Since the World Economic Forum launched its Value in Healthcare project in 2016, leaders in the global healthcare industry have developed a clear understanding of what it will take to improve healthcare value (defined as the delivery of continuously improving health outcomes to patients at the same or lower cost). In particular, the project has emphasized the importance of four key enablers that provide the essential foundation for any value-based health system:

- Systematic reporting of health outcomes by disease and population group, benchmarking across providers and research and development of decision support tools;

- New models of service delivery that are more integrated around the patient ensuring efficient and appropriate services

- Comprehensive health informatics systems for the capture and sharing of data on populations segments and outcomes that matter to patients;

- Value-based payment models that reward for value rather than volume; and

Putting these enablers in place will require transformation of current health systems, but many barriers stand in the way. Despite considerable progress in defining global outcomes standards for many disease groups, the routine benchmarking of provider organizations against these standards remains relatively limited. Care delivery suffers from the fragmentation of many health systems, the lack of integrated budgets for public health and acute care, and a persistent under-emphasis on prevention.

Obstacles to widespread sharing of health information data include a tendency by institutions to hoard their own data, concerns about data privacy, and the absence of clearly defined global data standards which limits interoperability between today’s highly fragmented EMR / application landscape. Finally, some systems are experimenting with a variety of value-based payment models, but fee-for-service payment remains the default model in many parts of the world.

What will it take to overcome these barriers? The starting point is to develop new ways of working together and new modes of cooperation — both across sectoral boundaries within the healthcare industry (e.g. between payers, providers, and pharma / med-tech) and between the industry and government (which is typically the main payer for healthcare budgets). It will also require dynamic leadership on the part of both industry stakeholders and government officials and policymakers.

In late May, a cross-section of industry leaders discussed these challenges at a special session organized by the Value in Healthcare team at the 71st annual World Health Assembly, in Geneva, Switzerland. The session, organized by the World Economic Forum in collaboration with The Boston Consulting Group, focused on some of the main barriers to value-based transformation in health systems and how stakeholders can work together to address them.

“We Need to Create New Alliances”

After opening remarks by Vanessa Candeias, head of the global health and healthcare system initiative at the Forum, and Admiral Brett Giroir, recently appointed Assistant Secretary for Health in the US Department of Health and Human Services, a panel of representatives from key industry stakeholders discussed the challenges of making value-based healthcare a reality. Admiral Giroir was joined onstage by Somesh Chandra, chief health officer for European markets at the global insurance company AXA; Jan Kimpen, chief medical officer at Royal Philips; Petra Laux, global head for public policy at Novartis; and John Schaeffler, head of government affairs and policy at GE Healthcare. Stefan Larsson, BCG senior partner and global leader of the firm’s health systems practice posed questions to the group and moderated the discussion.

In his opening remarks to the session, Admiral Giroir shared his vision for stronger disease prevention and better alignment of the US healthcare system to the key principles of value based HC. According to Giroir, “value-based transformation” is a key priority of recently appointed US Secretary for Health and Human Services Alex Azar, and there are three critical objectives in achieving it:

- Placing far more emphasis on prevention — as Giroir put it, “we need to transform the current sick-care system into a health-promoting system”

- Empowering patients through improving health literacy, connectivity, and choice

- Incentivizing health care providers through changes in payment models. “Today, incentives are horribly misaligned,” said Giroir. “Providers make more money comes from curing the sick than from keeping them well.”

The participants broadly agreed that transforming health systems in the direction of value-based healthcare is necessary for the future, but requires more effective cooperation among payers, providers, and suppliers. “A trust deficit does exist,” said AXA’s Chandra. “All stakeholders have been trying to own the whole ecosystem.”

How to overcome the trust deficit? The key is to put the customer at the center of care delivery, make value delivered to the patient the key criterion for performance, and create incentives for all stakeholders to collaborate to deliver the best outcomes for the patient. “It’s very easy to talk about what others can do in value-based healthcare,” continued Chandra. “But we all need to take ‘baby steps’ in our own expertise areas. We need to create new alliances.” Added Kimpen: “Collaborations and partnerships are critical for value-based healthcare to come to life.”

Panelists gave a number of examples where that kind of cross-industry cooperation is already happening. Payers and providers are experimenting with risk-sharing agreements that use value (e.g. health outcomes delivered for certain costs) as the basis for payments. Med-tech and pharmaceutical companies are pooling their capabilities to come up with innovative approaches to diagnosis and therapy in key disease areas. But much more needs to be done to encourage cooperation and risk-sharing, because the most effective value-based innovations in care delivery are likely to be found across the traditional sectoral boundaries of the system. “We need to create an environment where all stakeholders can do what they do best but are collectively responsible to a broader goal,” said GE’s Schaeffler.

To help seed that environment, the Value in Healthcare project has been working with industry stakeholders to develop new models for collective action and value-based transformation in local health systems. In 2017, the project helped convene a broad cross-section of stakeholders in the Atlanta metropolitan area in the US to work together to improve outcomes in congestive heart failure. And in 2018, we are helping launch a similar pilot focused on type 2 diabetes in the province of Ontario in Canada.

An emerging theme from these efforts is the importance of public sector leadership. At the local level, active leadership is critical to convene key institutional players and to get them to address value from a system-wide perspective. And at the national and international levels, policy and regulatory innovation will be key to long-term progress. Leaders in the “need to influence the creation of a policy framework that incentivizes the behaviors that we all agree are necessary to enable value-based healthcare,” said BCG’s Larsson.

“Getting the Informatics Right”

One area where cross-industry cooperation will be especially important is in the domain of health informatics. Like many industries, healthcare is in the midst of a digital transformation which is rapidly expanding the “art of the possible” when it comes to integrating health data around the patient. “You absolutely have to get the informatics right” said Giroir at the WHA panel, “because if you don’t, you can’t judge whether the quality you are attempting to pay for is actually there.”

But harnessing the potential of healthcare informatics to support value-based transformation will require overcoming a series of obstacles. Some panelists mentioned the problem of data hoarding — institutions don’t want to share their data because it is a key asset they want to monetize. “We need to move from a model where you make money from leveraging and using the data rather than holding it,” said Laux from Novartis. Others thought the primary roadblock wasn’t so much data access as data privacy. “We still can’t guarantee 100% data security,” said Kimpen from Philips. Still others emphasized the importance of developing global informatics standards so that systems are truly interoperable.

Here too, government leadership is key. “These issues of data access and data privacy will be battled out in ministries, legislatures, and policy committees,” said GE’s Schlaeffer. “We need a policy framework that encourages risk sharing and flexibility to incentivize innovation.”

But there is a lot that other stakeholders can do in the meantime. For example, to address the data standards issue, the Value in Healthcare project will be launching a pilot with key provider and research institutions to define a common data model for the collection and sharing of health outcomes data. Other examples of driving this agenda forward include patient advocacy groups pushing for more patient-centered approaches to care, and private sector players innovating their business models around value.

A Coalition for Value in Healthcare

As the examples shared at the WHA panel make clear, the cooperation across sector boundaries necessary for value-based transformation is starting to happen. But we need to accelerate the pace of change. To that end, in 2018 the Value in Healthcare initiative is working to create a Coalition for Value in Healthcare. Although still in its formative stage, the basic idea of the Coalition is to create a global network of industry stakeholders to support value-based transformation of health systems by playing three key roles:

- To serve as a catalyst and neutral platform for the launch of local initiatives like those currently underway in Atlanta and Ontario and to scale up and accelerate value-based transformation across local health systems;

- To create a community of practice in which practitioners from around the world to share practical examples from implementation and to learn from each other about how to undertake a journey towards a value-based health system; and

- To function as a center of excellence that develops methodologies and guidelines on best practices in value-based transformation, conducting research, training practitioners, and influencing public policy

As the global organisation for public-private cooperation, the World Economic Forum is currently preparing more detailed perspectives on how public and private health systems actors can mobilize through cooperation for value-based care. We look forward to sharing these learnings with you in the coming months.

Have you read?

• 5 key trends for the future of healthcare
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• The countries where people worry the most about healthcare

Originally published at www.weforum.org.

Catalyzing Health-System Transformation: A report from the Value in Healthcare project was originally published in World Economic Forum on Medium, where people are continuing the conversation by highlighting and responding to this story.

Nancy Brown, Chief Executive Officer, American Heart Association

Heather Bresch

Dr Lucica Ditiu

As a leader in promoting cardiovascular health, what are some of the game changing innovations that you feel has still not reached its full potential to improve global health?

Precision medicine holds significant promise to diagnose, prevent, and treat cardiovascular diseases and offers the global health community tremendous opportunity to design treatments and products tailored to the individual patient.

Since precision medicine is personalized to a person’s specific characteristics, such as their genetic makeup, or the genetic profile of their condition, scientists and researchers are positioned to create bold interventions to combat leading healthcare challenges like cardiovascular disease.

According to a recent study, in the next two decades, the number of Americans with CVD will rise to 131.2 million — 45 percent of the total U.S. population — with costs expected to reach $1.1 trillion. Tackling these urgent threats with bold and innovative approaches like precision medicine is paramount to reversing this trend.

The whole premise of precision medicine is to intersect health equity or “leave no one behind” because it provides the best treatment to all patients. We must balance however the technological systems with the patient’s complex background and needs, such as culture, values, preferences, and beliefs.

In the era of “big data”, the global health community can improve health care worldwide, but only if we focus on the wider societal and global environment. The tracking and collection of data by consumers will only continue to grow through wearables, sensors and algorithms, so making this data accessible and actionable for scientific discovery in real and meaningful ways is the next frontier.

Precision medicine should be at the center and balanced with population-centered approaches

By Heather Bresch, CEO, Mylan

As the leader of one of the biggest pharmaceutical companies in the world, and a spokesperson for access to quality medicine worldwide, what ideas or solutions have we as a society not yet utilized to its full potential to improve the lives of the 2 billion people who live without access to essential medicine?

The term “access” can mean a lot of different things to a lot of different people, especially when it comes to delivering medicine. It’s multifaceted and varies widely depending on where you live. I like to think about it from a patient’s perspective:

• Acceptability: I understand my risk for various illnesses and know what treatments exist. I am not embarrassed or afraid to seek help.
• Accessibility: Medicines approved for sale in my country are available whenever and wherever I need them.
• Availability: A robust and competitive marketplace encourages drug makers to bring products to market.
• Affordability: I can afford the medicines I need because prices are fair and equitable or because financial assistance is available.

By Dr Lucica Ditiu, Executive Director of the Stop TB Partnership

Every country has its own set of challenges when it comes to delivering healthcare. High-income markets, for instance, can sometimes get in their own way because their existing infrastructure makes it more difficult to implement new technologies. Whereas low- and middle-income countries are able to leapfrog and introduce groundbreaking healthcare innovations. Rwanda, for example, is using drones to help deliver medical supplies in remote areas.

As the four pillars above highlight, access is much more than making sure medicine is available behind the pharmacy counter. Think about the power of “acceptability.” More and more countries are introducing self-tests to help people quickly find out if they are afflicted with an illness — from Lyme disease to prostate cancer. These diagnostic technologies empower consumers to understand their health and equip them with the information they need to seek treatment.

As pharmaceutical companies, we need to consider the patient’s unique circumstances so when they do seek treatment they have access to their required medicine. For example, drugs for children produced in the West are often liquids that require refrigeration. But countries in sub-Saharan Africa often have limited cold-storage capacities or an inability to transport liquid in bulk. That’s why Mylan has developed heat-stable, taste-masked, dispersible tablets that can easily be incorporated into food. More innovations like these focused on the most basic forms of accessibility are needed to solve many of the real-world supply chain issues that patients face today.

The question for us as a society is how can we all come together, think unconventionally and develop innovative solutions that consider ALL facets of access? Because when we balance all of these areas of access — acceptability, accessibility, availability and affordability — we will be delivering not only essential medicine, but, more importantly, essential healthcare.

2018 — the year to break the 100 years of silence on TB united

Mycobacterium tuberculosis (the bacteria that is responsible for tuberculosis (TB) emerged over the last 3 years as the biggest infectious disease killer in the world, and is responsible for a number of deaths that is higher than the number of deaths due to HIV and malaria combined — around 4400 deaths every single day.

Even though TB represents the perfect “combination“ of a very scary disease — it is airborne so everyone breathing is at risk — but curable in 6 months with a cocktail of medicines costing around 32 USD for the entire duration — very few people in the world are aware of the public health threat this disease represents in 2018.

Over the last 100 years, there was less and less awareness in a population about TB, less and less political interest, very limited funding, reduced research investments, almost no new tools to fight the disease, no special initiative and no focus of any President, no interest among celebrities or high net worth individuals. Silence. In this desert environment, mycobacterium tuberculosis continued killing, becoming resistant to the few drugs we have available, grew stronger and dangerous, showing how we fail as human beings in ending a disease that has been with us for thousands of years.

This is why a lot of our hopes are linked to the autumn of 2018, when Heads of State will gather in New York at the United Nations General Assembly first-ever high-level meeting on tuberculosis (TB) to accelerate efforts in ending TB and reach all affected people with prevention and care. The theme of the meeting is “United to end tuberculosis: an urgent global response to a global epidemic”.

Having Heads of States and many other leaders in the global health arena attending the one day event on TB will result in an ambitious Political Declaration on TB endorsed by governments that will strengthen action and investments for the end TB response. The Declaration will be combined with a strong multi stakeholders’ accountability mechanism, which has the potential of being THE game changer we need to End TB.

It is indeed only a one day meeting, but it will be the first time that the TB agenda would reach the cabinets of the highest level political leaders and decision makers.

It is the first time for many of them to hear that TB kills their people at an incredible scale, impacts their economies and development and in spite of being a very cost efficient intervention — for each dollar invested there is a 50–60 USD return — is not properly addressed. It is for the first time that they will understand that the TB response which is in place now, where the funding levels and the outdated tools we have are so inadequate, that we will not end TB before 2180. And if we don’t end TB, we will not end HIV/AIDS (because TB is the biggest killer of PLHIV), we will not impact AMR (as drug resistant TB is responsible for 30% of deaths due to AMR), and we will not reach UHC (as every year we have 48% of people with TB being missed by health services).

So, we better buckle up, unite, engage, and make this meeting a success!

This is the moment we drop everything else, and we work together — irrespective of whether we are from country programs, community and civil society networks, private sector, researchers, donors. There is no other way to end TB than UNITED. There is no other outcome of this fight with TB than SUCCESS. We owe it to us, we owe it to our world.

Have you read?

• 5 key trends for the future of healthcare
• The countries where people worry the most about healthcare
• Global healthcare needs a revolution. This is how technology can help

Originally published at www.weforum.org.

The future of global health and healthcare: game-changers for impact was originally published in World Economic Forum on Medium, where people are continuing the conversation by highlighting and responding to this story.

Mauricio Rodas Espinel, Mayor of Quito, Municipality of Quito

In November 2019, the people of Quito will start travelling on the city’s first metro line, three years after construction started. The line will be expected to support at least 300,000 trips daily, becoming the spine of what’s billed as an “integrated multimodal transport system” for the Ecuadorian capital. It’s the answer to what has been one of Quito’s most pressing challenges: improving mobility conditions for its more than two million inhabitants.

Located within the complex topography of the Andes mountain range, Quito sits amid mountains and deep valleys. It is crossed by four tectonic faults, 192 ravines and surrounded by 20 volcanoes. The city has sprawled well beyond its geographical boundaries, with 70% of its population considered to be urban.

Lower-income residents have settled in areas in the northern and southern poles of the city, and on the surrounding mountain slopes. Families who used to live in the northern central plateau have moved to housing projects in eastern valleys, which just two decades ago used to be rural areas.

Constrained by mountains and ravines, Quito’s urban area occupies a long and narrow plateau. Sixty percent of the city’s jobs are concentrated there. More than half of all daily trips take place on the plateau, causing severe traffic problems. Congestion, along with the city’s topography, has drastically increased commuting times, even for trips of short distances.

Around 70% of Quito’s inhabitants commute using public transport. This includes the municipal transport system and a network of buses managed by private companies, as well as taxis. The other 30% of the population commute in private cars that occupy 60% of the city’s road infrastructure. Most of the time, these cars are occupied by just one person.

The construction of the first metro line has been considered by the Municipality of Quito and its financiers (the World Bank, Inter-American Development Bank, the Development Bank of Latin America and the European Investment Bank) as a unique opportunity to develop more efficient and inclusive mass transit for all citizens. The aim is to create a multimodal system, which means that on top of the current facilities of bus lines, bike-sharing scheme and new metro, two cable-car lines are being planned to connect people from neighbourhoods higher up the mountain.

Have you read?

• This city’s budget is decided by its citizens
• How does a city become ‘smart’? Lessons from Tel Aviv
• What Ecuador can teach us about poverty relief

Since 2014, Quito has also been working on improving the quality of its trolley buses. New buses helped to reduce the number of people packed into one square metre of bus from 15 to nine. Safety has also been key — new bus stops have rubber floor tiles and information in Braille. The 15 metro stations will all include elevators and lanes for wheelchairs. In an attempt to combat sexual harassment, the municipality offers “Bajale al Acoso” (“Down with Harassment”), a mobile platform for reporting antisocial behaviour.

The construction of the city’s first metro line and its integration with existing public transport systems represent a historic opportunity to rethink urban development and its dynamics. This multimodal system will change the way people move around the city, improving the quality and efficiency of their journeys. It will also build a more resilient city, adapting patterns of urban growth towards a more sustainable metropolitan environment.

Originally published at www.weforum.org.

The city of Quito just made commuting quicker and safer was originally published in World Economic Forum on Medium, where people are continuing the conversation by highlighting and responding to this story.

Alex Gray, Formative Content

London is where overseas workers want to be, according to a new survey.

More than one-fifth (22%) of respondents said that the UK capital was their preferred destination.

New York came in second with 16%, and Berlin and Barcelona were third and fourth, both with 15%.

Europe dominates the top 10 with five entries, including Paris in eighth place.

While the big European and US cities make up two-thirds of the 30 most popular destinations, other regions are catching up.

Dubai, Sydney and Tokyo also make the top 10, in sixth, ninth and 10th place respectively. Abu Dhabi and Hong Kong have also moved up the ranks in the past four years.

London’s dominance comes despite an overall drop in the appeal of the UK. Before the Brexit vote, the UK was the top European destination for foreign workers. It now sits in fifth place, behind Germany, and is less popular than the US, Canada and Australia.

Reluctance to move

The uncertainty around Brexit in the UK, along with tighter immigration controls in the US and elsewhere, may be partly responsible for the fact that people overall are less interested in moving abroad for work.

While over half the survey respondents (57%) said that they would move abroad for work, this is noticeably less than the survey result four years ago. In 2014, almost two-thirds (64%) said they would be happy to relocate.

“It could be that the world is becoming less mobile. Or it could be that work itself is becoming more global, making it unnecessary for people to uproot their lives to find satisfying, well-paying jobs,” suggest the survey’s authors, at Boston Consulting Group.

Called Decoding Global Talent, the global survey asked 366,000 workers for their views, thanks to a collaboration with market-leading job boards in over 130 countries.

Attracting top talent

As working habits change and we become a more decentralized, more mobile and globally connected workforce, cities will have to compete for talent. Employees will choose where to move to based on the cultural opportunities and standard of life on offer.

When it comes to quality of life, a different ranking places Vienna, Zürich, Auckland, Munich and Vancouver in the tops spots.

Have you read?

• These are the world’s most expensive cities for expats
• These are the cities where your salary goes the furthest
• Japan is replacing its ageing construction workers with robots

Originally published at www.weforum.org.

These are the most desirable cities for overseas workers was originally published in World Economic Forum on Medium, where people are continuing the conversation by highlighting and responding to this story.

Diane Hoskins, Co-CEO, Gensler

The smart building concept is one of the most radical innovations to come to building design in generations. But smart buildings are just emerging, and we still don’t have a single, shared definition. Within the architecture, engineering and construction industries, smart buildings generally refer to buildings that are equipped with the latest IoT and sensor technology, giving users new levels of control over the built environment.

While the total number of truly smart buildings around the world remains small, an impressive array of technology has been developed for this emerging market. The future looks bright. These innovations promise to do for buildings what smartphone technology did for the telephone, radically altering the way people interact with the built environment in ways that we cannot wholly anticipate.

Buildings are different from mobile phones however, since they are designed as shared resources for families, organizations, neighbourhoods and communities. This means buildings should be held to a different standard than we apply to other areas that are similarly being transformed by “smart” innovations.

Given the social importance and impact of buildings, we should strive to create something more broadly positive and outcome-focused than just a collection of smart devices and technologies. Instead of stopping at creating buildings that are digitally advanced, we should focus on creating buildings that are agile for people. This kind of building is responsive to the changing needs of its users, enables communities to become stronger and more resilient, and is ultimately better for people and the environment.

What are agile buildings and how do they work?

As urbanization trends lead to an ever greater percentage of the world’s population concentrating into cities, agile buildings will become essential platforms for promoting healthy and resilient communities. They can create stronger and more interconnected urban environments, by supporting office workers during the workday; sustaining neighbourhoods and communities with locally grown food from green rooves and gardens throughout the year; promoting smart land use with flexible and open floor plans; maintaining energy independence; and dispersing additional energy into the grid.

The first step toward creating a generation of agile buildings is defining the principles and establishing the outcomes that agile buildings need to embody and achieve. To truly make a difference, agile buildings should be carbon-neutral, energy positive, technically sophisticated, and support a diverse mix of uses and activities. They should embrace the concept of total building performance, which evaluates performance based on six core categories of design experience: spatial, acoustic, visual, thermal, indoor air quality (IAQ) and building integrity.

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• We CAN build a carbon-neutral world by 2050. Here’s how
• This Dutch city is building the world’s first habitable 3D printed homes

Agile buildings should leverage big data and real-time monitoring to make buildings safer, healthier and better for people and the environment. They should make extensive use of the latest sensor technology, and they should lean heavily into principles such as interoperability and passive design.

What kind of positive impact can agile buildings make?

Agile buildings should embrace biophilia, or the innate human drive to establish connections with the natural world. They should be attuned to the unique demands of their local climates and natural environments. Agile buildings should encourage walkability and provide easy access to mass transport while embracing transit-oriented design.

Environmental impact

Agile buildings can improve our lives through three major impact areas: environmental, physical and digital. Each of these speak to different aspects of building design, but they have complimentary (and sometimes overlapping) positive outcomes.

Buildings contribute one third of global greenhouse gas emissions and consume 80% of global electricity. Agile buildings such as Glumac LA use innovative design to operate at carbon-neutral levels and produce enough energy to be “energy positive”, helping to address important challenges such as climate change.

Located in a 62-story, modernist skyscraper in the centre of Los Angeles’ Financial District, Glumac LA’s 17,500-square foot office produces three times more energy than it consumes, providing water and air heating for 20 additional floors within the building. A new heat-recovery chiller specifically designed for the building harvests waste energy created by a lower-level data centre, converting it into heat that provides hot water and temperature control for each office located in the central 20 stories of this 45-year-old building. LED lighting and extensive use of daylighting throughout Glumac LA’s floor plan further reduces the office’s energy needs.

Physical impact

Indoor air quality can be significantly worse than outdoor air quality, having negative long-term effects on the health and wellbeing of building occupants. Another key factor in how buildings impact human health and well-being relates to how their design influences overall mobility. We should strive to make it easier for people to move around different spaces and utilize different amenities. The Tower at PNC Plaza in Pittsburgh uses several agile building design features to improve indoor air quality and user mobility, creating a positive physical impact for its users.

The Tower at PNC Plaza also has an innovative “double-skin” façade, a multi-layered glass exterior that surrounds the entire building. The façade acts as a natural ventilation system, opening and closing multiple layers of glass panels based on outside temperature and humidity, allowing healthy outdoor air to circulate throughout the building.

The Tower at PNC Plaza also has a central control unit or Building Energy Management System (BEM) that runs the building’s different mechanical systems and is programmed to ensure occupant safety in the event of fire or a natural disaster. A solar chimney keeps the building insulated during Pittsburgh’s cold winter months, utilizing rooftop panels to capture warmth and transfer heat throughout the entire building. The combined effect of the building’s façade and solar chimney means that the 800,000-square foot office building uses almost no outside energy for 42% of working hours.

An integrated stairway system allows for easy mobility, opening pathways to large “collaboration neighbourhoods” located on every second floor of the building. Located in Pittsburgh’s central business district, the Tower at PNC Plaza contributes to the positive densification of its urban core, providing easy access to mass transport. Multiple bike racks and a self-service maintenance centre help people use alternative, low-carbon options for their daily commute.

Digital impact

As BEMs become more sophisticated, their ability to serve as interoperable platforms for a wide array of smart, IoT technologies improves. Buildings can harness the growing power of digital technologies to save energy, improve indoor air quality and enhance user experiences. The Houston Advanced Research Center’s (HARC) campus was designed to be a living laboratory for ground-breaking research into the built environment, and features a range of innovative and interoperable building systems that help the building improve the experience it offers.

Smart sensor technology tied to HARC’s BEM gathers occupancy data, which is subsequently converted into big data tables that inform the building’s heating, cooling and air purification systems. Additional research is going into the development of a machine learning system that will automate building systems in real-time based on occupancy rates, and pre-set user preferences for temperature and lighting. Extensive wifi throughout the campus enables user mobility in the office and on the grounds outside, and CO2 sensors are used to ensure healthy indoor air quality.

Making the environment better, one agile building at a time

If current projections hold, there will be 2.87 billion smartphone users by 2020 (up from 2.53 billion today). That’s roughly 38% of our global population. Indeed, smartphones have become such a dominant feature of modern life that it can be hard to remember what things were like before Apple launched its iPhone in 2007. There are almost no historic analogies that parallel the smartphone’s incredibly fast rate of adoption only 13 years after being introduced. But fully digitized buildings may be the next great innovation to accomplish this feat.

A single building, whether it’s an office space, retail centre, school, museum, university campus, government building or civic centre, can serve hundreds or even thousands of people each day. These places have a tremendous impact on people’s daily lives, especially since we spend most of our time indoors. Results vary across countries, but we know that Americans spend an average of 90% of their time inside buildings, for instance. This means that the transformation of just 10% of the buildings sector can significantly impact the lives of a broad range of people, very quickly.

Agile buildings can be an important part of the solution to so many important challenges ahead of us, including climate change, improving human health, and creating inclusive and open cities that provide opportunities for everyone. Agile buildings have the potential to do for entire communities what smartphones have done for individual users. That is something that we can all be very excited about.

Originally published at www.weforum.org.

How tomorrow’s buildings will make you — and the planet — healthier was originally published in World Economic Forum on Medium, where people are continuing the conversation by highlighting and responding to this story.

Jürgen Fischer, President, Danfoss Cooling

Picture this: you live in a hot and humid climate, and you get access to energy. What’s the first thing you buy to stay cool? An air conditioner (AC). As incomes and standards of living increase around the world, so does the use of ACs. As a result, the global energy demand for ACs is expected to triple by 2050. However, people are buying units with average efficiencies of less than half of what is available on the market. To respond to the growing demand for cooling, we must, first and foremost, think energy efficiency.

Cooling appliances such as ACs consume energy and emit heat while running. Anyone who has ever put their hand behind their fridge knows what I’m talking about. In turn, these heat gains add to air-conditioning demand. This dynamic, combined with the rising demand for cooling, drives up both power needs and CO2 emissions. Hence the need to think energy efficiency.

Sustainable cooling solutions

I am fiercely passionate about supporting the development of technologies that cool people, products and the planet. Inevitably, the International Energy Agency (IEA)’s recent report ‘The Future of Cooling’ caught my attention. It shows that cooling appliances account for about a fifth of the total electricity in buildings around the world, or 10% of all global electricity consumption. In a nutshell, cooling is the strongest driver of growth in electricity demand from buildings. Just three countries — India, China, Indonesia — contribute to half of it.

Therefore it’s crucial to lead the way towards a sustainable cooling sector. We need to start today. We must follow a path that focuses on the best available technology and helps reduce the impact of cooling on energy demand and CO2 emissions. Smart energy solutions such as district energy, thermal storage or heat pump technology can combine heating and cooling cycles, and enable other innovations such as heat recovery. Combining cooling and heating synergies is highly energy and resource-efficient, and an affordable solution to help stabilize the wider energy system. Consider the next two examples of solutions that do exactly this.

Have you read?

• China is drinking more milk. Here’s why this could be bad news for the planet
• The power of money: Cash payments can convince people to do the right thing
• What a smart fridge tells us about the Fourth Industrial Revolution

Looking into the future with heating

Remember the ‘hand behind the fridge’ illustration? The cooling process produces heat. Traditionally, the heat is not used, just released into the air. Heat recovery is an innovative process by which we recover wasted heat and integrate it into the local energy system. This is a new and attractive way to make cooling more efficient.

Think about your local supermarket. Its refrigeration system generates a lot of excess heat while it cools down your ice-cream and frozen pizza. With a heat recovery solution, supermarkets can instead recycle that heat and use it to warm the store or provide hot tap water. For example, heat recovery from milk cooling systems can be used to pre-heat washing water, giving energy savings of 60%. Supermarkets can also sell heat to local heating plants and distribute it through district energy systems. In the end, heat recovery solutions can save energy for other uses and reduce pressure in the cooling system.

Buildings are part of the solution

What if buildings could deliver more energy than they use? We already know the growing demand for space cooling calls for technologies that can maximize energy efficiency. But did you also know that buildings offer the flexibility necessary for more innovative solutions, and can play a significant role in smart and integrated energy systems?

We can change cooling demand by starting with buildings. District energy is a future-proof system, connecting electricity, heating and cooling, demand and supply, all while utilizing big data to forecast and level out system peaks to increase efficiency dramatically. The same supermarket that uses a heat recovery solution, if integrated into the larger energy system, can unlock excess capacities that amount to 70% of a compressor’s cooling capacity.

These kinds of innovative, smart solutions require collaboration and a collective mindset. All the technologies exist today, but they are mostly utilized in “silo” fashion. Unlocking the enormous synergies derived from true connectivity and collaboration can turn a problem into a solution. It can lead the way to smarter, more efficient energy systems all over the world.

Achieving efficient and sustainable cooling for all

Increasing the availability of energy-efficient cooling technology is the solution to avoid facing a “cold crunch”, as the IEA calls it. System thinking must be front and centre of energy efficiency solutions. Integrating heating and cooling sectors can deliver huge efficiency gains. Cooling is not luxury — it is an essential part of our modern society. If we manage to do it sustainably, we can also keep the planet cool.

The technology is already available, and we need to call on governments to do more around efficiency. Policy interventions can address the problems that result from the growing demand for space cooling, and can have a significant and rapid global impact. The right policy action is critical to ensure a sustainable path to the future of cooling, and allow people to stay comfortable without straining energy systems or the planet.

Building codes that reduce cooling needs, and implementation and enforcement of efficiency standards for ACs are key to meeting the world´s space-cooling demand in a sustainable fashion. The average energy efficiency of the global stock of ACs could more than double between now and 2050. But without strong regulatory measures, efficiency could still be 40% below that of the most efficient ACs on the market today. The technology is available. From where I sit now, only policy action can put us on a more sustainable track.

Originally published at www.weforum.org.

Hot air behind your cold fridge? Why the future of cooling must be sustainable was originally published in World Economic Forum on Medium, where people are continuing the conversation by highlighting and responding to this story.

Elsie S. Kanza, Head of Regional Agenda — Africa, Member of the Executive Committe, World Economic Forum Geneva

At the 2018 World Economic Forum Annual Meeting in Davos, leaders from the world of business, government and academia were charged with finding ways to strengthen cooperation in an increasingly fractured world. Headline growth at the time may have been healthier than at any point since the Great Recession, but it masked deep divisions, both within societies and across borders.

South Africa, under new leadership and buoyed by the beginnings of an economic upturn, stood out as a beacon of optimism. Its government under President Cyril Ramaphosa is determined to herald a new dawn for the country. It has succeeded in building trust among the international community for the reform programme that it knows is necessary to place South Africa’s story back on track.

Now is the time to turn goodwill into action. This week, at the invitation of the World Economic Forum, 70 leaders from global businesses will convene in Johannesburg to advise and devise new ways that the private sector can help tackle the country’s deep-seated challenges. They are here because they know that South Africa’s government cannot provide solutions on its own, and they know that a prosperous, fair and inclusive South Africa is in their long-term interest.

The top priority for business is making South Africa a magnet once again for investment. The world’s best businesses want to invest and create jobs in the country — that was clear from the Annual Meeting. The challenge is rebuilding an enabling environment that allows competition to flourish. According to the Global Competitiveness Report, South Africa’s long-term competitiveness is in decline, not simply because of chronic challenges such as education, but also in areas of past relative strength, such as the quality of its institutions and financial markets. This decline suggests a complacency that cannot be allowed to continue.

Have you read?

• How to rebuild trust and integrity in South Africa
• Africa’s inspiring innovators show what the future could hold
• The era of doubt: How we can learn to trust again

The ultimate goal of investment is to create jobs and a more prosperous society. The urgency of this task is not lost on South Africa’s leadership, but the global transformation of labour markets is one megatrend that no government alone can fix. Economic anxiety stimulated by automation and globalization is driving political agendas across the globe. As it looks to diversify and strengthen its economy, South Africa needs to attract more manufacturing jobs. But it must go further, with nothing short of a massive reskilling drive to equip workers for success in the 21st century.

Improving the job prospects of South Africans is important, but so is building a fairer society. According to the Forum’s Inclusive Development Index, South Africa is one of the most unequal countries in the world. Wealth and incomes are highly concentrated, yet 36% of the population are considered poor, with a median consumption level of around $5 per day. A more inclusive growth model is urgently needed, one that encourages entrepreneurship, takes a zero-tolerance attitude to corruption, discourages rent-seeking and unproductive investing, and provides a safety net for the displaced.

Lastly, global business leaders want South Africa to prepare for the Fourth Industrial Revolution. Technology is rapidly altering the terms of global trade, disrupting not just job categories but whole industries. The implications for South Africa are profound and require a complete rethink of development strategy. This means going beyond traditional manufacturing and services industries, and applying the technologies of the future, including the blockchain, big data analytics, artificial intelligence and drones, to put South Africa in the big league of future-ready economies. This approach must not be seen as simply one option; the country cannot rely on a jobs bonanza from manufacturing, as other economies have in the past on their way up the development ladder.

South Africa’s challenges are not going to be fixed overnight. Building a fairer, more prosperous and more resilient society will be an ongoing endeavour. It requires restored trust and faith in institutions and governance. It demands commitment and energy from all of the country’s stakeholders, from civil society and labour unions to business and government. The international business community stands ready to play its role in supporting this great transformation.

Originally published at www.weforum.org.

It’s time for the world to stand up behind South Africa was originally published in World Economic Forum on Medium, where people are continuing the conversation by highlighting and responding to this story.

John Moavenzadeh, Head of Mobility Industries and System Initiative, Member of the Executive Committee, World Economic Forum LLC

Nikolaus Lang, Senior Partner and Managing Director, The Boston Consulting Group

Few technologies have generated more excitement than autonomous vehicles (AVs), and with good reason. AVs will not only change how people get around cities, they will change cities themselves.

However, AVs are not a panacea. Cities around the world should anticipate both positive and negative outcomes from our autonomous mobility future, then actively explore policies and incentives to move us toward positive outcomes.

To understand the impact of AVs on the world’s cities, the World Economic Forum and Boston Consulting Group recently completed a three-year collaboration. We started by building a global community of AV-savvy executives from across the industrial spectrum, from automakers to software companies to insurance providers.

To ground our thinking in reality, we decided to collaborate with a real-world city to catalyse actual testing of AVs. Additionally, we wanted to understand how consumers are likely to adopt AVs and what the impact of AV adoption would be on city streets. Boston emerged as the winner among ten applicant cities, and we kicked off our collaboration with Mayor Walsh and his transport team just under two years ago.

Understanding consumer adoption of AVs

We started by focusing on people. We asked more than 2000 Boston-area residents to choose among eight different transport options when presented with a specific travel situation (e.g., getting to work on a rainy day). Some of these eight transport options exist today, such as mass transit, personal car or taxi and ride-hailing. Some are future options, such as taking an autonomous personal car, autonomous shared taxi or autonomous minibus.

We expect the percentage of Bostonians opting for mobility-on-demand services to swell from 7% of trips today to 30% by 2030. Of those mobility-on-demand rides, we forecast 87% will be in autonomous cars, taxis or minibuses. Whether they are opting for shared services or not, more and more people travelling short distances are likely to turn away from walking and mass transit, choosing on-demand vehicles instead.

While most of the shift to mobility-on-demand comes at the expense of personal car trips, our analysis also anticipates a slight decline in public transport use across the Boston metro-area. Within the city limits of Boston, we anticipate a decline in mass transit use from 47% of trips today to 33% of trips by 2030. Furthermore, the shorter the trip length, the more likely consumers are to choose autonomous mobility-on-demand options.

Quantifying the impact of AVs

What does the increased adoption of (predominantly autonomous) mobility-on-demand services mean for cities? The next step in our research was to simulate how people and goods would get around Boston in the future, utilizing real-world data from the City of Boston and companies such as Inrix and UPS. The simulation, built by BCG’s advanced analytics arm BCG GAMMA, modelled traffic patterns across the entire city of Boston and used the results of the consumer study as the input. It took about 20 hours of computing to simulate 24 hours of traffic.The results showed that if Boston were to adopt AVs and mobility-on-demand as we expect, then overall travel times across the city would be reduced by about 4%. That’s not bad, but it’s not a radical transformation either.

However, when we dig into the analysis by neighbourhood, we see that travel times in the Boston downtown core would actually increase by 5.5%. AVs will make traffic worse in downtown Boston, not better. Most of this is caused by substitution away from mass transit to mobility-on-demand surface vehicles. However, in the Boston neighbourhood of Allston, on the outskirts of the city limits, average travel times would improve by 12%. Allston is home to many students who attend nearby universities and often walk, bike or take mass transit to class. We expect the number of people commuting from Allston to downtown by personal car to drop significantly as commuters opt for shared, autonomous mobility-on-demand services.

Another important finding from the simulation was that the number of parking spaces needed in the autonomous future will decline by 48%. Imagine the opportunities as we free up half of city’s the on-street and in-structure parking spaces.

What can cities do?

Which policies and incentives can nudge us toward a more positive outcome? How can we avoid a congested AV future? We identified three potential policy levers to enhance the positive impact of AVs:

- Creating occupancy-based pricing schemes

To reduce the number of vehicles on the road, cities should implement financial incentives that discourage riding alone. By charging a higher fee for single occupancy rides, more and more people will be encouraged to choose shared transport options. We tested this theory with the simulation and results indicated a 15.5% travel time improvement, compared to the current situation.

- Converting on-street parking

With increased use of mobility-on-demand services, fewer parking spots will be necessary. Cities could utilize the curb area as additional lanes for motor vehicle traffic and bikes, or as dedicated zones for picking up and dropping off passengers, or urban logistic zones for deliveries. The simulation indicates that converting on-street parking will yield a 10% improvement to travel time, compared to current times.

- Dedicating lanes for autonomous vehicles

Cities across the globe have high-occupancy vehicle lanes or bus lanes to keep traffic flowing for travellers using shared mobility services. Why can’t the same be true for shared autonomous vehicles? If they could operate in dedicated lanes, travel time could decrease by 8.3%, as indicated by the simulation.

Policy-makers must strategically prepare for what’s ahead now, rather than react later. The results of the simulation clearly point to a future of inconsistent benefits and challenges from autonomous transport.

Scaling up an AV pilot in Boston

From the beginning, Boston was eager to complement research and analysis with in-field testing of AVs. The city hosts a rich ecosystem of talent in both software and robotics, two pillars of AV technology.

In January 2017, soon after we initiated our collaboration with the city, nuTonomy began the first autonomous vehicle testing on the streets of Boston, confined to a small zone known as the Raymond L. Flynn Marine Park in the city’s Seaport district. Last week, Boston announced an expansion of its autonomous vehicle testing programme — from the Seaport neighbourhood to the entire city.

How did Boston move so fast to embrace this exciting new technology?

Our report highlights a number of success factors that have helped Boston elevate itself to a leader among US cities in AV technology and policy deployment. Three in particular are worth highlighting.

First, Boston took the time to understand what it wanted to achieve with its transport system. The city conducted an exhaustive study, called Go Boston 2030, to understand the transport needs and desires of its citizens. The result was a clear strategic focus on three simple objectives: safety, reliability and access.

Second, Boston created a tiered testing plan with clear achievement milestones. Finally, it sought to familiarize people with AVs. It deployed a concept devised in one of our workshops called “the AV petting zoo”. In October last year, the city hosted a Robot Block Party that featured several AVs.

As more and more cities launch AV pilots, city leaders and policy-makers should embrace this innovative technology — and with it, all of the potential positive and negative changes to the cityscape. Policy-makers must develop measures and incentives just as innovative to unlock the full potential of opportunities from AVs.

The full report, Reshaping Urban Mobility with Autonomous Vehicles, is available here.

Originally published at www.weforum.org.

Autonomous vehicles could clog city centres: a lesson from Boston was originally published in World Economic Forum on Medium, where people are continuing the conversation by highlighting and responding to this story.

Rigas Hadzilacos, Project Lead, Future of Education, Gender and Work, GLF, World Economic Forum Geneva

After a number of years of economic crisis, can we now be optimistic about the progress of global economies? What are the reforms that should be implemented? What are the implications of the backlash against globalization for the global economy? What would a fractured global economy mean for financial globalization? With the coming of the Fourth Industrial Revolution, do you see new opportunities or tools that can help keep the global economy together?

Originally published at www.weforum.org.

A glimpse into the future of the global economy was originally published in World Economic Forum on Medium, where people are continuing the conversation by highlighting and responding to this story.

Aditi Verghese, Policy Analyst, Investment and Global Value Chains, World Economic Forum

Sean Doherty, Head of International Trade and Investment System Initiave, Member of the Executive Committee, World Economic Forum Geneva

The Trump Administration’s announcement in February of new steel and aluminium tariffs on national security grounds, including on imports from allies like the EU, have set the stage for escalating trade tensions. The EU recently imposed retaliatory tariffs on products ranging from bourbon whiskey to motorcycles. The US President hit back with a tweet threatening a 20% import tariff on autos and auto parts, telling manufacturers: “Build them here!”

A number of US-based firms have voiced concerns over supply chain disruptions from trade wars. Harley Davidson stated that it would be shifting production aimed at the EU market outside the US to avoid the additional tariff burden, exemplifying the unintended consequences of this approach.

Earlier this month, the US announced a 25% duty on around $50 billion worth of Chinese imports on the grounds that they utilize intellectual property obtained from US firms through forced technology transfers or theft. China’s Made in China 2025 plan was named and scrutinised in the report. UNCTAD estimates that, like China, more than 100 countries have formal industrial policy strategies, many of which involve joining and benefitting from global value chains (GVCs). Tariff wars undermine growth models that rely on the benefits and efficiencies of globalization.

We asked policy experts and business leaders: how can countries really reap the economic and social benefits of GVCs, while avoiding inequality and environmental damage?

Don’t neglect services: Much of the recent talk of bilateral trade deficits has overlooked the importance of services to the global and national economies. Factors affecting services competitiveness have become important for economic growth and development more generally. Investment in human capital, digital infrastructure (including reliable mobile broadband), efficient and flexible domestic regulation and connectedness with international markets (including open cross-border flow of data, visa facilitation and mutual recognition agreements) are key. The services sector has strong inclusiveness dimensions: it is more SME-intensive than the goods sector is and has more women workers, owners and managers.

Co-operate on competition policy: Various anti-competitive activities by firms impede the efficient operation of value chains. Today, there are over 100 jurisdictions administering competition law. In the absence of global rules on competition, each jurisdiction applies its own system. Firms can find themselves facing conflicting decisions from different authorities with respect to the same merger or other activity. This leads to the most interventionist ruling of a major economy being enforced. In the case of digital products, questions of jurisdiction and enforcement are all the more challenging. Greater cooperation between agencies would improve clarity and reduce gaps in enforcement.

Prioritise tax certainty over incentives: In an attempt to attract GVC-linked foreign direct investment (FDI), many countries engage in harmful tax competition to woo multinational enterprises (MNEs). However, for the most part, FDI tends to be more sensitive to tax certainty than to tax incentives. Enhanced consistency in tax rules, interpretation and enforcement across economies and better cooperation between authorities help foster certainty. That being said, tax credits for education and training could help build a workforce suited for high-demand tasks through public-private partnerships. These and other programmes would need to be designed and monitored carefully to avoid tax evasion or aggressive tax planning by MNEs.

Incentivise sustainability: MNEs play a key role in coordinating activities and actors along the value chain. They set private standards that suppliers and affiliates have to meet. An increasing number (over 550) of these standards are sustainability-related. As these can be difficult for small producers to navigate and meet, coherent standards and simplified procedures are needed. Many big, consumer-facing brands are seeing greater demand for sustainably-sourced products from their customers. Others are finding ways to raise capital by tapping into investor appetite for sustainable business operations.

Implement doing-business reforms: Since MNEs play such an important role in GVCs, creating an enabling environment that attracts and sustains FDI is crucial. This involves reforms that cut red tape and corruption, improve infrastructure, provide quality education to the workforce to enable them to work in modern production chains and ensure that companies operating in the country have access to foreign exchange so that they can pay suppliers and repatriate profits.

So far, the tariff war has been just that: a tariff war, limited to the use of import duties on goods. Soon, though, the US is expected to release details of how it plans to restrict Chinese investment in US companies where it deems it a threat to national security. Meanwhile, the Chinese government could make things difficult for US companies operating in China — by imposing regulatory burdens or encouraging consumer boycotts. It could choose to block mergers, such as the one proposed between the US firm Qualcomm and Dutch firm NPX. The EU could consider retaliating against US banking and insurance companies and taxing digital services, hurting US tech companies.

Short-sighted, protectionist measures ignore and erode the opportunities that GVCs provide for driving inclusive and sustainable growth and do nothing to optimize outcomes.

Have you read?

• This is why US tariffs are likely to hit low-income families hardest
• These 5 technologies have the potential to change global trade forever
• How migrants who send money home have become a global economic force

Originally published at www.weforum.org.

Trade wars won’t fix globalization. Here’s why was originally published in World Economic Forum on Medium, where people are continuing the conversation by highlighting and responding to this story.