CHICAGO – "Without health there is nothing," said Hans Kluge, Regional Director for Europe at the World Health Organization, during the morning keynote Thursday at HIMSS23.

For that fundamental reason, for more than 7.8 billion people across the globe health equity is at the heart of the U.N. Sustainable Development Goals, from which WHO makes its mission.

But if the goal is "leaving no one behind," Kluge said that goal has still not been reached.

Around the world, too many people live in poverty and in substandard living conditions. Too many still lack access to quality and timely healthcare.

And many are being deprived of health and wellness by geopolitical situations beyond their control. The panel discussion was prefaced by a videotaped message to HIMSS23 attendees from Ukrainian Ambassador to the U.S. Oksana Markarova.

The ambassador spoke about the destruction and disruption in her country since the Russian invasion 14 months ago – and about the dedication of Ukraine's courageous medical providers who haven't wavered in their commitment to healing despite the chaos around them.

"Ukraine's healthcare providers have demonstrated remarkable resilience and devotion to their country and to our people," said Markarova. "Our doctors and nurses since February 24, 2022, have remained in the hospital 24/7. They performed surgeries and saved lives in unbelievable situations."

She thanked supporters from around the world, and expressed her hope that the liberated nation can one day emerge stronger than ever.

"Despite all the hardships and obstacles in place, we are hopeful," said Makarova. "We know we will win this war and we will rebuild our country." And she hopes the WHO, HIMSS and other international organizations will one day "assist in postwar digital health reconstruction for infrastructure and population health systems … and Ukraine can become a health hub, not only for Ukraine, but for the region."

'At a tilting point'

Joining the WHO's Kluge for a wide-ranging talk about health equity and the ways information and technology can help with other global population health imperatives were Päivi Sillanaukee, Ambassador for Health and Wellbeing in the Ministry for Foreign Affairs of Finland; Ernst Kuipers, the Netherlands' Minister of Health, Welfare and Sport; and Lester Martinez-Lopez, Assistant Secretary of Defense for Health Affairs at the U.S. Department of Defense.

HIMSS CEO Hal Wolf moderated the discussion, "Digital Transformation and Health Equity: A Global Discussion on the Journey Ahead." Ongoing digital transformation around the world is a key driver in the push toward wider health equity, he said – noting that assessment tools such as the HIMSS Digital Health Indicator and other maturity models can help healthcare organizations worldwide track their progress toward those goals.

"We have major issues. We are in terms of healthcare again at a tilting point. And it means that we have to do things differently."

Ernst Kuipers, Minister of Health, Welfare and Sport, Netherlands

No question, in terms of global health writ large, "we've made huge progress." said Kuipers, pointing to a slide from the Global Burden of Disease project showing that in just 25 years the life expectancy of the world population increased by 6.3 years.

"That actually meant that for 25 years, every week we added more than a day and a half to our lives," thanks largely to improvements in outcomes from cardiovascular conditions, infectious diseases, cancers and a range of other items.

But that progress comes "with significant downsides," he said. For many people around the world, "those 6.3 years basically are years living with disease. If you look at a healthy life expectancy, it did not change much, or even deteriorated."

Moreover, "all of these efforts literally come at a price," said Kuipers, showing OECD data tracking global growth of healthcare expenditure in red, and global GDP increase proportionately in blue.

"Every year we proportionally increase our healthcare expenditures faster than our GDP growth," he said. "Apart from that, despite all these efforts and money, we also see everywhere – in North America, in Europe and many other parts of the world – significant inequality, inequity and differences in access, as well as in outcomes.

"This has only increased in most parts of the world in the past 30 years. We seem to be going off track," said Kuipers. "We have major issues. And we are in terms of healthcare again at a tilting point, like we were at the end of the 19th century. And it means that we have to do things differently."

Health equity, of course, is a term that's hard to define. The panelists were asked what it means to them.

"Health is actually not the absence of a disease or infirmity," said Sillanaukee. "It's a state of mental, physical and social welfare. And then equity means then stages of rights, opportunities and state. So, regardless of economical, educational, social, gender, whatever background you have, you have the same opportunities and rights."

"When we think about equity, sometimes we think about minorities," said Martinez-Lopez. "But it may be geography. You may not have access to the care you need, because your geography may be in a place that is isolated. And somehow we need to answer that need. "As a country we have to address those needs, not just in the context that most people understand, is in the context of subgroups not having the access to care – which is probably one of the primary determinants of equity – but also that the quality of the cares and the biases are not there," he added.

"We have a lot of cleanup to do when it comes to equity. It's a journey, and I don't think we're ever going to be done. But the first thing we need to do is address what the challenges are. And then, one by one, we start knocking them out."

That challenging goal "goes beyond the healthcare sector," said Kluge. "The root causes are the socioeconomic determinants of health in which circumstances are people living, working and playing. So it means we need to make a massive effort to work across the sectors."

One part of the healthcare delivery system that needs special attention is clinical trials and life sciences research.

"Many of the studies we're doing for pharmaceutical development have 1% to 2% minority representation," said Martinez-Lopez. "And then we make big categorical statements of how effective a particular process is or not. We need to bring equity into trials. We need to bring equity into access.

He suggested the need for a "polyhealth" approach, where everything we do there's a health impact – whether it's with education, with nutrition, economics, internet – all policies at the national level, that links up with everything."

But ultimately, when it comes to clinical research and digital transformation, "we need to stop and say, 'Wait a minute, are we [developing for] those people that are isolated, who have issues with access?

"There are broad issues we need to address, and sometimes we need to get in the minutiae to really answer that," he said. "But if you have a very fancy solution that only addresses fancy people in cities, you have to go back to the drawing table."

In an increasingly interconnected world, "no one is safe until everyone is safe," said Kluge.

Over the past three years, we've seen how a "crisis anywhere [can become] a crisis everywhere," he said. Moreover, "the pandemic showcased the broken link between health and social care, and we left many people behind."

A more holistic – and ideally more home-based – approach to health and wellness is needed, said Martinez-Lopez, because a couple fundamental drags on efficiency and equity remain in U.S. hospitals and health systems.

"Shortages of doctors and nurses, and increased expenses, those are not going to go away," he said. "So my challenge is [for health systems] to multiply – you bring solutions and multiply the capabilities of the system to take care of more patients – or you change the business equation in such a way you take it off the plate from the providers.

"That's the way that digital health really is going to make the difference on how we deliver care and close the gap," he said. "If you don't take those two challenges seriously, we're just going to spin our wheels, developing fancy solutions that really are not going to make a big difference. And I hope that that's not going to be the case."
 

Mike Miliard is executive editor of Healthcare IT News
Email the writer: mike.miliard@himssmedia.com
Healthcare IT News is a HIMSS publication.