How life sciences can address the greatest health challenges and reduce inequalities
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Health is one of our most untapped opportunities for prosperity and happiness, as individuals and as a society
Yet we do not value it as such.
The opportunities that a healthy life provides are not shared equally, in turn worsening economic and social inequalities across and within populations. Addressing inequalities in health has long been seen as a public health issue with a limited role for those providing health services or therapies. While addressing the social determinants of health (the structural environments that we are born into, and learn, live and work in) will have the largest impact on reducing inequalities, all stakeholders across the health system could - and we suggest should - have a unique commitment and contribution to reducing inequalities in health.
In this report, we take a look at how inequalities across the medicine life cycle impact patients and populations. We paint a vision of what success could look like, and propose specific, feasible calls to action across industry, HTA bodies and payers that could transform the role of the life science sector in reducing inequalities and fostering healthy populations.
The issues highlighted by the pandemic are not new
The Covid-19 pandemic brought inequalities within and across populations to the fore. The social determinants of health were highlighted as we saw that those from more deprived areas tended to have a higher risk of being in sectors that shut down during lockdown periods, while those who kept their job were more likely to be unable to work from home, increasing their risk of Covid-19 infection. We saw a higher risk of poor outcomes from Covid-19, including death, in more deprived areas and among groups of certain ethnicities. Global health inequities were revealed starkly in the large variations in access to and pace of vaccine roll-out between low and high-income countries, even though vaccination was seen as a route back to ‘normal’ economic and societal activity.
The magnitude of the impact of the pandemic led to extraordinary approaches to try to mitigate the worsening of health and health-related inequalities, from government support such as furlough scheme through to vaccine scientists and producers’ commitment to an ‘at-cost’ vaccine to reduce barriers to inequitable vaccine access. In the UK, great efforts were made, through combining data and community networks, to address inequalities in vaccine uptake.
Vast inequalities in health and the drivers of good health were present before the pandemic and have persisted since. For instance, the gap in life expectancy between small geographies in England has increased to 21 years in women and 27 years in men. Meanwhile, there are even larger differences when looking at life expectancy across countries, from 87 years in Monaco to 53 years in Central African Republic. The inequalities persist across those factors that foster living in good health for longer too. Indeed, as we enter a global cost of living crisis, many of these factors are likely to worsen further and the potential impacts on equity of access to and delivery of healthcare are yet to be fully understood.
The life sciences ecosystem has a unique opportunity to contribute to addressing a range of inequalities across populations. This is one of the National Institute for Health and Care Excellence’s (NICE) core principles and there has been increasing commitment and rhetoric to the cause across the sector. In this report, we outline some feasible and specific measures that could translate this into meaningful action across the medicine life cycle.
Where life sciences can deliver change
Inequality is a vast topic with decades of science and policy and we cannot, nor do we pretend to, cover everything in this report. However, we aim to touch on the breadth of domains of inequalities that the life science sector can feasibly and meaningfully influence, while highlighting the complex challenges and acknowledging that there will be no single or simple solution.
Life science companies can have a substantive influence on some of the fundamental inequalities themselves and through partnerships with healthcare providers such as through NHS England’s Core20PLUS5 programme. This could be through access to therapeutics and partnering to improve outcomes across geography, deprivation, ethnicity, age, sex, vulnerable groups and disease areas.
Furthermore, life sciences organisations are, in many cases, large employers which can impact the social determinants of health of their employees, their families and local economies.
In this report, we identify two key challenges in addressing health inequalities that are tractable and most amenable for the life science sector to make commitments and contributions towards:
Challenge 1: Multimorbidity is increasing and embedding inequalities in health
Great successes across public health and biomedical science over recent decades have increased longevity and reduced the risk of dying from common conditions such as heart disease, stroke, diabetes and cancers. However, longer lives have not always meant living healthier lives for longer. Multimorbidity is increasingly common with more than 50% of adults living with two or more chronic conditions in England.
As a result, we need to create a twinned approach to broaden our efforts to increase longevity and ensure more years of life are lived in good health. A key factor here is prevention – prevention of the onset of chronic diseases and multimorbidity, prevention of progression to complex multimorbidity and prevention of the negative impacts of living with multimorbidity on prosperity and day-to-day life.
To effectively address the variation in the growing unmet health needs associated with multimorbidity, there must be a shift in approach throughout the medicine lifecycle and alignment of healthcare services. This should aim to move away from single diseases and towards patient-centred care informed by clinical trials that reflect the people and their increasingly complex health needs that make up populations today.
Challenge 2: Financial incentives across health systems are not aligned with patient and population health
Health systems must transition from importers of illness to exporters of health in order to realise health as an asset for local and national economies. Current payment approaches generally do not incentivise this. Typical activity-based payments ‘reward’ illness while for many health conditions, less activity – fewer unplanned hospital visits and admissions – is a sign of success. The theory and narrative of value-based care has had increasing traction for decades and yet examples of it being implemented are too few and far between. Through aligning the incentives of providers of therapeutics and those paying around patient and population health, innovative value-based reimbursement approaches could enable faster and more equitable access to innovative medicines for patients in a sustainable manner.
While the Covid-19 pandemic and the rapid advent of vaccines made clear the societal value and corresponding impact on equity that medicines can bring, this is rarely captured, quantified or incentivised. Understanding and quantifying the true value of medical interventions to patients, healthcare systems and wider society will help align priorities around boosting the health of people, communities and nations and in turn prosperity.
Achieving this through leveraging real world data to enable a realignment of financial incentives between payers and providers of therapeutics to coalesce around patient and population health would be a framework to boost health and reduce inequalities in health and wider society.
Moving to a better model
Throughout the following chapters of this report, we provide insights into drivers of inequalities in health across the medicine lifecycle.
We paint a vision of what success could look like in transitioning to a system with equity at its core and provide feasible measures that could help achieve this across the life sciences sector across four areas:
- pre-medicine approval
- market access
- post-approval, and
- the role of life science companies as employers.
I hope you find this report both insightful and interesting. If you would like to discuss any of the points we raise, please do contact us.