The case for investing in global health inclusivity

Chatham House

Going to give you a very quick health and safety update and then a short video’s going to be played on the screen, before the panel arrive for this session, that’s going to last for 75 minutes. The emergency exits you can see are on either sides of the building, so just head to the closest one in the very unlikely event of an emergency [pause].

Video

[Music] Health inclusivity builds stronger economies, unlocking billions of dollars in savings. This is the compelling new finding from the latest phase of the Health Inclusivity Index, a research programme looking at the health landscape of 40 countries around the world. Phases 1 and 2 analysed health policy and lived experience to understand the implementation gap between them. The latest research focuses on economic impact and reveals a strong case for removing the barriers to good health for underserved communities.

Reducing low health literacy by just 25% would dramatically lower healthcare costs, adding over US$300 billion a year to the economies of the 40 countries. Almost $35 billion a year would be gained by preventing tooth decay among working adults, particularly low-income groups. Over 291 million working days would be added every year if anaemia rates among women of reproductive age were halved, unlocking a further $19 billion and over $100 billion a year would be gained by meeting the World Health Organization’s air quality target. Greater health inclusivity builds healthier communities and stronger economies, with a proactive and preventative approach to avoiding disease delivering the biggest returns [music] [pause].

Kat Lay

Okay, well, good evening, everybody, and welcome to Chatham House this evening for our event, which is ‘The Case for Investing in Global Health Inclusivity’ and how we can promote health equity in a fragmented geopolitical landscape.

My name is Kat Lay, and I work for The Guardian, where I’m Global Health Correspondent. Just to remind everyone, the discussion this evening is on the record, and it is being recorded and broadcast online. And many thanks to Haleon for their support for this evening’s discussion. If I can encourage you all to tweet, or if you’ve joined the exodus to Bluesky, using the #CH_Events. For those of you in the room with us here at Chatham House, just a few instructions. When it comes to time for questions, if you could please raise your hand, stay seated if you’re called upon and a roving mic will find its way to you. And if you could also let us know your name and affiliation before asking your question. If you’re joining us online, you can submit questions throughout the event. They will appear on this screen next to me and I will read them out for you.

Now, I’m excited to be here, because health equity is something that comes up in almost every piece of reporting that I do. Who has access to care, who doesn’t, and why? I’m looking forward to hearing from our keynote speakers and then, we have an excellent panel to follow. And so, that’s probably enough from me to start with, so our first keynote speaker is Ed Petter, who is Chief Corporate Affairs Officer at Haleon. Ed [applause].

Ed Petter

Thank you very much, Kat. Hello, everybody, I’m delighted to welcome you to the launch of the third phase of the Health Inclusivity Index. A big thank you to Chatham House and the Chatham House team for hosting today’s event. For those unfamiliar with Haleon, we are a specialist global consumer healthcare company dedicating to delivering better everyday health. Our global brands include Sensodyne, Panadol, Advil and Centrum and are built on trusted science, innovation and deep human understanding and are trusted by over 1.5 billion people globally to care for their everyday health needs across oral health, vitamins, minerals, supplements, pain relief, respiratory, digestive and therapeutic skin health.

Now, to deliver our purpose, we are committed to addressing the social and environmental barriers that hold people back from better everyday health, and our single-minded social impact focus is on improving health inclusivity. But we recognise that disparities in health outcomes persist and in some areas, are increasing, significantly affecting communities and economies and we are committed to playing our role in addressing this gap. To that end, we’ve collaborated with Economist Impact for nearly four years to support the Health Inclusivity Index.

This data-driven research aims to understand and measure health inclusivity and its drivers, informing policies and actions to improve health inclusivity for all. Today, we’re going to reveal the Phase 3 findings, which quantify the health and economic benefits of addressing inclusivity gaps across seven common health conditions. As we’ve done this, we’ve considered the benefits of closing gaps for the overall population and also for specific groups who face particular barriers. That includes older adults, women, people on lower incomes and those with low health literacy.

I want to quickly highlight three key insights from the new research that really strike me and which highlight the opportunity and responsibility Haleon and wider healthcare actors have to improve health inclusivity. First, improving health literacy is key. By equipping people with the knowledge and understanding they need to take care of their health, we can reduce preventable health conditions and encourage people to seek treatment earlier. Levels of health literacy are low worldwide, limiting people’s ability to take their health into their own hands. Phase 3 shows reducing low health literacy by 25% could save over $300 billion annually across the 40 Index countries. That will help everyone, but particularly those with low health literacy, whose healthcare costs are three times higher than the average, which is driven by late diagnosis, unnecessary emergency care visits and poor treatment adherence. By encouraging people to adopt preventative health habits and seek treatment earlier, we can improve health outcomes as well as boosting productivity and economic growth.

Second, increasing access to preventative healthcare is essential. The model focused on tooth decay shows this really clearly. Some 3.1 billion working hours are lost across the 40 Index countries due to preventable tooth decay and the work shows that delivering targeted oral health promotion for low-income groups, who face the biggest barriers on accessing care, could save up to $12,000 per person over their lifetime.

And three, addressing prevalent health conditions which often go untreated is an unlock to improving health for women and older adults. Phase 3 shows that halving rates of anaemia, which is the most common micronutrient deficiency worldwide, could deliver $29 billion in healthcare savings. And promoting preventative actions to reduce bone density loss and reduce risk of osteoporosis can make a huge difference for older adults, particularly women. Phase 3 shows that reducing hip fractures by 20%, spinal fractures by 30%, could unlock over $30 billion in annual savings. Yet, none of the 40 Index countries are currently on track to meet the SDG target to halve anaemia and osteoporosis remains underdiagnosed and undertreated.

Now, these findings represent a fraction of the wealth of data and insights generated through Phase 3. I’d encourage you to explore the Index hub via the QR codes, which you will see readily round and about today, which are on banners and screens wherever you look. And you can interact with it, delve into the detailed findings about specific countries, conditions and impacted groups. So, just for me to conclude, appreciate we’re very grateful for you being here today, for joining us. Thank you again to Chatham House for hosting and thank you also to Economist Impact for partnering us on this really important work. And with that, Kat, I’ll hand back to you [applause].

Kat Lay

Well, thank you, Ed. Our second speaker is Jonathan Birdwell, who is Global Head of Policy and Insights at Economist Impact and can tell us a bit more about that report.

Jonathan Birdwell

Wonderful, thank you, Kat. Good evening, everyone. So, I want to start by first, thanking Chatham House, of course, for hosting this discussion, and a very big thank you to Haleon. Ed, Sarah, Vicky, for supporting this work, being a really fantastic partner over the past four years and really, for being so ambitious around driving progress on the topic of health inclusivity. And I also want to shout out my team, who are really the brains and experts behind the research, including our Programme Lead, Amanda Stucke, who’ll be joining for the Q&A, as well as Senior Researchers, Gerard Dunleavy and Alicia White, who are really, as I say, responsible for the work.

So, for those of you who don’t know Economist Impact, we are The Economist Group’s independent think tank. So, we exist entirely separate to the newspaper, to The Economist newspaper, but we combine expertise, research and analysis to help enable progress on critical issues from trade and tech to sustainability and health. And over the past four years, we’ve been very excited to work with Haleon to focus on advancing public discourse around this topic of health inclusivity. So, what do we mean by health inclusivity? Let’s define it precisely.

So, for us, it’s a measure of whether national policy systems and cultures give everyone in society the opportunity to optimise their health. It’s about improving health inclusivity. It requires removing barriers, whether those are personal, social, cultural or political barriers, that prevent individuals in communities from experiencing good physical, mental and social health. It’s important for – its importance resonates in the stories of people suffering unduly from lack of healthcare access, but also at the macro level, as poor health outcomes have societal and economic-wide impacts. So, with support from Haleon, we created the Health Inclusivity Index to av – to evaluate governments’ efforts, to ensure that good health is accessible to all individuals and to identify areas for action and focus.

So, in the first phase, we assessed the policy landscape. We’ve looked across the four – sorry, the three phases. We’ve analysed 40 countries, global countries, and in that first phase, we found that all countries, even higher income countries, still had a way to go to achieve the right policies for health inclusivity. In the second phase, we incorporated survey data for over 42,000 to look at the extent to which policies at the national level are translating into the lived experience at the community level. And the results showed us that people’s experiences certainly lag behind the policy in most countries. And so, putting the right policies in place, of course, is necessary. It’s the first step, but it’s not sufficient to achieve real impact on the ground.

But what is the incentive, right? It’s not just legislation, it requires investment. What is the incentive for governments to invest in improving health inclusivity? Especially at a time when they’re grappling with global uncertainty, strained public finances and competing priorities. So, that’s what we set out to do with this third phase, right? To model and quantify the health and economic impact of health inclusivity. And our approach, we focused on seven common health topics, for which we already have effective tools and knowledge required to address them, but for which limited access still creates health and economic consequences, especially for four underserved groups, who research shows tend to have difficulty accessing healthcare or who suffer disproportionately from these conditions. Including as I’d said, people with low health literacy, those on low incomes, women and individuals over the age of 50.

By focusing on targeted health issues and under – and these four underserved populations, we designed the research to provide specific practical examples that demonstrate the clear benefits of health inclusivity: better health outcomes, reduced health disparities, lower morbidity and mortality, reduced barriers to productivity and economic benefits to health systems and governments. And overall, there’s a lot of numbers in the report and you’ll hear them today, as well, but we found that improving health inclusivity for these four underserved population groups, with just with respect to these specific conditions, could generate hundreds of billions of dollars in significant cost savings.

So, Ed shared some of the results for three of the models and I’m going to highlight a few other findings from some of the other models. So, the first one I wanted to highlight was air pollution. We developed a first of its kind model that examines the impact of reducing air pollution across income groups. Air pollution contributes to lung cancer, it contributes to heart disease, stroke, asthma and COPD. Our model finds that if the 40 countries in our Index invested to achieve the WHO’s air quality target, they could collectively save $101 billion per year and prevent almost 4½ million cases of premature death. So, that’s lowest healthcare costs, more people able to contribute productively to their country’s economies.

Secondly, oral health. Ed mentioned ‘tooth decay’. We also looked at gum disease, and the benefits of improving oral health are not limited just to the mouth. Gum disease is associated with increased risk of diabetes and diabetes-related healthcare costs for people with gum disease in the Index countries that we looked at currently amounts to US$1 trillion over ten years. Tooth decay and gum disease also disproportionately affect people on lower incomes and barriers to preventative care among lower income groups mean that their total treatment costs are 50% higher than those of higher income groups. So, promoting better oral health, particularly among low-income groups, according to our model, could prevent 57 million people from developing type 2 diabetes over that same ten-year period and reduce associated healthcare costs, boosting productivity and resulting in $181 billion in economic gain.

Now, lastly, musculoskeletal conditions. In the 40 Index countries, the total annual economic burden of the recurrence of low back pain and neck pain and the onset of knee osteoarthritis and rheumatoid arthritis is $121 billion. Our model shows that increasing access to and uptake of primary and secondary prevention for four – for these four musculoskeletal conditions, particularly for individuals aged 50 and over, could save those 40 countries a combined total of $50 billion annually, through reduced healthcare costs and increased productivity.

So, in conclusion, our findings reveal that investing in inclusive health means stronger, healthier communities and a more prosperous future for all. And we make a call to action for leaders to, 1) prioritise inclusive health literacy as a strategic public tool to equip people to make informed decisions about their health and wellbeing, 2) to ensure access to care, both prevention and management for all, and 3) to make health inclusivity a crosscutting imperative and implement policies to strengthen social determinants of health beyond the health sector.

Now, governments worldwide are clearly, at this moment in time, seeking pathways to prosperity, right? These are challenging times, and helping people towards better health has not traditionally been seen as a way to boost economies. However, our research suggests that actually, health really does equate to wealth, if nations can build systems that work for everyone. So, I’d like to thank you all for coming tonight and again, thank you to Haleon and the team, and look forward to the Q&A. Thank you [applause].

Kat Lay

Okay, well, thank you both very much. Clearly, we’re talking about some big potential, if we can make global health inclusivity, you know, something that’s actually happening in the real world. So, I’m going to invite my next three speakers to the stage and hopefully, we can get into a bit more of the detail of how we do this. How do we collectively leverage the contributions of actors from civil society, public and private sector, to make this case for global health inclusivity?

So, I’ll introduce them to you. At the end, we have Samy Ahmar, who is Head of Global Health at Save the Children. Then, Dr Jarbas Barbosa, who is Director of the Pan American Health Organization. And next to me is Sarah McDonald, who is Vice President for Sustainability at Haleon. I’m just going to throw you straight in there. Tonight’s event is looking at, you know, how do we make this case for investing in global health inclusivity? I’m going to ask each of our speakers to, sort of, start by briefly making that case from their perspective, before we then move to a discussion. Dr Barbosa, would you like to go first?

Dr Jarbas Barbosa da Silva Jr

Thank you. First, I want to thank Chatham House for having this very important meeting. We are in a challenging period for global health, the – in this period, that I think that’s very important to have this kind of dialogue. I am from the Pan American Health Organization, so I come from a region that is the most inequal region in the world. You have the richest country in the world, the United States, then we have Haiti, that they cannot address basic public health needs of their population. And from my perspective, from this regional perspective and talking mainly about the Latin America and the Caribbean, the three dimensions that you were addressing by the report, I think that are really very important and work together to increase inclusivity.

I think that the – from the policymaking dimension, it’s very important we do – and it’s not in only Latin American, but in other parts of the world with national health systems that are fragmented. So, sometimes, even when they have the right to health in their constitution, their national laws, sometimes the different schemes, social schemes, they provide the inequalities in the access. But even in the countries that they have the right to health in their constitution, sometimes when they remove the economic barrier, that it is the most important. All the evidence shows clearly that the – when you have to pay out-of-pocket payments, you reduce the access. But even when you reduce or eliminate this barrier, there are other barriers, some of them visible, where a person from a additional community goes to a health centre and cannot the understanding, who cannot the – clearly understand what are they tell him or her, probably they will be reluctant to come back. If a LGBT+ person goes to a health centre, is not treated with respect, probably they will not come back.

So, there are other barriers, social, cultural, that it also can be a problem, and the third one, that is the social community participation, is always crucial. For this, we need to have a transparency, we need to have this aggregated data, in doing that, we need to have the participation of the community, the users, but also the general population, to get their participation in all the processes, from the planning to the evaluation of the health services. Thank you.

Kat Lay

Thank you. Samy, would you like to go next?

Samy Ahmar

Sure. Thank you very much, and again, delighted to be here and thank you for the invitation. I think before we delve into some of the technical – the issues around health inclusivity, I think let’s make no mistake, you know, the aid cuts have knocked out about 42% of global ODA for health around the world over the last few months. And global health inclusivity does rely, to a strong, significant degree, on solidarity and co-operation at an international level.

And the global health architecture, whatever its faults, and I could talk for hours and hours about everything that’s wrong with the global health architecture, the duplication, the inefficiencies that have plagued it for years, if not decades, health inclusivity does rely on making essential, you know, life-saving health commodities available to all, regardless of race, colour, level of income. Whether they are TB drugs, whether they are antimalarials and whether they are antiretrovirals or vaccines. And so, the tremendous progress that has been achieved on global health outcomes and more equitable health outcomes over the last 30 years is definitely at stake.

Interestingly, however, the issue of health inclusivity and equitable access to healthcare is an issue that matters enormously to people, and increasingly so, in fact. And this plays out in national politics the world over. Here in the UK, of course, where saving the NHS and keeping its spirit alive is a make or break issue in politics, you know, I’m originally from France, and in France the issue of medical deserts is consistently in the top three issues for every single group of voters and something that absolutely every single Politician needs to have an answer to. We’ve – I’ve done a lot of work in Kenya and 2022 Presidential election, the issue of health and equitable access to affordable healthcare in the primary healthcare system in Kenya was a massively important issue. And we experienced the effects of health workers’ strikes on a very, kind of, direct level in our programming work.

So, it matters a lot to people, but it also means that the political economy of inc – of global – of inclusive global health is increasingly complex and fragmented. It plays out in different places with different languages, with different, kind of, word – all of these issues are related to one another. The underlying themes and factors are the same, but the way they play out is very different, and there’s no unifying language that has enabled us, really, to, kind of, think about health inclusivity as a global concept. Universal health coverage is the best attempt that we’ve had at this, and I think it’s fair to say that it has lost momentum recently, both as an idea, as a concept, but also as a reality.

So, I think that the political economy of global health inclusivity is in trouble and that’s something that should concern us, but of course, there are a lot of technical things that we can do in each country at a national level. And this is, I think, some of the issues that the co – the report very helpfully, kind of, uncovers. And I’m sure we’ll circle back to the issue of health literacy, for example, which is an area that we have done a lot of work on, and which can absolutely improve health inclusivity, with a lot of caveats and conditions, and I’m sure we’ll come back to that.

Kat Lay

Great, thank you. Sarah.

Sarah McDonald

Brilliant, thank you. So, I’m going to respond to some of the remarks made and also make a bridge. Before we came into this meeting, we had a closed-door roundtable, where we obviously got some very interesting initial perspectives on the research that was published today. So, I’ll try and draw some of those threads together.

So, just maybe just starting by rit – reiterating why our – why has Haleon been supporting this work for the last four years? As Ed said, we’re a big global healthcare company serving people’s everyday health needs and we’re committed to delivering better everyday health with humanity and single-mindedly focused on improving health inclusivity. We want more people to be included in opportunities for everyday health. And one of the unlocks for that, as we heard through the research, is around improving health literacy, as Samy was just talking about.

But the discussion we were having in the room before is that it’s important to remember that it’s really important to give people the knowledge, the confidence, the tools, the resources to understand their own health and know how to manage it, but you need to do that in combination with other things. So, it links to two of the other barriers that we focus on in Haleon, which are improving healthcare accessibility. So, once people understand their health, they know what to do about it, they’ve got access to the resources they need, it’s important they can access those resources easily and affordably and in a way that’s adapted to their needs.

And then, the third barrier that we focus on, as Haleon, where we think we can make a difference, is around tackling bias and prejudice. Where we know that not everyone’s health is treated the same or taken seriously and people experience real challenges when it comes to accessing health. And as Dr Barbosa was saying, if you have a negative experience once where you feel your needs are not met, you’re not being taken seriously, you’re much less likely to go another time to access care. Yeah, so it’s really, really important to put those things together.

And in the discussion we had before, we talked about another potential social determinant of health that’s very real at the moment, which is trust and issues around trust. And we saw the publication of the Edelman Trust Barometer, specifically focused on health recently, and see that there is a real crisis in trust. And so, rebuilding people’s trust in health systems, healthcare professionals, knowing – being very transparent and open about what we’re trying to achieve, I think is important. And we were remarking before we came into the room that being super transparent about data is really important. And that’s one of the things we’re trying to do to the Index is to make it all open source. So, I do encourage you, as Ed said, to scan the QR codes, go in, dig into the data, use it for your own benefits. And, you know, it’s deliberately out there in the public domain so that everyone can use it in the ways that they most see fit and to hopefully join in in advancing action and informing policy to improve health inclusivity.

So, just saying a little bit more about health literacy. Clearly, you can’t tackle that in isolation. It needs to go alongside improving access, affordability, delivering services in a way that are adapted to people’s needs and overcoming inherent biases and prejudice that exists. But we were discussing how you best go about that and is it foundational and something that is, kind of, there as a foundation for everything? And how does that balance with specific interventions that we’ve focused on in this research, where you might pursue specific activities to improve oral health or osteoporosis and focusing on specific audiences? And I think there’s a few themes that have come out across the different phases of the Index that really emphasise to me how important and foundational health inclusivity is, because it’s come out every single time.

In Phase 1 we saw that eight out of the ten countries that were scored highest in the Index performed highest on the indicator around “people and community empowerment.” And so, it’s clear that countries that are doing a good job of that are getting something right when it comes to enabling and advancing health inclusivity. And then in Phase 2, as Jonathan was saying, where we looked at bringing in the lived experience of 42,000 people across the 40 Index countries, one of the findings we saw was that whereas Phase 1 looked at were countries designed for inclusivity from a policy and infrastructure perspective? Phase 2 really looked at are they actually delivering it in the eyes of their citizens? And what we saw was that there was a big policy delivery gap, basically.

But interestingly, that gap was smaller in countries that were really prioritising investment in people and community empower and growing health literacy. And so, it seems that it’s a protective factor. Either – even if your best policy intentions are not necessarily landing in practice in the experience of your citizens, if you’re investing, as one of your policy priorities, in growing health literacy, that that policy action gap was less. And so, I think we – I would argue that building health literacy and doing that in holistic way. We also talked in the roundtable before that this is not an activity that’s looking at the individual and saying, you know, it’s all on you to grow your knowledge, absolutely not. It’s about doing the right things through the education system. As companies, we invest a lot in growing people’s health literacy through campaigns and so on. And also making sure that healthcare professionals are equipped to give advice in a way that works for people, that they can understand and access and that’s adapted to their background and their preferences.

So, I think we can say that growing health literacy is something foundational that would make a real difference to health inclusivity. We’ve heard the statistic that if we could reduce rates of low health ricity – literacy by 25%, that could unlock more than 300 billion in savings, and so I think it’s certainly something to go after. And I think we’ve all, I hope, many of us in this room, got a role to play in that. Certainly, as a business, we invest a lot in building health knowledge through the work we do with our brands.

A good example of that is work we do in Chana around one of their biggest health priorities, which is the issue of osteoporosis and poor bone health as people get older. China’s got a very big ageing population and a very big problem in this area, as many countries have. And we invest a lot in doing education, with consumers, as individuals, and also with healthcare professionals, to better understand bone health. Doing bone density testing so people can understand where they are and then giving practical advice that people can follow in their daily life. So, changing their diet, taking supplements and doing strengthening exercises to help build their bone density.

I think a second theme that we talked about is this issue around – in the room before, “Should we be focusing on universal health coverage, or should we be focusing on specific targeted initiatives?” ‘Cause we’ve heard from the research findings that there are specific groups that are more left behind and specific areas that perhaps warrant more attention. And I’m not sure there’s an easy answer to that question, but we debated it long and hard next door and I think where we got to was that you need both. And one of our roundtable participants coined a phrase around maybe what we need is “progressive universalism,” where you focus on providing universal health coverage for everyone, but also in doing some targeted interventions that particularly address barriers that are impacting particular audiences.

So, I think that’s one for more debate, but certainly, we can see that there are particular groups that are commonly left behind and particular conditions that -where there are very known and quite simple and very affordable interventions that could be deployed, that aren’t being addressed. And Ed talked about a couple of them, anaemia amongst women and the big savings that could be unlocked there, and also osteoporosis, which if treated early, can be managed very well and yet, it’s goes very often underdiagnosed and under-addressed. So, I think maybe the key is finding a balance between universality and also targeted interventions to help level the playing field and drive greater health inclusivity.

So, I’m going to stop there, but just really to say I think there’s lots to go after, there’s lots of complexity in this and we really look forward to you joining in with us, delving into the research, using it for your own benefit and also giving us your ideas of where you think should be prioritised, what things would make the biggest difference. And we’re also always intrigued to get your thoughts and suggestions on what we should look at next for Phase 4, because I can imagine I’m going to finish this event tonight and then next – the next week, we’re going to get into a discussion on okay, so what are we going to do in Phase 4? So, any of your suggestions on what we should look at next will be gratefully received.

Kat Lay

No time to rest on your laurels.

Sarah McDonald

No.

Kat Lay

No. So, the three of you are from, you know, very different sectors, different backgrounds, so how can the public sector, the private sector, civil society, work together on this? I mean, is there a role for all of you and who needs to take the lead? I don’t – Dr Barbosa, maybe you can talk about how it works in your region.

Dr Jarbas Barbosa da Silva Jr

No, thank you for this question. I fevi – think that this is – of course, the governments are responsible to provide the – not only the legal framework, but also to identify the barriers that are preventing people to have the access. In the Americas, there was a very good discussion when the concept of universal health coverage was, for the first time, launched during the discussion when relate to the SDGs. And the countries in the region, they make the case that the – in the Americas, we should use the universal health coverage and access. Because sometimes, we can seek that the – just having the right to get the access to health services, the task is complete, and it’s not. Because we – if we don’t identify what are the groups that are being left behind and why they don’t have the access, what are the new strategies that we need to adopt in order to remove the barriers, probably, you will not overcome the problem.

Just to mention one thing. In Latin America and the Caribbean, 50% of the economy is the – an informal economy. So, half of the population, they don’t have the social protection to – if they miss one day of work, they reduce their income. With all the new vaccines that you have incorporated, a father or mother, mainly a mother, because 50% of the policy families, they have only one adult that it has an income and this adult is a woman. So, this woman needs to go ten to 12 times if he – she has a baby, during the first year, to get the – all the vaccines. So, the vaccines are there, they are free of charge, but if the health centres are open only Monday to Friday, nine to five, these women will not – this is a barrier.

So, this is a, kind of, a concrete example to having lots of them. But at the same time, is important you mention the privative sector, the companies, because people that work, they are – almost they – a very important part of their life they are there. So, if you don’t have a participation of the private sector in order to increase awareness about non-communicable diseases, hypertension, cancer, preventative measures, so I think that the – we are also missing one part. And also, communities, families and people, all these conversation about the digit – healthy literacy is important, because the – every person has the right to know about the – their health, about what they are the tools that they have to improve their health, so they can make the better decisions.

So, of course, we need to think about the – how these – all the nations, we work together to improve the access, the real access, and the – also to improve the health and the wellbeing of the population.

Kat Lay

Sarah, given that a lot of countries are currently operating with, you know, reduced fiscal space, the health systems are struggling a bit, is there room for the private sector to do more or for people to, you know, do more in the realms of self-care?

Sarah McDonald

I think definitely, yes. So, I think we’ve hopefully demonstrated that the case for empowering people to take more self-care of their health is very clear. I think there’s much more to do. We’ve talked a lot about the statistics from this year’s study, but another one that I like from a piece of previous work we did is eight out of ten people really want to take more active self-care of their health, but only two out of ten feel very confident they know how to. So, I think there’s a big role for the private sector to play around health education, doing that in ways that are accessible, that are even fun and entertaining. I might, kind of, hesitate to go as far as that, and using some of the things we’re good at in terms of doing mass media communication, doing content on digital.

We’ve experimented a bit with doing content on TikTok, which I know is a, kind of, controversial platform because it spreads a lot of health misinformation. But we – I think we’ve got to go where people are and go to the channels that they’re trusting. And we’ve seen, actually, from Phase 2 of the Index, that with younger consumer – younger people, particularly Gen Z, they are – they’re not following the same pattern as their parents might be and they’re more going to social media, their friends, influencers, for their content. So, I think experimenting with different ways to get trusted health knowledge out there in bitesize ways that people can digest, and going to them where they are is really important.

I think the private sector can also play a role in using our networks. So, we do a lot of work with equipping healthcare professionals with simple tools that they can use with their patients to share knowledge and particularly in places where are really accessible. So, most people have a pharmacy within ten minutes of their house. I think we saw pharmacies play a huge role during the pandemic in bringing access to people and equipping pharmacists to be able to give advice, I think is a great thing that we can do. Obviously, pharmacists need to have the space and some of the renumerations all needs to be sorted out for Pharmacists so that they can do more of what they’re particularly good at, which is giving advice in a tailored way in the community. But yeah, I think there’s a big role for the private sector to play in growing knowledge.

We can also do that with our retail partners. Again, we saw how important that retail was during the pandemic, and we partner a lot with big retailers, Walmart, Tesco, in delivering interventions in-store. People go to the supermarket a lot and that’s another way that we can bring healthcare to them. So, I think there’s a lot the private sector can do. Clearly, we’ve got a role to play around making products more affordable and accessible, as well, for people. We talked about, you know, the cost barriers, and then I think finally, there’s a role we can play around tackling bias and prejudice.

So, we’re currently running a campaign in Hungary around tackling age bias, which the WHO, it talks about, is “robbing people of seven years of healthy life expectancy” ‘cause of negative attitudes around ageing. And I think as a – as the private sector, we can use the power of media, the power of in-store, the power of communication, to put forward a more progressive portrayal of ageing, for example, or other biases that exist, to try and move the, kind of, cultural norms forward in a positive way.

Kat Lay

Hmmm. I think I remember Age UK have set out, sort of, a bank of images of older…

Sarah McDonald

Yeah.

Kat Lay

…people that the media can use in a slightly more positive way than sometimes. Samy, I mean, when it comes to, you know, health literacy, which is, I think, coming across as, kind of, one of these almost easy wins, is it still important in terms of health inclusivity if we’re talking about more humanitarian settings or is it really important when we’re talking about the, kind of, chronic diseases that we know are increasing everywhere?

Samy Ahmar

I think it’s important across the board and I think health inclusivity is a really interesting starting point to the – sorry, health literacy is an increasing - incredibly helpful starting point, because on the face of it, it has nothing but benefits, right? It keeps people healthy in the first place, it reduces the burden of preventable illness, it reduces the pressure on the health system, on triage systems. And crucially, it tells people and hopefully empowers them, to know about their health rights, which isn’t the absolute critical starting point.

When you know what good quality healthcare looks like, you feel empowered to request it. You – when you know how much it could cost – how much it should cost, where you should be able to get it, when. To what degree of quality and inclusivity, how you should be treated by a health worker. All these elements of, kind of, empowerment then can create a whole, kind of, virtuous cycle of social accountability, where people have the power to hold the health system, Politicians, duty bearers generally, to account for delivering on that, potentially for improving and investing further, both from the public and the private.

The problem is that what we see and what we’ve seen time and time again in our programming research is that the difficulty that knowledge has to translate into change behaviours, right? And the moment you underestimate the enormous economic, social, psychological pressures that multidimensional poverty inflicts on people, you do not see change. The mental space that is required to act on your knowledge is always invariably underestimated. And I think a great example of that is exclusive breastfeeding. And me and my team, some of them are present in the room, I think, have done extensive work and research in, kind of, driving up rates of exclusive breastfeeding in a number of different countries, Nigeria, India, Kenya, DRC, to – just to, kind of, name a few. And as you probably know, exclusive breastfeeding for the first six months and complementary breastfeeding for two years is one of the essential and, kind of, lifesaving interventions for infant – young – infant and young child feeding, alongside vitamin supplementation and others.

And what we’ve seen is that social and behaviour change interventions, including some of the most rigorous, tried and testing, evidence-based, like, mother-to-mother support groups, with the right level of quality, intensity and so on, struggle to really drive up rates of exclusive breastfeeding. And the reason is, in fact, rather simple, is that really poor women who just gave birth and need to start generating an income really quickly after birth cannot afford to breastfeed, or really struggle to organise themselves around exclusive breastfeeding.

And we’ve – we did a big, kind of, flagship programme in the north of Nigeria, in Jigawa, at the time supported by DFID. And what we found is that social and behaviour change, trying to shift health-seeking behaviours through various techniques along really struggled to improve rates of coverage in exclusive breastfeeding. However, the moment you combine that with cash, 30% – so, 30 percentage points, in fact, increase in exclusive breastfeeding and sustainably over a number of years.

And what that tells us is that, of course, everyone has a role to play in health literacy in the private sector, civil society and so on, but the government has to be in the driving seat and has to be the orchestrator of that. And looking at health uniquely from a health standpoint is never going to really, kind of, achieve significant gains in health inclusivity. In that particular instance, it’s social security that provided the answer, combined with health. In other areas, it’ll be transport, it’ll be housing, it’ll be climate policy, it’ll be energy.

And having that, kind of, whole health approach is absolutely critical and it’s not what we’re seeing. And to, you know, to, kind of, bring it home a little bit, health inequities and health inclusivity in this country is a massive problem and it will remain a massive problem as long as we have five million children living under the poverty line. It’s as simple as that. And so, thinking about a whole government approach to health is one of the – is possibly the single most impactful thing that any government can do.

Kat Lay

So, Dr Barbosa, how can we bring the voices of people from these marginalised groups, people with lived experience, into policymaking in this area?

Dr Jarbas Barbosa da Silva Jr

The – I – this is a very important dimension that you need to bring to the discussion. I think that it – there are several incentives that can be – that, you know, work together in a synergistic way. First, I think that it’s important to have a transparency. So, I think that the governments need to be transparent in to share data and to share what are they – the situation that they have.

Second, I think that is very important to have a good data and disaggregated data, because sometimes in countries that they have a very unequal society, the national averages, they’re not telling the whole truth. They are saying that the – maybe the coverage is good, but the – when you go to different groups, in – for some groups, they are very, very low. If you cannot have a disaggregated data or quality data to identify what are the groups that are not having access, you cannot identify the barriers and you cannot put in place the strategies to overcome the barriers.

And the third is how we can get the user’s opinion about the quality of the care that they received, about the respect, the way that they were treated when they go to a hospital or to a health centre and to have the community participation from the beginning, from the – from establishing policies, to the assessment of the outcomes. We have some good experiences in the region and in some national laws they included the social participation as part of the processes to establish the priorities. Of course, there – I think that you have a lot of things to improve, even in these countries that you have this participation. But of course, that they are in a much better way to understand that the policies really producing some concrete effects when they listen to what the users of the systems are saying, what the communities are requesting.

So, I think that this is really a very important part, because the public policies in the health sector, we cannot treat them as a, kind of, a bureaucratic approach that is only to have the evidence, the data in – translated in a policy, that this will happen immediately. When we look to the real world, we can identify that some strategies that were very, very effective ten years ago, now they are not the – moving forward, because exactly they are not being able to overcome the real barriers that people are facing.

Kat Lay

And Sarah, Samy was talking about health literacy and the idea that, you know, it empowers people to know what they should be asking for. I mean, is there a risk from that point of view that you are creating new demand on health systems that are already quite overstretched?

Sarah McDonald

Well, I think the aim is to reduce some of the demand by helping people take preventive action so that some of the conditions that are tying up a lot of time and cost and effort in the healthcare system are reduced. So, I think it’s – it can certainly lead to pivoting of what is it people need? But the intent of growing health literacy is that we can reduce the amount of time and healthcare investment that’s tied up in conditions that could be prevented. So, I think that’s important.

But certainly, we were talking in the roundtable that as people gain more health knowledge and know better how to look after their health and have the tools and resources and the access and the affordability and the adaptation to do it, that it is likely to lead to different needs and asks of the healthcare system. So, I think as that happens, it’s important to think about what those are and be ready for them. So, I certainly think it can lead to pivoting, if need, but hopefully, it should result in a lot of preventable demand going down and yes, certainly, there may be different demands that come up.

Kat Lay

Hmmm hmm. Yeah, how resilient are health systems at the moment in face of all of the challenges that we are seeing in terms of cost-cutting from governments, you know, loss of aid, changes in demography? Are they, sort of, in a position where they can flex to be more inclusive? Maybe Dr Barbosa, if you want to start.

Dr Jarbas Barbosa da Silva Jr

Well, thank you. We do believe that the renewed and the strengthened primary healthcare is a backbone of a resilient health system. I think that during the pandemic, it was clear that the countries that didn’t have this perspective, they were struggling to guarantee access for chronic diseases during the pandemic. And when we look to countries in our region that have good data, we had an excess of mortality for all causes during the pandemic. So, when we think about the pandemic, it’s not the direct death is relate to COVID-19, but all the deaths is relate to cardiovascular diseases, to cancer and other causes, that – because people didn’t have the access to services.

And when we are talking about a renewed and strengthened private healthcare, we are talking about comprehensive packages from health promotion and prevention, surveillance, and also, to our care that it can address all the priorities that we have in that community. So, when we were talking about the motor disease, your focus, approach, I think that we need to have a people-centred health system. So, if we had in a, I don’t know, in a rural area in Peru or in Colombia, this, well, at the same time, we need to address pregnancy among adolescents, non-communicable diseases that they have even more. The one third of the deaths in Latin America and the Caribbean could be prevented if we had the – if these people had the access to early detection and prevention. We are also talking about some communicable disease that is still persisting. These are, like TB, like malaria and all these.

So, I think that the – this renewed and strengthened view of private healthcare, using telehealth and telemedicine, that it can, at the same time, improve the quality of care and the care reducing barriers. That I think that’s, like, one obsession that you need to have. Because if you’re one person in this village who needs to go to a Neurologist, sometimes this is impossible. Okay, there is a hospital that is – this person needs to take a bus, to have two or three days travelling, without income during these days, without working these days, with another person of the family to support the – his or her. So, we are talking about using the technology that is – now is available for a relatively low cost, that you can probably put that people in contact with a Neurologist in the same village that he or she lives.

So, I think that is a – when we are talking now about digital transformation, providing better training for healthcare workers to increase the capacity of your primary healthcare, we are really working talking about here, about not only the first-line of the care, but for this comprehensive way to guarantee the access of these people to the national health system.

Kat Lay

And Samy, where – in the health systems that Save the Children works with, do you have a sense that there’s resilience there? Is there still interest or, I guess, space to think about inclusivity, or is it, kind of, firefighting at the moment?

Samy Ahmar

It’s – it – there is space and it’s a necessity, as well. I mean, first of all, the resilience of health systems in sub-Saharan African, I think as we have seen during the COVID pandemic, you know, countries like Senegal, like Rwanda and others, managed the early days of – or the early days/the early months of the pandemic far better than any European country. And so, we often underestimate, actually, the resilience, the capacity to flex, the capacity to prevent disease, the capacity to implement actual WHO recommendations to the letter in a way that we do not in the Global North, because we feel that we don’t have to. So, I think it’s – we underestimate their resilience.

However, let’s be honest. There is a huge amount of – the hu – a huge amount of stress on the system, not just caused by the recent cuts. I think it preceded that and it’s due to the fact that the epidemiological pattern of the Global South is changing and chronic diseases are absolutely exploding, as we are seeing. And so, the mix of infectious, non-infectious and chronic illness is changing and putting pressure on the health system to adapt. And health systems, as they have been designed in a lot of countries, are very much designed for curative services. As they are here in the UK, to be fair, and in the Global North, as well, but to a much stronger degree, because a lot of the investment has gone into treating illness, treating infectious disease.

That is beginning to change. I think a lot of low-income and lower middle-income countries are realising that this different mix of illness cannot be coped with, with that system. And I suppose that’s why the whole issue of health literacy, yes, it will save huge amounts of money in the long-term, and I think it’s very clever for the report to look at the economic impact of all of these measures, because frankly, the rights-based argument right now are simply not working, you know, whether they were working 25/30 years ago.

So, it will save a lot of money in the long-term, but it will require investment in the short-term, because health literacy’s not just about pushing out information on health. It is a part of it, of course. Pushing out sound public health information is absolutely critical, but it is about having a dialogue with patients, with communities, and that takes health workers, it takes Community Health Workers, it takes Nurses, Midwives and so on and so forth. So, it will take an investment in the first instance, and that will progressively – hopefully, that – it – that – this is what must happen, kind of, transform the health system and make it perhaps more focused on counselling and less foc – less, kind of, obsessed with treating disease, which it currently is. For right reasons, right?

Sarah McDonald

Hmmm.

Samy Ahmar

So, that’s absolutely the journey that they have to go on. They are acutely aware of it, more than – perhaps even more than us, because the urgency is there, because the mix of illness and the epidemiological pattern is already changing in ways that the system struggles to cope with. And because frankly, people are demanding it, and, you know, Africans living with diabetes, living with cancer, living with hypertension, are increasingly needing these, kind of, long-term multiple touchpoints with the health system, which the system wasn’t designed to provide, certainly not for everybody.

And so, yeah, again, that power, that collective power to change, is what we in Save the Children, and I think the civil society organisations, must support, first of and foremost, right, is people understanding their health rights and gaining that ability to mobilise for change. Unfortunately, as we’re seeing, civic space is being seriously squeezed all around the world and so, that is the challenge that we’re facing.

Kat Lay

Okay, thank you. I don’t know if we can get another chair up here on the stage for Amanda Stucke, who is from Economist Impact and led the research for the report we have been talking about. So, she can come up and she can answer any questions that you might have specifically about the content of the report and how it was designed. Amanda, while everyone is thinking up their fantastic questions, could you maybe just give us a little bit of a quick overview how you decided where to focus this report?

Amanda Stucke

Sure, happy to. I think, you know, the intros that Ed and Jon gave and certainly some of the discussion in the panel teed up some of our findings really well, so I won’t rehash those. But when we were thinking about this phase, we had such a rich dataset to rely on from Phase 1 and 2 and so, we thought about what would, sort of, drive the highest impact when we think about what we can be adding to this evidence base, which is really, ultimately, the goal of this effort. And so, I think like was said, we saw a real gap when it came to an understanding of not just, sort of, the costs that are involved with the topic areas that we studied, but really, what the savings could do for economies. And so, that really became the focus as we zeroed on, on what would make the most impact in this phase.

And so, how we went about designing it, we, you know, had already selected the 40 countries of the Index for Phase 1 and 2, so we thought about the populations and that research that, sort of, rose to the surface as being widely impacted by the issues that were cropping up in the Index from Phase 1 and 2. And those were already mentioned as women, older people, over 50, people on low incomes and oh…

Member

Health literacy.

Amanda Stucke

…health literacy, health literacy, yes, thank you. So, among these four populations, we think about, sort of, the – how many people globally fall into those groups.

And then in choosing our health topics, finally, we thought about, sort of, the different health areas that we have for science to treat and to solve and to address. There are certainly many other areas we could’ve looked at, but with the seven topics we chose, it really allowed us to take a good understanding of what we could do with the tools that we have, but really highlight the gaps that are created when not everybody are – has access to those tools and is included in the ability to address these issues. So, that was really what drove our focus in this phase.

Kat Lay

Thank you. Right, let’s open it up to questions. As a reminder, if you’re in the room, if you could raise your hand, stay where you are and a microphone will find you. Yeah, at the back, there.

Member

Thank you very much for your – sorry, yeah, thank you very much for the talk. This question is specifically to Dr Ahmar. So, I’m a Resident Doctor with a specialisation in cardiovascular genetics or heading towards there. My question is, what do you think is the role of genetics and – you know, for both clinical and Researchers, in providing global health inclusivity, especially for paediatric health?

Kat Lay

Okay. Samy, I think that was one for you.

Samy Ahmar

I’m going to duck that question because I’m not actually a Clinician, I’m a Global Health Economist, and I’m not sufficiently grounded in genetics to answer that question, I’m afraid. But if anyone else on the panel would like to have a go.

Sarah McDonald

No, we’ll pass, no, no.

Samy Ahmar

I don’t think so.

Kat Lay

I think we might…

Samy Ahmar

Sorry.

Kat Lay

…pass on that one.

Member

Hmmm hmm.

Kat Lay

Thank you.

Member

Thank you.

Kat Lay

I think there was someone else over here, yes, at the back and then we’ll come to you next.

Frederik Otto

Thanks. Hello, my name is Frederik Otto, I’m a Director at AccountAbility, which is the world’s oldest issuers of non-financial reporting and sustainability standards. Thanks for the talk, really interesting. All that makes quite a lot of sense. My question is, how much more difficult has it become to bring your advocacy and your message across, especially with policymakers and businesses, in a world that’s very occupied with geopolitics, geoeconomics, trade, climate change, AI? These tend to be the topics currently. So, social, you know, from my experience, is more on the bottom at the moment of global boardrooms and governments. So, how much more tough is it from your position?

Kat Lay

Is that for anyone in particular, or…?

Frederik Otto

No.

Kat Lay

No, anyone?

Frederik Otto

Hmmm hmm.

Kat Lay

Okay.

Sarah McDonald

I can start, if you want.

Kat Lay

Yeah, go for it.

Sarah McDonald

Yeah, so thanks for the question. Look, I think there’s – you know, we always face many – multiple competing priorities and certainly, we’re in a particularly acute time for that now. I think a number of people on the panel talked about when it comes to, kind of, elections and whatnot, that – and what individuals and people in society care about, health is one of their top priorities. And it’s not going – it – you know, that is going up people’s agenda more than ever. So, I think in terms of our ability to engage with policymakers, actors around health, I think if we take a people first approach, this is something that people really care about. I really care about it for me and my family. I’m sure many of you do. So, I think that is one way in that helps is that this is top of people’s concern and it should also be top of government and Politicians’ concern because it’s something that their electorate want. So, I think that helps.

Yes, there’s lots of noise and I think one of the things we’re trying to do with – as Amanda talked about, with this phase, was to talk in different languages so that we can engage people in different ways. And that’s why we focused this phase on quantifying both the health benefits, but also the economic benefits of action, so that we can take this agenda to different actors that are motivated by different things, savings, productivity, growth and so on, and that’s what we’re seeking to do with this phase of the research.

Dr Jarbas Barbosa da Silva Jr

I think that is a very important topic there. As you mentioned, we having many competing priorities. I think that the – it’s important, of course, to have what I call “advocacy with evidence,” not only about the relationship between economy and health. I think that this is well-known, and we were talking before coming to here that we need to break that leg of dialogue between health and the economy. Because the Minister of Health are all the time saying, “I need more money” and they are right, because it – the average, you know, in Latin America, in the Caribbean, as percentage of GDP that the countries are putting into the public – the national health system is only 4.5%. So, they are under-financed because the Economists say that they need to put at least 6%.

But then the – and the Minister of Finance answer, “No, you need to be more efficient,” and they are also right. So, what we are trying to do is to be very specific with some interventions. So, for instance, countries that they have implemented this comprehensive package of the interventions, training protocols, access to medicines, can increase the percentage of the people with hypertension that they have hypertension control, for the average of 25% to 63%. And this will contributed to reduce the preventable deaths related to hypertension. Or if we can introduce the self-collected – the molecular testing for HPV, we can reduce a barrier – we can bring in women that have never been tested, with its additional Papanicolaou, because they need to go three or four times to a health centre to have the test, we can save 40,000 women in Latin America and the Caribbean.

So, I think that you need to be very specific. If you even reduce the TB in prisons, in some countries in Latin America, we can reduce it 10% the total burden of TB in the community. So, I think that we need to, not only to bring the global discussion about the health in economy, but to show to the Minister of Health, Minister for the Economy, and the – also to the political level, that there are some relatively easy wins in the short-term that can guarantee more access, that can expedite the introduction of new strategies and new technologies. That will change the game. That will improve the quality of health of the population.

Samy Ahmar

So, if we, kind of, co…

Kat Lay

Briefly, yeah.

Samy Ahmar

Well, yeah, very briefly add on this. I think it’s, yeah, it’s a great question. I think the effect I’ve seen, certainly over the last few months, is both a sense of paralysis and urgency weirdly combining at the same time. Paralysis in the sense that so many civil society organisations, Politicians, governments, Civil Servants and also the private sector, feel absolutely paralysed about what they can say and do. No certainty and no clarity on what impact it could have on their bottom line, and I’m not talking about Haleon. I’m talking about – more in general terms.

But at the same time, a source of – a sense of absolute urgency, because now is the time to talk about the inefficiency in the global health system, for example. Now is the time to talk about the fact that Gavi, the Global Fund, WHO, the World Bank, the GFF, are all trying to do health system strengthening. They’re all doing market shaping. They all doing things that overlap to such a degree that not thinking about, in radical terms, about what we can do differently to create an enabling environment globally in terms of access to essential commodities and so on, would be insane. So, now is the time to have that conversation.

And so, it’s spurring some long overdue dialogue, I think, and also, it is pushing certain, you know, certain constituencies to step up in that space, including, actually, the private sector, including philanthropy. And we’ve had some really positive noises over the last couple of weeks about, you know – Gates in particular, but not only. So, it’s, you know, it’s both paralysis and urgency. It will become clearer, I think, over the next six months, where we are.

Kat Lay

Who else? I think – I did say I’d come to this gentleman here. Maybe we’ll take a couple of questions at a time and yes, this lady here at the front, as well.

Saul Walker OBE

Hi, I’m Saul Walker, I’m from the Coalition for Epidemic Preparedness Innovation, which focuses on vaccines and equity against emerging infectious diseases. I’m not going to ask about vaccines. It’s a politic – I mean, I think in the end, this is a political question. We’ve got health systems that are still largely focused on acute care, as you said. Even in low-income countries, the budget is sta – still largely focused on acute care, but we know good public health that’s done with people, not to people, primary healthcare, environmental healthcare, that’s where the real gains are. But when you come to elections, what do people care about? They vote about their local hospital being closed down.

So, the, kind of, the political discussion around health still tends to come in around acute hospitals and those visible system – visible symbols of the health system. So, how do we make that transition in a – in political terms? What are the factors to build that momentum around health that is actually de-institutionalised in some way? Because that doesn’t seem to be there at the moment.

Kat Lay

Okay, start thinking about that and then we’re going to take a question here.

Member

There’s a mic there.

Hatice Beton

Oh, okay. Hi, good everyone. Hatice Beton, I’m the Director of the G20/G7 Health and Development Partnership. And to Dr Jarbas’s point, we have been advocating since nine years amongst G20 Finance Ministers how health can be seen as a strategic investment to economic growth.

Now, we’re writing a report right now on how to implement a classification system, a health taxonomy, that could shape the perception of investors and Asset Managers to strategically invest into certain health components going forward. And speaking of – to the many investors, we have seen that there is a change from climate change towards investing more into AI in healthcare, preventative healthcare, some of the components you raised here today.

My question to you is, if you put your investor hat on, the metrics you have put in the nice report today that you outlined, including health literacy, could these be metrics that could be strategically included to incentivise investors to invest long-term? And how could – maybe that’s a more technical question, but rating agencies don’t have health metrics in their ratings for their sovereigns, and they’re interested to look into classifications. Could we go further to talk to them differently and to align the language between the government, the implementing party and the investor by also using some of your metrics you presented today? Just wanted to have your views.

Kat Lay

Okay, so, kind of, both questions around how we’re making a case to a particular group. Who would…

Sarah McDonald

Do you want me to…

Kat Lay

…like to start?

Sarah McDonald

…with…

Kat Lay

Yes.

Sarah McDonald

…this question? So, it’s a very salient one. I’ve been with investors over the last two days, so I think the key – I think there is a real opportunity here, and I think the thing we need to solve is how to get comparable data. Because one of the things that holds investors back from focusing on social indicators is we don’t have a greenhouse gas protocol for social impact and a, you know, set of rules around how you can comparably measure things. And so, I think that is a big unlock. So, a lot of work to be done. That’s partly why we invest in this research, ‘cause we’re trying to bring more objective data, put it in the public domain and so on.

But I think that that is the unlock, is to try to find a way of measuring health impacts that maybe it’s never going to get to the level of – I mean, tonnes of carbon, a tonne is a tonne, you know. It’s like – I think it’s going to be hard to get to that level, but how can we introduce some more data-driven comparability that would allow investors to compare and contrast and use their models and analytics to assess where to invest and bring social impact investing into their investment decisions? I think that would be very interesting, and any ideas gratefully received on how to do that.

Kat Lay

And how about the case for prevention, when we’re all obsessed with ambulances outside A&E?

Dr Jarbas Barbosa da Silva Jr

No, let me – just to – because you are – mentioned G20, but I think that last year was a very important – was a very good experience that I think that South Africa is also following, the Brazil leadership last year to keep the health as a very important pillar of the G20. We worked together with WHO and with the Government of Brazil to have a several relevant discussions around the health, from digital health to healthcare work – health workforce. Several different things, we have original production of vaccines and health technologies.

That I think that it’s very important to highlight that this needs to be part of this conversation, as well. That for the fifth time in June, in Sevilla, during the conference around the development, health will be also be part of that. And I think that it is important, maybe it’s an indicator that things are beginning – at the very beginning, to change that the health is being perceived by societies, by policymaking decisions – make decisions that the healthcare needs to be part of these conversation, I think that this is very good.

You know, that it – when people they are asking for a hospital closer to them, I think that thi – for me, this is a clear indication that they are right. That it – they have barriers when they need to access. And this is also telling us that even countries that they have a strong primary healthcare, I don’t know if this is the case of the UK, I don’t know – I have to go to a health – to the health system…

Samy Ahmar

Yeah.

Dr Jarbas Barbosa da Silva Jr

…these days, but I don’t know if this is the case, and I cannot criticise the country that is hosting me. But even if countries that they have a strong primary healthcare system, there is an – a lack of better integration between primary healthcare in the other levels.

So, people sometimes they don’t feel that the primary healthcare is the best way to solve their problems or to be – the best way is to go to the other levels when they need to go there. So – and their response to that is, “Okay, so, I don’t want the only a health centre, but I also want a hospital in my neighbourhood.” So, when – and I think that this is happening in many countries and is also telling us that you need to rethink the care system as a whole, thinking about a strong primary healthcare. But also, how it can provide better integration with the secondary and tertiary level so people will – with all the challenge that you having, because in all countries in the world now, the backlog, the waiting time that they have for surgical – surgeries, for more specialised treatment, is a political – became a political problem. So, you really need to rethink how to put this on a more integrated way.

And the – for prevention, I think that prevention need to be – I think that is clear that you are talking about two different things. We are talking about the laws and regulation, that it can change the way that the – that can reduce this economic – socioeconomic and commercial determinants of health. And then the same time, to provide the – all the information that the people needed to make the better decisions about their health. Because as was already mentioned, I just will not repeat it, but it’s not the only problem in the real world solution.

You – okay, you say healthy – you need to eat the healthier than you are eating now. A family in the Caribbean pays 40% more than a family in the US to purchase these vegetables and fruits. So, if you are – we are not talking about the access. This is one example, but for health activit – physical activity, you – in a violent slum in Bogatá, even if you are totally convinced that you need to have a walk, one – yeah, a hour walk every day, you cannot do that because you have fear to go outside there after 5pm. So, we are talking about a combination of public policies, together with transparency, information about the rights and the better way to protect the health.

Kat Lay

Thank you so much and thank you to our audience for questions. I’m afraid we have run out of time. The good news for those of you in the room is that there is going to be a networking reception happening upstairs in the Neill Malcolm Room until quarter past seven. So, if you had burning questions that weren’t addressed, you can come and buttonhole our speakers up there. Otherwise, thank you very much for attending, thank you to all of our speakers and to Haleon for their sponsorship of this event, and yes, hopefully see you soon [applause].