Leading up to last year’s World Health Summit, we reflected about the outlook for global health. This included a two-sided perspective around the future—one optimistic and full of promising developments in innovation and collaboration, and another more discouraging through a return to past norms and siloed behaviours. Sitting between these opposing forces was the “opportunity for generational change in how we tackle and manage health”.

Has the window been missed? Despite some steps backwards as the world continues to deal with the many reverberations of the pandemic, there is a strong argument to be made that we are already on the path towards that generational change. We see evidence of this every day in the trend of a new mindset in health and well-being—a sincere focus on mental health, a more expansive ecosystem of actors tackling inequities, and a recognition of the importance of health by non-health leaders.

With this context in mind, I think we’ve reached an important moment in global health. This moment is not so much about identifying the issues that really matter and the levers available to tackle them as driving sustained action and shared accountability. To facilitate the focus on action, I’ve asked some of our leading voices in health and well-being to offer their perspectives on the state of key themes and the steps they would prioritise in the near term.

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

Theme 1 - Fulfilling the promise of digital health and disease management
Written by: Elly Vaughan

Digital technology is a story rarely away from the headlines, particularly with the rise of AI (and people’s concerns about it). But to many in health, it can feel like the conversations about “the promise of digital” are ones we’ve been having for decades now. So how do we advance these conversations into action?

While excitement about the promise of innovative technologies is justified—AI has already been in use in health diagnostics for some time, and robot-assisted surgery is firmly established in many parts of the world—we shouldn’t forget the frankly more mundane side of digital infrastructure. Can the technology systems within our health systems talk to each other? Can we assess the cost and clinical effectiveness of digital tools to ensure evidence-based interventions enter the market? Are we considering the impact of digital tools on human rights, equity and access to health care? How are we assessing and enhancing the information and health literacy of our populations? A recent Economist Impact analysis of digital health in 10 countries found that only one scored full marks across policy and governance, adoption and acceptance, and implementation of digital health. The same analysis found that the share of appointments that were delivered via telehealth ranged between 24% and 59%, indicating there is still a way to go.

The digital health infrastructure within our health systems is no different from all other infrastructure, in that to be resilient and sustainable it must be built on solid governance, financial and ethical foundations, just as is required for a physical hospital, for example. Equally, the ethical principles of equity of experience and access must apply to the digital health system as much as they do to the broader health system. Core technical principles should also mirror the broader aims of the health system to promote the appropriate use of digital technologies to deliver patient-centred care that is as seamless, effective and efficient as possible. Integration is key—the digital health system is our health system.

Theme 2 - Spurring both impactful innovations and equitable access
Written by: Neeladri Verma

Innovation has always been a cornerstone of health care. From the development of new treatments and the use of modern technologies to innovative models of care and policies that enhance health outcomes, health care has numerous examples of innovation.

However, are all innovations equally impactful? To truly make a difference, innovations must address the needs of a large population, or of those most in need—and in either case they must be accessible to the relevant groups. Consider the groundbreaking CAR-T therapy, which has revolutionised the treatment of blood cancers. It exemplifies the innovative spirit within the health-care sector. Yet its high research and development costs make the treatment exorbitantly expensive, limit its accessibility to a select few, reducing its potential impact.

In contrast, innovations seen during the covid-19 pandemic, such as telehealth for managing chronic conditions in older patients and the use of mRNA technology for large-scale vaccine development, showcase impactful innovation. They were novel, practical and were made accessible to those who could benefit from them.

There is growing recognition that when a health innovation lacks equitable access, its overall impact is inevitably diminished. In a survey conducted in 2021, 58% of US-based health-care leaders identified health equity as one of their organisation’s top three priorities. This sentiment is shared by health leaders worldwide. With the rapid pace of technological progress there is an increasing focus on inclusivity and equity to ensure that innovations are accessible and beneficial to all from the outset. Although progress is being made, there are still areas where we can improve:

• Incentivising the right type of innovation: Governments need to encourage innovative solutions with broad applicability or profound impact, using financial and non-financial incentives. For instance, by increasing investment in research and development governments can fuel the creation of innovative solutions and reduce development costs, ensuring equitable access to these advancements.
• Building a conducive policy landscape: To address systemic barriers to equitable access such as rigid regulations, limited financing options, infrastructural barriers and low awareness, policies should be flexible, receptive to new technologies, offer alternative payment models for access, support infrastructure development and prioritise education about the benefits of innovation. This will create a conducive environment for impactful innovations and promote equitable access.
• Promoting collaboration: Innovation does not happen in isolation: it requires a supportive ecosystem. Collaboration among traditional stakeholders such as researchers, health-care providers, policymakers and patient advocacy groups is vital. Including non-traditional health players such as tech firms, startups, universities and non-health stakeholders like food producers and impact investors can enhance this network. This expanded collaboration can create a dynamic ecosystem that can drive the development and implementation of accessible and beneficial innovative solutions.

Promoting impactful innovation is not enough: gaining a nuanced understanding of success is equally important to assess progress. Success can be measured through various indicators, including:

• Improvements in health outcomes, such as reduced disease prevalence or mortality rates 
• Increased access to care, especially among underserved populations
• Improvements in the quality of care, such as reduced medical errors and improved patient satisfaction
• Affordability of health-care services and the cost-effectiveness of innovative interventions
• Development and adoption of new health-care technologies.

Measuring success is key both at government and organisational levels. For governments, these indicators provide a framework to identify the types of innovation to incentivise. At the same time, they help organisations understand how the innovations can be more impactful. 

Benchmarking is another valuable tool for assessing the success of innovation efforts and comparing the performance against industry standards or best practices. The 2022 Access to Medicine Index serves as a benchmarking tool to assess and rank 20 of the world’s largest pharmaceutical companies on how they perform in improving access to medicine, including innovative therapies and vaccines, for people in low- and middle-income countries. Benchmarking can help identify areas of strength and pinpoint opportunities for improvement, paving the way for impactful innovation and equitable access.

By prioritising impactful innovation and equitable access, we can create a future where healthcare innovation is not only groundbreaking but also accessible to everyone, effectively solving complex problems and delivering desired outcomes for all.

Theme 3 - Ensuring women-centricity across the continuum of health
Written by: Latifat Okara

In the landscape of women-centric health, there’s no denying the significant progress we’ve witnessed in recent years. From improvements in breast cancer screening to the inclusion of women in clinical trials, and increased women’s leadership in health care, and awareness campaigns on various health issues, we’ve come a long way. Merely two decades ago, only half of women aged 50 and older reported having a mammogram within the past two years, according to the U.S. Department of Health and Human Services. Fast forward to 2021, the Cancer Trends Progress Report reveals a heartening shift, with 75.9% of women aged 50-74 years received a mammogram within the same timeframe. This isn't just progress; it's a testament to our dedication to safeguarding women's health.

Yet, as we celebrate these achievements, let us not forget the profound challenges that continue to persist:

• Gender-Based Violence: Gender-based violence, as evidenced by the global #MeToo movements shedding light on workplace harassment and violence, impacts on women's physical and mental well-being. Furthermore, the stigmatisation of mental health and the ongoing struggle for work-life balance all underscore the work that remains to be done. The World Health Organization (WHO) estimates that approximately 1 in 3 women worldwide has endured intimate and non-partner sexual violence in their lifetime. This harrowing statistic reminds us that our fight against gender-based violence is far from over.
• Female Genital Mutilation (FGM): A 2022 USAID report on women’s issues confirms  that at least 200 million women and girls in the world today have undergone female genital mutilation/cutting across 30 different countries, including the United States. The slow progress made on these issues reflects and reinforces structural inequalities at global, regional, national, and local levels and emphasizes the need for continued advocacy.
• Underrepresentation in clinical trials: Although a 2022 study reports that there has been a steady increase in the representation of women over the last several decades, the study recognizes that women, particularly women from diverse racial backgrounds, still face significant underrepresentation in clinical trials. This lack of representation hampers our understanding of biology and exacerbates health disparities and social injustice.

Promoting women-centricity across the health continuum requires leaders to take several crucial and high-impact actions. These include:

• Investments in cutting-edge women-centric innovations: The 2023 Goalkeepers report highlights the use of a one-time, 15-minute intravenous drip to replenish women’s iron reserves during and after pregnancy, alleviating maternal anemia currently affecting as many as 37 percent of pregnant women around the world, and 80 percent of women in South Asia.
• Gender-inclusive medical research which investigates the impact of gender on disease risk and treatment response.
• Implementation of comprehensive sexual and reproductive health education programmes in schools and communities to empower women with knowledge about their bodies, contraceptive options and family planning. For example, a study showed that applying Virtual Reality-Based Sexual and Reproductive Health Education creates an immersive and memorable learning experience for adolescents, while increasing their knowledge of sexual and reproductive health and gender-based violence.
• Advocacy for family-friendly workplace policies, embracing intersectional approaches and promoting gender diversity in health-care leadership.

Success can be measured through indicators such as increased women’s participation in health research and leadership, improved access to family planning, reduced maternal mortality rates, lower rates of gender-based violence, and positive feedback from women about their health-care experiences. These actions and metrics are essential to creating a health-care system that truly prioritises and serves the diverse needs of women.

As thought leaders in the domain of health care, we bear a collective responsibility to push for transformative change. By addressing these challenges head-on, we can shape a future where women receive equitable, gender-sensitive health care that honours their unique needs and paves the way for healthier, more fulfilling lives.

Theme 4 - Embedding people’s well-being into planetary health efforts
Written by Anne Slovic

Climate change is the world’s most pressing issue. There is an urgency to act now. According to the World Meteorological Organization, severe extreme weather events and climate related hazards account for 2 million deaths over the last 50 years. The organisation reported that most frequent hazards such as storms and floods have cost together a total of U$ 636 billion. Effects of climate change can be seen in environmental degradation that in turn threatens our health and will add an estimated US$ 2-4 billion cost to health by 2030, causing immediate health implications.  Environmental degradation leads to greater exposure to extreme heat, poor air and water quality, infectious agents and people´s displacement. Heat related diseases, respiratory and cardiovascular cancers. In the long term, climate change threatens our ability to supply food and energy to the world’s growing population. Its impacts on mental health may also be considerable. Thus, despite all the evidence and knowledge on climate change effects on health it is very likely that global temperature will rise above the 1,5 degrees celsius recommended by the IPCC.

This raises a series of concerns. The impacts of climate change are often felt most by the world’s poorest people. With an estimated 68 to 135 million people at risk of being pushed into poverty by 2023 because of climate change. People who are poorer are also generally less resilient to the effects of climate change such as failed crops, lack of clean water, lack of insurance/financial support etc. Climate change requires an all-of-government response, with health a particularly important voice that is often absent in the development of climate change policy.

It is urgent to address global governance to work on a long-term solution to mitigate the effects of climate change on health. To do so, we will have to combine efforts, with the public and private sectors working together to develop sustainable solutions with global and local impact. We have already seen positive progress in deforestation, where the Green Gigaton Challege has drawn on public-private partnerships to finance and align the efforts of governments and companies to address deforestation. Some countries in Europe have published national adaptation plans for their health sector, but crucially we need to ensure that the impact on health is incorporated as a consideration in climate change policy. As the WHO says, climate change “threatens the essential ingredients of good health”.

This is a moment for global action that is not limited by sector and borders. Maintaining good health means putting health at the heart of the climate change agenda.