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STR 2020
01 Health
1.1Key trends
1.2Growing momentum in personalised healthcare
1.3Emerging lessons from the healthcare response to COVID-19

1.1

1.1 Access to healthcare is highly uneven

The number of people in the US without health insurance remains high, particularly so for Hispanic and for Black Americans. Partly as a result, people with lower incomes pay a higher share of their incomes in out-of-pocket healthcare expenses.

Figure 14: Health insurance, uninsured rates, by race and ethnicity, United States, 2008-18
Figure 15: Average share of family income going towards health insurance premium contributions and out-of-pocket medical expenses, by family income level, 2017

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Gains in life expectancy have been slowing for a while

In the United States, life expectancy at birth has been in decline for several years (the most recent data suggests that it has levelled off). It is improving in China, but still at quite a low rate.

Figure 16: Annual increase in life expectancy, 1965-2019

Data in the chart refer to a five-year moving average

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More emphasis needed on prevention rather than cure

As the COVID-19 pandemic has shown, prevention is often better than cure. Yet, governments spend tiny amounts on public health*, and typically cut spending during downturns.

Figure 17: Flattening the curve during a pandemic
Figure 18: Share of government spending devoted to public health, OECD, 1995-2020

Figure relates to median OECD country

* Public health refers to all organised measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole.

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Efficiency is key to ensure healthcare costs are manageable

In the United States, as in many countries, healthcare costs are set to rise sharply, due to a combination of demographic and technological changes. Productivity improvements are crucial to limit these increases.

Figure 19: Projections for growth in healthcare spending, US, 2018-28
Administrative costs need to be reduced, especially in the United States

In some countries administrative costs account for over 5% of total health spending. Billing-and-insurance-related expenses are a particular cost drain, especially in the United States.

Figure 20: Administrative spending as a share of total health spending
Figure 21: Administrative costs in California as a share of total revenue
The COVID-19 pandemic has galvanised interest in new types of medical delivery

People have turned to digital health services in their attempts to understand COVID-19. These are structural changes that may persist beyond the pandemic.

Figure 22: People who have used telehealth service for the following, 2020
Figure 23: Teledoc, third-party iOS app downloads, 2019-20

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1.2

1.2 Growing momentum in personalised healthcare

Interest in personalised healthcare was growing long before the COVID-19 pandemic

Interest in direct-to-consumer healthcare is growing rapidly, and there is rapid innovation in new personalised treatments.

Figure 24: Personalised medicines, as a share of total FDA approvals, 2005-19
Figure 25: Monthly news mentions, direct-to-consumer health, 2014-19
Dramatic cost reductions in sequencing the human genome underpin many advances in personalised healthcare

The cost of sequencing a human genome has collapsed.

Figure 26: Cost per human genome, 2001-19
Cancer mortality rates have been improving over time

Far fewer people are dying from cancer than would have been expected 20 years ago, while deaths from certain cancers have fallen precipitously.

Figure 27: Cancer incidence, male and female, 1975-2015
Figure 28: Cancer mortality in males, 1975-2015
Figure 29: Cancer mortality in females, 1975-2015

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We expect this trend to accelerate due to innovation in personalised therapies

Rapid progress has been achieved in chronic myeloid leukaemia (CML). Drugs target the molecular abnormalities that cause uncontrolled tumour growth. But malignant cells often develop a resistance to this first-line treatment. By identifying the particular type of resistance occurring in individual patients, tailored drug therapies can be used.

Figure 30: Mortality from leukaemia, UK, 1971-2017
Innovation in liquid biopsies will make key contributions to personalised cancer care

Liquid biopsies can help to detect disease early, monitor responses to treatment and predict relapse and metastasis. These breakthroughs are the culmination of a long history of genetic testing. The surge in recent innovation activity in this area reflects its huge potential contribution.

Figure 31: Patents related to liquid biopsies, global, 2011-19

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Advances in personalised healthcare often involve large-scale collection and analysis of patient data
Figure 32: Health AI startups, number, 2020 count

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Direct-to-consumer genetic tests are becoming less popular, in part due to privacy concerns
Figure 33: Online DNA kit sales, US, 2019

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Data governance is a major challenge for the whole healthcare sector

Data breaches in healthcare are becoming more common, in part because users often have a poor understanding of how their data are used.

Figure 34: Healthcare data breaches of 500 or more records, 2009-19

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Growing momentum in personalised healthcare
Accelerating sustainability trends

The personalised healthcare revolution is set to transform how people benefit from and experience healthcare.

Personalisation of cancer prevention, diagnosis and care has been at the vanguard of this trend and is already having a meaningful impact on patient outcomes.

There are also important lessons from the pandemic concerning access to healthcare. In the US, highly stratified access to treatment appears to have had a big impact on life expectancy for different groups.

Personalisation coupled with digitilisation of healthcare delivery provides important opportunities to cut costs and close the access gap.

Radical partnerships

Enhanced data governance will be pivotal to build trust. Consumers need to understand what data are collected about them, and have confidence in how they are used.

1.3

1.3 Emerging lessons from the healthcare response to COVID-19

The pace of scientific research has accelerated in response to the pandemic

The pace of vaccine development has rapidly accelerated. Clinical trials to find treatments for COVID-19 have proliferated around the world.

Figure 35: Time from viral genetic-sequence selection to first human study
Figure 36: COVID-19 clinical trials, by country

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Resources have been redirected to find COVID-19 solutions, though often not quickly enough

There is a surge in patent filings in the wake of the pandemic. Governments have sought to rapidly scale up testing capacity, some more successfully than others.

Figure 37: Number of patents filed relating to coronaviruses, per year, 1990-2020

2020 figure is estimated using data as of 29/06/2020

Figure 38: Average daily number of COVID-19 tests per confirmed case
Many companies have worked with or alongside the public sector to help the effort
Hand sanitiser produced at a brewery in Scotland for use in the National Health Service

Jeff J Mitchell/Getty Images

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The pandemic has affected certain groups more severely

Black Americans are at a higher risk of dying from COVID-19, and there appears to be good evidence that people living with higher levels of air-pollution are also at greater risk.

Figure 39: Chance of dying from COVID-19, compared with whites, England and Wales
Figure 40: Chance of dying from COVID-19, by air quality of residence, relative to cleanest area

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The focus on solving one problem has had some unintended consequences

It has been widely reported that people are nervous about visiting hospitals and are therefore not receiving treatment when it is needed. In April, Nature reported that 23 countries have suspended measles vaccination campaigns as they cope with COVID-19.

Figure 41: Global reported measles cases, 1980-2020
The crisis has exposed a worrying lack of global cooperation

During the 2008-09 financial crisis, there was some degree of coordinated action by the major economies. Not so this time. Whether it is prioritising supplies or closing borders, many countries have adopted protectionist policies.

Figure 42: Popularity of the term “G20”, US, 2004-20
Figure 43: Countries and customs territories introducing export prohibitions and restrictions due to COVID-19, by categories of products

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Emerging lessons from the global healthcare response to the pandemic
Accelerating sustainability trends

Progress on vaccines, testing and treatment is slow given the pace of the pandemic, but the progress achieved and the pace of innovation have nevertheless been extraordinary.

Many healthcare companies will come out of this crisis stronger than they went in. It underscores how businesses focused on society’s needs tend to be stronger and more resilient.

Climate action

Weaknesses in our preparedness to respond to an all-encompassing crisis have relevance beyond healthcare, not least for the climate. It will trigger new thinking on social-safety nets and the role of essential workers. In many countries, it has raised fundamental questions about the nature of the social contract.

This pandemic changed our understanding of what was possible regarding innovation, from R&D through to global deployment of certain medicines in a matter of weeks. We must take this lesson into the climate crisis and other urgent global challenges.

Radical partnerships

Alongside healthcare companies, multiple sectors and stakeholders are involved in the response to COVID-19 and the economic fallout. Examples include consumer companies producing hand gel, tech companies crafting track-and-trace technology and retailers getting food to essential workers and vulnerable people.

The pandemic has revealed the importance of global cooperation, not only for coordinated advice, lessons sharing and vaccine and treatment development, but also for avoiding trade spats and rebuilding economic stability.