Hello and welcome to this session of the LSE Festival.
My name is Alistair McGuire,
and I'm professor of Health Economics
and Head of Department of Health Policy at the LSE.
Today I want to tell you a little bit about
some work we're undertaking on health systems
resilience and sustainability.
And that work draws upon a partnership of a number
of individual private companies,
as well as eight other countries across the globe.
Now, all of this was kick-started of course
by the COVID pandemic,
but it's against the background that all healthcare
systems are relatively new.
Most stem from policy reforms
which were introduced in the late 19th century
and early 20th century
just over three or four generations ago
so all healthcare systems are pretty new.
In fact in the UK the National Health Service began in 1948
which is not that long before I was born.
And for many global health care systems,
the initial date of them being introduced
into their countries was even later.
Not only that, it's estimated by
the World Health Organization,
that around 10% of all income in the world
is spent on healthcare.
Not only that, that expenditure is growing relatively fast.
It was growing about 4% per annum
just before the COVID pandemic
and of course, as a reaction to the COVID pandemic,
it's growing even faster now.
Now, whilst the growth in income spent
on healthcare is growing,
the disparities around the world are huge.
There's about $40 per capita per head of population
spent on health care in low income countries
but over $3,000 per head of population spent on healthcare
within the United States.
And low-income countries of course,
are trying to develop their healthcare systems
within very tight constraints.
And rely upon development assistance for somewhere
between 30 to 40% of the public healthcare coverage.
So the pandemic has highlighted that healthcare systems
are built on and often technologically remain
in the 20th century.
And yet, we have to build on the lack of resilience
that healthcare systems have had to the pandemic
to move forward.
COVID has tested many of the countries healthcare systems
beyond their limits.
Healthcare systems in many even developed
and high-income countries,
have been overwhelmed by COVID patients
and the populations are often facing barriers
in trying to get access to healthcare.
And the pandemic itself of course,
has displaced healthcare in other areas.
The access to cancer treatments
and cardiac treatments for example.
So, we recognise that all healthcare systems are different
and they're evolving in different ways
but there's a lot of common issues which face
all healthcare systems globally.
There's lots of financial constraints.
We have to ensure that everybody
has universal healthcare coverage.
There's equity of access to health care issues
which are common to all countries.
Most countries are facing some form
of workforce supply constraints
so the training of the workforce and the employment
of workforce is a common problem for all healthcare systems.
We need to define the healthcare risks
that populations face
and we need to create information on the integration
of new practices, new treatments and new technologies
into healthcare systems.
The COVID pandemic has spotlighted these issues
and spotlighted them in particular,
in terms of the problems of resilience and sustainability
of all healthcare systems to a shock to their system.
The COVID pandemic was of course the catalyst for this work.
But in fact it's only the catalyst because
although the pandemic showed how many systems
were not very resilient in terms of adjusting to the shock
of the COVID pandemic,
we want to roll this general research forward
to look at resilience and sustainability
in general of health systems globally.
So the current work is in partnership with AstraZeneca
who seed funded the work,
The World Economic Forum and eight individual countries
who are producing case studies for the work.
So the countries are France, Germany, Italy, Spain,
the United Kingdom, Poland, Russia, and Vietnam.
And the work is concerned with
defining, designing and implementing
policy relevant tools which attempt to address the issues
of healthcare system resilience
and sustainability globally moving forward.
This partnership builds on our working collaboration
with the European Observatory on Health Systems and Policy
and our newly established
African Observatory Platform as well.
Now, let me acknowledge first of all
that there's no common definition of what's meant
by health system resilience and sustainability.
Our definitions are, for resilience,
we take this as a focus on the short term ability
of healthcare systems to react to shocks to their systems.
So it's an ability of the healthcare system
to prevent, withstand and rebound from chronic shocks
whereas the definition for sustainability that we take
is that it is a much longer term goal
of healthcare systems to adequately
provide quality health care for its populations needs
and to withstand external and internal stresses.
Epidemiological stresses, economic, social stresses,
political stresses and environmental change.
We want to attain our objectives by building
on a consensus of definitions of
health system resilience
and sustainability
and the factors underpinning them
so that they can be analysed consistently
and globally across different countries
and their individual contexts.
We want to generate knowledge and understanding
of resilience and sustainability
so that we can identify the various strengths,
weaknesses, opportunities and threats
which exist in individual healthcare systems across the world.
We want them to guide action by generating
evidence informed solutions
and policy recommendations to improve
resilience and sustainability
and we want to do that by facilitating cooperation
across individual countries,
getting individual countries to learn
from what other countries are doing to solve their problems.
This work on resilience and sustainability is a partnership as I said,
the partnerships is in its pilot phase.
It's running in its pilot phase
from last August until February 2021
and it's focused on developing a framework
for healthcare system sustainability and resilience
based on desk research and consultation
with experts in the field.
The framework has been hopefully used to guide analysis
and the eight pilot countries will be reporting
on case studies going forward.
The findings will be captured in a framework document
which will be released in March this year
and individual country reports will follow.