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Health and Healthcare - What issues constutite it?
Sustainability of Healthcare Systems
By 2040, the world will be collectively spending an estimated $25 trillion every year on healthcare, representing a 150% increase compared with 2014, according to a study published in The Lancet. A transition to value-based models that improve outcomes and reduce costs is necessary.
The cost of healthcare is increasing at double the rate of global economic growth. And yet, many systems have proven to be unnervingly fragile in the face of crises. The COVID-19 pandemic has pushed many healthcare systems to or beyond their limits, vividly demonstrating the interdependence of good health, economic stability, and growth both for individual countries and at the global level (the International Monetary Fund has estimated that by 2022, cumulative per capita income will be 13% below pre-pandemic projections in advanced economies, and 22% below pre-pandemic projections in developing countries excluding China, for example).
As the number of confirmed cases of COVID-19 has exceeded 120 million and resulting deaths have totaled more than 2.6 million - even as new variants continue to emerge - the pandemic has made efforts to add greater resilience and sustainability to health systems an overriding global priority.
The creation of more sustainable healthcare provision should include a particular focus on transitioning to value-based systems. Value-based frameworks focus on improving patient outcomes; related models are driven by the accurate measurement of outcomes across the full cycle of care delivery, and by alternative compensation models.
However, accelerating such a systemic change will require greater coordination and partnerships among both public- and private-sector stakeholders, in order to champion more innovative and personally-tailored healthcare systems that eliminate unnecessary interventions while potentially ensuring a better return on investment.
These innovative systems could result in improved early diagnostics that enable the earlier identification (and treatment) of diseases, and pave the way for technologies such as artificial intelligence to augment efficiency and care, through the use and analysis of larger amounts of data. In 2017, the health ministers of Organization for Economic Co-operation and Development member countries said in a joint statement that health systems need to become more “outcome-focused,” and providers must evolve towards a value-based concept that improves outcomes while lowering costs.
The majority of the average person’s health needs during their lifetime are related to preventing disease and preserving long-term well-being. Some three-quarters of deaths from non-communicable diseases occur in low- and middle-income countries. However, primary health care usually tends to focus on immediate issues. Medical care only accounts for about 20% of the contribution to health outcomes for people, according to a study published by the journal Health Affairs; some portion of the remainder can be attributed to genetics (20%), while the bulk is related to social and economic determinants (60%).
Social determinants include the quality of someone’s housing, their “built environment” (the man-made structures that surround them), their nutrition level, education, workplace environment, and the degree of their access to (or barriers to) open and green spaces. Mental health is a critical aspect of overall well-being; the World Health Organization has estimated that nearly one billion people worldwide live with a mental disorder, resulting in an annual global economic burden of $3 trillion. COVID-19 has only increased concerns about the general state of mental health, amid restrictive countermeasures that have isolated people from friends and loved ones.
Despite the many pressing issues related to our collective state of mental well-being, only an estimated 3% of all global healthcare resources are directed at brain health. One of the United Nations’ Sustainable Development Goals, which are designed to point the global economy in a healthier, more sustainable direction by the year 2030, includes a target of reducing premature deaths from non-communicable diseases (NCDs) by one-third.
Heart disease, diabetes, cancer, and other NCDs are intrinsically linked to socio-economic conditions - exposure to related risk factors is distributed in a highly unequal way, imposing a disproportionately greater burden on low- and middle-income countries. According to the WHO, nearly three-quarters of all NCD deaths - and 82% of all premature deaths (that is, deaths that happen prior to the age of 70) - occur in low- and middle-income countries.
Currently, NCDs including cancer and diabetes cause more than two-thirds of all deaths annually; cardiovascular disease is a particularly problematic NCD, in that it accounts for an estimated 17.9 million deaths annually, according to the WHO.
Enabling Access to Health
While much of the world may take health services for granted, COVID-19 has aggravated inequality in terms of access. About half of the global population currently lacks access to essential health services, according to the World Health Organization, and hundreds of millions of people are pushed into extreme poverty every year due to their health-related expenses.
As many as half of the confirmed cases of some infectious diseases originate in the workplace, which means employers must generally play a more proactive role in ensuring access to quality healthcare for their workers. COVID-19 has only further aggravated the problem of unequal access to health and healthcare among the most vulnerable populations - an issue that also presents pressing concerns related to infectious diseases such as hepatitis, tuberculosis, and malaria.
Tuberculosis kills more people than any other infectious disease, with some 10 million cases reported in 2019 alone and 1.4 million resulting deaths. And in terms of hepatitis, the WHO estimates that about 4.5 million premature deaths resulting from the inflammatory condition could be avoided by the year 2030 through improved educational campaigns, more comprehensive vaccination strategies, diagnostic tests, and improved medicine delivery.
Changing demographics in places like the European Union, Japan, and increasingly China are resulting in older populations, lower birth rates, and shrinking working-age populations. These trends are reshaping healthcare needs, creating new barriers to healthcare access, and increasing the financial burden of long-term care.
According to a report published by the World Bank in 2019, inefficiencies and instances of inequitable access to health exist in many places, and financing universal coverage would cost the poorest 54 countries in the world some $176 billion annually. The private sector can play a crucial role in funding health for all, by developing innovative and relatively affordable business models.
Facilitating mobility and connectivity is key for delivering adequate healthcare to ageing populations via emerging technologies and telemedicine, as are public-private partnerships that push innovation forward in terms of data-driven care. The WHO has called on governments to participate in multi-stakeholder dialogue, and to engage with the private sector to help achieve universal health coverage by 2030 - meaning that everyone would have access to the healthcare they need.
Preparing for and Responding to Epidemics
Better preparing for future outbreaks will require closer collaboration. COVID-19 is just the latest in a series of outbreaks including Ebola, Severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS) that have highlighted the risks tied to emerging infectious diseases of epidemic and pandemic potential - and led to devastating impacts on public health and economic well-being. Better preparing for and responding to future outbreaks will require strengthening the coordination necessary for early, rapid detection - as well as building more resilient global health systems.
Accelerating our ability to sequence the genetic material that forms agents with pandemic potential is the first step; when paired with platform technologies like synthetic biology, sequence data can enable the rapid prototyping, testing, and deployment of vaccines.
Cooperation among key healthcare stakeholders is also essential; global efforts to tackle the COVID-19 pandemic have led to pioneering partnerships across the public and private sectors. For example, Pfizer worked with the much smaller German biotechnology firm BioNTech, while the pharmaceutical multinational AstraZeneca paired up with Oxford University, with each combination resulting in the development of a COVID-19 vaccine in record time.
In order to scale up vaccine supply around the world, manufacturers like the Serum Institute of India have joined forces with both governments and non-governmental organizations. Gavi (the Vaccine Alliance), CEPI (the Coalition for Epidemic Preparedness Initiatives) and the World Health Organization have combined forces to operate the COVAX Facility, a global risk-sharing initiative that pools the resources necessary to purchase COVID-19 vaccines and distribute them to developing countries.
Developing more agile, adaptable, and crisis-resistant supply chains for critical goods like the personal protective equipment (PPE) that fell into short supply in some places as the COVID-19 spread will be crucial - for keeping societies functioning more smoothly during crises, and avoiding severe shortages. The COVAX Facility shipped its first vaccine doses in February 2021, to Ghana - and further deliveries to Côte d’Ivoire were expected soon after that.
However, maintaining such a well-functioning global supply chain of critical goods will require close collaboration among governments, and coordinated efforts with the private sector. This will help match demand with available supply, even during the largest-scale emergencies.
Historically, health technology innovation has given us basic but essential resources like the electronic medical record, as well as more complex developments like robotic surgery and precision medicine - or the use of a patient’s genetic information and environment to tailor treatments and care. The pandemic has created an opportunity to increase digital innovation and the use of telemedicine. A number of new tools have enabled us to cure previously-fatal diseases, and to make chronic disease more manageable.
Mobile technology in particular has presented intriguing opportunities to expand access to care in all parts of the world, including in more remote areas of developing countries. The overall “mHealth” (mobile health) market was already worth an estimated $23 billion by 2017, according to SNS Research - and it is expected to grow significantly. In sub-Saharan Africa, which bears the highest relative disease burden in the world, and where mobile phone penetration rates have increased significantly (GSMA estimates that about 475 million people in the region will be mobile internet users by 2025, and nearly a third of connections will be on 4G), mobile operators have begun to facilitate health payments made via mobile devices.
While COVID-19 has been tragic, it has also created a unique window of opportunity to respond with digital innovation and to facilitate the uptake of telemedicine. Already by April 2020, consumer adoption of telehealth in the US had increased to over 50%, from 11% as of 2019.
According to a McKinsey survey, more than 76% of consumers are moderately likely to use telehealth in the future, and 74% reported “high satisfaction” from past use.
Technologies like federated data systems, and the development of common technical and regulatory standards, could help address this situation. Psychiatry has the highest telehealth penetration, followed by neurology, gastroenterology (the digestive system), internal medicine, pulmonology (the respiratory tract), and family medicine. The aggregating and sharing of data can improve diagnoses, lead to new discoveries, and strengthen scientific results - including in clinical trials for rare diseases.
The World Health Organization has stressed the importance of ensuring data interoperability; however, the complex and dynamic regulatory landscape of data privacy and localization laws tends to complicate data collection, sharing, and utilization - both between countries and institutions.
HEALTH AND HEALTHCARE
COVID-19 has highlighted fundamental problems with our capital-intensive, hospital-centric model of healthcare. According to the World Health Organization, half the world still lacks essential health services - and 90% of countries have reported disruptions to healthcare services during the pandemic. One of the United Nations’ Sustainable Development Goals seeks to ensure healthy lives and promote well-being for all by 2030; in order to achieve this, health systems will have to change how they connect with patients and communities. To ensure every person on Earth has equal access to the highest standards of preventive health and clinical care, a coordinated and data-enabled approach is necessary - as are new models of collaboration.