Personal worlds9

titles were a way to relax, not the way to relax. This segment wasn’t as interested in games as the traditional market. It was a different market, and one which now seems close to saturation.

Facebook has been key. The frontrunner in this new business is Zynga, and the premise is simple: games are easy to access, casual, social and free, with paid microtransactions available in-game for those who want to take their experience further. The business model borrowed

from the world of the massive multiplayer role-playing games, in which keen players can buy extra resources and assets. Certainly, casual games have a huge playing base; Zynga has 232 million monthly active users5 over the dozen or so titles they’ve produced. In comparison, the best selling traditional game franchise, Mario, has achieved 262 million6 sales in 30 years. Using the Facebook

platform makes Zynga as accessible as possible, but poses issues as well as advantages. Zynga is utterly dependent on Facebook, and on the continuing popularity of social networking. The Flash software used to deliver the games has limitations; while it can render 3D environments it only shines in simple 2D games. Zynga also relies on a small proportion of its players for its revenue7, and as Zynga’s casual games don’t engage its audience it needs to release new software constantly to maintain player interest. It seems unlikely that ‘freemium’ web-based games are the future of the sector; Nintendo made (a disappointing) $986m in 2009/10, but Zynga made just $95m.8

So what is the future of gaming? The secret will almost certainly be in the interface. Motion based controllers look likely to become ubiquitous in a whole range of games in all parts of the market. And this means in turn that consumers need to be provided with standards across different

games. By way of example: an interface standard in platform games is that A is ‘jump’ and B is ‘run’. Similar standards have not yet emerged in motion technology. When they do,

we can expect to see new types of games and even new genres. But the money will still be found in the world of the committed gamers, for whom gaming is a life, not a lifestyle. [KR]

Casual games had short development times and sold very well

The secret of the future of gaming will almost certainly be in the interface

© 2012 The Futures Company. Some rights reserved. 10

Health in 2020Keywords:

healthy ageing, preventative health, diagnostics, health innovation transfer, genomics, stratified medicine, datasets

The next decade will be dominated by three interrelated “grand challenges” that will spur innovation in healthcare

■ An ageing population: by 2020, the median average age on the planet will be 31.6, two and a half years older than today9. The average in China will be 38, the same as in the US, and 48 years old in Japan.

■ An older workforce: people will have to work longer as a result, and the average retirement age will extend as a result

■ Large public budget defcits in the US and Europe, putting pressure on current levels of healthcare spending as a percentage of GDP

Consequently, there will be much greater incentives for the governments and businesses that foot the bill for healthcare to pursue more cost-effective ways of keeping citizens and employees healthy as they age. The current system of healthcare in most countries has been compared to an inefficient

‘breakdown maintenance service’ for the sick and unwell, whereas a more preventative model of healthcare could be much more cost-effective, and also more beneficial to society as a whole. In the US, where more money is spent on healthcare than anywhere else in the world, a huge proportion of this expenditure goes on chronic diet and lifestyle related conditions such as heart conditions, diabetes and even back problems10 which could have been addressed more efficiently at an earlier stage. It costs less to prevent diabetes or high cholesterol than it does to manage it later.

Consequently we expect to see much greater innovation in cheap diagnostics and health monitoring technologies that reduce our total outlay on chronic ‘lifestyle diseases’, particularly if business models are developed that make the prevention and early diagnosis of these as profitable as treatment and cure.

In less affluent countries with lower levels of healthcare expenditure there is already by necessity a much greater focus on low cost/ high impact technologies, much of which are preventative or diagnostic rather than curative, such as long-lasting insecticide treated nets (LLINS) which have been shown to avert around 50% of malaria cases, while being around 4-5 times cheaper than regular spraying methods11. Some of these innovations may make their way from South to North as their utility and efficiency is proven, for instance cheap, rapid, local/point-of-care tests for diseases such as Chlamydia and HPV12, or remote healthcare advisory services delivered through a mobile device13.

In developed healthcare systems, there is a huge opportunity to realize efficiencies without developing any new drugs or treatments. We know that some people respond better to certain treatments than others, but

Analyzing data on the genetic profile of the whole population could be massively valuable both socially and economically

Personal worlds11

with advances in genomics and much more widely available genome testing, it will become easier to gain a more accurate and complete understanding of this. This has been called “personalized medicine”, the idea that targeted therapies can be developed for a specific genetic profile. However, over the next decade the less ambitious intermediate step of ‘stratified medicine’ – developing treatments for groups of people with shared genetic characteristics – is more feasible. Early stage applications will likely focus on common (but easy to identify) conditions within high risk

groups, but may eventually lead to a more sophisticated form of ‘stratified prevention’: using data to improve health outcomes among groups of people with similar genome types. Even if this data is held anonymously at population level it will hold tremendous epidemiological value.

Healthcare systems that are already set up with the capacity to track and analyze

data on the genetic profile of the entire population could be massively socially and economically valuable as a result, both because they would give us a far richer understanding of how health outcomes are affected by genetic factors, and also because they could become testbeds for new types of genetic therapies for the entire world. In this context, the British National Health Service, for instance, could have a repository of information which is as rich and valuable to the UK economy as loyalty card data is to a supermarket.

Endnotes1. Divining a Digital Future: Mess and Mythology in Ubiquitous Computing, Paul Dourish and Genevieve Bell, 2011

2. Image available online at http://honeywellalarmmanualifo.wordpress.com

3. See “The Heterogeneous Home”, Proceedings of the 10th international conference on Ubiquitous computing, Aipperspach et al. al: “...the ability to get away is limited by missing boundaries, such as reduced separation between work and home. These blurred boundaries, along with centripetal technologies like television screens or computers that rarely move, can collapse the effective extent of the domestic environment onto a few focal points within the home”

4. http://www.priestmangoode.com/bright-ideas/

5. http://www.sec.gov/Archives/edgar/data/1439404/000119312511180285/ds1.htm

6. http://www.businesswire.com/news/home/20110531005315/en/Nintendo-DS-Lite-Suggested-Retail-Price-Drops

7. http://www.sec.gov/Archives/edgar/data/1439404/000119312511180285/ds1.htm

8. http://www.nintendo.co.jp/ir/pdf/2011/110425e.pdf

9. UN World Population Prospects, 2010 revision

10. See US Agency for Healthcare Research and Quality findings on top ten most costly conditions in US as of 2005 http://www.ahrq.gov/news/nn/nn012308.htm

11.“Insecticide-treated mosquito nets: a WHO position statement”, WHO 2009

12.See “Health Innovation Transfer from South to North”, RAND 2011

13. See for instance the Sana mHealth application designed to improve health care accessibility in remote regions http://www.sanamobile.org/index.html

We expect to see innovation in cheap diagnostics and health monitoring technologies that increase prevention

© 2012 The Futures Company. Some rights reserved. 12

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Technology 2020: Personal worlds was written by Andy Stubbings, with contributions from Alex Steer (ASr) and Kit Richardson (KR), and edited by Andrew Curry. Design was by Augustus Newsam.