In the run-up to the World Health Summit in October, it is valuable to reflect on where we are today in global health. There is much to be hopeful about, such as promising innovations like the Malaria vaccine and mRNA technologies; improved recognition, language and action around mental health; a greater level of cross-sectoral collaboration; and a more nuanced definition of individual wellbeing. At the heart of this positive outlook is a recognition of the interrelationship between health and society.

However, a reversion to past norms looms. The return of cost containment, conflicting views between stakeholders, competing priorities, a lost focus on healthcare workers, and reactive, ineffective health policies are all possibilities as the world attempts to move on from Covid-19. Bill Gates recently labelled this as a paradox in health—despite the pandemic, funding for other infectious diseases may decline.  My greatest concern is a missed window for generational change in how we tackle and manage health, with past momentum lost as we seek short-term normality.

Although it’s difficult to know which direction will win out , for today we must aspire for the better path. This can be done by keeping a disciplined focus on the issues that matter and adopting a more holistic, integrated view on health. I have asked global experts in Economist Impact’s health policy team to address important themes in health and discuss vital questions: 

• Where are you most hopeful for seismic change in how we approach health?

• Where do we risk falling short in this endeavour, or worse take steps backwards?

• What is one key priority that drives this hope towards reality?

If you have any thoughts on the themes below or are interested in engaging us in further debate, please contact me at [email protected].  

Health risk communications (Sarah Aleyan, Manager—UAE)

The manner in which governments communicate with populations is critical in ensuring an effective

response during times of crisis. The evolving information environment has made it easier for misinformation to spread at a rapid pace and scale—particularly on social media platforms—exemplifying the importance of effective health risk communication. Specifically, cogent  health risk messaging plays an important role in empowering citizens to make well-informed decisions and dispel misinformation. 

As evidenced by experiences drawn from the Covid-19 pandemic, countries that utilised clear, co-ordinated and transparent health risk messaging were better able to obtain public buy-in and motivate changes in health behaviours. For instance, Chile mounted an effective communication campaign aimed at enhancing rates of vaccine uptake. In the case of Vietnam, a multi-pronged and co-ordinated communication strategy was used to  foster trust in public institutions and encourage adherence to public health measures. Other countries such as Denmark held multi-disciplinary press conferences and used trusted public figures to build and maintain trust in governments and effectively engage communities. In the case of New Zealand, consistent and co-ordinated messaging across stakeholder groups greatly enhanced the public’s co-operation and adherence to public health measures. 

The emergence of novel infectious diseases—such as monkeypox—demonstrates that this threat to the resilience of health systems goes beyond Covid-19, drawing attention to the importance of ongoing and effective health risk messaging across the world. Timely and evidence-based information plays a crucial role in mitigating the spread of misinformation, which causes confusion, sows mistrust and undermines public health efforts. 

AI, digital health and undiagnosed NCDs (Santos Das, Manager - India)

It has long been known that non-communicable diseases (NCDs) are the leading cause of both disability and death globally. The increasing burden of NCDs globally is seeking attention from policymakers, clinicians and health service providers. 

Digital health and the use of artificial intelligence (AI) can help in early identification of risk factors. Undiagnosed/under-diagnosed diabetes, hypertension and cardiovascular diseases (CVD) contribute to the increasing prevalence of NCDs. Artificial Intelligence (AI-CVD) risk score can be used for early identification, referral and prediction purposes. An AI-based CVDs risk approach is a cost-effective means to identify the most vulnerable so that immediate short- and long-term preventive steps can be followed to mitigate the risk. This approach will benefit resource limited settings like low- and middle-income countries.

For example, leading hospitals in countries including Singapore, India and USA have piloted an AI-powered tool to predict risk of cardiovascular disease. Physicians can use the risk assessment tool to deliver proactive, pre-emptive and preventive care for at-risk individuals, improving lives while mitigating future pressure on healthcare systems. It delivers a CVD risk score using algorithms and helps in developing standardised care regimens. It also gives insights on the risk contributors that can be modified to improve the score. For example, Mayo Clinic applied AI techniques to a new screening tool for left ventricular dysfunction in people without noticeable symptoms.

There are challenges in making this happen. For example, efficient digital infrastructure—the plumbing allowing data to be gathered, moved, processed and acted on will be critical to enabling AI in real-world healthcare settings. “An immense digital revolution has taken place around us. What is missing is the ability for data integration at the right place at the right time for the right purposes and ensuring there are data governance mechanisms built in for data sharing,” said one of the subject matter experts in AI.

There is an urgent need to focus on implementing large-scale digital health interventions like AI, if the world is to meet the UN’s Sustainable Development Goal (SDG) 3 and achieve a 30% reduction in premature mortality due to NCDs. Recognising its importance, Economist Impact is advocating for the integration of digital health in the healthcare system through its evidence-based research and insights, for example the Healthcare Redefined podcast series.

Ultimately, a digitally enabled healthcare system has the potential to empower people, support industry professionals and boost clinical care. AI and digital health can complement the health system in the surveillance and early diagnosis of risk factors and predictions, which will have a significant impact, to ease the overstretched healthcare system. This in turn can be fundamental in reducing the overall burden of NCDs.
 

Private sector in healthcare (Marcio Zanetti, Country Manager—Brazil)

There are two major issues in Latin America that can be resolved in part through a greater role for the private sector. One has to do with data availability and system fragmentation. New outbreaks can be more easily fought through effective surveillance and well co-ordinated efforts to inform the population at risk, launch rapid interventions to people at risk and effectively track results. However, without data integration, which is a consequence of the lack of systems integration between public and private entities, it is difficult to conduct effective surveillance and ensure fast response to potential future pandemics. 

An offshoot of health systems fragmentation and lack of  investment is the difficulty of building resilient and integrated health systems that in turn bring equity to a country’s population. One way to close these gaps could be through well-designed public private partnerships (PPPs) in healthcare. By partnering with the private sector, governments will be able to deliver care more efficiently, without increasing the  public debt. This will enhance the government’s ability to bring broader health coverage to its population—providing good healthcare with equity and building resilience to its public system. 

Fortunately, there are good examples of these arrangements in Latin America. For instance, the State of Bahia, Brazil, implemented a successful PPP arrangement in which 86 primary health centres (Unidades Básicas de Saúde, or UBS), as well as an imaging diagnostic centre, provided centralised imaging diagnostic services to the public health service in the state. Also, privately held specialised tertiary treatment centres in the State of São Paulo, such as Perola Byngton and the Barretos Cancer Hospital, have become models of success throughout the Latin American region.

Resilience and healthier communities (Nuriesya Saleha, Senior Manager—Singapore)

What determines health outcomes? Public health experts know that 20% stem from care in health systems,

while 80% are related to social—and environmental—determinants of health. However, investment efforts have not increased or shifted in similar proportions towards building the right support—policy levers, infrastructure—to address the latter. The Covid-19 pandemic has also exacerbated the widening inequality gap in many countries, particularly in emerging economies in Asia.

How do we move the needle? There needs to be greater interaction and commitment across all sectors, referred to as a “whole-of-society engagement” by WHO in one of its recommendations. Here are three  important considerations:

1. Healthcare providers have to work closely with local communities to integrate processes to reduce health inequities and improve social drivers of health. Initiatives from Johns Hopkins, such as Medicine Alliance for Patients (JMAP) and a Social Determinants of Health (SDOH) wheel within the clinical notes system, are good examples of putting SDOH in practice.

2. Governments must consider creating clearer communication and infrastructure to facilitate collaboration across ministries on health matters. In Singapore, to better support the health of elderly individuals living alone, the first assisted living public housing was launched in 2020 through joint efforts across ministries. 

3. Employers have a responsibility to encourage employee wellness. Supporting efforts such as self-care within workspaces can not only be a tool to build healthier communities and further promote integrated care, this can also lead to reduced burdens on health systems.

As Peter Drucker wrote, “a healthy business cannot exist in a sick society”, and similarly healthy economies cannot exist in a sick society. As per the insights gained in our recent project on building a healthy productive workforce, collective efforts are needed to build healthier communities, and a stronger workforce. We must all do our part towards promoting healthier communities to build more resilient health systems, and consequently stronger economies.

Climate change and planetary health (Rob Cook, Principal EMEA and Clinical Director—UK) 

Climate change is acknowledged as a major threat for global health, but paradoxically it also presents an opportunity for wise investment. The recent focus of policymakers, researchers and business on how to address the consequences of climate change—including heat waves, droughts, floods and storms—is welcomed. These weather extremes can directly impact hunger, infrastructure loss and the spread of infectious diseases. In a complex dynamic way these outcomes can lead to increased migration, the spread of misinformation and political instability. The solutions to such multifactorial societal problems are not necessarily complex, but require collaborative thinking from global to local and an alignment of environmental, social and governance (ESG) agendas.

Decades of progress in health outcomes are at risk. Opportunities for refocusing collaborative efforts where we already know local solutions exist seem most likely to succeed, including:

• Support for expanding the surveillance capabilities of countries for infectious disease laboratory based infrastructure coupled with simple diagnostic tests used outside laboratories.

• Combine community, particularly school programmes in health literacy and hygiene behaviours coupled with the Water, Sanitation and Hygiene (WASH) infrastructure required to facilitate this, for example training of teachers and community workers in low and middle-income countries  (LMICs).

• Countering the spread of health misinformation using high quality evidence-based information and insights, using the same channels where misinformation spreads.

Climate change itself needs global direction. But  in vulnerable populations where the health effects of climate change are at their worst local action and investment in local public health priority areas could be the stimulus required. A focus on transforming the ability of communities to address hunger, infrastructure loss and the spread of infectious disease holds promise. The unprecedented challenges we face following the Covid-19 pandemic demand an unprecedented response.

Childhood stunting in Sub-Saharan Africa (Clare Roche, Manager﹘Dubai)

Reduction in child stunting has been a major target set by leading multilaterals, as recognised in the UN’s SDG Goal 2. A well-established risk marker of poor child development, stunted children are subject to physical and cognitive delays, often impeding them from reaching their complete developmental potential with significant and lifelong health, social and economic implications. The Global Food Security Index shows that hunger and stunting in children are most closely tied to the quality and safety of food. Populations with diets that lack quality protein and micronutrients, and where access to drinking water is limited, score worse in food security.  

Although stunting in children under five years of age is declining globally, Africa is the only region where the number of stunted children has increased, from 50.3m in 2000 to an estimated 61m by 2025, even without understanding the full impact of Covid-19. Climate change further poses a threat to the health and wellbeing of poor and vulnerable populations and will have a significant impact on food production and food security. According to the World Food Programme, an estimated 13m people are facing hunger as prolonged drought drives up food insecurity in the Horn of Africa. 

The economic impact of stunting is well established: Africa is estimated to lose $25bn per year in costs attributed to child morbidity and mortality and impaired cognitive, physical, and economic development due to malnutrition.The mirror image of this is the investment case. A 2013 study of 17 high burden countries estimates that every $1 invested in stunting reduction generates about $18 in economic returns.) Looking at investment in nutrition more broadly, data from the African Development Bank indicates that every $1 invested in nutrition interventions generates as much as $138 in improved health and increased productivity.

Accelerating action against stunting and all forms of undernutrition is an economic necessity as much as a moral imperative. In an environment of constrained resources, investment should be directed towards a subset of interventions that target the drivers of stunting at a country, regional and community level, are appropriate to the local context and maximise existing resources and capabilities. Empowering women through improved maternal health and education, alleviating the burden of high food prices and economic downturns and supporting cross-sector integration and resource sharing are amongst the many examples of effective policies. 
 

David Humpreys will be moderating the Game Changer: A New Lens on Investment in Health and Well-Being panel discussion at this year’s World Health Summit on October 17th CEST: 16:00 - 17:30.