By Dr. Stephanie Allen, senior partner, Global Health Care leader, Deloitte Australia
This week’s blog, by Dr Stephanie Allen, a senior partner in Deloitte Australia and Deloitte’s Global Health Care leader, appeared first as a US Center for Health Solutions, Health Forward Blog. In drawing on the findings from Deloitte’s 2022 Global Health Care Outlook report, it explores how the pandemic has been a catalyst for significant reform of public health systems globally. Our reasons for sharing it with you is not only is it incredibly relevant to what we are seeing in the UK and Europe but it also resonates strongly with the findings in our UK ‘The Future of Public Health’ report series.
Reimaging public health after COVID
We are now little over a month into 2022 and COVID-19 shows no signs of abating. Omicron is surging around the world, and other variants are likely to emerge as the virus continues to mutate. Over the past two years, more than 355 million people around the world have been infected with the virus and more than 5.6 million have died. While COVID-19 vaccines have been available for a year, more than half the world’s population has yet to receive a single dose, a figure that drops to less than five per cent in low-income countries.
While this situation is dire, the legacy of this pandemic might be the profound impact it is having on the global health sector. Our 2022 Global Health Care Outlook takes a deep dive into what we expect will be the start of a world-wide transformation in six critical areas. Namely, the importance of health equity and how we are inter-connected as a global community; the impact and responsibility of the health care industry to reduce its carbon footprint (but also to be able to support and treat citizens in the future who will be impacted by the trauma and diseases of climate change); the elevation and future of mental health and well-being; the long-awaited digital transformation of health care; the future of medicine driven by scientific advancements and the future of public health in a post-COVID world.
This year’s paper explores how COVID-19 has shone a spotlight on our public health systems, forcing us to reconsider its role and functions and current strengths and weaknesses.
Public health reimagined
General practitioners and public hospital systems have fared relatively well. However, with few exceptions, the pandemic lay bare the inadequate, poorly funded, and often fragmented systems we have for public health protection in terms of disease surveillance, outbreak management, mass vaccination, and the need to rapidly acquire new capabilities such as contact tracking and tracing.
COVID-19 has also helped underscore the inherent racism and health inequities that have existed in access and health outcomes for generations. At the same time, the pandemic increased awareness of the inadequate digital investment and workforce challenges in our public health systems.
A reimagined public health system should help predict—and proactively prevent—illness at a community level rather than merely provide reactive care when an individual gets sick. Preventing disease before it happens can reduce both health care spending and the occurrence and severity of disease, according to Deloitte’s recent report on The Future of Public Health. But there are multiple hurdles that need to be overcome to achieve this goal.
Partnerships could be critical for public health
The core mission of public health is to protect and promote the health of all people in all communities. However, adding COVID-related expenditures to public health’s other challenges (e.g., climate change, health inequities, communicable and noncommunicable diseases, deteriorating infrastructure, and a global shortage of clinical workers) will likely require new partnerships across public and private health care providers with non-traditional players. National governments have the ultimate responsibility for health emergencies and for protecting their populations from serious health threats, as my colleagues in the United Kingdom explained in their recent paper, The Future of Public Health: Bridging the gap. The complex array of health protection services required involves a broad network of stakeholders including local and national government, public health experts, academia, private industry, and the public.
The paper also calls out that we are only as strong as our most vulnerable populations, and early health promotion, detection, and intervention are essential to prevent, reduce, or delay the onset of chronic disease. In the wake of COVID-19, nearly all governments have introduced—or are expected to introduce—new public health policies and reforms. Not only will they likely invest in 2022 (and in subsequent years) to control the pandemic and roll out vaccine programmes, but many are also considering a broader range of reforms that will transform their respective public health systems.1
Around the world, public health systems are reinventing themselves. Consider these examples:
- New Zealand recently instituted a well-being budget based on the idea that gauging the long-term impact of policies on the quality of people’s lives is better than focusing on short-term economic output measures
- Japan established a “digital agency" in an effort to update an outdated IT infrastructure that has hampered data collection. In addition, the country’s health ministry has implemented an online system that will allow citizens to access their personal health records
- Germany’s federal parliament passed the Hospital Future Act (KHZG), which will provide significant funding to close the digital gap in that country’s health system. Potential projects include patient portals, digital medication management, IT security measures, telemedicine, robotics, and cross-sector telemedical network structures2
- Brazil established the Support Program for Institutional Development of the Unified Health System (PROADI-SUS), a collaborative of six private hospitals that aims to strengthen and develop their relationship with public health departments to better meet the needs of the Unified Health System (SUS).
Five strategies for transforming public health systems
COVID-19 has been a pandemic of inequality. The impact has been particularly severe on people who are already marginalised or disadvantaged such as ethnic minority groups, women, the unhoused, and people who struggle with addiction to alcohol and drugs. There is an unquestionable need to reimagine and transform struggling and constrained public health systems into ones that are human-centred, inclusive, and resilient to future shocks. Here are a few strategies from our report that could help transform public health systems:
- strengthen existing models of collaboration, or establish new ones, across professional, institutional, and organisational boundaries. Public health systems should work closely with the private and non-profit sectors. Public health agencies do not need to be at the centre of all activities in the ecosystem that improve health outcomes. Public health leaders can begin by assuming the role of convener, nurturing new and budding relationships with ecosystem partners to improve processes and innovations, as well as strengthening collaborative infrastructures across offices and agencies
- clearly articulate a shared value proposition. Shared value is created by cross-sector investment in public health and is based on timely and transparent evaluation and measurement of public health initiatives. Public health communication will be critical to defining shared value and building trust. Public health leaders should quantify the business case for public health investment and include community members in public health decision-making from the start
- align funding and incentives with prevention, health promotion, and wellness. Public health funding models should include mechanisms to streamline the current patchwork of government support, private equity funding, social impact investing, public health trusts, community development financial institutions, and environment, social and governance (ESG) investments. Public health leaders can start by leveraging existing and untapped funding sources, incentivising investment in prevention (from health plans and health systems) and capitalising on next-generation financial investment models that could promote health
- share data across sectors, in real time. Public health data systems should enable cross-sector, real-time data-sharing, with public health data sets forming longitudinal data that cuts across public health concerns. A country-level vision should articulate the architecture and data standards, with regional/municipal data governance organisations overseeing traditional, non-traditional, and self-reported data collection. Public health leaders can join growing networks to enable real-time data sharing, leverage existing research tools, and extend the reach of current resources through automated technology
- centre future public health around health equity. Achieving health equity requires closing the opportunity gap, placing equity at the centre of public health aims, incorporating health equity measures into public health initiatives from the start, and infusing diversity, equity, and inclusion (DEI) into all aspects of the workforce. Public health leaders cannot tackle equity alone; however, they can kickstart efforts by empowering community partners to lead change, building health equity metrics into funding and national guidelines, and galvanising communities to advocate for equitable fiscal policy as a public health imperative. Public health leaders cannot tackle health equity alone.
Despite COVID-19’s many devastating impacts, it does present the public healthcare sector with a powerful opportunity to accelerate innovation and reinvent itself. As we have been envisioning the Future of Health™ and what the ecosystem may look like in 2040, we had anticipated many of the changes that are occurring today. What we hadn’t predicted, was that the global pandemic would be the catalyst to kick start and accelerate those changes so quickly. This is perhaps the silver-lining around what has been a devastating economic, health, and social pandemic.
1World Industry Outlook: Healthcare and pharmaceuticals, Economist Intelligence Unit, February 2021.