As the COVID-19 pandemic spread rapidly around the world, attacking lives and livelihoods alike, it exposed a worrisome preexisting condition: too many people lack access to high-quality healthcare, starting with basic prevention. The most vulnerable among us have been hit the hardest: people in the lower socioeconomic groups (who had a poorer health status even before the pandemic) and in the areas with the least developed health infrastructure, from minority groups in the United States to the inhabitants of slums in India.
During the Bloomberg New Economy Forum (NEF) in November 2020, global leaders from the public and private sectors came together to share insights and explore what it will take to improve global health, and the infrastructure that supports it, in the aftermath of the pandemic.
Initial lessons learned
First and foremost, COVID-19 has once again demonstrated that inequity is bad for global health. Diseases hit society’s most vulnerable people and areas first and hardest. In Mumbai, more than half of all slum dwellers were exposed to COVID-19, compared with 16 percent of people elsewhere in the region. And when some of these underserved population groups got infected, they experienced higher mortality rates, linked to a higher incidence of obesity, diabetes, and other preexisting health conditions. “The disease outcomes of minorities were worse even before COVID,” said one expert in public health, noting the general challenges the underserved face as a result of worse housing, income, disease prevention, and healthcare access.
Health inequity will remain at the top of the agenda even after COVID-19. Across the world, the poor have a higher chance of suffering bad health: the life expectancy of the bottom 1 percent income group in the United States is 14 years below that of the top 1 percent, and the gap is similar in countries with universal healthcare systems.
Second, the pandemic exposed long-standing pressures on healthcare systems. In many areas, hospitals were overcrowded and primary care was neglected in pre-COVID times. As population growth increases the pressure on the healthcare infrastructure, governments will need to reconsider their current investments to ensure that hospitals can rapidly escalate capacity when another pandemic emerges in the future.
Third, the pandemic has shown that it is easier to stay out of trouble than to get out of trouble. Dr. Penny Dash, a senior partner at McKinsey, argued that “in a resource-constrained world, it is better to put your money in preventative care.” In fact, Dr. Wang Linfa of the Duke-NUS Medical School suggested that “If we would have detected COVID-19 early, I strongly believe we could have prevented it.” Prevention extends further than pandemics. The severity of COVID-19 is linked to environmental and health factors, such as poor air quality and obesity, both of which can be avoided. Dr. Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO), also agreed that preventative care should become the priority.
A recent McKinsey Global Institute report found that by 2040, the global disease burden could fall by 40 percent and that preventative measures could realize 70 percent of this reduction. What’s more, the majority of it would cost less than $100 per healthy life year saved. The necessary moves include not only investing in programs to get the basics of prevention right (for example, vaccination and safe childbirth) but also developing alternative financing models. These improvements could be significant net contributors to the world’s economic growth.
Getting ready for the next decade
The delegates of the New Economy Forum identified five key takeaways, inspired by the world’s experience with the pandemic during the past few months, to prepare for the next decade of public-health challenges.
Healthcare data systems. Governments, often at the city level, developed the ability to respond quickly and flexibly to the challenges of COVID-19: when it struck, Singapore moved quickly to set up dynamic dashboards like the Ministry of Health’s interactive COVID Situation Report, New York launched drive-through testing, and Cape Town restarted collaborations with private partners from previous crises. Governments worked with partners such as Google1 and Tencent to develop tracing apps.
Of course, there is space to improve; for example, as the head of one healthcare provider said, “Policy makers should ensure they better understand their population.” The pandemic has emphasized the importance of leveraging data (about people’s incomes, movements, and housing, among other things) for tailoring the approaches of governments—especially for the most vulnerable communities. These data can be used to measure the outcomes, effectiveness, and equitability of healthcare.
Collaboration and knowledge sharing. A health expert noted that “the private sector really stepped up, manufacturing healthcare equipment or sharing data to support contact tracing.” Across the public and private sectors, organizations such as C40 and the Africa Medical Supplies Platform were used to exchange communication strategies, share ventilators, and find ways to reach vulnerable communities. Nonetheless, “in preparing for pandemics, we did not sufficiently act as a global community,” according to the head of a development bank.
Networks and international agencies can boost the resilience of healthcare systems by monitoring diseases and sharing policy guidelines, such as advice on running public transport safely and operating outdoor gyms. Governments should not be afraid to experiment by learning from the way others are dealing with the pandemic and from earlier pandemics—as China leveraged its experience with SARS—and incorporating whatever policies turn out to be most effective.
Technology. The unprecedented role of technology in the COVID-19 pandemic included linking user databases to facilitate contact tracing in South Korea, and the use of messaging applications such as WhatsApp to provide updates on caseloads in Singapore. Technology also played a key role in ensuring that healthcare could continue operating as the pandemic raged. “Some healthcare systems have innovated more in the last six months than in the last six years by rapidly adopting virtual and digital health solutions,” noted a healthcare consultant. Digital tools were proving valuable even before the pandemic; for example, a technology player developed a platform to increase healthcare access for disadvantaged populations in sub-Saharan Africa and made it possible to detect measles outbreaks before national disease authorities could pick them up. No doubt, the future will see more and improved digital healthcare.
Yet during the pandemic, the limits on collaboration hampered further analysis, according to Professor Lauren Gardner of Johns Hopkins University: “There was too little standardization of which variables should be reported, in which format, or how to make them machine readable.” Governments should work with the private sector to set standards and regulations. In India, for instance, “account aggregators allow people to pick up the data from different sources and move it around. However, we also need to pay attention to being able to perform analysis on anonymized data,” said Nandan Nilekani, chairman of Infosys. Local healthcare systems could take the initiative to “show that these tools work, which will in turn increase investment in them.”
Taking a holistic view of health. The world is not prepared for the future, and pandemics are only one of a series of challenges it will face, such as climate change and social inequality. “We are no more prepared for a non-health-disaster scenario than for a pandemic,” declared a prominent epidemiologist. “People are vulnerable regardless of whether it is a climate or a health threat.”
Governments should take a holistic view to protect their people; prepare structured plans for health, social, and environmental crises; and incorporate these efforts into urban planning, infrastructure, and technology. For example, Yu Liang, the chairman of Vanke, praised Shenzhen, which constructed parks that not only serve as outdoor areas but also double as “sponges” for floods. Another delegate warned that New York “needs to add broadband to its public housing, without which working from home is almost impossible.” Delegates also worried about the lack of opportunities for fitness and exercise in low-income areas. Cities that have moved to ameliorate this problem include Barcelona, which launched its Health in the Neighborhood program to improve health outcomes in some 21 poor neighborhoods, and Mexico City, which started an urban innovation lab to improve access to data on air quality.
Governments should take a holistic view to protect their people; prepare structured plans for health, social, and environmental crises; and incorporate these efforts into urban planning, infrastructure, and technology.
Communications. “COVID is one of this century’s biggest communications challenges,” according to the CEO of a leading communications firm. The way the COVID-19 crisis has been communicated to the public (such as messaging and transparency on the rationale for certain public-health measures) has meaningfully influenced compliance and outcomes. Unfortunately, in the Western world, the pandemic comes as trust in society’s key institutions stands at an all-time low.
In the short term, the communications strategies of governments will be essential for the adoption of vaccines. And long after this crisis passes, clear communications, outreach, and trust will continue to be critical for the broader challenge of improving public health, especially for minorities and vulnerable communities. As one CEO mentioned, “citizens’ trust tends to be highest toward people who look like themselves,” so policy makers must ensure that health workers are recognizable and approachable for minorities, since this can help build trust and inclusiveness.
The pandemic has once again put the spotlight on health and demonstrated the power of healthcare systems if leaders of the public and private sectors react quickly, responsibly, and collaboratively. Participants in the Bloomberg New Economy Forum agreed, however, that significant challenges will remain after the pandemic ends. Leaders should help realize inclusive health for everyone, in an efficient and resilient way, by putting health at the center of policy and collaborating widely. This will not be easy. But history suggests that we can once again rise to achieve such a worthy goal.