Why has progress on health gains slowed down and what can we do about it?

World Health Day, which was celebrated on 7 April this year, is held annually to mark the anniversary of the founding of the World Health Organization , and is also an opportunity to highlight specific public health concerns. This year, the theme was “Health For All” to reflect on public health successes, as well as to call for further global action to tackle ongoing health and health equity challenges.

Over the past 200 years, there have been huge gains in life expectancy across the world, mainly due to the impact of a few public health measures – particularly access to clean drinking water, and improved hygiene and sanitation solutions, as well as to medical advancements that have led to life-saving treatments, in particular, antibiotics, but many others as well.

Healthcare technologies of the future

More recently, we have seen far slower but still impressive gains in life expectancy due to improvements in treatments such as statins and blood pressure lowing medications to prevent cardiovascular disease, and in the early detection and treatment of cancers and other conditions. The chart below shows clearly the rapid gains in life expectancy since 1900 due to treatments for infectious diseases, followed by the slowdown in mortality gains from around the 1950s.

Advancing technology and recent breakthroughs in fields such as genomics and molecular biology are driving the emergence of more effective treatments in new categories of medicines such as biologics, immune and gene therapies, and these hold out great promise for being able to cure life-threatening diseases in the future.

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For me, the strongest illustration of the immense power of modern medicine is the incredibly rapid development of diagnostic tests and vaccines against COVID-19. What would typically have at least 10 years, and often many decades, was successfully developed within 12 months, thanks to advances in genomic sequencing, worldwide scientific cooperation and public and private entities uniting to fund vaccine development efforts. We are now seeing the immense benefits of these breakthroughs in new vaccines being tested, including for malaria as well as vaccines designed to assist the immune system in fighting certain cancers.

But … longer, sicker lives?

Yet, at the same time as all this impressive progress, we see clear evidence that across the globe, populations seem sicker than at many points in human history, largely due to the rise of chronic diseases of lifestyle.

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At Vitality Global , we’ve spent decades working with our own insurance customers and with those of our major partners - 友邦保险 , Sumitomo Life, John Hancock , Life Group , Generali - and we have accumulated tens of millions of life years of health and wellness data. The data continues to show the rising prevalence – and consequences on health and mortality – of major chronic illness.

What this means, in simple terms, is that while lifespan is getting progressively longer, what we call “healthspan”, the years lived in good health, is not. Because of this, millions of people live out the last decade or more of their lives (what Peter Attia calls the “marginal decade”) in poor health, and with often very limited functional ability – resulting in an often very low quality of life.

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As if the impact of this on us as individuals and our families were not enough, this also means a huge cost burden for health systems across the globe, impacting public payers (governments or national insurance systems) and private payers alike. The World Economic Forum suggests that the global economic impact of the five leading chronic diseases (cancer, diabetes, mental illness, heart disease and respiratory disease) could reach $47 trillion by 2030.

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So, what is driving this growing burden of chronic disease despite the ongoing progress in modern medicine? Many are aware of the first key factor - the impact of modern life on our physical and mental health. We have evolved as a species to move a lot, to eat particular foods and to sleep at least 7 to 8 hours a night, yet the majority of people today do way too little physical activity, eat food that is actively harmful to our long-term health, and get too little, often low-quality sleep. We also face growing levels of stress impacting on children and adults alike. In many ways this is a perfect storm for the tsunami of chronic disease we now see.

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A second factor, which is not identified as often, is the way in which modern healthcare systems are designed to detect and treat illness, but much less focused on actively encouraging healthy lifestyles and preventing illness from occurring in the first place. Research from the Centers for Disease Control and Prevention shows that every dollar spent on prevention can save up to $5.60 in health spending.

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Yet inertia and the incentives inherent in modern health systems keep them operating in the same old way – what Peter Attia – calls “Medicine 2.0”. By contrast, a new approach to medicine and healthcare, which Peter Attia calls Medicine 3.0 – would focus strongly on preventing illness in the first place through tackling the problems of lack of activity, poor nutrition, sleep and stress, and also on more aggressive screening and earlier treatment of emerging chronic conditions.

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I plan to post more on “Medicine 3.0” but in the meantime, I highly recommend Peter Attia‘s new book – Outlive, which is a brilliant manifesto for this new and critically needed approach to healthcare. ?

Emerging solutions?

There are emerging solutions to both of these complex sets of problems. Behavioural science-based programs that incentivise healthier lifestyles are a critical part of the solution. These programs start with recognising the obstacles to healthier lifestyles – lack of knowledge is one of these, but so is the powerful cognitive bias that leads our brains to prioritise pleasure and rewards in the present, and to discount risks that are some way off in the future (the technical term is hyperbolic discounting). All of us know the attitude of teenagers and young adults who feel invincible, with health risks very far in their future, but this same bias affects us at every age. But this same attitude affects our judgements at all ages – bad things happen to “other people”, and they happen far off into the future.

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Behaviour change programmes that address these obstacles can be very effective.?Our Vitality programme has accumulated experience and data on the impact of healthy behaviour change on millions of our clients over more than 30 years.?Vitality now engages 30 million lives across 40 markets globally, and our data shows that engaged Vitality members get more active, eat more healthily and take preventative measures towards better health.

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The graphic below illustrates the impact of increasing engagement with the Vitality programme in the form of increased physical activity, better nutrition and increasing use of preventive health screening on healthcare costs, mortality rates and interestingly, on COVID specific mortality rates. In the case of COVID, our data was surprisingly powerful – showing a very significant impact of increasing physical activity on the risks of dying from COVID (adjusted for all other relevant risk factors).

A critical contributing factor to the success of Vitality has been the extensive use of data analytics, ongoing innovation and most critically, the deep integration of our behaviour change programme into life and health insurance and other financial services products – making access to exercise and healthy eating affordable, and offering material rewards for those who actively engage and maintain a healthier lifestyle. Vitality is integrated into our own products in Discovery Limited and Vitality and into the products of some of the worlds best insurers who are our partners in 40 markets across the globe.

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Our data shows that this deep integration of a science and evidence-based behaviour change programme creates substantial incremental surplus right across the insurance and healthcare value chains, resulting in rich benefits and value to all stakeholders – customers, shareholders and healthcare providers as well.

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In a nutshell,

• Engaged customers get the long-term benefits of better physical and mental health and earn regular rewards for their engagement;
• Our insurance businesses and those of our partners experience improved loss ratios, enhancing their value and sustainability;
• Engaged healthcare providers can earn higher remuneration for actively engaging their patients and improving health outcomes;
• And ideally, with sufficient penetration of these products, Society can benefit from a healthier population with all the financial and other benefits that this entails.

The data is compelling, and it is clear for all of us as individuals as well as for employers and governments – if we wish to live out our longer expected lifespans in good health, we need a much more active approach to reducing our health risks and preventing disease much earlier. Our own behaviour needs to change, but so does that of healthcare providers and systems. Employers can also reap major benefits in productivity and employee engagement by encouraging healthier lifestyles of their employees; and for governments, this approach will be critical in the efforts to manage the growing financial pressures of ageing populations and higher healthcare costs.