Predicting the future of health equity in the pharmaceutical industry

Health equity is an ambitious goal, but the drive to deliver life-changing innovation to all eligible patients is increasingly shaping how pharma operates. In this interview, two Syneos Health experts discuss how the industry is meeting the challenge and what the future may hold.

1. Why has health equity gained so much attention recently?

Natalia Barkalina (NB): Health equity conversations are not new. We’ve long known that social and economic status – education, wealth and health literacy – are key drivers of health and well-being. But once we quantified that socioeconomic factors and behaviours account for over 80% of health outcomes, compared to just 16% from clinical care1, the need for targeted action became clear. We must empower healthcare systems to look ‘beyond the drug’, with the pharmaceutical industry partnering with providers and policymakers to make that shift.

Noah Froud (NF): Healthcare systems are stretched, so a lot of the drive on health equity is backed by a recognition that services need to prevent and address disease concentrated in vulnerable and disadvantaged populations.

I see that 80:16 figure a lot, but I think it hides the value of equitable access to treatment. For example, there are some clearly-defined risk factors for hepatitis C – such as unsanitary medical procedures or injecting drug use – but treatment can cure hepatitis C, prevent liver disease and prevent someone from passing on the virus. Policymakers can address those risk factors, but without the ‘treat to eliminate’ strategies we’ve seen, health systems – and some of their most vulnerable patients – would be staring down an even greater liver disease burden. Treatment does not address the root, but it does stop the burden compounding.

2. What steps is the pharmaceutical industry taking to advance health equity?

NF: There’s been a move to create dedicated health equity teams or roles – sometimes linked to policy or market access – both at a global level but also right down at a local field level.

Pharma is a global industry and discussing health equity without a global lens misses the mark. While inequities between countries exist, they’re complex and evolving. For example, the divide in access to medicines between Eastern and Western Europe seems to be decreasing. The term ‘LMIC’ (low-middle income country) is outdated – nations like China, Brazil, Mexico, Indonesia and India have improving healthcare services and rising health spending. Policymakers in these regions now face challenges more aligned with high-income countries. Interestingly, people in these countries are more optimistic about their healthcare futures than wealthier nations. Understanding and adapting to this shifting landscape is key for any company. Smart companies will collaborate globally, sharing data, experiences and insights to drive progress.

NB: I see the role of Medical Affairs teams gradually evolving into that of health equity architects. Medical Affairs teams are already expert in bringing innovation to the right patient at the right time by explaining science clearly, building trust and removing access barriers – but this evolution takes the mission further. By embedding deep medical insights into evidence generation plans, and even clinical development, Medical Affairs teams can future-proof data strategies for health equity. Increasingly, one must ask: are we measuring value in the patient groups that will receive the treatment? And do we understand what they perceive as value in the first place?

3. What does the future hold for the role of the pharmaceutical industry in health equity?

NB: We need to embed ‘health equity by design’ into drug development. We need an unprecedented depth of landscape awareness and foresight to prepare our data generation plans for the realities of tomorrow. This means predicting who the primary treatment recipients will be in three to five years, how their journeys, expectations and concerns will evolve and what healthcare context they’ll face. We must also model scenarios across pricing, access and system capacity. At Syneos Health, our predictive modelling tools are designed to help clients explore future patient and access scenarios – supporting strategies that aim to broaden equitable access to innovation.

NF: As Natalia says, that patient journey is vital. How does the funnel of eligible patients get narrowed down at each stage? Is poor treatment optimisation with existing, first-line, generic treatments stopping specialists identifying the patients who need your innovative add-on therapy? Could successfully reaching the 10% of patients who are eligible for a treatment require you to catalyse a change that benefits 100% – eligible or ineligible?
If you’re working in a complex system, your thinking and strategies need to fit with that.

Disclaimer: This interview reflects the professional views of the participants and is provided for informational purposes only. It does not constitute medical, regulatory or policy advice.

Reference:
1. Hood C, et al. Am J Prev Med. 2016;50:129–35