Next great hub for Digital Health? Look North.

I’m not one of those people looking for the “next Silicon Valley.” I don't believe Silicon Valley is out of ideas, or Silicon Valley is past it’s prime. I love being in Silicon Valley, despite it’s flaws, and I think it’s a place all people should experience if they plan on a life of entrepreneurship.

At the same time, I'm constantly on the look out for new sources of talent and inspiration, and with that in mind I accepted the invitation to keynote a Health 2.0 Toronto event. It did not disappoint. It certainly was not my first exposure to Toronto — I've had the pleasure of working with Ontario Telehealth Network (OTN) during my time with Health Hero, and most recently Xtreme Labs was a major contributor to the launch of Better, but the extent of Toronto’s Digital Health capabilities was eye opening.

I’m going to let you in on a secret — if you are tracking Digital Health and only watching San Francisco, New York or Boston, you are missing out.

There are big things coming from Toronto, fueled by three key factors:

The MaRS Innovation Center (er, Centre)

The MaRS innovation center is a regional “innovation hub” in the heart of Toronto. I would, in most cases, immediately ignore anything that calls itself an “innovation hub” on principle alone, but I'm happy to be proven wrong on this one. MaRS is the type of long-term investment in a community that will have returns for decades to come. I have no doubts that we will look back on a wave of successful Digital Health entrepreneurs and find ties back to the MaRS programs.

So what is MaRS? Think of it as a mashup of office space, incubator, seed fund, and architectural gem. Of course, they've said it much better than me in their marketing materials. Of the most interest to me is their interest in healthcare and startups, the very intersection of my personal Venn diagram.

How deep are MaRS roots in health care? It’s built on grounds of the original Toronto General Hospital — you know, the birthplace of insulin. It’s literally on the corner of the University of Toronto (more on that in a minute) and the new Toronto General. They like to say it has $1 Billion of annual healthcare research located within 2.5 square kilometers. Forget the $1 Billion part. The fact they use kilometers proves they are smarter than us already.

When I asked the people of MaRS why the rest of the world doesn't know about this amazing place and program, they gave me the standard “Oh, well, we're Canadian and don't talk much about ourselves.” (Side note: Can someone tell the people in my ice hockey league about this personality trait?) So, if they won't talk about it, I will.

It’s as nice as any space you will find in San Francisco, and it’s full of people motivated for change, focused on Health and Cleantech. It’s well designed with an excellent mix of collaborative space, which is more important than any amount of exposed brick or fancy glass whiteboards (although they have that, too). People actually work together here, and the energy is palatable. It’s the type of investment that took an incredible amount of foresight, rising from the ashes of economic downturn. Originally slated to be condos, a lot of smart people got together and made sure that didn't happen. (I’m looking at you, Mountain View) It’s the embodiment of a vision that makes you believe in a community and it’s government.

Education System

Silicon Valley has Stanford Medical and Berkeley. Boston has Harvard Medical and MIT. New York has Columbia and NYU. These communities are pumping out top talent in both engineering and medical science.

Toronto has the University of Toronto Medical School and Waterloo. Before you get all crazy that Waterloo is actually in Kitchener, I'll put it this way. According to Google Maps, it’s 1 hour and 42 minutes from MaRS to Waterloo (Don’t ask me what that is in kilometers). Let’s see you do that on 880 from Palo Alto to Berkeley at any meaningful hour of the day.

Over the years I've hired a number of people from Waterloo, and been exposed to them in other startups, such as DJ and the team at Athos. They are as talented as anyone I've met in engineering. I’m going to talk more about the importance of people in the following section, but this is about the systems that fuel an economy. Oh, and if you are Canadian, it cost $13,000 to attend Waterloo. It cost slightly more to attend Stanford.

Toronto is teeming with talented people, and that starts with a solid education system. Toronto checks that box as well as any other startup hotbed.


The talk was sold out, and had roughly 200 people attending. I believe this can be attributed to the free food and drinks. It’s startups, after all. Despite the gratis treats, the group was engaged, asked smart questions, challenged assumptions, and tweeted like mad. That continued with the Q&A after the talk (always the best, and most revealing part) and the office hours I had with the startups the next day. I meet at least 7 different startups, and these folks are smart, informed, and passionate.

Put all of your misconceptions aside about “foreigners” understanding our healthcare system in the US — and know this, they are coming for the US market — they know the US market better than the average American healthcare startup. When I discussed this with a few of them, they explained that coming from a drastically different system meant they started with no bias at all, which actually made it easier to understand.

I don't totally believe this — they all have the same core bias we have: the American system spends a lot of money, gets poor outcomes, and Americans are all fat — but they understand the details better than most startups. They can make a real comparison to an alternative system and discuss its pros and cons intellectually. They spend the time to understand these details because tapping into the US Market is worth the effort, whereas most American startups don’t look to other systems for solutions, as they appear to be distractions. This is and incredibly powerful advantage that often goes overlooked.

That said, don't get too chesty, Toronto. You still elected for Rob Ford.

It’s hard to explain how much praise this is, but that group of people made the travel worth it.

That, and a number of them who I’m trying to hire.

Finally, every community needs a few people that spearhead it — like Akhsar Kharebov in Silicon Valley, Elliot Cohen in Boston, and Unity Stokes in New York, you need people who are driving the community, organizing, and carrying the heavy load for the rest of us.

In Toronto, they have a solid group lead by Sonia Strimban (MaRS), Jonathan Graff (Health 2.0 Toronto) , Prateek Dwived (MaRS) and Nikolai Bratkovski (H2.0T). The foundation is here for greatness.

So, if you are the type of person that bets on things like “next big hub in digital health,” put your money on Toronto. I am.