Esther Dyson: We Need to Fix Health Behavior

Investor Esther Dyson is a former reporter and Wall Street analyst who has set out to tackle what she calls “the most interesting unsolved problems in health care and human behavior.” Top among them is the high rate of self-inflicted illness from bad diet and too little exercise.

In March, Dyson released a manifesto describing new idea: create a challenge among small U.S. cities to see which can most improve its health, measured by factors like weight, blood pressure, and sick days. The effort, she says, will be propelled by hard data on the best prevention practices, and aims to find ways to turn good health into a profit-making strategy.

It’s a long-term project, and one that’s still looking for a “benevolent but ultimately profit-driven billionaire” or patron to back it, she says. But Dyson has already laid some of the groundwork by investing in 27 health startups, many of which are trying to use technology to bring individuals new insights into their own health, such as consumer-genetics company 23andMe and health-answers site HealthTap.

MIT Technology Review asked Dyson about her plans. 

Why are you involved in disease prevention?

Because I hate seeing stupidity. And it’s colossal stupidity that people aren’t healthier, because we know how to do it.

What’s the big idea that you have to help?

I just founded something called HICcup, which stands for Health Initiative Coördinating Council. It’s my main job now. The goal is to coördinate five or six communities that will compete in a contest to be the most improved health community over five or 10 years.

The fundamental premise is that a single health intervention has a low degree of virality—they don’t catch on. If you start with a diabetes intervention program, the impact peters out. But if you do multiple things, they reinforce one another. You need the bike path, a diabetes program, and maybe a bunch of quantified-self tools. If you have a critical density of these things interacting, they are likely to have a multiplied effect. We want to prove that, so other people will copy it, and make money doing it.

How far along is your project?

I am looking for all the effectiveness studies that I can find. Unfortunately there are not many. It’s easy to find studies of a drug and how many people got cured of cancer, but I am looking more at the population-level sorts of things—what happens to the average weight of a population if I put in a bike path? We need that data so we can build a model where someone else can look at it and say yeah, I want to spend my $100 million in this way, on these three programs. It’s going to be a big data story.

Is the idea to reduce medical spending?

The challenge in health care is to cut off the bad spending and increase the good spending. Some of the lower-cost things we can do are just environmental changes. Having a sign next to the elevators saying  “Please take the stairs.” It’s like, instead of promoting doughnuts, you promote carrot sticks.

Can technology help create these kind of population-level changes in health?

A lot of this requires very little exotic technology. What it requires is social buy-in and changes in diet. But technology can help because it’s a reminder, it’s personal, and it’s cheap. That sign by the elevator, it could be customized to say “Hey, Esther. Please take the stairs.” My smartphone could say “Your goal for the day is to walk up 10 flights of stairs and it’s 9 p.m. How are you planning to complete this goal?” There are devices to tell you how many steps you took, the composition of the blood, and sleep patterns. Those are more personal, they are more self-involving, if they are well designed, they can be gamified so that you just want those extra points, and you’ll take another walk around the block in order to get them. We’re going to let communities choose which technologies and interventions they want to use.

How is anyone going to make money with prevention?

The only way that this is going to work is if there is money in it. The ultimate purpose of HICcup is to prove that there is a return on investment, so we need a model not just for the health side, but for the financial side, where the money comes from, and how you can capture it as an investor. Think of an employer who spends $500 million a year on health care, and it’s growing at 3 percent a year. If you agree to take that over, to keep those people healthy, and you can cut costs by $50 million, well, you are making $50 million a year.

There are huge inefficiencies in health care that technology, properly applied, could help with. And there is starting to be dramatic changes in the payment mechanisms with Obamacare. You’ll get paid for health outcomes rather than [medical] activity. So there is a lot of opportunity.

It seems like health care, and specifically prevention, is drawing more interest from venture capitalists.

Well, partly, some of them are getting old and are probably beginning to notice their own health. And it’s a problem worth solving. It’s not the latest app for finding friends you can go to a concert with. Yeah, sorry, that just doesn’t excite me as a challenge.