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A Question of Health: The Key Challenges Shaping the Global Agenda in 2024


Commentary5th January 2024

The year ahead promises to be an exciting one in the health sector. Breakthroughs in drug discovery and precision medicine, increasingly affordable genome sequencing, and novel technologies like artificial intelligence (AI) are rapidly changing the way we diagnose, treat and even prevent serious health conditions. With many of the world’s health-care systems still recovering from the knock-on effects of the Covid-19 pandemic, these innovations couldn’t come at a better time. The Tony Blair Institute for Global Change (TBI), through its partnership in the Global Health Security Consortium, is working closely with governments to turn these challenges into opportunities.

But if the world is to feel the full benefit of these advancements, health must stay at the top of the global agenda and world leaders must move with agility to incorporate novel approaches into existing structures – or create new ones. How far these innovations can take us will ultimately be determined by how well we capture their momentum.

Will the prevention debate finally hit home? For too long, our health-care systems have focused almost exclusively on treating illness. But new tools and technologies are making it possible to shift to “health creation” mode and prevent people from getting sick in the first place. Based on data from 2020 and 2021, the Organisation for Economic Cooperation and Development (OECD) estimates that nearly one-third of all deaths in countries surveyed could have been prevented. Furthermore, preventing illness rather than treating it could also lead to enormous cost savings: in the UK alone treating preventable diseases accounts for 40 per cent of the UK’s National Health Service (NHS) costs, and a recent estimate indicated preventable illnesses cost $730.4 billion in the United States alone – more than the GDP of 171 countries. Can leaders be persuaded to switch more funding to prevention and take a long-term view of the benefits of creating health rather than treating illness?

Can governments help citizens mitigate the risks of overweight and obesity? A big aspect of the prevention agenda is tackling obesity and overweight. If successful, this will likely reduce the risks for many conditions such as type-2 diabetes, cardiovascular disease and potentially some cancers too. And it’s not only individuals who experience negative effects from these conditions. A recent TBI analysis found that the cost to the UK's NHS of treating obesity was £19 billion in 2021, and Goldman Sachs estimates that by 2035 the cost to global GDP will be $4 trillion. But the current approach to obesity policy across much of the world has not worked. As we have previously argued, reforms to the food system in conjunction with recent advances in technology and treatment will ensure individuals are able to live healthier lives. The World Health Organisation (WHO) has also recently called for more levies on sugary drinks and alcohol to tackle obesity, among numerous other health issues, saying current taxes in many countries are too low. By approaching it as a systemic problem rather than an individual one, governments could make 2024 the year we start to prevent the broader health impacts of overweight and obesity.

How will politicians respond to spiralling health costs? As is the case with prices in general, health costs are increasing across the board due to inflation. Governments are already taking different approaches to mitigate rising drug prices. Beginning in 2026, the Inflation Reduction Act will allow the US government to dictate the price of certain common drugs and biopharmaceuticals and even take action against companies whose prices outpace consumer inflation. The EU is coming at it from the other end: by trying to reduce the exclusivity period for new drugs so generics can enter the market more quickly to increase competition and choice and drive down prices. It’s worth noting that 2024 is going to be the biggest election year in history, and the price of health care is likely to loom large in some election campaigns. Each government will need to make a choice about how to address health costs or potentially face the consequences.

Will patients trust the AI revolution in their own day-to-day care? The health-care industry is set to invest 10.5 per cent of its budget in AI and machine learning in 2024, according to an analysis by the investment bank Morgan Stanley. That’s nearly twice last year’s investment. The benefits will cover everything from basic back-office efficiency in hospitals through to more accessible and efficient screening and diagnostics. In 2024 we’ll also hear more about the next frontier in generative AI: supporting the shift to personalised management of disease risk and towards truly preventative care. Many companies are now investing heavily in AI for drug discovery after systems such as AlphaFold by Deepmind have shown how it can dramatically reduce development timelines as well as costs. The market-research company Bekryl has estimated the adoption of AI could potentially save the drug R&D industry $70 billion by 2028. However, as citizens become more aware of how AI is being used in health care, governments and industry will need to shape the public debate – especially when it comes to the responsible use of data.

Will health-care systems start to fully embrace the potential of wearables? Following the demise of early digital-first health-care companies such as Babylon Health, there will be renewed questions about the best business models for health tech and telemedicine. At the same time – due to backlog pressures and staffing issues – there will be an increased imperative for governments to explore virtual wards and other methods of continuously monitoring patients in their own homes. Wearables will become much more sophisticated and interface with other tech. There will be more apps that will provide virtual health-care assistance, offering patient-centred advice on taking medication or prompting exercise. With the right investment in 2024, wearables could act as a cornerstone for a viable model of virtual health care.

Are there better ways of stopping health-care “brain drain”? Last year the International Council of Nurses warned that a dire shortage of nursing staff had become a global health emergency. It suggested the world would need to replace 13 million nurses by 2030, as 17 per cent of the global workforce is due to retire in the next few years. Post-pandemic burnout and retention problems in wealthier countries mean the situation is only set to get worse. But the ethics of recruiting from low- and middle-income countries to resolve this issue will come under more scrutiny. Governments must also focus on incentivising health-care work by changing working conditions, increasing salaries and providing access to innovative technologies. But this will be easier in some areas – for example, diagnostics in hospitals – than in others, such as adult social care. And with the greatest shortages of nurses concentrated in poorer countries where high-tech solutions may not yet be available, leaders will need to accelerate access to these technologies and look beyond them for a better way forward. The UK and Ghana are among the countries that have been exploring a new model emphasising exchanging skills and time-limited migration, whereby health professionals return to their home country after a period abroad. An announcement of a memorandum of understanding between the two countries, expected in the next few months, could shed further light on the viability of this approach.

Are we fit enough for the hottest year on record? Governments around the world are going to need to think harder about how heat stress affects workforces and vulnerable populations such as the elderly, those with heart and respiratory conditions, and pregnant women. COP28 was the first in the conference's history to have a special day devoted to the health repercussions of climate change. This emphasis needs to continue as 2024 is expected to set new high-temperature records. But it’s not just the heat that will complicate health issues. The map of infectious diseases is also changing due to the effects of climate change, with the disease-forecasting company Airfinity estimating that France could see a 50-fold increase in locally acquired dengue-fever cases by 2030. The WHO is also expected to roll out advice for health-care workers on treating air pollution-related health problems in the year ahead. And the climate consequences of pharmaceutical-company practices will be under scrutiny as well. There will be pressure for the industry to cut its own emissions, for example by developing greener types of asthma inhalers.

Can the world make concrete progress on pandemic preparedness? In May 2024 the WHO hopes the “pandemic accord” will finally be agreed after much discussion between member states. This will help refocus the debate on whether the world is really prepared for another outbreak. Aside from the fanfare over the accord, 2024 will see exciting progress on the vaccine product pipeline, especially for malaria and dengue fever. Off the back of the pandemic, there will also be continued progress in nucleic-acid vaccines, such as those using mRNA and DNA, allowing for more cost-effective and scalable manufacturing. Though these developments are not intended to prevent a pandemic or treat an outbreak on their own, vaccine innovation will certainly bolster pandemic preparedness. TBI, through its Global Health Security Consortium partnership with the Ellison Institute of Technology and scientists at the University of Oxford, has been consistently advocating an Always On approach, suggesting that investing in infrastructure for routine life-course adult immunisation allows a country to more quickly pivot to emergency response during a pandemic.

Will countries up their game on e-health? Data continues to revolutionise innovation in biotechnology and health care, but are our health systems well equipped to make the most of these new discoveries? The 2025 WHO target for countries to develop their own strategies for digital health, including the safeguarding of sensitive data, is looming. But the OECD says even many industrialised countries are still ill prepared for the digital-health transformation. The organisation points out that 90 per cent of OECD countries have an electronic health portal in place but less than half of these have systems whereby the public can access and interact with their own data. TBI has outlined plans for a personalised digital-health platform that would allow individuals to access their own records as well as a marketplace for services that could help improve health-care systems like the UK’s NHS.

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