Mehr Einsatz Wagen Folge 79: "Why Health is the Foundation of Democracy" with Bogi Eliasen

Where do health, technology and democracy intersect?

How do we invest in society?

And what, exactly, is a silent disease?

This engaging conversation explores these questions and more, touching on:

Health as a Democratic Right – Why health literacy and prevention are essential for resilient societies.

Data & Dignity – How individuals can reclaim agency in a world of personal health data.

Future of Health Systems – Moving from acute care to prevention and wellbeing.

Work, Aging & Purpose – Rethinking retirement and value in an age of longevity.

Futures Thinking – How scenario planning helps design desirable, actionable futures.

Our guest Bogi Eliasen shares insights from his work at the Copenhagen Institute for Futures Studies on reimagining health systems, social contracts, and dignity in the age of data and longevity.

This conversation challenges us to act — to build prevention into policy, and to see health as the foundation of democracy itself.

Listen and discuss with us in episode 79, on why  “We can’t solve digital challenges with analog legal mindsets.”

Schreibt uns Eure Kommentare gerne an MehrEinsatzWagen@healthcarefuturists.com und vernetzt euch mit uns auf unseren Social Media Kanälen.

Transcript

Mm, let's get started. Today is Thursday, September 26. We are in Bad Hofgastein at the European Health Forum and I have the pleasure to be speaking with Bogi, do I pronounce it correctly? Bogi Eliasen. Okay, perfect. Yeah. So, a pleasure having you here. We go back quite some time. I was always interested in what you're doing because one of your denomination, if you will, is you are part of the Copenhagen Institute for Future Studies, which rings a couple of bells with me, like an interesting bell. So, please introduce yourself and then probably also tell us about what the Copenhagen Institute of Future Studies does. 

Bogi Yes. So, I am from the Faroe Islands, so I am, you know, a small island, far away guy. And why do I start with that? Because I do think, and I will come back to that, that this gives us strength in dealing with modern technology actually. So, I have worked the last 10 years building a health portfolio at the Copenhagen Institute for Future Studies and the Institute was established in '69 by a former Danish finance minister and the first OCD general secretary. So when he came back to Denmark in '68, I think, he wanted an independent think-tank, so that was not dependent on the public nor the private side. And this is what the Institute is still doing and this is what I saw a great opportunity in health, so you could begin to bridge across sectors, but also across the public-private philanthropic side and between countries, which I've used a lot. And then also going back to the institute, so it is actually called Copenhagen Institute for Futures in Plural Studies. So what we do a lot is to work with scenarios, but also to imagine possible futures as imagination in order to change things. So in order to improve things, not always, but often, it might be good to think, what does good look like? What is it that we would like to have? Or as a famous children movie also states, if you don't know where you're going, every road will take you there. 

So it might be important to go forward in that way. I love this one because this is the children's side of if you're a sailor and you don't know which harbor you want to go, no wind will be good for you. But I rather love the children part of it.

Before I came to the institute, I worked in my native Pharos with building what was the first Population Genome Project. So I worked with the big persons around the world in trying to figure out how do we actually make this usable, not just for research, but actually having direct impact for people. The Pharos this was of course interesting also because it's a very small population that has been very isolated for a long time, so you have some bottlenecks of diseases, so inherited diseases. So there was more readiness in the population to think about genomics. But nevertheless, being very early, I got my ears into all the ethical, different challenges. But I also learned after some time that only working inside one discipline is very interesting, something that alone that cannot change the world. The second part which made me want to work at the Copenhagen Institute for Future Study was also that I saw a lot of potential getting lost because we did not prepare the society for what we knew was coming. So the readiness in the society, the readiness for regulation, the readiness for decision makers was not there and not even the comparative or side technologies that you needed to link with in order to do that. So the personal/society readiness and the technological readiness as well as the behavior that you to put to it. So that is what I've pushed a lot. But I can also say that at a very young age, I spent two years in Brazil. First as an exchange student in high school, and then I went to work a year before I went to university. And I was much easier just to go to school than to work in Latin America at that point. I also spent some of my spare time working with street kids. 

And that has always been one of my goals on working, is saying eventually what I do needs to reach these persons. So not saying is the first thing that will happen, but it has to have the possibility to go all the way. So that's one thing. And the other thing here is that I came to Brazil as an exchange student in 1919. So this was just after a military dictatorship, so the transition to democracy. And I was horrified by what a dictatorship for three decades actually does to a society on the way of thinking, on the way of discussing, on the way of being open to different ideas. And this has been one of my drivers also for my studies in political science. So it's a lot about democracy, but also now working, for instance, with Nordic health that we will discuss a bit more on health as the most important pillar for society. Not just to provide health, but actually to keep a healthy democracy in that way. 

It's like what I always say democratize health care and it's like, yeah, not just looking at health care, but also keeping people from being ignorant against their own body or against the state body, if you will, and to take good decisions. 

That is the one pillar. And the other pillar is that we are talking a lot about right-wing movements, extreme left-wing movements. But in reality, these are decades of left-behinds. So this is the other way of democratizing health, as you are saying, and also to make sure so with health literacy that we actually get those who potentially need it the most, but that we, to a large extent, are leaving behind. So right-wing movement is not something that happens from one day to That's something that takes time to come up. It's interesting. 

I do a lot of work with insurance companies on prevention, and especially the private insurers in Germany. They tell me, "Look, we do a lot of preventive programs, but they are only being used by people that don't need them, because they understand what's going on. They treat their body well anyway. And those who are in need of it, they are ignorant to it." 

Yes. And this is about literacy that probably needs to start in school. So if you look at meta-studies that look at what is it that gives good health in your lifespan, I think the average number says that it's only 13% that's clinical. The rest is behavior outside. And some of us are lucky, like us two. We got it from home. But some are not so lucky, so that should also be a part of schooling. But now I do think going forward that there is a huge challenge with everybody because of excessive screen use. Suddenly you have a boom in different kinds of vaping and stuff which you don't really understand in a knowledge society why does this happen. And here I do think that we need to go back and say what is the civil society's obligation in working with this. It's too cheap to say it's a political problem. We are giving too much power to politicians. We need to take back as individuals, as civil society, as companies, as administrators in the public sector. We really need to step up and take responsibility back and work with the politicians but not expect that they can solve the issues for us. So yeah, and I think this is what you are putting on the table here. I think it's very, very important for several reasons. So one part is – and I would add the insurance companies into this in different ways. Of course, they're different in different countries. So what is happening now is that you as an individual potentially has a lot of data on you. So the insurance companies are not sitting with the upper hand anymore and they are scared. They have until now always known more about you than you did. 

This moment just arrived. You know, I read an article by Otto Oles about that who said that now the point is near where we have more medical data through smart watches and whatever of ourselves than the government and insurance companies. 

What it is – and this is then also moving back to the doctor's side or the health system. So we can – I mean the society with technology is not going to roll back. So you can choose – do you want to be a part of steering or do you just want to be steered and be conservative and saying this is not good. And everything in development is not always because this is the best scenario but it's there. So what do you do on those part? Just for an example, in Denmark in the late 80s, you had protests in front of the parliament against in vitro fertilization. From left-wing parties, you know, those who would be – what you would say would fight most for human rights. Okay? Thirty years ahead, same group of people – not the same people – same group of people are demonstrating in front of the parliament for free in vitro as a right to everybody, no matter which sexual orientation you have. So things change, right? And ethics change and sometimes you forget it. And this is why I'm really trying to develop dignity as a concept to work with because ethics becomes politicized. But dignity we understand. Are we actually doing something with dignity in mind? Are we helping this person with dignity in mind? And here I think – I mean, you're a doctor yourself, but you are a very open-minded doctor doctor as well. 

If a person can be given agency, capacity to take care of themselves or part of the self-care, of course, that's a part of respect of dignity if you can take it. There will always be ten to twenty percent in a society who need much more medical help than the rest. So if we help these eighty percent to be more self-helped, we have much more energy to help the ones who need it the most. And this is where we are failing in our health systems today. This is why it's breaking apart. We are not doing that. 

And this is basically also what happens in the educational system. So if you look into nowadays classes, there is like in twenty or thirty children there are two or three that need a lot of attention and the other twenty-sevens are just being left behind. So, obviously, we are facing an issue here. Just talking about dignity, it just so happens that part of the German constitution talks about dignity, it's like the human dignity is something that cannot be sold. It just comes with being a person, being a human being. 

Well, so this comes back to what I also have focused a lot on also in my Siena work with Elona is social contract. So when we have a health system, we do risk sharing. It doesn't matter if it's public or private or philanthropic or a mix. It's a risk sharing. And a risk sharing is a social contract. So everybody pays in. And when you need help or if you need help, you will be helped. 

Like the rich for the poor, the healthy for the unhealthy, or for the sick one? Yeah. 

Yes. You could say it. If you are a part of a Krankenkasse, you pool your resources. Right? You never need anything but if you need, you get help. But how about the conflict in different systems? 

Well, there might be some systems like the NHS where everything is government funded. Then there are systems like the German healthcare system where you also have private insurance companies. And there's a lot of talk in the press, they do not take part in this kind of risk sharing. 

No. Well they do, but just in pockets. Right? They're not going to buy home pockets. Yeah. So, but there's a bigger picture here. So we have moved from a society which was first based on city states and then to countries. So, our social contract was very geographical with those we saw and could see. 

And then the last twenty years. You're not going back to the ancient Greek time, but you going back to the medieval times where you had these little towns with walls around. 

Austria where we are now and Germany where now, that was pieces in different ways. So, what happens over the last twenty years, maybe a little bit more, is that we become also online as well. So, for instance, if you have a rare disease, it's fantastic because suddenly you can connect. When you like Spanish and English football, it's fantastic for me because I can almost be there. Right? But it changes our next of kin feeling on who are we responsible for, because a part of our life is online, not people that we are connected to, not people that we are in the same tax jurisdiction with. And nobody has really tried to figure out, what do you do when this happens? So, if you look at all the legal frames, also the ones in the European Parliament, and all these big dreams on how we control data and all of these things, is made with an analog teutorial mindset. Right? Okay. That's right. And somebody is probably going to be angry with me of saying this, but we are not going to solve digital challenges and open the opportunities by trying to force-fit it into analog legal mindset. So, what are you saying? 

if I wind it back into the Copenhagen Institute for Futures. 

The future is not the linear prolongation of what happened in the old times, but it's somehow fuzzy so we don't know. And obviously what you're saying, politicians are trying to do this linear because they are being used to linear. Yeah. 

Yeah, that's a part of it. But it's also that those are the tools that we have to work with. So, this is where we do a lot of work, for instance, in the Nordics, where we sat down and said okay. And this was in 2018-19 where we start to develop this part, saying, okay, we can see that we get a population that is much older, which means that if you keep your retirement system, there is an imbalance there. And then of course, we have had a bigger rise in disease burden than we thought would happen. A lot of it avoidable and unnecessary, but that's the factum. And then we have a health system which was created 100-150 years ago, focused on acute. So, communicable diseases, very, very acute diseases, and accidents and violence. Right. But the whole system was built on. So, the training, the recruitment, the building of the physical buildings was all made on acute. And now we are seeing that the health systems are being strained, are being stressed. There is a lot of burnout. A part of it is, of course, because of a bigger disease burden. So, the reason why it becomes so big is that we are dealing with chronical disease that you could catch very early, in a very lean manner, when it becomes acute. And of course, then you get a massive flood of this suddenly. But also, the healthcare personnel are trained for and recruits for acute. It's not for the long-term caring in that way. So, we probably also need to reconfigure what is it we do when we provide health. 

And the reimbursement is also not about being preventive or being decision-shared, but it's more about being acute. And it reimburses those who are working in acute care. Let me revert a little bit on, in this matter, on the social contract. In the old days, the social contract was you give money into some pension fund or some insurance fund and then people retire at the age of 60 and they live till the age of 70 and that's it. So, those were the proverbial good old days. Now, if you are in your 40s and 50s, you have to provide for your own kids. You have to look after your parents. You have to provide for yourself, which puts a lot of stress on things. And if demographics just carry on going as they are going, this might be a disaster for the social contract. Because at one point in time, when our kids will be in this rat race position, they'll probably say, "No, you know what? I just can't do this anymore." 

Yeah. So, yeah, I think there are a couple of things really to look at. So, the one-size-fits-all health system with protocols and standards and really going through vaccinations has been very good for So, we have moved the average lifespan from around 30 to almost 80 in some part of the world. So, that's fine. But it's also outlived. So that's a paradigm. So, it's not because we have to throw it out, but we have to reconfigure and build a bit on top, but much on the side. 

So, we have moved the average lifespan. But the peak lifespan has not moved for all times that we know of. So the oldest, they don't get older. 

The oldest, they never needed the health system. So, it's not because – so, when we see projections that we will be 200 years in five decades, well, 

maybe a magic pill will come, but not with the knowledge and trajectory that we see right now. So that's one side to take in on it. The other side is – so, there are some really hard questions to take in here. So, I work a lot with trying to push secondary prevention understood here for chronical disease. So, we have developed genomics, imaging, use of data, biomarkers, so – and nanotech will come in with bots inside that will give us automatic information, all of these things. So, if we are not going to do that to catch things earlier, more precise, and then have many more years with good health, there is no reason to do it. So, you're going – you're underlining preventive medicine here? Yes, but I think the first step is to do it early onset or chronical diseases today because then you can prove that this actually works. I mean, I've tried, just like you, really to talk with people about primary prevention, but nobody's interested in paying. So those who get the benefit, they are not interested in investing in it. Maybe it comes. So municipalities, for instance, they are sitting with people who should be active, but are not active because they have an avoidable disease burden. That should be prohibited. So they should be interested. Insurance companies and pension funds, well, they don't really want you to have a long line after you stop working. You know, I've told them, so they laugh when I say it at least in closed rooms. But that is the reality. But we need to find a way how we get them interested. So how does this become a win on those parts? 

This already has started. You know, if you look, we were talking about prevention beforehand. And I see the longevity movement is something like that. But as I said, you know, prevention is, according to the private insurance company, just being used by those who don't need it in the first place. I agree. We see people coming up with healthy longevity and expanding their lifespan to 120 and exercising and so forth. But it's not there for all because it's costly and it takes some time and it takes some time also to, you know, look after your body and to understand some context. 

But there are low hanging fruits and or as I learned from a doctor in Denmark, heavy low hanging fruits. So the Western disease is over processed food, right? Too much drinking, still too much smoking, these kinds of things. So this is something that we probably will focus more on. In the 30s, we had commercials on cocaine for tooth pain, right? So sometimes things just change. 

So that is one side. The other side is, which I'm trying to work with and which we're trying to do in the Nordic is to say, okay, what happens if you just imagine that health is an investment that creates value in society? So the first thing here is that you have to separate money and value. So money is a part of value, but there's a lot of value that's not money. So we are not monetizing or we are not valuating health as a monetary value in society, but it has a huge value. So well-being economy is a start in trying to think about these things and we will not get to prevention before we figure that out. So how do we provide value on those parts? Then there are other things here on which we work with or are trying to figure out is, can we articulate a cost of inaction? So what is the price for society on not having the population as healthy as it could be, right? That doesn't mean that everybody needs to be super, super, 100% fanatically healthy. But today, our estimation is that 30% of the disease burden that hits our health systems in the northern part of the world, specifically the chronicle disease, which is almost 90% of the disease burden, is totally avoidable if we got the timing right and if we got the diagnostic better at the first stage. Like you're talking about diabetes type 2, COPD, lung cancer… Yeah, and we have just worked very deeply the last year with COPD and just released an index and a deep report on it. So over 90% is totally preventable, right? And this is the third biggest killer, third biggest cause of disease. It hits the weakest in society much more than others. So it's also called the silent disease. So these are areas where if we got the guidelines into place, strategies for all countries, you could probably reduce this a lot, very fast. 

Yeah, so we are getting much more focus on the non-communicable diseases now and there is a big meeting next year on the side of the UNGA, of the UN General Assembly next year, so it's the fourth meeting in three or two or three decades on this. So it's getting on the agenda because the reality is that our society cannot handle the way we are dealing with diseases today. So there are movements, but when we come back – so to touch this back to the social contract – so what we are not doing is really thinking about, OK, when you have a social contract and you have a system where we help each other and it's very data driven. Have we ever sat down and said, OK, we want to work with the big tech players, we need to do that. But have we ever said to them, you can't just reap all the value out. We want – we pay for your services, but we need the data value to circle back into the system so we actually can help people better. So, these hard discussions are not really being taken. And if we – and going back to what you said with the pockets of the rich and then the rest in different ways – that will be growing if we are not taking these hard discussions on what is it really we want. Another part which we know from very good Danish data is that when people retire from one day to another, is actually very bad for most of the people for their health. It's more or less 10% who are fine with it and then there are probably 20-30% who are OK. But at least half do really get a worse life of retiring from one day to another because you work full-time and the next day you don't work. 

Let's dwell a little bit on the retirement kind of thing because we were already talking about lifespan increasing. We're talking about the issues it will have when you retire at the age of 65 or 67, whatever, given the lifespan is longer and the time you spend on retirement money is longer. So, the impact on society will be bigger. However, it seems that we haven't yet learned to understand that you might have a third or a fourth career, like you might have a second or third career in your 50s and you might have another career in your 60s. But we still consider the human workforce to be something like, yeah, we need people that are young and fit and then there's a decline, there's a steady decline. Once you turn 50, it trickles down and then you are in emeritus by the age of 65 or 67 and then they just let you off and you do some lemon tree harvesting and let the other guys do it. Do we think we need to rethink as a society, even especially given the demographic change with the boomers now going into retirement?

Yeah, so that is one side of it, but I think there are other aspects. So, we are too technology focused. Technology is a tool, right? And I've had the luck to work with very, very strong but old, fairly old people from a young age. And of course, if you ask a 65 year old to set up the newest digital gadgets in the next half hour, that might not be the right fit. You know, I've not looked at a manual for something for many years because I just throw it to my kids, you know, teach me how to use this. And… But what happens is that the experience of life gives you a calmness to see, firstly through bullshit and secondly, not to get, you know, put off course because everything is not working. So, you have that experience, senior people with experience to make plans, to have things run smooth are much more efficient than young people. There is no doubt about that. But that value has gone lost in society somewhere. So, probably we need to get back to those, maybe we are just two old grumpy men. I mean, who knows? But… But then, again, the reason for staying alive is that you need to wake up to something, right? If that's a paid work or voluntary work or what that is, doesn't really matter. If that's true, right? And a part of society is, and again, money and value, is that everything should not be paid for, but you need to have people on a decent living. So, dignity again. That's right. 

And… Which is a very Nordic aspect in a way. 

Yeah. Yeah. Yes. But, of course, you should have the right to a good senior life. But as you said at the beginning, this was 10 years, you know, when this was made. And now, for some people, it's reaching 30 years. Because even if our average lifespan is like 78 or 80 or 82, depending on the consciousness you look at, the ones who reach plus 60, 65, they actually… their average lifespan is actually quite more than that. So when we say average lifespan, it calculates those who died younger. So sometimes we forget in this longevity discussion that it's not… then the data is actually worse than what we think on those parts. 

Yeah. It's like this one statistic flaw that said, actually, smoking prolongs your life. And they just… we're just measuring the people that lived beyond 65. Because if you die… if you don't die before 65, because of you… because you've smoked, then, of course, you live longer. Yeah. So, yeah. Statistics is all to it, isn't it? Yeah. 

So I think… so I do think, and I've worked also with labor unions on this years back. I think there is also a need to rethink what does it mean to work in different ways. So firstly, our structure, just like our health system, is very backwards thinking. Our labor market structure is still very much when it was very manual, which is not the case. A lot of jobs can be done from wherever. So a taxing issue will also come in. You know, do you tax more where people are than what they do, which will probably be a need in many countries where you don't have property tax in those ways. 

And then it also comes in that maybe you should just stop working full time when you turn 60. Maybe we should just work half time as a default, as a design. because people when they reach a certain age, they probably can do much more for a longer time if you work two or three days a week instead of working five days a week. Oh, you mean they're more effective then? Yeah. Yeah. 

But this all is also to a decent living. You know, if you still need to pay down your mortgage at the age of 60 and then you need to cut down by 30 percent. Probably then you run into trouble and your children are off to university. Yeah. 

Yeah. Yeah. But here is, you know, the scenario thinking and what is the future we want? Who says that they need to go down on payment? 

I totally agree. And this will bring me to the idea of scenario thinking. And because I'm very interested in methodology of foresighting or future studies. I like the word futures because it's it's not the one future, it's it's, and then I like the German word for future, which is Zukunft. And it means, "Es kommt zu." Which means it comes to you, you know, which is kind of interesting. Yeah. Like how we form our language around it. Yeah. So I do know you also work with WHO. Yeah. So you work with very influential people. However, they are still dependent on the individual governments for the governments to put money into WHO. How do we bring about this kind of mind change, which is we need to look at a well-being economy? We need to look how we design for people to get, getting older, how we design the overall work market and workforce, how we design health care, how we provide health care also in pockets where there is no health care so people don't feel left behind and so forth. And I think this is loads of things that politicians are aware of. that in the end of the day, they also need to take structural decisions. How do you do this? How do you work with them? 

Yeah. So firstly, I believe there are several parts here. So one thing is first that, and there are many ways of working with the future. So what I prefer to do is to work with imaginary or plausible, they should not be totally fantasy scenarios, but you have to articulate what would the world look like that we would like to live in. Then you can do a back casting saying, OK, what would it actually mean to get there? And you don't go from the zero to the 100 to say, you go the other way around because you have to say, OK, if we were there, what was the last step before we got there? 

Like if you envision 2035, then you think of 2030 and you think of 2028. And then you think of 2025. 

So one thing is that you get people to leave their daily challenges and say, OK, I would actually really like a world like this or several worlds like this. But what also happens is that then you get a common destination and you only have to be 70, 80 percent in agreement on that this is a good destination. So when you clash, it becomes a challenge to solve. But if you go forward, a clash becomes a war, right? Because you don't have the common, you don't have the goal inside, so to say. So but when we say scenarios, it's also that there are several potential futures. What future arises depends on what we do, right? So bringing the future to you, as you were saying. Yeah, the future is a product of what I do today. Yeah, but but there is also a very important thing when you work with with megatrends and scenarios. It's also to prioritize and be honest. So what what are we certain about? So what will happen anyway? So these are the megatrends. How they play out in different places is not like urbanization, climate change, overpopulation. Yes, but inside those, you know, you can you can then try to say, OK, can I influence 

or can I not? And then you also look at, OK, if I spend 100% of my energy on this, what is the impact? So because what you don't want to do is to end up like Don Quixote and fighting windmills, right? Which is happening a lot. So so this is why you also prioritize impact versus energy that you need to use on this. 

And when you begin to look at these things in these ways and I have never experienced that how I imagined people would agree on that the scenarios for scenarios on a possible future would look like ends up as I imagine, even if I'm trained in this. So so people get also surprised because when you when you then articulate, OK, I would really like this. And then suddenly you figure out that the drivers you thought were going to realize this, maybe they are there, but they are not the main drivers. There are some other drivers that will help. Then the other thing is also what I call to to serve the wave. You need to figure out. So this is with the megatrends. What is really running? So so where can you serve the wave so you can use your energy on other things that that need to be built? And you probably you need to go against the stream somewhere. But you can't go against the stream everywhere. So this is also about selecting, you know, which which battles to to take in it. 

Let me just ask you, you said you were trained. So there's a formal training at the Copenhagen Institute of Future Studies where you can like become a futurist. 

Yeah, yeah. There are courses also for for externals. Yeah, yeah, so so that that is a part of it. But but this is this is also something you need to use. I mean, it's it's the most of the knowledge comes by applying it. 

There you go. And you work with focus groups like if you if you work with if you want to do foresight on how to get older, for instance, you work with focus groups of people that would be affected by this. 

That can be I mean, there are many different ways. So so for instance, in the Nordic Health work, we have had somewhere around 30, 35 stakeholders who were in the process the whole time. And then you work with them on defining, OK, what are the biggest challenges, what where are we uncertain? Where are we certain? And then you build scenarios with them. So where could but there you also go in and you decide on access, what we think are the core drivers. So for instance, in the last one, it was very much on. Do we want a a more responsive, secure system? So one that provides state of the art health? Or do you want one that goes more into the preventive side? And do we want one that is more, more commercially driven or public driven? And there they all said, no, no, it needs to be a mix. So so there we needed to, you know, drive out new dynamics in that one. But what you sometimes forget is that what we call is very conservative on a sick care approach. They can actually be very, very good to provide, you know, cutting edge for very specific things. Voice over: Right. Those things that give Nobel prices, you, you won't necessarily get that in a system that will try to help the many much more, right? So there are straight off in that. And that's also something and you said, how do we change this? We actually need to talk with the population about that. There are different ways we can go because the reality is that our politicians, they're responding to public demand and the public demand is cut me or give me a pill. So, okay, so this is where the democratic part comes in again. 

But how, how do you do this in normal? It's like, do you, do you publicly broadcast? Look, those are the potential future scenarios. Please give us your vote or write a comment on, on our YouTube channel. Or how do you make this public? You know, how do you actually make people aware of these kinds of things? Because in their everyday life, they probably need to mention completely different things.

Yeah. So, I also think that you should be very aware of what you want people to listen to in that part, right? Because everybody's not interested in how the health system works. But they are very interested in being healthy, right? So, so that's one side. So, so on. And this is health literacy. And, and, and… And they start being afraid of the healthcare system. 

So, I got, I recently got numbers from Saxony from hospitals that are underserved. Not people are not sick there, but they don't dare going to these hospitals because the reputation is bad. they don't do well. They don't, they don't do well. But, yeah, I mean, that's the other side. 

So, so, so, but, but we have a focus today and then I will end with this. We have a focus today on that access to care is our democratic rights. I agree. That needs to be there. But if we want a sustainable, fair, dignified health system is actually the, the, the right to health and the access to health for everybody, which, which is the prime driver. So, I'm trying also in, in the many projects I'm in to push for that the main target indicator 

should not be if everybody can access a hospital, but to lower the average disease burden for a person's lifespan over time. So we have, you know, we should do a clear benchmark in 2024 or 25 saying, okay, this is the average disease burden we have. We can break it down into different diseases. And then five years ahead that has to be lowered by five or 10%. So I think that's the way we, we need to go forward. which currently is contradictory to what the OECD says, right, because of the OECD classification is access to health care. If I'm not mistaken. What everybody does. But that's what you can measure, right? But what you measure is what you do. Last question here. 

that's why is there, why is there no Cologne Center or Institute for health future studies or for future studies at all. Why is the Copenhagen Institute such a unique kind of thing? 

very much the other, they do not. Well, it was established by a very, very strong personality with international experience, very, very respected in the society and in a very clever way as a non-for-profit, self-governed, kind of thing, self-government, self-government members-based organization. So that's one thing but it also, it also needs to have a room for free spirits, right? So probably you have a bigger portion of crazy heads there than in a normal institution set in a positive way, including myself. 

And then, of course, you need to be interested in wanting to bring this way of working with the future to the society, which is not the easiest thing to do. 

Yeah, I can imagine. And you know, I try to establish this little room here in my van. So these couple of square meters obviously resemble a place where we can think about futures and potential things that happen in a not-so-distant future. I would love to continue our conversation and probably also, you know, rub some ideas in our heads about establishing a Cologne Institute for future studies. Because I think this is something we need. You know, room for free spirits, room for multidisciplinary approaches, room for toying around. We've got the nice German word Spielraum, which I love, you know, because it provides its playing. But it also provides a room and it's not just like a children's room, but it's Spielraum, it's a thoughtful kind of thing. And I'd really love to institute something like that. 

"So, yeah, let's start with it and I will just end with more multidisciplinary approaches. So quantum physics, mechanics, is really beginning to be more understandable and how do things also, biology, you know, begin to affect. And this becomes not multidisciplinary, but multidimensional already. And these are things we, if we want to work with the future, we would need to begin to think about." 

"Thank you. Nothing to add. Thank you very much. This was Bogi Eliasen. Lovely conversation. Thank you for being here." 

"Thank you so much for inviting me. Thank you." "Thank you." "Thank you."