January/February 2023 • PharmaTimes Magazine • 16-17
// EQUITY //
Some more equal than others
Realigning R&D to reduce inequities in health and drive local prosperity
The nation’s ‘stock of health’ is getting worse. That is the conclusion of the Office for National Statistic’s (ONS) most recent health index, which looks at 56 indicators across health outcomes, health-related behaviours and the wider social and economic drivers of health.
Not only that, but the ONS found enormous variation across the country, with physical health disparities especially acute depending on region. This should not be surprising as the gap in healthy life expectancy – the number of years lived in good health – between more and less deprived areas has consistently been twice as large as the gap in the numbers of years lived.
There is good news buried within these figures. The reason for the gap between life expectancy and healthy life expectancy is because of the relative success in reducing mortality compared to preventing disease onset or preventing the impact of diseases on people’s day-to-day health.
Much of this progress has been built upon public health measures tackling the largest drivers of ill health such as smoking and a disease-by-disease focus in biomedical sciences resulting in declines in heart disease mortality by more than half in recent decades.
Challenge of a lifetime
A notable shift in illness away from single diseases to multi-morbidity is proving to be a fundamental barrier to addressing health inequalities.
The greatest potential to improve population health and address unwarranted variation in outcomes will undoubtedly come from public health measures, as it has historically, but we believe there is a clear, if rarely articulated, role for R&D in this preventative agenda.
The majority of research funding, infrastructure and life sciences partnerships in the UK are focused around academic university and teaching hospitals that are located in areas of relative affluence.
To tackle the biggest health challenges of the day, R&D activity – in particular clinical research and experimental medicine – should increasingly be delivered where the health burden is evidently the greatest.
Doing this would align scientific, health and economic incentives around populations who will benefit most from new discoveries while increasing economic activity and reducing health disparities in areas that most need it.
We suggest three core principles to aligning R&D priorities with health and economic outcomes. Firstly, scientific research should represent specific populations. Secondly, access to innovations should be proportionate to health needs and, finally, the value of R&D to local and national economies must be aligned and clearly demonstrated.
Clear and present
Living with chronic conditions across multiple organ systems is 26% higher in Yorkshire and Humber compared to London, but R&D activity does not reflective this. Clinical trials have traditionally excluded people with chronic conditions, yet 50% of adults live with two or more chronic conditions – a number likely to increase further as our population ages.
Meanwhile the increasing availability of real-world evidence has the potential to provide representative insights into health needs and monitor the impact of medicines and devices.
While many of the relevant data sets are not currently representative of wider populations, Genomics England has recently launched a Diverse Data Initiative aimed at increasing the amount of genetic data available for research from people from underserved communities. This should serve as a model for future clinical research.
The 2021 Chief Medical Officer’s Annual Report estimated a ‘coastal excess’ of ill health including an estimated 18% ‘excess’ of stroke rates compared to non-coastal areas. Proximity to an academic teaching hospital and whether your disease is rare or not are the two biggest drivers of ability to access innovative treatments.
Other factors often cited as barriers to enrolling in medical trials or engaging in services include transport. To counter this geographic exclusion, community-based diagnostics and digital therapeutics have the potential to prevent chronic disease onset and deterioration while improving economic activity.
Providing positive financial incentives for health systems – like the new ICSs – to promote these kinds of technologies to hard-to-reach patients should form part of the NHS’s innovation strategy.
Access all areas
Addressing inequalities in access to new medicines and treatments will require innovative payment models. The pandemic demonstrated the wider societal impacts of innovation, such as productivity and reduction of the need for informal care, yet these wider elements of social value are not routinely captured in the evaluation of interventions.
Meanwhile innovative reimbursements that align patient outcomes with financial incentives would encourage healthcare systems to transition from importers of illness to exporters of health into local communities.
Whether it is the development of novel reimbursement approaches, new approaches to clinical trials and real-world data, or evaluating new therapies, devices and diagnostic via traditional health-technology assessment, we believe that embedding R&D in the areas with the largest needs will deliver most value both in health and wealth.
This means a new conception of R&D that is less focused on a small number of centres of excellence and more rooted in communities through public health and primary care. It means actively engaging citizens in disadvantaged communities and providing easy access to participation in rigorous clinical research.
Most of all it means providing those citizens with a sense that the system is putting their health needs first.
Thought from the editor
During the current wet, windy and periodically worrying winter of discontent it has become obvious that the complexity of our healthcare system has disproportionately impacted on certain communities and regions.
Whether or not you actually receive medical attention or get to a hospital can depend, literally, on which side of the tracks you happen to be located. Our systems, quite rightly, lean towards the moral principle of parity but this has been tested to its limits in recent times.
With pharma so heavily invested in data and research, it is clear that our industry is very much the key master when it comes to closing the gap. With this in mind 2023 must witness the commencement of many more cross-sector partnerships.
The level of mind-boggling innovation, leveraging of digital medicine and detailed knowledge of the patient experience unfolding in pharma must be used collaboratively across healthcare in the UK. Only then can we boast a system that talks and walks to the rhythm of inclusivity.
John Pinching
Lord James O’Shaughnessy is a former health minister and Dr Jonathan Pearson-Stuttard is Head of Healthcare Analytics at LCP. Go to lcp.uk.com
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