Advances in healthcare have helped transform the way we live, and have contributed to average life expectancy at birth increasing by 20 years since 1960. But those benefits are not distributed evenly, with health inequities persisting between and within countries and even cities. In England, life expectancy in the south-east of the country is three years higher than in the north-east.
Differences in outcomes could worsen as already overstretched health systems contend with the challenge of ageing populations and changing disease patterns, with chronic conditions like heart disease and cancer on the rise. In the face of these challenges, health experts and decision-makers are looking to the potential of earlier intervention and prevention.
As well as the potential to improve individual health outcomes, investing in prevention can also bring social and economic dividends. “There’s an enormously higher return on investment in prevention,” adds Hartenstein.
Based on the McKinsey Global Institute and the McKinsey Health Institute’s modelling, as much as $12 trillion could be added to global GDP by 2040 “just by scaling up the health interventions that we know work and 70% of that potential is through prevention and promotion”. Known interventions include creating cleaner and safer environments, enabling healthier behaviours and broadening access to vaccines and preventative medicines. Around half of the annual economic benefits would come from a larger and healthier workforce.
Getting ahead of HIV
HIV is a prime example of the power of prevention and timely treatment in action. Access to HIV prevention, diagnosis, treatment and care means that HIV has become a manageable condition. “A disease that was once almost uniformly fatal is now a disease that can be controlled with treatment,” says Kimberly Smith, head of R&D for ViiV Healthcare – a global specialist HIV company majority owned by GSK.
Treatment not only helps control the virus in individuals living with HIV, but also prevents transmission of the virus through sex. “That’s what we call treatment as prevention,” Smith explains. “Treatment itself is preventing people from transmitting sexually and that’s really quite revolutionary.” Another option for HIV prevention is the use of antiretroviral therapy in individuals who are not living with HIV. This is called PrEP, for which there are several different options for people living with HIV to choose from, to best suit their needs.
Getting ahead of HIV is one instance of how innovation is needed to help prevent and change the course of a disease. This is why prevention is a focus for GSK beyond HIV too, from supplying vaccines to help protect people from illnesses across their lifetime to researching medicines that could help stop chronic conditions progressing to more severe complications.
But if the global community is to meet its goal of ending the HIV epidemic by 2030, more action is needed to address the stigma and discrimination that precludes people from accessing testing, prevention and treatment when they need it – and perpetuates inequities in health. One example is in South Africa where HIV incidence among women remains stubbornly high. “We aren’t going to treat our way out of this epidemic. We have to somehow get to these populations and protect them from HIV acquisition,” says Linda-Gail Bekker, Chief Executive of the Desmond Tutu Health Foundation in Cape Town.
One way to do this is by increasing the prevention options for these vulnerable populations, including young women and girls in Sub-Saharan Africa at high risk of HIV acquisition. For example, for some women in South Africa, certain prevention and treatment options are too visible and could make them vulnerable to violence and stigma from their partners and communities. That’s why alternative tools such as long-lasting options, and more choice about where to access these tools, such as in mobile clinics, is important. “We now are beginning to invoke choice and we think this is going to make a big difference,” says Bekker.
Raising the voice of communities
The ambition to end HIV is a case study of the need for the right levels of investment as well as engagement of community and other stakeholders in strengthening prevention and timely treatment to improve outcomes and shrink inequities.
The involvement of communities has been central in helping to test innovations and ensure they meet people’s needs. This degree of engagement is key to reducing discrimination, enabling access, and addressing inequities in health outcomes. “We tailor our drug development pipeline to the needs of individuals – we want to hear their voices in order to do that,” says Smith. GSK and ViiV last year committed $7.5 million to the Global Fund’s Gender Equality Fund to support the influence of women, girls and gender-diverse communities in national strategy, policy and programming relating to gender equality and health, with a particular focus on HIV, TB and malaria.
Harnessing the voices of individuals and communities to improve health outcomes and reduce inequities goes beyond HIV and can be applied to preventative healthcare more broadly. “The conventional health system alone cannot solve prevention and promotion,” says Hartenstein. Only around 5% of health budgets in the wealthiest countries goes towards prevention. “Yes, that should be higher,” he adds. “But there is an opportunity to bring in a much broader set of stakeholders that are influencing the drivers of health – including businesses, civil society and philanthropists.”
Preventative healthcare is a powerful tool for improving the health of populations and closing gaps in health outcomes. But it will require the right mix of innovations, policies and behaviours to unlock the value of prevention and promote shared health and prosperity.
