Partnering to build resilient and sustainable health systems

The first day kicked off with a panel exploring the range of responses to the health impacts of climate change. Anca Toma (European Patients Forum) shared the importance of holistically approaching health in both a needs and outcomes manner. She added that establishing a dialogue of inclusivity by engaging members of society to shape health systems is a practical way of placing patients at the centre of decision-making.

Resilience and sustainability in the health system are contingent upon the ability to both treat and prevent, a theme which cropped up throughout the day and provokes one to consider the true meaning of ‘healthcare’ as not just being ‘illness care’. Although the current system favours a curative approach to health, Glynn Richards (Bupa) declared that preventative medicine is fundamentally the more environmentally conscious way of treating people. The panel agreed that it is imperative that we tack the climate crisis and its interplay with the health crisis by ‘looking beyond the healthcare system’ at the ecosystems that drive human health. Glynn went on to say, ‘doing less harm is only part of the solution, we need to do more good’.

So, what can doing more good entail?

Robert Metzke (Phillips) suggested establishing science-based targets and Martin Price (Janssen) cited long term financing and continuous improvements in governance as other prime examples. He also underlined the importance of thinking about a value-based healthcare approach when shaping the care pathway and reframing the common question of ‘can we afford to do this?’ to ‘can we afford not to?’.

Other concrete actions to move towards the long-term vision include partnership between public/ private sectors, academia and beyond to optimise innovation, regulation, transparency, and accountability. Another important element of building resilience is encouraging individuals to make greener choices, as Bupa’s CO2 calculator in the Blua digital health app is doing.

The panel concluded by agreeing that whilst the immediate burden of disease demands a curative approach to health, we should not be investing in this alone. Instead, we need to glean lessons from the existing data and trends to project into the future and formulate better preparedness plans. Cross-sector partnerships will be fundamental to federating and leveraging the necessary data.

Future proofing healthcare systems: preparing for emergency and recovery

In an interview with Roland Driece (Ministry of health, WHO intergovernmental negotiation body), Elly Vaughan questioned the four key drivers of problems that healthcare systems are facing. Roland responded with: nuclear problems, pandemics, AMR, and the climate crisis.

Roland underlined that although the pandemic unravelled some of the most prevalent national and international flaws in the system, we still need to enhance preparedness. Due to strong international cross borders, negotiation between member states of the WHO in the creation of a preparedness instrument would be one of the best ways to do so. This would require agreement upon several issues, including IP rights.

There needs to be a drive to invest in systems in the global south to bridge the inequity gap between healthcare systems across the globe. Importantly though, he stated that ‘public health should always be the starting point of these discussions, not politics’, something often forgotten in the political arena.

Roland also recognised that it is human nature to focus on present problems, and preparedness is no longer top of the media and political agenda. The WHO is focussing on not forgetting the hardships of the last decade and using them to press the issue of preparedness to ‘future proof’ the healthcare sector. Again, the importance of prevention is clear when we consider that building resilience reduces the likelihood of an overburdened healthcare system in the face of some of the aforementioned driving issues.

Is Europe ready for future health hazards?

The WHO are also encouraging members to have more responsibility in making changes, using the State Party Self-Assessment Annual Reporting (SPAR) tool to detect and score risks. Jenny Harries (UK Health Security Agency DHSA) cited this tool as an example of how we can push to be more prepared to prevent, rather than to respond.

Another notable example is the development of sequencing and genomics for surveillance purposes. Sharing such data is valuable for tracking disease temporally and geographically to enhance our understanding of resilience. The WHO’s International Pathogen Surveillance Network (IPSN), which was brought together by the WHO hub for pandemic and epidemic intelligence, demonstrates how pathogen genomics are used for public health decision making.

Jenny Harries concluded by stating that collaboration in policy and progression are the ‘bedrock of getting this right for the future’ echoing the previous session’s points around the multifaceted value of partnership.

Are health systems ready for population change?

The global population is expected to reach 9.7 billion by 2050, leading to worrying concerns that the healthcare system is not set up for such a change. In a panel discussion on this issue, Josep Figueras (European Observatory on Health Systems and Policies) shared the value of a positive attitude which views health as an opportunity. He pointed to empowering ourselves and using ‘health for all‘ policies that concurrently benefit the environment, education, gender equity, and poverty.

As the panel examined concrete ways to enhance preparedness, Jo Etienne Abela (Minister for active aging, Malta) emphasised the need to restructure education to give people more job mobility in the healthcare sector. This led to a discussion about the value of migration for recruitment in the sector, which the panel agreed requires careful consideration. Particularly, how it impacts the country from which healthcare workers are emigrating. This provoked comments in the audience about the ethical legitimacy of having laws that require workers to stay in the country where they trained for a specified amount of time before migrating. The panel discussed the value of international training schemes and globally recognised medical accreditation.

Coming back to prevention, Ilona Kickbusch (Global Health Centre) stated that ‘if we don’t invest and regulate where it matters, we are not able to solve the problems of healthcare systems’. For example, obesity costs Europe 20 billion per year. If it could be adequately prevented, the money could be invested in other areas, such as preparing for demographic changes.

Ammar Qadan (Cepheid) asserted that innovation is more important than ever before. After Covid revealed how aging populations are at higher risk, the need for early diagnostic tests available at point of care is clear. He reminded us that economic evaluations are critical here, to demonstrate value for money to healthcare systems, as well as a myriad of other positive repercussions. This again, highlights the value of cross-sectorial partnership.

Josep raised an interesting point about not neglecting the opportunities offered by informal care and utilising this as a productive source of capital and economic growth. There is already a huge body of research confirming the positive ramifications on health of something as simple as socialisation. Therefore, finding cost-effective ways to reduce the burden on the healthcare system is a key opportunity to prepare the system for the future.

Addressing the healthcare workforce crisis

The second day opened with a session on addressing the healthcare workforce crisis, moderated by Graham Cookson (OHE). The WHO predict the workforce will be short of 18 million workers by 2030, underlining the immediate need for opportunities.

The panel agreed that digital innovation is a huge piece of the puzzle in tackling this, taking care beyond the hospital and offering a unique opportunity to improve efficiency, accessibility, and quality of care. Importantly, transitioning to this new model of care requires inter-productivity, communication, and education to ensure effective and equitable implementation and adoption.

Istvan Ujhelyi (European Parliament) shared that the lack of coordination across member states hinders the development and deployment of innovative solutions, with major discrepancies in long term care expenditure and digital health policies and regulations. Coming out of our silos to foster cross sector work will help upscale and rescale healthcare, said Elizabeth Kuiper (European Policy Centre). She also stressed the role of civil society and patient organizations in co-creating and co-designing digital health solutions that are tailored to their needs and preferences.

The panellists discussed the broader picture of what drives the health workforce crisis in Europe, which they agreed is a complex problem. Elizabeth pointed out the difficult European context that affects health systems and policies, such as migration, geopolitical tensions, demographic changes, climate change, and social inequalities.

Istvan added that there is also a political dimension, as health is often deprioritized by governments and parties. He called for political parties to talk about health issues, especially during campaigns and elections. He also suggested curating a campaign for health workers at the European level, to advertise the sector as an attractive career choice and encourage them to be a ‘hero of society’.

Bjorn Zoega (Karolinska University Hospital) noted the lack of appreciation for health workers across countries, with low salaries, poor working conditions, frustration, burnout, and attrition. Whilst things like sign-on bonuses might offer a short-term solution, a paradigm shift is needed for fundamental change.

Graham asked whether the extent to which the workforce crisis is a gendered one. Elizabeth Kuiper (European Policy Centre) explained that the health workforce is predominantly female, especially in long term and primary care, and they are unfortunately often underpaid, undervalued, and overworked. Other challenges include gender-based violence and failure to receive adequate upskilling or reskilling to catch up with the changing demands of the sector following parental leave.
Another aspect of the problem was raised by Istvan: the brain drain of health workers from poorer to richer countries. He said that this is a serious challenge for many countries in Eastern and Southern Europe, which lose their skilled and trained workers to other countries that offer better opportunities and conditions. Not only is this unfair, but also unsustainable as it creates imbalances and gaps in the health systems of both sending and receiving countries. He proposed some possible solutions, such as vocational training and skills exchange programs between countries, or agreements that require health workers to work in their own country for a specified period before they can migrate.

Digitalisation as a driver for a sustainable and resilient global health

The European Commissioner for Health and Food Safety, Stella Kyriakides, presented on the role of digital health in the EU and beyond. She highlighted the importance of having a global strategy that takes account of the needs of low- and middle-income countries outside EU borders. She also stressed that European health data is the backbone of EU health policy and can make the EU a global leader in data enhancement.

Stella explained that access to health records is crucial for regions that suffer from a lack of health services, or “medical deserts” as the data can contribute to evidence-based policymaking and improved health outcomes. She added that a key requirement for strong digital health is health records that respect patient privacy and rights. She announced that the EU is investing 810 million euros in the rollout of digital health infrastructure across the member states.

Digital health can increase the quality, accessibility, and resilience of health services, which in turn enhances preparedness for future health threats. Stella listed better screening, diagnosis, and treatment of diseases as other digital health benefits. She cited the prime example of Europe’s Beating Cancer Plan, which aims to provide digital tools to prevent, detect, and treat cancer.

The potential pitfalls of digital health were also acknowledged, including risks of digital exclusion perpetuating health inequality. Equity needs to be at the forefront of digital health initiatives so that digital literacy does not become a barrier for health care access. Stella called for more investment and cooperation in innovation and research, as well as ensuring ethical and legal standards for data protection and governance. She concluded by noting that digital health is not an end, but a means to achieve better health for all.

Shifting the focus to wellness and wellbeing

This panel started by agreeing that wellbeing is not only a matter of health care, but also of social, economic, and environmental factors. Accordingly, a cross-sector approach enabling communities to tailor programmes to specific needs and contexts needs to be adopted by local authorities. Hildegarde Naughton (Department of Health, Ireland) exampled Ireland’s implementation of ‘The Healthy Ireland Framework’, which aims to improve wellbeing by addressing health determinants including education, transport, housing, and environment.

Axel Heitmueller (Imperial College Health Partners) added that healthcare systems are often thought about in a deficit model, focusing on the negative aspects of disease and illness. He argued that we need to shift the focus upstream to staying healthy with prevention, promotion, and protection. He cited examples of how Imperial College Health Partners have supported innovation and improvement in healthcare systems through creating networks of social prescribing link workers to connect people with community-based services and activities.
Christian Roques (European Commission) noted that wellness is also influenced by workplace culture, and exampled their BeWell policy, which strives to improve wellbeing and foster multistakeholder partnerships to reskill and upskill the workforce.

Charlotte Frost (Schroders) shared that they have also adopted a holistic approach to wellbeing, covering physical, mental, financial, and social aspects. As well as providing access to appropriate support, they have leveraged AI to analyse employee feedback and sentiment.

Barriers hindering the shift to wellness include the difficulty of changing values and behaviours. Whilst the pandemic raised awareness and appreciation for health and wellbeing among the public, it also created some resistance and fatigue towards public health measures and restrictions. The panel agreed that we need to find a balance between protecting public health and encouraging individual responsibility whilst respecting autonomy and individual rights and freedoms.

Addressing the health consequences of climate change

In her interview, Vanessa Kerry (SEED) shared a myriad of health consequences, from air pollution killing as many as 7 million people annually, to the loss of 100 billion dollars from reduced productivity caused by heat. Climate change is affecting every part of the fabric of our society, and perpetuates inequality, disproportionately affecting women and children, who are more vulnerable to malnutrition, waterborne diseases, vector borne disease, and displacement. This not only threatens health, but diminishes education, livelihoods, and human rights.

When asked how communities can be prepared to respond, Kerry answered that investment in health workers across the globe is essential for achieving universal health coverage and sustainable development. Through partnership with local institutions, SEED are training physicians who can combat 80% of health issues, building resilience to the changing climate.

Kerry also shared that every dollar spent on health care in low/middle income countries returns 9 dollars in increased productivity and 20 dollars in improved welfare. This is why health care needs to be prioritised as an investment for socioeconomic benefits, rather than framed as a cost.

In terms of mobilising the private sector, business practices need to be aligned with ESG goals, such as through investment in renewable energy and circular economy promotion. Setting mission critical examples is a brilliant way to commit to the agenda and pave the way for other organisations.

One of the biggest challenges is escaping the short-term cycle and looking at the bigger picture. Kerry underlined the importance of reframing metrics from temperature degree change to something more impactful, like lives lost. This is more meaningful when encouraging people to consider the tangible cost of inaction and importantly, the human benefit of action.

Finally, we need to communicate that addressing the health consequences of climate change is not only a moral imperative, but also an economic opportunity. To exemplify, in India, 9 billion dollars are spent annually on managing non-communicable diseases, such as diabetes, heart disease, and cancer. These diseases are largely preventable, and often linked to environmental factors, such as air pollution, poor diet, and physical inactivity. By investing in preventative and primary health care, we can not only save lives and reduce suffering, but also save money and resources that can be invested elsewhere. Mitigating the health consequences of climate change is not a trade-off, but a mutually beneficial win.

Reviewing spending as the burden of disease shifts

Non-Communicable Diseases are the leading cause of death and disability worldwide, responsible for more than 70% of all deaths globally, and accounting for a staggering predicted burden of over US$ 30 trillion over the next decade. When considering that most of these diseases are preventable through simple and cost-effective interventions, the need to push the prevention agenda is clear.

Lucy Chappell (Department of Health and Social Care) shared how the NHS’s prevention programme is an initiative to move away from a curative approach to health by focussing on prevention in several areas. This includes AMR, HIV, cardiovascular disease, cancer, diabetes, TB, as well as alcohol and tobacco dependency. To encompass the benefits of prevention, she called for a multi-disciplinary approach, this system change will facilitate a shift towards integrated care systems, and improved use of technology and data.

Graham Cookson (OHE) presented the benefits of prevention, which include improving health outcomes and quality of life as well as reducing inequalities and saving lives. It also generates significant economic returns, avoiding the direct and indirect treatment costs. He argued that prevention offers a unique opportunity to contribute to several social and environmental goals, such as reducing poverty, improving education, and protecting the planet.

The key challenges and barriers hindering the uptake and implementation of prevention were outlined by Graham. Firstly, with most political lifecycles outliving the timeframes in which prevention benefits become obvious, there is a lack of political commitment to prioritise an alternative to a curative approach. As a result, prevention programmes and policies receive insufficient funding and resource allocation. Secondly, a fragmented and siloed approach to prevention across sectors and levels of governance results in low awareness and participation amongst the public and health professionals.

Graham called for a comprehensive, coordinated approach that involves all stakeholders and sectors to advocate for prevention as a strategic priority for health and development. This requires mobilising adequate and sustainable financing for prevention programmes and policies to support the transition to a wellness focused health system. This involves enhancing the knowledge and skills of health professionals to deliver preventative services as well as adequately monitoring and evaluating prevention outcomes using robust data.

Graham concluded the presentation by directing the audience to the report, ‘Reimagining Prevention for a Healthier, More Prosperous Society’ which outlines supporting evidence and key recommendations for the future of the prevention agenda.

The economics of prevention: thinking about people before they become patients

In this discussion revolving around the utility of prevention, the panel agreed that the costs of curative care and absenteeism from ill health outweigh the costs of sickness prevention. For example, cardiovascular disease costs Europe 210 billion euros annually. Investment in prevention and harnessing our understanding of the health determinants of this disease would have vast socio-economic benefits.

The panel agreed that there is unfortunately a fragmented approach in and across member states when utilising health determinants to prevent. To prioritise investment and political engagement in prevention, awareness, and health promotion, Cyrus Engerer (European Parliament) called for cooperation between member states, as he is doing in the Beating Cancer Committee. When considering that 40% of cancer in the EU is avoidable, the necessity of pushing the prevention agenda is clear. Importantly, he noted the biopsychosocial interaction of diseases, calling for a holistic approach that also includes mental health, which has high levels of comorbidity with many diseases.

To consider the role of digital solutions, Raghib Ali (Our Future Health) shared how they are currently collating information on genetic susceptibility into a database, to facilitate early diagnosis and delayed disease progression. This is a prime example of how digital innovation can play a role in monitoring, diagnosis, and ultimately, prevention.
Equity was an important discussion point, especially considering that many health determinants are interwoven with social determinants. This is why education is key to ensure all members of society are included in this required shift towards prevention.