When we made our first investment in a company called Future in 2018, we didn’t fully grasp how much the mission of that company, and the movement it exists in, would be central to our careers in venture. We started to formulate nascent ideas of human health and how to meaningfully help people change their habits in the diligence process. We reflected upon the health of our households and extended kin networks, and how they might be different relative to our classmates at Princeton. That first investment led to others in the space, and it became the central thematic focus of our fund, although we did take bets in other areas. When we first solidified our identity as a Human Performance-focused fund, we continually sought to develop a clear grand theory of the next phase of human health within a wide set of social, cultural, political, economic, and commercial trends. In time, and in the intellectual debt of many, most especially our founders, we began to develop a clear perspective about the magnitude of changes that were about to occur, and understand the social and economic opportunity. As a thematic fund, we wanted to share and articulate our understanding, and raise our voices on behalf of founders and engineers building the next generation of companies that will advance human health.
We often operate from a perspective that the world as we see it now always was, as we have short lives, and shorter memories. The system of industrialized healthcare that we now enjoy, one which has pushed forward the boundaries of science past our imaginations, commercialized and distributed countless life-saving discoveries, and created access to care that would be unprecedented in human history, is relatively new.
Our modern healthcare system was built in the last 80 years, well within the memory of people living today. The technological underpinnings of our modern healthcare: antibiotics (1928), medical imaging (X-Ray-1895, Ultrasound-1955, MRI-1973), and vaccines (Influenza-1945, Hep B-1972, 1961-MMR), have saved tens of millions of lives and increased the average life expectancy from 1925-1955 by 20 years: a feat without precedence in human history. No longer do those with access to care in industrialized countries, particularly in the West, die of diseases born of poverty like cholera, diphtheria, whooping cough and tuberculosis. Others, like smallpox and polio, have been almost, if not entirely, eradicated. The technologies emerging through development-by-accumulation: mRNA vaccines (the first new type of vaccine since Smallpox-1798), genetic testing and engineering, the biotechnology revolution, and stem cell research represent some of the most promising future technologies that will further advance the bounds of science.
It is our belief that, when we look back, we will recognize that healthcare system as the predecessor to an entirely new social paradigm and technological architecture around human health. A convergence of technological, social, and cultural factors have led to this moment, which represents an epochal change in Western society’s social understanding of what it means to take care of your health, and be healthy by extension. The reason, put simply, is that the structures that we have built no longer address the problems that they were originally built for.
As our society has become wealthy and industrialized, it created a set of conditions that made us more healthy in some very meaningful ways, but less healthy in others. While we have solved the diseases of poverty, we are beset by those of wealth.
When we look at the statistics of how healthy people are and the quality of their lives, we encountered two statistics that revealed the dimensions of the problem.
- for the first time in American history, life expectancy has decreased, caused by chronic, preventable disease, deaths of despair, and plague.
- the vast majority of our healthcare system (80%) exists to manage, not heal chronic conditions, caused by some interplay between the individual and their environment.
Our healthcare system, built to deliver healthcare to the sick, is not structurally oriented towards reducing the incidence of sickness in the first place. Indeed, it is expensive, wasteful, difficult to access, and stifles innovation. We reject that the solution to an endemic and long-known problem will be solved by this healthcare system, and according to its logic, power structures, and commercial arrangements. The most common suggestions: increasing access to small-molecule pharmaceuticals and large-molecule biologics (like Ozempic, in the case of obesity), using government economic intervention to create, stabilize, and protect markets, moving towards a “risk management” perspective when evaluating populations, and developing technology to scale healthcare delivery will help us trim the margins, but ignores the underlying social crisis that is creating these outcomes and entrenches the current systems of power. The modern healthcare system is merely a part of a larger social and environmental system we have built that has lately only succeeded in making us sicker, more anxious, physically stagnant, and spiritually impoverished. It degrades the planet. What we, and those alongside us, are calling for is a fundamental reweaving of the social and environmental fabric to create more actual flourishing- completely rethinking our own social relationship with our health and creating a new paradigm of how we understand our well being.
Medicine, it must be remembered, is a social practice. We contextualize our understanding of health based on the social, cultural, and emotional signals that we are taught. It was not written by Hippocrates (in his oath) that doctors must wear white, and “an apple a day keeps the doctor away” is written in our hearts, not medical textbooks. As such, it must be understood as reflecting and co-evolving with our technological, economic, and cultural evolution. There’s a saying that “Generals always fight the last war.” The war of healthcare delivery has largely (although unevenly) been won. A new paradigm must emerge to solve the problems of today, and not those of yesterday.
Our new paradigm, which we call human performance, begins with a radical idea: centering and empowering the human as the central agent in managing their own health. It focuses on the basic constituent elements of our health: eating, moving, sleeping, and mental health as creating the basic conditions of our overall flourishing. We invest in solutions that focus on health, not sickness, prevention, not treatment, and habits, not interventions. This shift represents the great promise of the new paradigm of human health, driven by a human-centered ethic that does not blame, but empowers and educates consumers about how their choices affect their health, generates affirmative structures around them and in their communities, and creates a positive relationship with how they manage their health. As a paradigm, it serves as both a conceptual framework, a social vision, and a descriptive tool for how our social understanding of health will change.
Human Performance rests upon three pillars:
- The fundamental constituent acts of living (eating, sleeping, moving, and mental health) represent where we should be putting the greatest amount of effort in managing our own health.
- Behavioral change is the goal of human performance companies, and the metric upon whether they will succeed or not.
- Users are empowered by personalized, relevant data to measurably improve their well-being.
At the simplest level, we invest in the products, services, platforms, and communities that enable everyday people to live better, for longer. We’re less concerned with any particular model of business, relative to the problems they exist to solve:
- ⅔ of adults and ⅓ of children are obese
- Comorbidities include coronary heart disease (CHD) and stroke, type 2 diabetes, metabolic syndrome, certain types of cancer, sleep apnea, osteoarthritis, gallbladder disease, fatty liver disease, and pregnancy complications.2
- 14 percent and 20 percent of cancer deaths among men and women, respectively, were due to overweight and obesity.
- $169 billion in annual medical savings could potentially be saved if overweight and obesity problems were eliminated in the United States, and even modest caloric reductions (100 calories per day) across the population could save as much as $58 billion in medical costs (Dall et al., 2009).
- More than 70M Americans have a sleep disorder.
- Sleep deficiency is linked to many chronic health problems, including heart disease, kidney disease, high blood pressure, diabetes, stroke,obesity, and depression.
- ½ adults and 77% of high school students don't get enough physical activity
- Reduces anxiety and risk of heart disease, cancer, diabetes, and dementia
- In 2019-2020, 20.78% of adults were experiencing a mental illness.
- 15.35% of adults had a substance use disorder in the past year. Of them, 93.5% did not receive any form of treatment.
While these statistics are American, they are mirrored across the Anglosphere. In Canada, the UK, Australia, and New Zealand, we see similar trends, occurring at similar inflection points. What we are facing is not a function of the particular systems (such as healthcare) that exist within these countries, but rather something that we are facing within the Western world. The structures being transnational reflect the fact that they are more fundamental than differences in between systems, and speaks to the broader need for a paradigm shift in human health.
The “wellness” movement, with a holistic approach towards health and a growing emphasis on the importance of social and environmental factors in promoting health and well-being, represented the first competing paradigm to human health, especially in the way that we understand it in the Western world. Long regarded with skepticism and as partially if not wholly pseudo-scientific, it did introduce many novel or emerging cultural concepts and practices in our social understanding of health, starting with the term “wellness” itself. Its idea of health being constituted of various modalities: spiritual, physical, emotional, etc. created space for a wider diversity of practices to emerge. Human performance, as an emerging sector, represents an commercial evolution within the wellness culture, one which shares cultural space but exists towards different ends and leveraging different methods (ie, growth and profit). Accordingly, human performance is a better conceptual and commercial framework that can meaningfully represent a true antithesis to the traditional healthcare’s orthodoxy and orthopraxy.
The trends that created the condition for this emergence are as follows:
- The first is cultural. Globalization is creating new integrations for new forms of cultural knowledge, as new influences are being integrated into Western society and culture. Cultural synthesis with the East, particularly India, has given us new epistemological frameworks for wellness- from mindfulness and meditation to yoga. Science, as a social practice, is built on top of culture, and different cultures approach truth from different directions and validate conclusions in different ways. While we in the West are used to the peer-review process and the scientific method, we ourselves suffer from a crisis of replicability in our experiments. Diversity, as always, will challenge our norms, break apart groupthink, and allow cultures to create more fully developed understandings of truth. South Asians are meaningfully over-represented in the wellness sectors as founders, and we are better for it.
- The second is technological. In the coming years, the revolution in artificial intelligence will have wide-ranging applications in healthcare, not just in traditional medicine, but as the underlying technology in the next generation of consumer applications. With the internet of things (as wearables), we could collect an unimaginable array of personalized data, allowing us to proactively identify and mitigate threats to health, identifying the types of interventions necessary, and reducing overall cost. As we get more comfortable interacting with technology in terms more resembling social equality, artificial intelligence will play a powerful role in being our health coach- one which has access to our biometric data, learns how to spur us to change, and communicates on our behalf with other stakeholders in our health. Cutting-edge innovation and practices developed at the top of the market for the world’s best athletes and the 20% of Americans that heavily invest in their health will enable companies to reach for broad-based adoption.
- The third is social. We do not want to understate the degree to which a human-performance centric vision of health is a competing system to traditional healthcare, even though they may present similarly. The social relationship between a doctor and a patient, in one system, is incredibly different from the relationship consumers have with companies. In a traditional healthcare setting, for instance, your data is protected under law. In another, you essentially become a broker of your own data, selling it in return for what could very well constitute your entire healthcare. They could exist in radically different regulatory structures, reflecting completely separate legal norms. Our society has grown comfortable, in certain ways, with the tech companies behind our favorite products. Their approach in the health sector will reflect their core business and compete to win against the traditional healthcare system, rather than emulate it.
We are, after all, talking about 20% of the economy.
In technological circles, we often talk about “an iPhone moment,” where an innovation arrives that fundamentally changes everything. When the iPhone gained sufficient adoption, it became a platform in and of itself. On that platform, trillions of dollars of economic activity was built, in the form of the products and services that we now use in our daily lives that are smartphone or tech-enabled. We are in another iPhone moment, with the emergence of health-focused wearables. Wearables, most notably the Apple Watch and the Oura Ring, will be the platforms upon which the new healthcare system will be built, a belief that Tim Cook advances when he says “Health will be Apple’s longest lasting contribution to humanity.” Gould, in the field of evolution, taught us about punctuated equilibriums: the observation that there are isolated episodes of rapid speciation. We are about to embark on an incredible amount of speciation in the field of human health.
In the coming years, we will undergo a paradigm shift in how we think about and manage our health, both on an individual and a collective level. The Cambrian explosion of new ideas, ventures, and technologies will create a dynamic and lively sector where competition will be over how we can improve the health of consumers (or at least get them to buy a widget). The work is truly yet to begin in comparison to the level of work that needs to be done: reweaving the social, environmental, and commercial fabrics that constitute the contexts in which we live.
As such, we’ve identified four ways that reflect our understanding of the opportunities in the sector and the underlying trends that create them.
- HEALTH OUTCOMES: The central determinant of success in this sector will be whether the solution provided meaningfully identifies the correct problem set and creates a fit-for-purpose solution that results in a healthier consumer. As we have seen, goods and services can very rapidly create demand in this sector, but longevity will be determined by results. Healthy consumers will be created by healthy companies.
- THE SOCIAL RELATIONSHIP WITH THE CONSUMER: One of the first questions that we ask companies is how they’re considering the social relationship with the consumer. When we talk about health, we are talking about something that is immensely personal, extremely ingrained, and determined by the contexts in which we live. To break long-established patterns of human micro-behavior requires a company to have a clear moral vision, with a brand, persona, and engagement strategy that will create a positive relationship with the consumer. People inevitably have emotional relationships with the things in their lives, including technology. In many cases, the addressable market or the public at large needs to be introduced to a concept or a practice that is emerging within our popular understanding. These can be both cultural (such as mindfulness) or scientific (metabolic health). Companies like Levels, which operate in public and are at the center of the social conversation around metabolic health, will create trust around both the problem and the solution.
- PROPRIETARY DATASETS: As the variety of specific capabilities that we now call “artificial intelligence” are commercialized, companies will win or lose on their data quality, specialization and insights. Proprietary datasets will enable companies to generate more-effective, personalized interventions, increasing the stakes of competition. Network effects will ensure that advantages compound- both on an individual product level and ecosystem level.
- TECHNOLOGICAL INTEROPERABILITY: To the extent that there exists some form of “Holy Grail” within consumer health, it is this: broad interoperability. All of the trends that we have identified above are driven by the creation, interpretation, and dissemination of data. A series of technological, cultural, and regulatory changes could pave the way for devices -of all types- to create a deeply detailed, fully comprehensive model of your health. To do so, companies would not only need access to all personal data that you could give them, but solve the technical problem of how the devices, across a variety of product segments, would talk to each other. This information would then be shared with your medical provider to provide you with health strategies or health care delivery when you need it. The AI will anticipate your needs before you even do, in the same way that retailers like Target and Amazon already can identify the onset of pregnancy based on shopping habits.
The future of human health will be built by the daring, delivered by the caring, with knowledge meant for sharing. We look forward to backing entrepreneurs with big dreams who are bent on solving bigger problems.
At TXV, we’re focused on supporting the next generation of builders in this rapidly evolving industry. We bring to the table the first complete ecosystem geared specifically to building Human Performance companies.
First and foremost, our team and advisors have built some of the most successful companies in this industry, such as Oura and Levels, and understand the unique operational challenges confronted in this space.
We have personal experience competing at a high-level and are building an ecosystem of advisors who are truly some of the best athletes in the world.
Last, we are a thematically-focused fund. We have a keen understanding of the human performance space and have evaluated a series of dynamic perspectives.
As a result, we have watched the best and are built towards disseminating that knowledge to scale companies.
If you are pursuing the same mission as we are, please feel free to reach out! Please reach us at email@example.com
People centered, diverse perspectives, insightful capital.