When I was training in the NHS in the early 1990s, the care of patients admitted to hospital with a heart attack mostly focused on opiate pain relief, oxygen, ECG monitoring and drugs to manage irregular heart rhythm. All relatively simple and inexpensive interventions.
Fast forward to today, and you’re likely to be admitted into a specialist centre, with high-quality care and emergency interventional cardiology procedures that will increase your likelihood of a better outcome. It’s fantastic progress and we’re fortunate to live at a time of such pace of technology and medical improvements. Earlier interventions and more effective treatments could lead us to more years in good health, as well as help to avoid complications and costly hospitalisations – which would be of benefit to the NHS.
The challenge
The UK is experiencing a profound change in demographics and disease patterns. To give a sense of this, in 2016 2 per cent of the UK population was aged 85 years or older, and this is set to double over the next 25-year period. For a health system, older populations mean more chronic health needs which can be complex – and costly – to treat. It also means fewer people working, adding further pressure to public finances. We’re also seeing a rise in the number of people living with co-morbidities – those suffering from two or more chronic conditions such as hypertension, diabetes and hearing loss. This is associated with worse health outcomes, more complex clinical management and increased healthcare costs.
So, what does all this mean for how we approach prevention in the UK? Healthcare is one of the biggest – and I would argue, most important – investments we make as a country. With an ageing and increasingly co-morbid population we need to focus more on extending people’s healthy life years, avoid them needing interventions in the first place and make best use of the resources we have. And with the reality we’re confronting, the case for investing in prevention is stronger than ever.
Instead of waiting until someone is ill, a preventative approach looks at preventing disease in the first place (“primary prevention”). It also encompasses earlier detection and treatment to change the course of a disease – slowing the progression and limiting longer-term complications – and ultimately supporting people towards better health for longer (“secondary and tertiary prevention”). There are new opportunities here.
Increased availability of health data – for example through Our Future Health, the UK’s largest ever health research programme – can help identify patient populations who are at higher risk of disease and intervene in more targeted ways and earlier than traditional screening programmes allow.
An important lesson to build on coming out of the pandemic is the role prevention has in increasing the resilience of populations and the economy. We’ve seen the toll respiratory disease can take on the health and wealth of our communities through our country’s experience of Covid-19. Lung disease – including chronic obstructive pulmonary disease (COPD), asthma, and pneumonia – is on the rise and the third leading cause of death in the UK, while hospital admissions for lung conditions have doubled in the last 20 years. Preventing people from getting infections in the first place and slowing a disease from progressing would result in more people breathing easier, and less impact on patients, carers, the NHS and the economy as a whole.
It’s clear that health matters more to our economic growth as a nation than ever before. The Treasury has estimated that a 1 per cent increase in the number of people aged 50-64 in work would increase GDP by around £5.7bn per year; while more recently the Tony Blair Institute estimated that between a 10 and 20 per cent reduction in working days lost to illness each year could generate £60bn for the UK economy – almost 3 per cent of GDP.
Building belief in prevention
As a biopharma industry we can support a prevention-first approach and mindset by maximising the opportunities to prevent and get ahead of disease through our investment in research and development. In HIV, treatment has evolved to the point where not only can a person live a long and healthy life, but someone on effective treatment with an undetectable viral load cannot pass on the virus. In the vaccines space, instead of trying to tackle every new variant that arises, one area of research aims to create vaccines targeting more strains of pathogens in single vaccines, stimulating a stronger immune response and providing broader, longer lasting protection. It could also make manufacturing new vaccines quicker and easier.
Research also continues into targeted therapies that take aim at the underlying drivers of disease in different people, which has the potential to change the course of their disease. Better understanding of the role the immune system plays in chronic conditions like asthma and COPD means that targeting specific immune drivers with precision medicines may reduce flare-ups and the corresponding ongoing damage caused to the lungs.
Using the latest developments in AI and data science to use digital twins – virtual representations of biological entities and systems – we can also better understand the unique biology of individual patients. In cancer, for example, this allows us to better understand how patients will likely respond to a given treatment, and their propensity to relapse, providing an opportunity to intervene earlier with the right patient cohorts to reduce risk of disease recurrence.
Of course, it’s not enough to only focus on the pace of science and technology. As we saw during the pandemic, people need to access healthcare in ways and places that are convenient: vaccines in pharmacies, home-delivered medicines and health checks in supermarket car parks, for example. Doing things differently in how healthcare is delivered can help to build belief in prevention and engagement in local communities in accessing healthcare.
Better use of health data to provide support where it’s most needed is an example of where we can do things differently. Using data helped with the patient identification of a GP federation located in one of the most deprived areas of the UK with one of the lowest adult immunisation uptake rates in the country. Working in collaboration with the GP federation, GSK provided project management and administrative support to upskill staff – including better using existing data – to improve patient identification and clinic capacity. This led to a substantial increase in uptake, moving the area to above the national average and a legacy of improved, more equitable vaccination access.
We have an opportunity to get ahead of disease and to change its course, but ultimately, if we’re to truly move towards preventative healthcare, we need a whole society approach and a willingness to think differently about how we better protect the health of the nation. In this mission as GSK, we continue to be very willing partners, with great energy for driving progress on the things that matter most.
NP-GB-NA-ADVR-240001 March 2024
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