David Bowen
David Bowen

When revolutions happen slowly, it’s easy to miss just how revolutionary they are. One such revolution is the democratization of healthcare that has occurred within living memory.

In 1950, only in a few northern European countries could people expect to live more than 70 years. Today, a life expectancy of 72 years is the global average. In 1960, the global infant mortality rate was 18.5%. Today it’s 4.3%—still too high, but dropping. In short, millions more people are walking the earth today than would have done so without this revolution.

One major result of those remarkable improvements in the human condition is increased demand for quality healthcare around the world. Increasingly, even in communities remote from major population centers, consumers are no longer satisfied with the basics of healthcare. Digital technologies and distributed ways of providing care have democratized access to care, and populations the world over are demanding economic models that support this democratization by allowing care to be accessed by all. The results of these demands are visible the world over, from the Modicare program in India to national health insurance schemes in sub-Saharan Africa to the unique Ubudehe program in Rwanda that involves local communities in solving issues of poverty.

With that democratization comes expectation—the expectation that the quality of healthcare available in developing economies will match that of traditionally developed economies.

This global wave of rising expectations creates both opportunity and challenges for healthcare stakeholders. The challenge is to ensure that high quality care is available wherever it is provided. The opportunity comes from the chance to attract customers by leading the wave of global quality improvement.

Communication is an integral part of rising to the challenge. Healthcare communication needs to match the demands of consumers by increasing in quality and sophistication the world over. No longer is it acceptable to have a sophisticated program of healthcare communications only in the richest markets. Rather, communications in healthcare have to be truly global, providing nuanced, informative, and culturally appropriate messaging in every community.

This global and systemic democratization of healthcare is matched by a democratization at the level of individual patients too. No longer are patients content to passively accept the recommendations of experts. Instead, they come to the medical exam room increasingly armed with data, information, and conclusions (whether accurate or erroneous) derived from online sources.

This individual democratization of healthcare information and decisionmaking must force a profound change in the way healthcare is communicated. Already, personalized prescription reminders from pharmacies and messaging from doctors’ offices have become the norm—and in the near future, the healthcare system will be even more integrally linked to patients through always-on smart sensors and the internet of things. Each patient will become an informed, data-rich audience of one, and each new wave of information or disinformation on digital and social media can affect the way care is provided or perceived.

For healthcare communicators looking ahead to the middle decades of the twenty-first century, the prospect of globally and individually democratized healthcare is both exhilarating and daunting. Increased demand for care across the world provides new opportunities and new markets. Massively increased volumes of information—and fragmentation of that information—means communication will have to step up the pace to remain relevant.

For those who master the communications challenges of this radically democratized healthcare environment, the rewards will be great: new and better ways of connecting with billions of empowered healthcare consumers.

As Robert F. Kennedy said, “Democracy is messy and it’s hard.” But in healthcare, as in politics, no matter how messy and how hard, democracy remains the only viable choice.


David Bowen is global lead of Hill+Knowlton Strategies health practice and head of WPP Health's policy & public affairs group. Previously, he was health policy director for Senator Ted Kennedy, where he had a leading role in developing the Affordable Care Act before moving to the Bill & Melinda Gates Foundation to lead initiatives to create partnerships with governments to support polio elimination.