Reducing inequalities in health. How can industry support the new Office for Health Improvement?
With the launch of the new Office for Health Improvement and Disparities suggesting a shift in focus within Sajid Javid’s Department of Health and Social Care, what role can the life sciences industry play in supporting this agenda?
On Friday 3rd September it was announced that Secretary of State Sajid Javid had given the go-ahead for the new Office for Heath Improvement and Disparities to launch on the 1st October. As his predecessor Matt Hancock was synonymous with digital and e-health, sources suggest that Mr Javid is keen to make health inequalities and disparities a main focus of his tenure, perhaps reflecting his position as the first BAME Secretary of State in that Department.
As well as being a personal area of interest, the investment in health inequalities also fits very well with Chief Medical Officer Chris Whitty’s interest in deprivation and its impact on public health (with the CMO believing we can’t solve issues of public health in England without addressing underlying poverty and health inequalities such as access to services). It also supports No. 10’s wider ‘Levelling Up’ agenda. But as with all new agendas, success will be born from partnership with patient, academic and private sectors, so what might the ‘ask’ of the life sciences industry be in meeting the Department’s new priorities?
COVID-19 has shone a light on just how stark health inequalities are in the UK with individuals from black and minority ethnic groups, poorer socioeconomic backgrounds, deprived locations, and vulnerable groups of society suffering the full force of its effects.
But inequalities in health have existed for many decades and have led to unjust consequences in morbidity and mortality. Life expectancy is a key measure of how healthy a society is: and so inequality in life expectancy or quality of life are key measures of health inequality. In England, there is a systemic relationship between how rich you are and your life expectancy. Men living in the least deprived areas can expect to life 9 years longer than their counterparts in the poorest areas. Inequalities in both healthy life expectancy and disability-free life expectancy are even wider than inequalities in life expectancy.
People in poorer areas spend a far greater part of their already far shorter lives in poor health. The sad fact is that inequalities in health, or future health, begin in utero: higher incidence low birthweight, premature birth, infant mortality and cognitive problems are associated with poor maternal health and deprivation. Evidence shows that a quarter of deaths under the age of 1 could be avoided if we had no health inequalities.
Reducing health inequalities and giving everyone the chance of a positive, healthy life is not just a health or an ethical issue, it makes fiscal sense. As noted in the DHSC release, ill-health amongst working-age people alone costs the economy around £100 billion a year, and it’s estimated that 40% of health care provision in the UK is being used to manage potentially preventable conditions.
So the challenge is clear, but what’s the solution and what could the role of the life sciences sector be in helping all patients, regardless of postcode, get the best chance of a healthier life?
- Understand the full extent of the problem. Pharmaceutical communications has, rightly so, become far more patient-centric and based on the lived experiences of real patients. But which patients do we hear from most? Arguably those who are engaged, educated and already part of patient communities. We hear from patients who can articulately describe their experience, who challenge the care they receive and know how to ask for more. I personally hate the term ‘hard to reach’, but industry would do well to listen to a broader choir of voices to fully understand how deprivation impacts the ability to get the best care.
- Take the path less trodden. So much of our work is London- or major city centric, whether that be working with specialist centres or the media. Researchers from the Massachusetts Institute of Technology (MIT) have found that residing in a city actually adds an extra year to someone’s life. But what about the 25 per cent of the UK that live in rural areas? What about the patient who can’t drive to a specialist centre or knows about the clinical trial currently running? Industry could focus more outside of its geographical comfort zone to speak to a greater (and arguably more needing) percentage of the population.
- Be authentic. Instead of trying to tackle the whole problem, companies need to be able to articulate what their heritage and commitment to reducing health inequalities has been and consider carefully what further value they can add to their patient communities. HSBC, in response to the country’s homelessness crisis, has released a bank account specifically designed for people without a permanent address. Here is a company designing an innovative solution to an established problem in a way which draws upon their expertise. Pharmaceutical companies would do well to think about where they can have the greatest impact, vs trying to impact the greatest number of people.
In summary, industry should be thinking about how to articulate its commitment to meeting the government’s agenda, to improve patient care and outcomes. Pharma has arguably done more than most to understand health inequalities; now that this matches to the government’s agenda so clearly, how can we ensure that the industry’s voice is heard and we are seen as part of the solution? The key will be getting on the front foot and showing Government how the sector has been leading the way vs. waiting to be asked, or even worse, told. In the same way that ‘innovative medicines’ and ‘health technology’ were the focus under Hancock, we now will be asked to answer a different exam question.
The industry needs to evolve its approach in order to answer it.