In the UK for example, black women are four times more likely than white women to die in childbirth. Furthermore, babies that are black or black-British, Asian or Asian-British have a more than 50% higher risk of perinatal mortality, compared to white-British babies.

Typically, people with the highest incomes from dominant or majority groups enjoy the best health and the most years of their lives in good health—while people with lower incomes from marginalised groups are most vulnerable to morbidity and mortality. There is a need to think dynamically about the role of structural barriers and sociocultural influences and how they impact holistic health:this is where inclusivity in health comes in. It’s about challenging us to think differently about health: exploring new partnerships, better understanding of what good health means to the different communities within our societies, engaging with the public and thinking outside the box to bring new stakeholder groups into action.

In October we launched the Health Inclusivity Index, developed by Economist Impact and supported by Haleon. The first edition of a three-year research program assessing the state of health inclusivity in an initial 40 countries, based on three domains: health in society,  inclusive health systems, and community and individual empowerment. I had the pleasure of sharing a stage with influential opinion leaders during the launch event–organised by Haleon at the Wellcome Collection—where we discussed how inclusivity is essential to better health for all. We explored the role of policy in facilitating collaboration to improve health and removing structural barriers to accessing care, and  the critical need to match policy with structured implementation mechanisms.

The majority (93%) of countries in our index recognise health as a human right; only Jordan, the UAE, and the US fail to do so. All but seven countries also recognise that health (as a human right) means more than access to healthcare and includes access to safe drinking water, sanitation, food, housing and other requirements for a health-promoting environment. Despite this one in five countries have exclusionary policies or practices that explicitly restrict access to healthcare for certain groups or individuals. Six of these eight countries are also countries who claim to  recognise health as a human right. Professor David Napier, professor of medical anthropology at University College London, introduced the concept of defining “who we, (the population) are”. He highlighted that governments must define “we” and this is often  narrowly focused   on the majority, leaving those who fall outside of this definition of ‘we’ without access to social services.

According to our findings there is a clear role for inclusivity in improving health and plugging the inequitable gap in outcomes for the most vulnerable. While life expectancy has improved globally, healthy life expectancy has not, meaning we are living more of our life in poor health. Countries with a higher inclusivity index have populations that live for longer in better health.

We know that inclusivity goes beyond the provision of services. Barriers to health prevent individuals within a population from accessing services, even when they are readily available. Services that are free at the point of use are not inclusive if they are under-resourced, low in quality,  have limited hours of service, do not cater to language differences and require long-distance  travel. Baroness Tanni Grey-Thompson, a member of House of Lords, detailed how under-resourced they are and therefore lack the capacity to effectively respond to the overwhelming number of public requests.

People need the capacity to engage with and influence their health, recognising that many barriers are outside of their control. Examples include being time poor - lacking  the time to exercise or prepare healthy food and having a job that does not pay for time off to seek healthcare. Language barriers and limited literacy skills,—particularly health literacy and the ability to understand health information. Domain 3 of our index, “Community, and Individual Empowerment”, emerged as the strongest driver of inclusivity. Countries that prioritised empowering local communities—removing these socio-cultural barriers—and placing individuals at the centre of service delivery, were among the highest-scoring for health inclusivity.  Eight of the top ten scoring countries achieve their highest score in this domain. Beyond this, Domain 3 has the strongest correlation with overall inclusivity score, indicating that it is the best predictor of a country’s overall score in the index.

People need the capacity to engage with and influence their health, recognising that many barriers are outside of their control. Examples include being time poor - lacking  the time to exercise or prepare healthy food and having a job that does not pay for time off to seek healthcare. Language barriers and limited literacy skills,—particularly health literacy and the ability to understand health information. Domain 3 of our index, “Community, and Individual Empowerment”, emerged as the strongest driver of inclusivity. Countries that prioritised empowering local communities—removing these socio-cultural barriers—and placing individuals at the centre of service delivery, were among the highest-scoring for health inclusivity.  Eight of the top ten scoring countries achieve their highest score in this domain. Beyond this, Domain 3 has the strongest correlation with overall inclusivity score, indicating that it is the best predictor of a country’s overall score in the index.

What should be done?

Don’t stop campaigning for universal health coverage and the social determinants of wellbeing —they are critical to expanding access to healthcare particularly for the most vulnerable

Empower communities and enable self-agency:an effective approach to expanding access to whole health. During our discussions, Katy Jon Went, head of methodology at the Human Library, reminded us at the event of the “need to humanise the data” recognising that there are individuals, communities and societies behind the numbers

Work from the outside in. By deliberately supporting vulnerable groups, you will help improve health for all and remove structural barriers that mostly impact the minority

Pull in the same direction: elevate the importance of coordination to achieve common goals

Advocate for high-quality data collection, and “real-world evidence” for inclusivity

Nations must tackle all three domains of the Health Inclusivity Index to achieve an inclusive system that promotes universal wellbeing . The Health Inclusivity Index provides the first ever quantitative measure of inclusivity, but also provides a framework for countries to pull levers that drive inclusivity and improve health for all.  For more information, explore the Health Inclusivity Index Hub and white paper.

Personalised healthcare for billions: Communication challenges in the post covid-19 age is a report written by Economist Impact and commissioned by WhatsApp. 

Understanding the healthcare communications methods that worked during the covid-19 pandemic, and the new and innovative approaches and digital tools that facilitated this, can help guide the development of an improved approach to healthcare communications in the future. The experience of governments in managing complex healthcare challenges, such as mass vaccinations, while combating misinformation and ensuring data privacy, also provide key insights to guide the development of further digitalisation of healthcare communications and services.

Key findings from this project include:

Effective healthcare communications is critical. Beyond its sizeable physical impact, covid-19 revealed how vulnerabilities in healthcare systems have implications for health, economic progress, trust in governments, and social cohesion. It also highlighted the importance of healthcare communications to overall health among populations, and its impact on trust and national structures. Transformation of healthcare communications requires support. The need for digitalisation of healthcare communications during the pandemic shows that governments, and public and private healthcare organisations, must drive transformation through funding and access to innovation. This will ensure that the healthcare communications lessons from the pandemic are not lost, and better prepare systems to be resilient in order to respond effectively and help protect lives during future pandemics. Cooperation is key. As well as funding and guidance, partnerships between different levels of government, between governments and technology companies, and with nongovernment organisations and stakeholder groups are vital to provide an ecosystem that supports and encourages the longterm positive transformation of healthcare communications. Fundamental communications principles remain. Digitalisation enables new ways of communicating and engaging with healthcare information and services, but the fundamentals of targeting an audience, crafting reliable, trusted messages, and keeping things clear and simple remain. Humans remain at the heart of healthcare communications, and fostering their development is just as important as improving digital technology. More research is required. Investment in and development of digital tools like chatbots and telehealth that facilitate healthcare communications and services are expanding rapidly, often without sufficient evidence that these tools are effective. Further research is required into the pros and cons of such services before they are fully embraced by healthcare organisations.

Economist Impact would like to thank the interviewees who generously offered their time and insights, including:

Shri Abhishek Singh: President & Chief Executive Officer, NeGD and MyGov, and Managing Director, Digital India Corporation Setiaji Setiaji: Chief of Digital Transformation Office, Ministry of Health of the Republic of Indonesia Diego Fernandez: Secretary of Innovation & Digital Transformation, City of Buenos Aires, Argentina Noella Bigirimana: Deputy Director General, Rwanda Biomedical Centre Dr Genya Dana: Global Head of Health Policy, Avellino, and former Head of Health and Healthcare, The World Economic Forum

The findings and views expressed in this report are those of Economist Impact and do not necessarily reflect the views of survey respondents, interviewees or the project sponsor.

How will digital health evolve? Will cost containment come back? Are we prepared for the next pandemic? Will mental health remain as a priority? These are common questions Economist Impact gets from stakeholders in health, nearly two-and-a-half years since covid-19 first dominated the world’s agenda. While it’s challenging to separate passing fads from long-term drivers, there are clear themes that will rightly shape the future of health. However, the path each takes is not predetermined—at least not yet. 

Here are five important trends we are tracking in a post-pandemic world of health:

Is covid-19 really over?

In most of the world, the pendulum has already swung from one end to the other and back again with responses to covid-19. Long periods of strict mask adherence, widespread testing and restrictions on social interaction have given way to activities that are nearing pre-pandemic levels. A reason for this shift is due to human nature, where the combination of exhaustion and desire for normalcy drive current behaviors. However, another factor stems from changing perceptions about the virus, levels of risk posed and the anticipated movement to endemic status. 

There are positive signs,  such as the ratio of cases to hospitalisations and the effectiveness of vaccines, indicating a different stage in the covid-19 evolution, but it’s also clear the path forward will be both uneven and unpredictable. Countries employed varying tactics during the pandemic, from “zero-covid” strategies in China and New Zealand to a mixed-policy approach in America and the UK, but all have experienced similar or worse metrics this month, than a year before. Also, with mounting evidence about long-term health concerns for those with prior infections, we are likely to see more—not fewer— risks in the near future.

In this sense, there is a need for a balanced approach moving forward. Instead of “learning to live”with the virus, affected stakeholders—health, economic, societal—can seek out nuanced policies and integrated actions to mitigate future threats. The scars of the recent past should also spur proactive monitoring and preparation as frantic, reactive efforts across the world have already proven too costly. As covid-19 maintains an active presence, these actions allow for a greater chance of success and will  also foster an environment better placed to deal with future pandemics. 

What to do with the silent pandemic? 

Many health experts argue that another major crisis had been prevalent before covid-19, but its slow-building nature ensured it did not attract nearly as much attention. The “silent pandemic”of non-communicable diseases (NCDs)—diabetes, cancer, respiratory and cardiovascular conditions—had plagued advanced and emerging economies for decades. This stems from a combination of underlying lifestyle choices and ageing populations. While progress had been made, countries were still falling behind targets such as Sustainable Development Goal (SDG) 3.4 and the reduction of premature deaths from NCDs.

The pandemic not only halted progress but led to regression: postponement of public health screenings, disruptions in quality treatments, lower patient engagement, worsening healthy behaviors and overstretched healthcare workforce. In the past year, as much of the world has attempted to return to past care dynamics, these factors have led to a “double burden” with NCDs, where the backlog of cases weighing down fragile health systems is putting the “silent pandemic” on an even more precarious path.    

Tackling this will be an ongoing effort for years to come. However, positive ramifications from the pandemic—new tools in health, better understanding of wellbeing, active support from outside of health systems—can lead to improved interventions and outcomes. A pertinent example is the current dialogue and action around mental health—in the workplace, in communities and the mainstream media— raising awareness and promoting openness to combat a critical issue. Sustaining that trend across different NCDs could lead to lasting change.

What will technology’s role be in the future health ecosystem?

Technology has long offered great potential for health; the challenge has not been generating innovative ideas, but translating them into real-world solutions. The pandemic experience—either through necessity or real progress—has in part bridged the existing gap, providing a clear roadmap for the application of tools such as “augmented intelligence” in proactive decision-making. This type of problem-solving goes beyond health, intersecting with societal challenges such as ensuring the important principle of medical neutrality in conflict zones. 

The question of who will lead the way in generating impactful solutions remains. For years, expectations have been high for technology firms increasing their health presence, yet measured impact has been inconsistent at best. However, the pandemic has accelerated this movement with Alphabet’s growing investment in health and Amazon’s recent acquisition of a US primary care entity.. This trend is expected to continue, especially as the technology industry applies lessons from its role in the pandemic response towards more mainstream healthcare needs.

Where is health’s voice in the sustainability movement?

Health is intertwined with one of the world’s most important movements: the urgent need for global action towards a more sustainable planet. The recent heatwave across many parts of the world is another reminder of the importance of sustainability efforts and its relationship with health. As Natalia Kanem from the United Nations Population Fund (UNFPA) aptly stated at last year’s World Health Summit, “climate change affects poverty, affects hunger, certainly affects health”.

Acting upon that clear and logical connection will be a critical area of focus for health. From more eco-friendly healthcare supply chains, to access to sustainable food systems for balanced diets, a multitude of opportunities exist for stakeholders to assume greater leadership. Not only will health further strengthen the need for increased investment and attention on this issue, a “health in all policies” approach will also ensure a holistic, societal view around sustainability goals. 

Will the pandemic foster a new age or will we revert to past norms?

One of the most critical lessons from the pandemic is found throughout history—the power of collective action and singular focus on a shared goal. In the case of covid-19, this was manifested through numerous collaborations: vaccine development and distribution, research and public health communication and societal interventions to slow the spread of a dangerous new virus. Actors that embraced a dedication to the “common good” instead of individual objectives, generated clear results: findings from an Economist Impact study on pandemic response is one example of many that identified stakeholder collaboration as a vital element of success.

The opportunity exists to employ the same tactic for the biggest issues that rose in importance following the pandemic: health equity, sustainable innovation and holistic wellness. Underpinning this window for seismic change is a greater recognition from actors in health and society that known problems in health require new approaches. That recognition, along with existing models of success, such as a cross-sectoral group of actors working together for healthy ageing, offer a roadmap to replicate in the future. 

Tackling these issues requires the same collaborative spirit and long-run view; two dynamics that are difficult to maintain beyond moments of crisis. Indeed, a return to short-term focused, incentive-driven and siloed activity in health is likely. To ensure the window is not lost, it is vital to reframe the benefits of wellness in a way that aligns shared goals between a wider group of actors. The vision laid out by business leaders, who increasingly see health as a strategic imperative, is a signal of a larger paradigm shift in how we can collectively work towards a world of better health for all.