news
October 2013
Sustainable health care calls for innovation in disease prevention
There’s ample evidence that investing in disease prevention is a far better way of spending money than treating the consequences. Prevention needs a higher profile. It also needs innovation, says Monika Kosinska
One important step would be in giving due weight to research into health promotion and disease prevention in the programme of health-related R&D that is to be carried out as part of the European Union’s €73 billion Horizon 2020 between 2014 – 20202.
Another would be to make a shift away from viewing technology as the sole source of innovation, to embracing the potential of social innovation and process innovation to improve how health care systems operate, says Monika Kosinska, Secretary General of the European Public Health Alliance.
The need to improve diet and nutrition is one very stark case in point. The global pandemic of malnutrition, with approximately one billion people crushed by chronic hunger while 1.4 billion people are overweight or obese, underlines the need for innovative approaches to ensure food security, sufficiency and access, and for a more integrated approach to agriculture and food systems.
In Europe, most attempts to get people to eat healthier diets revolve around measures such as labelling and education. But appealing to individuals in this way is not effective because industrialised food systems mean it’s hard make good choices, Kosinska says. “What is happening in trying to change the demand side, you are putting all the responsibility on individuals,” Kosinska says.
But it is the last 50 years of change on the supply side that leaves people faced with unhealthy choices. “Why ask individuals to act rather than attempting to reform a flawed food system?” says Kosinska. A lever that the European Union could reach for here is the Common Agricultural Policy, which currently provides subsidies for beef and dairy cattle, but not for vegetables, Kosinska notes.
Innovation in patient empowerment
Similarly, social innovation, such as measures to promote health literacy, could make an important contribution getting patients more involved in their own care. In parallel, process innovation could open up channels to make health care system receptive to patient feedback.
Such innovation could also underpin a shift from acute care to community care, reducing costs and improving outcomes, Kosinska says. “If people have a greater sense of ownership and participation in their own care, it makes them feel better.”
Despite the scope for bringing innovation to bear on health promotion and disease prevention, currently less than three per cent of health expenditure is devoted to this area. “It’s hard to get an increase in spending on prevention in times of austerity because even though it is known to be cost-effective, it takes a longer time to play out than other types of measures,” Kosinska says.
In effect, what prevention strategies need to do is bring about cultural change. “You’ve got to be realistic about this, it does take time,” says Kosinska. However, there is evidence that young people are becoming more receptive to fast change, raising prospect that cultural shifts could be achieved over shorter time frames.
Technology innovation and sustainable health care
It is widely assumed that one of the main cost pressures on Europe’s health systems is coming from the rising care requirements of its ageing population. In fact, as Kosinska points out, ageing is responsible for only 10 per cent of recent rises in costs, whereas 70 per cent is attributable to technology. “You have to be careful about ensuring technology innovation is cost-effective,” she notes.
This is not to say technology does not have an important role to play in making health systems sustainable, but rather it illustrates that the conditions for fostering innovation in health care systems are completely inadequate, Kosinska believes. “The current set-up favours large, established centres and large companies, but they are not the innovators. Meanwhile, it’s very hard for small innovative companies to get access to health care systems, to introduce and bed down new technologies.”
Horizon 2020, which gets under way in January 2014, is putting both research to promote healthy ageing and moves to increase the participation of SMEs, at its heart. However, Kosinska says small companies will still face disparities vis a vis their larger counterparts, simply because they don’t have the same administrative capabilities or financial resources.
And it’s not only SMEs that are at a disadvantage. Young people and women, both important sources of the social innovation that is needed to increase the sustainability of health systems, also find it hard to get access to EU R&D grants, Kosinska says.
Finally, there is a pervasive barrier standing in the way of bringing any form of innovation into healthcare, which is that real innovation is disruptive. “You have to fundamentally rethink, not just tinker. I’m concerned that health systems have not got the tools to do this,” Kosinska concludes.