Longer lifespans and expanded use of information technologies are expected to be among the most disruptive forces to health in the next decade.

Still, the underlying question of who pays for healthcare, and who gets access to its benefits, highlights how inequality is still at the heart of many health challenges, speakers on a panel Shaping the Future of Health and Healthcare Systems” said on the second day of the World Economic Forum 2020.

“Millions are being left behind not because the science isn’t there, but because we make choices that privilege the mainstream and not the weakest and the poorest and the most vulnerable,” said Winnie Byanyima, executive-director of UNAIDS.

Along with Byanyima, the panel featured a diverse group of leaders in pharma, health technologies and hospital systems – including Christophe Weber, the CEO of Takeda Pharmaceuticals; Yidu Cloud Gong Yingying, chairwoman of a health data start-up; and Shobana Kamineni, the vice-chairwoman of the Indian hospital system, Apollo Hospital Enterprises.

“Many of us could statistically live until 100 years old, thanks to advances in technology. Now the question is the inequality – who gets access to that longevity?” asked Weber.

“Its important that societies understand that with increasing longevity, financing health care is very important,” he said. As people live longer, more people require access to quality health care and social services. Long anticipated in high-income countries, the demographic shift is also hitting health systems in middle and low-income countries.

China for example, has a rapidly growing population elderly people, including some 290 million people today and projected to reach 400 million by 2025, said Gong. With demand for healthcare services also increasing,  one major issue that healthcare providers face is managing the sheer amount of data that patients generate.

“On the supply side, in terms of [managing raw data in] drug development and clinical services, we are still very primitive… so a lot of infrastructure work has to be done,” said Gong. She, along with Kamineni, honed in on the role of leveraging new information technologies like artificial intelligence and smartphones, for delivering and managing health care.

“To bring down the complexity that we live in, we must center it around…what has made ‘The Patient’ different from 10 years ago?” asked Kamineni. “That difference is information.”

Kamineni said that access to smartphones has “enabled” patients to more easily access health care and health information outside the doctor’s office. She points to a recent development in the United States, where patients use smartphones to manage chronic non-communicable diseases virtually with their physician, cutting down on the number of clinic visits required.

“There’s not a single healthcare player that is not using data. Today now we think of the world as bionic. But [bionic is] not just about making a single body part work better –  it really comes down to the human, and how we can make technology work so much better for us.”

The Question Remains: Who Pays And Who Gets Access?

“In the next decade, I think we’ll see an acceleration of new treatments and therapies,” agreed Weber. “But the key question is how do we finance that? How do we make it affordable, and who has access to these innovative new treatments that are coming every year?”

Byanyima urges governments to take more responsibility. “A healthcare system that doesn’t give primacy to public provision is not delivering on human rights,” she said.

“We are now in this SDG and UHC world – UHC focusing on health coverage not health care, and the coverage part seems to be more about bringing the private sector in. In a way, we are saying public provision is not possible, and now you need health insurance sold by profit makers. In my view, this is going to leave people behind.”

As an example, Byanyima highlighted that for the first time in over a decade, an increase in new HIV infections has been seen among so-called “key populations” such as sex workers and injection drug users – those deemed at highest risk for getting the infection, but the least likely to be able to access health care and financing mechanisms.

Helen Clark, former New Zealand Prime Minister, agreed.  She referred to the widespread measles outbreak in the Samoa islands. With a population of just 200,000, Samoa reported 5697 cases of measles and 86 deaths in a widely publicized outbreak in 2019. While vaccine hesitation due to misinformation about the measles vaccine contributed greatly to the outbreak, Clark questioned whether it was also a matter of “public services failing to reach the poorest and most marginalized communities.”

Image Credits: World Economic Forum / Boris Baldinger, World Economic Forum / Boris Baldinger.