the World Health Organization (WHO) declared the novel coronavirus outbreak a Public Health Emergency of International Concern (PHEIC), WHO’s highest level of alarm. Two years on, more than five and a half million deaths from COVID-19 have been confirmed , as well as tens of millions of life-years lost from COVID-related morbidities . Throughout the pandemic, health systems and healthcare workers were placed under enormous strain.
Although the pandemic will eventually find its end, its direct impact on population respiratory health, and its indirect impact on other health conditions such as cancer, heart disease and many others due to the disruption of health services experienced over the last few years, will affect population health for many years to come. Millions of people across the globe will be negatively impacted both physically and mentally with this “collateral damage” caused by COVID-19 projected to exceed the number deaths caused by the virus itself .
This crisis prompts important questions about what should have been done differently to prepare. A decisive response is now needed so health systems are made more resilient to future crises, and in turn sustainable in the face of long-term pressures.
The Healthcare System Resilience Summit, held at the World Expo in Dubai from 30-31 January 2022, has convened leaders from across the globe to share learnings and plan actions together so the greatest health crisis of our lifetime will become the catalyst for stronger health systems across the globe.
We – a group of current and former government representatives, leading clinical and health experts, universities and technology innovators, patients, citizens and civil society groups – stand together in our commitment to take action and to collaborate across sectors and borders to build more resilient and more sustainable health systems for the future.
Urgent action for more resilient and sustainable health systems
Emerging from this Summit, we are calling on all stakeholders to set ambitious goals, be courageous and commit to far-reaching actions as some of the longstanding paradigms in healthcare and in fiscal policy need revision on the path to building stronger health systems:
1) Treat healthcare as a strategic asset, with an investment mindset. The growing human, social and economic cost caused by communicable and non-communicable disease is unsustainable. For too long, health systems have been viewed narrowly as a driver of costs to be contained. A behavioural and mindset shift is needed to reverse this cycle. Political and business leaders must urgently recognise that spending in health is investing in wellbeing, stability, and prosperity. Health systems should be endowed with resources based on a forward-looking perspective of what they need to fulfil their mission, rather than the carryover of historical budget allocations. A new era of leadership will balance the continuing need for an efficient health system with stronger attention to ensuring its effectiveness in delivering on its goals: improving health and health equity, in ways that are responsive, financially fair, resilient to shocks and sustainable in the face of underlying stressors such as the growing burden of chronic diseases.
2) Ensure the right to health, and the right care – for everyone. Health is a fundamental human right, and health systems should embed the principles of equity. Universal access to high quality health promotion, health care services and goods are a ‘must have’ for all nations. Healthcare provision must become more inclusive and tailored to the needs of the individual, rather than assume all patients are the same. Health data and health technology should be leveraged more effectively to establish and implement care models that not only engage patients and their caregivers more, but which will improve access and health outcomes for marginalised groups – be it citizens in rural areas, people in lower-income groups, or single parents, who all depend on different care- and support models.
3) Prevention to be prioritised within all healthcare systems. In the OECD, less than 3% of total health expenditure is spent on prevention, of which less than 20% (or 0.6% of total health spend) is spent on immunisation and early detection of disease . Only by acting earlier to prevent, diagnose and treat disease can the increasingly unsustainable cost burden of illness be reverted. Health budgets and health spending (investment) decisions need to better account for the holistic and long-term benefits that can be realised through primary or secondary prevention. Health education and health promotion need to become a priority rather than an appendix in public health- and budget plans. Screening and early detection of silent killers such as lung cancer or kidney disease – amongst other ailments – is now possible, and more disease-modifying and potentially curative interventions are available. Political leaders must set clearer primary and secondary prevention targets, commit to stage-shift goals, and dramatically dial-up initiatives to ensure that chronic diseases are acted on earlier and more decisively.
4) Build a digital capability and policy framework to make health services more targeted, efficient, and responsive. Digital technologies have played a vital role in maintaining and extending access to health services during the pandemic, bringing healthcare directly to people’s homes and, where the infrastructure exists, to underserved communities. The proliferation of digital-enabled healthcare during the pandemic provides a platform to build on for the future, as health systems leverage and ideally pursue opportunities to harness digital technologies with a focus on those areas which will have the most significant impact to render health systems more resilient and sustainable. A systematic, evidence-based approach to the adoption of digital health technologies is needed and should be underpinned by a bold digital strategy and policy framework, with dedicated funding.
5) Collaborate across borders and sectors to learn and act together in building more resilient and sustainable health systems globally, as per the B20 Health & Life Sciences recommendations of 2021 . Governments should recommit to a science-based, pragmatic approach to strengthen national- and cross-border health systems, deploying a ‘One Health’ approach at all levels of government policy decision making. Collaboration across academia, public and private sectors and political borders should be promoted and harnessed to enable rapid learning from the pandemic and to promote those actions and reforms which will be most beneficial to building resiliency and sustainability, such as introducing common benchmarks and stress-tests for health systems. The Partnership for Health System Sustainability and Resilience (PHSSR) and the Reform for Resilience Commission are examples of new platforms where countries, private and public sector, and academia are coming together to learn from each other, and work with each other at all levels of healthcare policy and delivery.
We urgently call on all governments, health stewards, health workers, patients, citizens and civil society groups to take science-based and decisive action to lay a stronger foundation for population health and health system integrity in a post-pandemic world. Join our commitment in taking these actions forward with urgency, collaborating for the greater good, so that this pandemic will have enabled fundamental change in healthcare systems and societies, benefitting the health and wellbeing of generations to come.