This abstract was submitted to and presented at CCRC International Conference 2022.

Medical Inclusion
Design of Medical and Healthcare Systems of 2050Authors (A to Z): Amina Sugimoto, Chris Dai, Hitomi Sano, Jun Murai, Kiyoshi Kurokawa,Isao Nakajima, Pieter Franken
Affiliation: Keio University, Cyber Civilization Research Center, Japan,

MEDICAL AND HEALTH CARE AFTER THE INTERNETThis research investigates the design model of medical and health care systems of 2050 under
the cyber civilization era. The idea of 'Medical Inclusion' can be challenging in many ways
because it would need a comprehensive perspective for the fundamental transformation of
conventional medical care.
An extraordinary hint to this quest is a complete assumption of cyber civilization. That means
exploring the possible new medical and healthcare systems with a whole assumption of cyber
civilization basics, after the Internet, the world wide web, Blockchain, COVID-19, and so on.
Medical and health care have developed with the scientific paradigm, and the Internet has
been leading the recent paradigm shift everywhere. It is essential to re-recognize thefundamental premise of medical and health care systems in the rapidly changing digitalsociety.
However, there has been surprisingly little research to ask what medical and health careshould be in the digital era.Now, humankind has lived with the global pandemic fromCOVID-19 for over two years. This pandemic allowed us to see how the Internet and cyber
civilization can impact our healthier and happier society. Medical Inclusion will lead to afundamental transformation for conventional medical systems, which were the domestic andexclusive domain in many cases, compared to other social systems.
We already have a history of drastic revolutions in many aspects because of cybercivilization; e-commerce, e-banking, social network media are examples of suchprocesses.Therefore, in the cyber society, medical and healthcare systems also have muchroom to be changed.

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THE TECHNOLOGICAL BASICS OF THE CYBER CIVILIZATION
Here, it is necessary to get back to the essential ideas of the technological basics of cyber
civilization for shaping the design model for Medical Inclusion.
First of all, what is the Internet? It is a single global space for everyone and everything. In
short, it is a global infrastructure that can break any boundaries. (Jun, 1995) The Internet will
have 100% coverage of the surface over our planet. People on the Earth will be eventually
covered by the Internet securely by 2050. Namely, more and more people will interact overthe Earth, instantly and safely.
Second, the World Wide Web is also a single global space for sharing digital data as anapplication platform for the open development of software, including enormous medical andhealthcare applications. It can also be a security platform with public encryption anddecryption.
Third, Blockchain has been developing trackable trust for keeping our digital data set.
Last, Artificial Intelligence analyzes the accumulated data through the Internet will
powerfully reveal all the correlations in human life and further develop medical care. It has
been accelerating the need for data science in the medical and healthcare field.
Already, the COVID-19 pandemic has shown the importance of data and science to build
back more resilient health systems and equitably accelerate towards our shared global goals.
(World Health Organization, 2021) It also will lead to rediscovering the fields which havebeen missed for a long time. On the other hand, many challenges will emerge, such as ethicaland legal governance of the collected personal data.
For example, Femtech is a recent notable transformation of the health and medical industry.
Femtech is a coined word that combines Female and Technology and refers to products andservices that can solve women's health problems with technology. It includes a broad
spectrum of digital technologies dedicated to improving women's health and well-being.
(Femtech Analytics, 2021)
Whereas such new medical and healthcare areas have been emerging, we have to tackle
finding the proper privacy control of these new types of healthcare data, for example, how tomanage the data of women's menstrual cycles. All in all, what is the ideal medical and healthcare system on the premise of these fundamental technologies of cyber civilization? If we canPage 2 of 6

design, not tightly with the incremental manner, rather, innovative way with thesetechnological basics of cyber civilization.
THE GOALS OF MEDICAL AND HEALTH CARE SYSTEMS
From a systems point of view, medical and healthcare systems have several common issues
with these cyber civilization basics mentioned above. First, it must target everyone’s health.
Second, it must have excellent responsiveness. Third, fair means for cost burden arenecessities. (World Health Report, 2000) In short, medical and healthcare systems have somegoals from quality, efficiency, accessibility, and equality.
Conventional medical care systems should have these goals with digital technologies.
Nevertheless, those points have been overlooked for almost thirty years regarding digitaltechnologies. Significantly, a global cost design may have been the most challenging issue
because the medical system has been supposed to be the nations’ responsibility.
However, something complicated before the Internet might not be complex anymore.
GLOBAL DESIGN FROM COST AND EQUITY
Therefore, Medical Inclusion for 2050 should be designed instead from the sides of cost andequity with digital technologies, which could not be realized so far without the fundamental
technologies of the cyber civilization.
According to the United Nations Development Programme (UNDP), 1.2 billion people inpoverty did not have access to the essential goods and services, including education, work,
food, health care, drinking water, housing, and energy. Eight hundred million of them also
had no access to health services.
Moreover, due to the negative economic impacts of COVID - 19, the potential short-term
poverty is expanding in developing countries. (Andy, 2020) There are fatal diseases that cost
too much for some people who can not access essential medicine but can access the Internet.
Indeed, Medical Inclusion may be a part of concrete solutions to mitigate the worst effects ofthe disparity between the rich and the poor, which continues to widen on a global scale in themodern world. The main aim of this design model of Medical Inclusion is to create equalmedical and healthcare systems globally for the socially vulnerable.
How can we break this problem with the essential technologies in the cyber civilization?
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First of all, one of the minimum requirements must be that all of the stake folders are coveredby the Internet, and they own any digital devices: they are in the state of connecting tocyberspace. The expanding use cases of telemedicine which are on the premise of accessing
the Internet, have already become examples of the medical and healthcare methods in thecyber age.
However, in the Medical Inclusion, extra pieces of the design model have to be added.
In 2050, access to essential medical and healthcare will be enriched from both cyber and real
space. Advanced Artificial Intelligence will accelerate clinical trials of medicines. It will
increase the frequency of introducing innovative medicines and speed up the process of theinternational approval of medicines and medical devices.In addition, pharmaceuticalinsurance schemes will be drastically transformed due to access to and analysis of vast
amounts of social data, incl uding medical and healthcare data.
As a result of such practical data use: by the cyber civilization's essential technologies which
expect lower potential costs, the interest rate which affects the total costs of one's medical andhealthcare would change. A digital society in the cyber civilization can effectively manage
the resources and cost of medical and healthcare. In other words, it enables people to support
their own healthy life in a longer span, even if they are in an aging society or in a society
where there is a high mortality rate in childhood. There is no question that this scheme willaffect children's educational achievement in poverty.
Conclusively, making this situation under the global pandemic better depends not on how
long the pandemic lasts but on how the global community reacts.
PLANETARY - SCALE COOPERATIVE DESIGN
The global pandemic proved the urgent need for global-scale medical care. It also revealed
the flaws that made the fragmented medical systems in each country lead to the global crisis.
(Arush, 2021) The pandemic is a global issue, so we should replace this disaster as one of theplanetary-scale problems. Medical and healthcare investment, funding flow design, andgovernance must be consistently revisited on a planetary scale.
The critical point is that the cost design above needs advanced global policy frameworks ininternational relationships and advanced technologies simultaneously. That is, Medical
Inclusion needs to organize multi-stakeholders global cooperation to move forward, forPage 4 of 6

example, national governments, commercial institutes, academics, religions, unions, andindividuals, so that cyberspace will be able to include medical and health care. Moreover,
Medical Inclusion must have a strong connection between cyberspace and real space.
Namely, the design will be a dynamic fusion of cyber and real space on a planetary scale.
CONCLUSIONThe Internet is the concept of a large-scale distributed computer system with a network thatsurrounds the Earth, as a single global space. One of the most significant issues to concrete an
ideal digital society is how future medical and healthcare systems would be incorporated into
the cyber civilization. In other words, the design of the new medical and health care systems
is depicted within a single global space, i.e., cyberspace. More importantly, how humanbeings can cooperatively work for it.
Being healthy is one of the most fundamental demands of human nature: pursuing one's
healthiness must be one of the fundamental rights. People should have some opportunities toreceive medical and healthcare when they are covered by networks and have digital devices.
This proposal of a design model for Medical Inclusion above will continually need a broader
range of wisdom and ideas, and each piece of design has to be tested. At the same time, wehave to promote smooth cooperative frameworks globally.

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REFERENCES
Jun, Murai. (1995). The Internet (in Japanese). ISBN-13: 978-4004304166, Iwanami

Publishing Company, Japan.
World Health Organization. (2021). COVID-19 responsible for at least 3 million excess
deaths in 2020 [web log]. Retrieved from https://www.who.int/news-room/spotlight/theimpact-of-covid-19-on-global-health-goals
Andy, S. Chris, H. & Eduardo, O. (2020). Estimates of the impact of COVID-19 on global
poverty [PDF file]. UNITED NATIONS UNIVERSITY WORLD INSTITUTE FOR
DEVELOPMENT ECONOMIC RESEARCH, WIDER Working Paper 2020/4/3. Retrieved
from https://www.wider.unu.edu/sites/default/files/Publications/Working-paper/PDF/wp202043.pdf
Femtech Analytics. (2021). FEMTECH INDUSTRY LANDSCAPE OVERVIEW 2021 [PDFfile]. Retrieved from https://analytics.dkv.global/FemTech/FemTech-Industry-2021Report.pdf
World Health Organization. (2021). World Health Report 2000, Health Systems: Improving
Performance [PDF file]. Retrieved from https://apps.who.int/iris/handle/10665/42281
Arush, L., Ngozi, A. E., David, L. H., Githinji, G., & Robert, Y. (2021). Fragmented healthsystems in COVID-19: rectifying the misalignment between global health security anduniversal health coverage. THE LANCET, HEALTH POLICY, 397(10268), 61-67.

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