27 February 2009
The focus of this blog is healthcare and life sciences, the politics of health, which in Europe can be if nothing else, interesting.
So what do we mean?
Health systems are composed of the usual things we think of such as hospitals, doctors, nurses, and clinics. However, it also includes research communities, the pharmaceutical and medical device industries and many support industries (from glass blowers for labs to fine chemical manufacturers for medicines to incubators for vaccines).
Expenditure on healthcare itself, whether at the level of individual member states or at the level of the EU, accounts for around 9% of GDP. Adding in the additional economic activity in healthcare, and industry and research and development, brings the total to closer to 15% of GDP. A lot of people work in this broadly construed sector.
I am not ignoring the potential impact on this sector from aerospace and defence, of military health, of prison health and other areas often neglected in the academic perspective of the sector. Others to think about include health in the workplace, refugee health, and nursing homes. From a scientific perspective, too, let’s not forget the potential from nanotechnology, biotechnology, marine biotechnology, information technologies, simulations and modelling, robotics, and so on. The list will in some respects cover most economic activity, which is why the health of the health/life sciences sector is so important.
It is hard not to pay attention to such massive levels of expenditure without also asking pointed questions about the setting of priorities for healthcare delivery, for research priorities, and for economic activities which flow from the whole health system, for economic incentives for research translation and adoption of innovations and so on.
The whole consellation is really an eco-system: it has many moving parts, many of which do not necessarily link happily with other parts. That makes the healthcare and life sciences sector a complex adaptive system, with the added elements of high levels of public expectation, powerful interest groups, and major drivers of economic activity.
Life sciences is one of the big spenders on research and development and potentially one of the most powerful economic drivers. And I haven’t even taken into account the potential benefits from associated information technologies. Healthcare itself is probably a decade or more behind in adoption of ICT and one barrier to entry and adoption may lie in the way healthcare is regulated, which protects professions from changes to workflow, protecting cartels and ensuring that labour market challenges can be avoided. This keeps costs to payers high, and ensures that at the minimum, labour substitution does not occur: just think of control of medicines prescribing and diagnosis or ability to admit patients to hospitals and why nurses, pharmacists and physiotherapists are excluded from wider and more influential roles in healthcare.
With ageing populations, we see increasing demands being placed on governments, insurers and providers to deliver high quality, safe, accessible and reliable healthcare. Yet changes are slow coming and in the Age of Austerity, healthcare expenditures are coming under increased pressure as in the main they are funded through public sources or involve governments.
So, a lot to think about and fertile ground for fresh thinking.
Introduction to the author
The blog is written by Michael Tremblay PhD, a specialist in health and life sciences policy, including research, technology and commercialisation for industry and governments. He has over 25 years of international experience, with Europe, North America and emerging markets. He lives and works, at present, in the UK, but has lived in Belgium and Malta, and worked across the EU in Hungary, Sweden, Netherlands, Spain, Germany and others. British by birth, he grew up in Canada where he worked at McMaster University before returning to the UK to teach health policy and management at the University of Birmingham. He runs a life sciences consultancy and is a research fellow at the University of Kent. He is also an abstract painter and shows his work from time to time. Please feel free to get in touch at mike <at> tremblay-consulting <dot> biz.