have insufficient revenue to secure loans. In her case, after a 2 ½ year process (with a bank supported by the SBA), she was forced use her house as collateral for a $100k loan.

d.   Elizabeth Isele, Senior Entrepreneurship Works, expanded on microloans as the way forward for seniors and starting out small. She identified agencies like Accion and Kiva as micro-lenders who help mitigate risks for senior entrepreneurs. She also used Kickstarter.com as an example of a strong player in the microloan market and as an example of a social media/online based resource. Isele emphasized that artisanal capital requirements for seniors are typically low, approximately 1K. As such, capitalizing senior entrepreneurs requires a small initiative that won’t take millions to get off the ground.

e.     Dr Greg O’Neill, NAAS, spoke of the banker paradox. While seniors hold the majority of their assets in banks, the banks don’t have an understanding of the needs of this population. He echoed Isele’s comments with respect to micro-lending and crowd-funding stating they must be made accessible to older adults and specifically target the long-term unemployed, where older people are disproportionately represented.

2.     Regulatory burdens, red tape and the existing tax code don’t lend themselves to succeeding and sustaining success for seniors. 

a.    Conchy Bretos, MIA, cites the silo mentality at the federal agency level, resulting in a lack of interagency cooperation. While the IRS and HUD both have capital programs, with subsidies and the HHS has Medicaid waivers, no national capital programs exist at the same time each state and agency has its own programs.  She used this scenario to explain how tax credit regulations work against getting a license for an assisted living facility: “The tax credit regulations state that you can’t force services onto someone living in assisted living but if certain services are not provided, they can take the license to operate away.”  The regulations are overwhelming and counterproductive and interfere with expediency.

b.   Elizabeth Isele, SEW, highlighted the fact that people over 60 only have a 6% chance of being reemployed. Meanwhile, these people have to wait 18 months, reporting that they have been unsuccessful at finding a job, before they can start receiving benefits. Isele proposed an alternative; whereby, unemployment benefit subsidies are given out earlier, provided they are earmarked for entrepreneurial education and training programs designed to help make the unemployed older person re-employable or able to start their own business.

Specific questions posed by Senators:

1.     Senator Casey asked: “What is one thing the House and Senate could do in the next year to foster better policy and bring about better opportunities for encore entrepreneurship?

a.     Dr O’Neill offered the following on encore entrepreneurship.  Approximately 1/3 of encore entrepreneurs come in to self-employment after 50, many of whom were “pushed” into entrepreneurship due to redundancy or scheduled retirement.  As such, they are very different from other 2/3’s who have spent their entire careers in self-employment. Echoing Isele’s proposal above, he believes that the encore entrepreneur can use unemployment benefits to help them get them back into the productive labor force and back into making contributions to the tax base, to social security and to Medicare.  O’Neill pointed out that the self-employed are shown to have longer work lives than salaried employees because they have a clear passion for their livelihood.

b.     Elizabeth Isele’s number one priority would be to change government attitudes toward seniors. She challenged the government to view seniors as assets not liabilities and to downplay all the rhetoric about how they have ring-fenced entitlements for seniors due to its negative connotations.

c.    Conchy Bretos, highlighted the need for better access to government and advocated changing policy, not necessarily introducing new legislation. She spoke of the White House Office of Social Innovation and Civic Participation, created under a mandate to identify human and financial capital to bring about community solutions. This is an organization which has been in place for five years, headed by a Mr Greenblatt but does not appear to have a phone number or answer email. This example illustrates the need for identifiable staff to connect senior entrepreneurs with federal government officials charged with coordinating the efforts of senior entrepreneurs.

2.     Senator Nelson asked, how does the Affordable Care Act impact senior entrepreneurs?

a.   Dr O’Neill highlighted the fact that the self-employment decision is inextricably tied to the phenomenon known as “job lock” or “job anchor”; when health insurance is tied to your workplace. Meanwhile, the risks of a health condition arising in the 55-64, high entrepreneurial group are greater as this group is more likely to have a pre-existing condition. Coincidentally, what stops people pursuing self-employment is the lack of health care outside of the workplace. He cited a recent survey by the Brookings Institution, which suggested that the introduction of the ACA could push some one million people into entrepreneurship. In addition, the age 64-65 transition has been researched extensively by the Kauffman Foundation. Their studies have shown that a big trigger for entrepreneurship is when Medicaid kicks in at 65, with an additional 13% of people moving into self-employment then. He concluded that while the overall net effects of ACA cannot be known yet, they could be substantial.

3.     Senator Nelson next asked what are the economic benefits of senior entrepreneurs?

a.     Dr O’Neill sees benefits as economic and social. Self employed individuals who enjoy what they are doing, stay in work longer and retire later and continue their contributions to tax revenues and social programs. Remaining in employment allows older people to increase their standards of living in retirement; particularly true for the long-term unemployed.

b.   Conchy Bretos added that older people have a greater social conscience and strong desires to help circumvent and solve social problems.

c.    Elizabeth Isele pointed to the fact that over 60% of the entrepreneurs she has worked with are involved in green business development.

4.   Senator Nelson then asked the panel to comment on the lump of labor fallacy, the mistaken belief that employing older people takes jobs away from younger people.

a.    Elizabeth Isele commented that senior entrepreneurship actually creates more jobs for young people when they get hired to help scale organizations. Additionally important, this also assists in expanding intergenerational connectivity opportunities because prosperity knows no age boundaries. Net effect, everyone benefits.

Take away’s:

1.    Senators Landrieu and Nelson are introducing a new bill empowering seniors via the Encore Entrepreneur Act S1454 before Landrieu steps down to join the subcommittee on Energy.

2.  The AEO, Association for Entrepreneur Opportunity has documented that if just one in three small businesses hired just one additional person, the unemployment rate in the US would be zero.

3.    Senate bill 208, SCORE Act for 2014, will strengthen resources for  entrepreneurs and improve services offered by SCORE volunteers to specifically include seniors.

4.     Senator Collins is working with Isele and O’Neill to craft new legislation to adapt unemployment insurance benefits for long-term unemployed seniors so they can use their unemployment benefits to explore entrepreneurship.

5.     Senator Collins was in agreement with Isele comment, “…we are not facing a silver tsunami, and we are looking at silver linings, that will yield golden dividends.” Collins plans to borrow the silver linings metaphor.

Summary:

There is no room for confusion or doubt regarding the critical importance of senior entrepreneurship. Of course, there will be challenges but the advantages illuminated by this testimony are undeniable. The over 50 entrepreneur represents an untapped, unexplored, unsupported and key piston to the economic engine of the immediate future. Therefore, efforts to retool this enormous demographic and empower them to move past intimidation and fear to optimize their bonus decades makes physical, fiscal, psychological and economic sense. Meanwhile, the digital exclusion issue does remain relevant to this debate, particularly for those seniors who are intimidated or daunted by technology. In conjunction with debunking the lump of labor fallacy, perhaps the digital divide might be simultaneously addressed. Full employment across the life course and digital literacy both provide excellent opportunities for intergenerational connectivity.

In closing, in February 1970, the official report from the Senate Special Committee on Ageing opened with the following quote from the Honorable John E. Fogarty, House of Representatives. It was his opening address to a 1958 hearing, when he demanded that a conference on aging be set up. It took an additional three years but finally, in 1961, things got underway.
 
"In spite of the many surveys, books and conferences on aging, the greatest accomplishment to date has been the output of words."

In 50 years time, I hope that the results from the 12 February 2014 Senate hearing will not be viewed as another exercise in verbosity.

Deborah Gale

 

A Super Bowl Story

Not your typical update but it does reflect the passage of time, for this ageing aficionado!


A Super Bowl Story

A 30 second spot at the Super Bowl, will set you back a cool $4M dollars.
Small change.

30 years ago, I worked for Apple and signed the check (cheque) payable to the advertising agency Chiat-Day, for a one minute spot, that aired on Super Bowl Sunday, January 24, 1984. In the afterglow of that commercial, I knew I'd had a hand in something important but never fathomed what this singular event, would unleash. That check was for $1M.
Big change.

Today, along with the likes of Budweiser, GoldieBlox, the upstart toymaker for starting up girls to think differently about their future, scored one of those highly coveted 30 second spots. And in Obama's SOTU address he reminded us "....You know, today, women make up about half our workforce, but they still make 77 cents for every dollar a man earns. That is wrong, and in 2014, it's an embarrassment."
Socio-culturally, ENORMOUS change.

Go,
Fight, 
Win. 


Deborah Gale

My link to the Super Bowl

My Super Bowl Story

A 30 second spot at the Super Bowl, will set you back a cool $4M dollars.
Small change.

30 years ago, I worked for Apple and signed the check (cheque) payable to the advertising agency Chiat-Day, for a one minute spot, that aired once on Super Bowl Sunday, January 24, 1984. In the afterglow of that commercial, I knew I'd had a hand in something important but never fathomed what this singular event, would unleash. That check was for $1M.
Big change.

Tomorrow, along with the likes of Budweiser, Goldie Blox, the upstart toymaker for starting up girls to think differently about their future, scored one of those highly coveted 30 second spots. And in Obama's SOTU address he reminded us "....You know, today, women make up about half our workforce, but they still make 77 cents for every dollar a man earns. That is wrong, and in 2014, it's an embarrassment."
Socio-culturally, ENORMOUS change.

Go,
Fight,
Win.

Pennies, pence, sense and sex.

I've collected some thoughts about the Health 2.0 Europe conference held in London last month. Now in its fourth year, this event is a coming together of ideas, creativity and plentiful energy chasing dollars, pounds, pennies and pence. There's interest in making sense out of digital health's huge remit and its potential to transform later life and end of life care. Or is there?

The context for this event was punctuated by reminders of the problems still plaguing the Obama Care rollout in the states, along with potent reminders of the mid-Staffordshire fiasco and the Colchester cancer records scandal. Uncomfortable truths locked in a swirl of gamesmanship, dilly dallying, management weaknesses, human error and that unmistakable whiff of institutionalized corruption, again. Only this time we are talking about violations to our basic human access, to dignity. Unutterable, amidst the whole, shiny shebang, was the specter of what Health Secretary Jeremy Hunt has labeled our national shame; the new untouchables, our lonely old.

It seems however, that we're putting the cart before the horse here. The US has apparently spent some £2B on digital health compared to £700M in Europe. That's a lot of dough. There is some evidence that self tracking of chronic conditions seems to be working and "Big Data" is happening.  In NY state, a reported 19M people out of a population of 19.57M are sharing health data over a network! Then, in the UK there is a remarkable resource called the HES or Hospital Episode Statistic that contains records for the entire population where each interaction of the NHS has been tracked since 1989. Wow, but what does this actually mean?  I'm curious about this sharing and tracking - with who and what data? Clearly, patients are becoming more demanding about involvement in their own care. This is a good thing because chronic disease management is certainly one of the biggest challenges our ageing planet faces. But while all the signs of progress that were bandied about at the conference sound exciting, it somehow doesn't jive with the statistic that 80% of care homes in the UK have zero internet access. Shocked? Surprised? Data access and even data collection aside, assuring that data content is meaningful, so that it can be beneficially interpreted, seems to be another missing link. Taking this down to the basics, it is probably a good thing to track how many times someone has fallen down. Wouldn't it be more important to understand why they fell in the first place?

In the opening remarks and again at the keynote, mention was made of a £1B innovation fund. I must have misheard that because I can only find mention, on November 15th, of a new Regional Innovation Fund (RIF) of £5million made available this year to support and promote the adoption of innovation and the spread of best practice across the NHS. This, on the heels of the October announcement that NHS England had scrapped a £50m fund designed to promote innovation as part of the flagship government policy aka Innovation, Health and Wealth. This IHW program was announced in 2011, finally rolled out in August 2013 and then "suspended indefinitely", two months after its launch.  From £1B, to £50M to £5M? Exactly how serious can we really be about moving the conversation forward? This is not just technology and treatments, it's about the patient provider dynamic and the future design for optimizing the most basic ADL (activities of daily living) for an increasingly, ageing global citizenry.

Leaving the sadness of loneliness aside, the wave of older people dealing with increasing frailty and the  projected increase in people living with dementia is the profoundly shocking visual to take on board, beginning with the people who are innovating and designing for our future. Older people and even the ageing boomers may not be so technologically savvy as we'd like to believe and while advanced technology can be great, personal interaction is not advanced. We need cleverer, simpler ways for the increasingly, simpler needs of these now, not as clever people.

Help Age International continues to hammer home the message that the continual exclusion of ageing from national and global agenda's is inscrutable and must be addressed. This makes the first ever G8 Dementia Summit in London, on December 11th, a very important gathering for anyone living.  The point is clear, ageing needs to be on the agenda and fast, but I disagree with Victor Wang of GeriJoy who says that ageing isn't sexy, so we need to make it as sexy as global warming. I don't see ageing and global warming as comparable. Climate change has slid sideways on the agenda because of insufficient, conflicting evidence. Evidence of ageing surrounds us, if we choose to look. Silence remains the most outspoken form of denial. Ageing is multi-dimensional, complicated, challenging and reaches far wider than health care alone because it is rudimentarily social.

Ageing is about real life. So is sex. The race to make ageing, a sexy part of life, is officially on.

Deborah Gale