Why health system resilience is key to a sustainable future
Resilience in the context of global health may not be a phrase that trips easily off the tongue, yet the COVID-19 pandemic has thrust this critical issue to the forefront of our collective minds in the pursuit toward access to healthcare for all. The world is waking up to the need for a transformative shift to ensure a sustainable and resilient future.
Functioning and sustainable communities are dependent on the health of their populations, yet non-communicable diseases (NCDs) such as diabetes, heart disease and respiratory conditions are the world’s biggest killers and are responsible for 71% of deaths globally. Some 41 million people still die every year from preventable NCDs.1
Historically considered conditions of high-income countries, four out of five people with an NCD now live in low- or middle-income countries (LMICs),2 where patient outcomes are also impacted by variations in healthcare provision. In such developing countries, disadvantaged populations are also disproportionately affected by the COVID-19 pandemic3 – exacerbated by the synergy with NCDs4 – and further strengthening the argument for greater health equity as part of the ambition toward sustainable and resilient health systems.
What this pandemic has made clear is that taking ambitious, proactive measures to future-proof global health systems and translating these measures into action on the ground is paramount if we are to address this crisis; to be part of a future where we can help people live healthier lives and make equitable access to healthcare for all a reality. This is the vision for AstraZeneca where sustainable healthcare for all is front and centre of our company agenda.5
The urgent need for global access to healthcare and strengthening of local health systems resilience has been brought into sharp focus by the challenges communities face in managing the COVID-19 pandemic.
Against a background of widespread health inequality – with disadvantaged populations and those with NCD co-morbidities disproportionately affected – the pandemic represents a watershed moment for healthcare systems.
“There is a direct connection between broader health system resilience and the sustainable delivery of healthcare in the community,” says Ashling Mulvaney, Head of Access to Healthcare, Global Sustainability at AstraZeneca, adding that the pandemic has thrown a spotlight on those geographies where the need for strengthened healthcare systems is particularly pertinent.
Although there remains some uncertainty around how to robustly assess resilience, success will require policy shaping at the global level with clear strategies for local implementation if we are to sustainably manage people living with NCDs and reduce their vulnerability during major health challenges such as COVID-19.6,7
Creating sustainable healthcare for all requires investment in health system strengthening to ensure – not only preparedness – but, more critically, to deliver a solid healthcare infrastructure designed to be responsive to the needs of the population it serves. There are evolving lessons to be learned on the path to healthcare resilience. Shining a light on the need for greater health equity requires us to look through a local lens and work in partnerships with open, transparent dialogue and shared goals – this is key to making an impact and to sustainable, successful healthcare.
Health as a human right requires access to timely, affordable healthcare and providing for the underlying determinants of health, such as safe drinking water, sanitation, food, housing and health education.8
At the heart of our sustainability approach is access to healthcare and its connection to environmental protection, ethics and transparency. We are working toward a future where all people regardless of location or situation have access to sustainable healthcare solutions, with a focus on disease prevention, responsible R&D, investment in health systems, environmental impact on health and affordability (see Figure 1).5
Figure 1: Our company approach to sustainability
“There is already a common language and that is the language of sustainable development goals and universal health coverage,” Ashling points out. “To address healthcare inequity and support access to healthcare, no organisation, no government, no professional body can do it alone.”
There are ambitious targets being set by countries and governments to address health inequity and mobilise toward universal health coverage by 2030, a critical component of the United Nation’s Sustainable Development Goals. “In regard to health equity,” says Allan Mackenzie, Associate Director, Global Sustainability, Access to Healthcare, “a robust, resilient healthcare system is vital in achieving universal health coverage.”
“It’s a multifactorial process,” he adds, “which also encompasses the environmental factors that affect human health – where people live, where they're housed, the level of air pollution and access to appropriate and tailored education on preventive methods.”
Every individual has the right to access quality care, no matter where they live, with education and prevention being key priorities in achieving universal health coverage. “As a global community, we must focus on that long-term goal – acknowledging the need for flexibility and agility – to deliver access to healthcare for all alongside healthcare preparedness, resilience and sustainability,” Allan observes.
There is already a common language and that is the language of sustainable development goals and universal health coverage. To address healthcare inequity and support access to healthcare, no organisation, no government, no professional body can do it alone.
In regard to health equity, a robust, resilient healthcare system is vital in achieving universal health coverage.
Without doubt, the COVID-19 pandemic has further highlighted the need for attention to health inequity in NCDs. But with many health programmes unable to scale to reach underserved populations, partnerships play a pivotal role in ensuring improved access to care.
At this year’s United Nations General Assembly (UNGA) – a forum for multilateral coordination – advancing resilient health systems will be at the forefront of the pressing global challenges up for discussion.
As part of this, evaluating the full patient ecosystem and the partnerships within that offers the potential for longer-term impact and healthcare resilience. Combining the unique attributes or contributions of individual companies or organisations presents a greater opportunity to unite partners in tackling the common aim of universal health coverage.
At a local level, this means forging sustainable relationships with stakeholders, including governments and healthcare professionals, to build infrastructure, remove barriers and collaborate within local healthcare systems to improve outcomes.
“There are fantastic examples of the health sector coming together to address critical health issues, the most obvious recent example being the COVID-19 pandemic,” Ashling observes. “The same approach must now be directed toward tackling the burden of NCDs. Key to success will be the inclusion of non-state, non-traditional actors, including corporations, private institutions and non-governmental organisations, and local actors on the ground in-country.”
With a developing understanding of the interconnectivity between co-morbidities, prevention and resilience, the perspective of non-state actors’ experience of health resilience is critical to continued mobilisation.
Earlier diagnosis and treatment to prevent disease progression or comorbidity can reduce hospitalisation and health system burden – thus strengthening resilience. “It’s long been a commitment at AstraZeneca to put health into action through prevention and treatment initiatives with our patients and partners,” says Ashling. “Now, more than ever, it’s become important to look at the full picture – the connection between the health of the planet and healthy people. Only through multilevel partnerships, locally implemented, will we be best placed to co-design sustainable healthcare for the future.”
This vision is the cornerstone of our long-standing commitment to sustainability. From the air we breathe, the water we drink, to the climate we live in, the circular relationship between the environment and health is at the heart of this ethos.
Many of the factors that impact NCDs, such as smoking, drinking, sedentary lifestyles and poor diet, can result from lifestyle choices or other social and environmental determinants of health. In fact, the World Health Organization estimates that nearly 13 million people die each year from environmentally related health risks, including 7 million people from air pollution alone9 – now the second leading cause of NCD deaths worldwide, behind tobacco smoke.10
With the Lancet Commission citing climate change as the century’s greatest global health challenge,11 we are taking action across all our activities to contribute toward a healthy planet and healthy people.
“Supporting a healthy environment helps slow or even prevent the onset and progression of certain diseases and improve health outcomes,” says Jason Snape, Global Head of Environmental Sustainability. “We continually evaluate our own environmental footprint, including an ambition to be carbon negative across our entire value chain by 2030. We are building on our recognised environmental leadership to gain a deeper understanding of the environment’s impact on health, its connectivity to access to healthcare in our diverse populations and the disease prevention solutions essential for a healthy planet and healthy people.”
The need to connect the health of people with the planet’s health is key to driving more sustainable solutions for healthcare.
Member of Dunga Beach community using wood-burning cookstove that could be replaced with clean energy
“Multidisciplinary collaboration must continue to be pushed to the top of the global agenda if we are to deliver the policy change and implementation that will put societal and environmental health at the forefront of a resilient, sustainable and healthy future for people and the planet,” Ashling points out. Not only is our sustainability strategy linked to the United Nation’s Sustainable Development Goals,5 but we also contribute directly at that level. Our partnerships with the United Nations Global Compact and more recently with the World Economic Forum12 mean we are able to contribute at a strategic level to the ongoing debate on global health challenges.
“There are well established shared goals with the UN’s Sustainable Development Goal 3 ‘ensuring healthy lives and promoting wellbeing for all’, including universal health coverage by 2030, being key,” Ashling adds. “Understanding global drivers and unmet needs will allow stakeholders to deliver an action plan to support local health systems around training, education and infrastructure for long-term success. The next steps are to take this global ambition and implement it locally, which requires a deep understanding of local and regional needs to deliver bespoke programmes that align with global and organisational objectives.”
“We need to understand what more we can do to improve access to healthcare, to be inclusive, to be more diverse in our thinking,” Ashling explains. “We need to ensure we speak and listen to both traditional and non-traditional actors to get to the heart of the unmet need and be able to co-create sustainable solutions. This, in turn, also requires partnerships to be borne from agility, flexibility and with open dialogue at their core, with the ability to adapt to challenges along the way.”
We need to understand what more we can do to improve access to healthcare, to be inclusive, to be more diverse in our thinking.
We are building on our recognised environmental leadership to gain a deeper understanding of the environment’s impact on health, its connectivity to access to healthcare in our diverse populations and the disease prevention solutions essential for a healthy planet and healthy people.
Young Health Programme
Photography: Marco Betti
Our Young Health Programme (YHP) is one example of this proactive vision. A global community-based prevention programme co-founded with Johns Hopkins Bloomberg School of Public Health and Plan International, YHP aims to reduce the uptake of unhealthy behaviours among young people (10 – 24 years old) to improve health outcomes and lessen the burden of NCDs on health systems.13
Almost 70% of adult premature deaths from NCDs can be linked to behaviours that started in adolescence.14 “If you engage with young people early on topics such as smoking cessation, healthy eating and the environment, you can positively impact both individual and community health outcomes,” says Helen Seibel, Global Lead, Community Investment & Philanthropy. “Working with partners on the ground, we train young people to educate their own communities on prevention and health issues in a way that’s designed to engage local populations and set them up for future success.”
Results of a five-year study (Wellbeing of Adolescents in Vulnerable Environments – WAVE), commissioned with Johns Hopkins, asked young people what they felt has the greatest impact on their health, with the key response being to live in a safe, clean and unpolluted environment.15
“With the expansion of the World Health Organization’s Global 5X5 NCD Framework to include air pollution as a major risk factor,10 we have added educational modules and activities related to the environment’s impact on health to all of our programmes in low- and middle-income countries,” Helen shares. “This means that our peer educators build and teach activities related to this topic and use them in their work with young people, schools, healthcare workers, community leaders and government representatives. They also include the environment in their advocacy efforts.”
If you engage with young people early on topics such as smoking cessation, healthy eating and the environment, you can positively impact both individual and community health outcomes.
Photography: Marco Betti
Finally, Healthy Lung is a multi-country, multi-stakeholder project founded on partnerships with policymakers, governments, healthcare providers and patient organisations to help people through better diagnosis and treatment for asthma and chronic obstructive pulmonary disease (COPD).
As with YHP and HHA, Healthy Lung is also designed to build local health systems, which involves not only the medical infrastructure itself, but also capacity building for healthcare professionals and policy advocacy, in order to support the diagnosis and treatment of respiratory diseases.
By uniting thought leaders from 13 different countries, including Mexico and the Philippines, to share their ideas and learn from each other, Healthy Lung has helped embed a long-term and resilient approach to respiratory health.
The approach is unique to each country, reflecting local knowledge of existing unmet need. In Mexico, for example, we are a part of a multi-stakeholder strategic partnership to improve capability building of primary care health professionals in diagnosing and treating respiratory disease and generating local evidence to drive better outcomes for asthma and COPD patients in the healthcare system.5
We have set ourselves the ambition to reach 25 million people across the world to improve early diagnosis and access and have already exceeded our target to train 75,000 healthcare workers through our Healthy Heart Africa, Healthy Lung and Phakamisa access programmes. In 2019, we trained more than 81,000 people through these programmes.5
Health is key to a thriving global society. If we are to reduce the burden on health systems and stimulate longer-term resilience, it is vital that all elements of the continuum – from prevention and awareness, diagnosis, and treatment to post-treatment – are reinforced throughout the health journey.
Healthy Heart Africa
Similarly, Healthy Heart Africa (HHA) is a community blood pressure screening and prevention programme to help tackle the increasing burden of cardiovascular disease (CVD) across the continent.16 “The success of HHA is founded on the strength of local and global partnerships that support access to hypertension care – training healthcare providers; driving care out of central hospitals to community levels of the healthcare system; and increasing awareness and educating around lifestyle choice and CVD risk factors,” says Saras Rosin, Director, Healthy Heart Africa, BD and Implementation. “Through public, private and faith-based partnerships, HHA has so far helped to integrate blood pressure screening and hypertension treatment into routine care in Kenya, Ethiopia, Tanzania, Ghana and Uganda.”
With 150 million people in Sub-Saharan Africa expected to be diagnosed with hypertension by 2025,17 and NCDs projected to be the most common cause of death in the region by 2030,18 prevention through screening, training, education and awareness programmes will be pivotal in tackling this looming public health burden.
“This is only possible when we work with partners on the ground to develop sustainable interventions tailored to specific local challenges,” Saras adds. “Since the launch of HHA in 2014, we continue to identify learnings that allow us to react to local priorities and apply resources where they have most impact, for example driving healthcare delivery to lower levels such as the church setting where many communities have high engagement and the opportunity to share experiences. This allows more complex disease management to take place in hospitals.”
HHA also goes beyond blood pressure screening and early diagnosis of hypertension to establishing foundational infrastructure and healthcare resilience in-country, as well as implementing protocol and clinical guideline development. At the individual level, health passports including information on healthy eating and healthy lifestyle tailored to the individual’s circumstances, for example, hypertension in pregnancy, are routinely provided.
“The blueprint for this approach has since been adopted and applied to other therapeutic areas,” Saras notes.
The success of HHA is founded on the strength of local and global partnerships that support access to hypertension care – training healthcare providers; driving care out of central hospitals to community levels of the healthcare system; and increasing awareness and educating around lifestyle choice and CVD risk factors.
There is an urgency, sharpened by the COVID-19 pandemic, to define priority areas of action and establish a comprehensive approach to delivering established global policies at a local level.
Combining a global policy-led strategy with local stakeholder partnerships requires a clear vision for how to translate the bigger picture to local level implementation. This two-pronged approach toward thinking globally, acting locally, has the ultimate aim – to achieve access to healthcare for all, underpinned by health equity and health system resilience – and should be tackled simultaneously at the global, national and organisational level if it is to achieve maximal impact.
“Governments, industry and health systems are all moving in the right direction, but there needs to be ongoing commitment, action and funding to keep a laser focus on the end-game despite the inevitable short-term population health needs,” says Ashling.
The melting pot of the climate emergency, growing prevalence of NCDs and a global pandemic threatens to destabilise health systems worldwide. The NCD burden alone is predicted to cost the global economy $47 trillion by 2030 in lost productivity.19
However, with every threat comes opportunity. The fast and flexible response of nations and businesses across all sectors to adapt to the COVID-19 pandemic has demonstrated what can be achieved when we laser-focus on actionable solutions. Those with the power to drive change must work together to mobilise across every layer of society – bringing together public and private organisations, including government, industry and the international development community – to ensure the investments and infrastructure set up a future of equitable access for all.
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13. AstraZeneca. Young Health Programme. Available at: https://www.astrazeneca.com/sustainability/access-to-healthcare/young-health-programme.html. Last accessed September 2020
14. World Health Organization. NCD and Youth. Available at: https://www.who.int/global-coordination-mechanism/ncd-themes/ncd-and-youth/en/. Last accessed September 2020
15. AstraZeneca Young Health Programme, Johns Hopkins Bloomberg School of Public Health and Plan International. The WAVE (Well-Being of Adolescents in Vulnerable Environments) study. Available at: https://www.younghealthprogrammeyhp.com/content/dam/young-health/Resources/Publications/The-WAVE-Well-Being-of-Adolescents-in-Vulnerable-Environments-study.pdf. Last accessed September 2020
16. Healthy Heart Africa. Available at: https://www.astrazeneca.com/sustainability/access-to-healthcare/healthy-heart-africa.html. Last accessed September 2020
17. Van de Vijver S, Akinyi H, Oti S, et al. Status report on hypertension in Africa: Consultative review for the 6th Session of the African Union Conference of Ministers of Health on NCDs. Pan African Med J. 2013;16:38. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3932118/pdf/PAMJ-16-38.pdf. Last accessed September 2020
18. World Health Organization. Global status report on non-communicable diseases 2010. Available at: http://www.who.int/nmh/publications/ncd_report_full_en.pdf. Last accessed September 2020
19. Stanford University. Non-communicable disease could cost $47 trillion by 2030. Available at: https://publicpolicy.stanford.edu/news/non-communicable-disease-could-cost-47-trillion-2030. Last accessed September 2020
Veeva ID: Z4-27075
Date of prep: September 2020