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.
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.
Data in the chart refer to a five-year moving average
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 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.
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.
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.
People have turned to digital health services in their attempts to understand COVID-19. These are structural changes that may persist beyond the pandemic.
1.2 Growing momentum in personalised healthcare
Interest in direct-to-consumer healthcare is growing rapidly, and there is rapid innovation in new personalised treatments.
The cost of sequencing a human genome has collapsed.
Far fewer people are dying from cancer than would have been expected 20 years ago, while deaths from certain cancers have fallen precipitously.
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.
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.
Data breaches in healthcare are becoming more common, in part because users often have a poor understanding of how their data are used.
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.
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 Emerging lessons from the healthcare response to COVID-19
The pace of vaccine development has rapidly accelerated. Clinical trials to find treatments for COVID-19 have proliferated around the world.
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.
2020 figure is estimated using data as of 29/06/2020
Jeff J Mitchell/Getty Images
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.
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.
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.
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.
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.
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.