In Australia, as in the UK, the US and many parts of Europe we are seeing life expectancy gains slowing, and even reversing in some countries, for the first time in decades. At the same time, health care costs are continuing to increase year on year. And on top of this, inequalities in health outcomes between the rich and poor are increasing.
These are difficult issues and will require big changes to business as normal – whether to our food system to prevent obesity, to our workplaces to prevent job-related stress, or to our hospitals to allow patients to receive the care they need when and where they need it.
Recently, I visited some pioneering researchers in Europe tackling these problems. Research traditionally takes a reductionist lens, trying to work out the effect of a specific treatment or risk factor on our health. But these big issues need research to work out what might a better food, work or hospital system look like. And it needs to help us work out how to make the changes we need in a timely, low risk and efficient way, that works for all those involved. So how are these researchers doing that?
In Germany, at Technical University Munich, Professor Stefanie Klug is particularly interested in how we might best use cancer screening to prevent cancer. In one experiment she worked with the national cancer screening program to see whether a personal invitation to the national cervical cancer screening would increase attendance at screening services. She and her team found that a personal invitation letter doubled the likelihood that women would attend a screening, and that this was particularly important in women with lower education, migrant women and older women.
Because she performed her experiment on the German population, using its actual national cervical cancer screening program, they now have a lot of confidence that this simple intervention is worth implementing across the country. The key to this research? Working with a real-world program, developing an intervention that could work in the current system, and ensuring that they would have access to the national health data.
In the Netherlands, I met with Professor Judith Bosmans, who uses health economics and health technology assessment to enable us to compare which are the best approaches to these big issues considering both health outcomes and health costs. One area in which she works is improving and treating mental health. In one recent study, she worked with a wide range of colleagues to identify whether a self-help approach delivered through primary care, could help reduce the recurrence of major depression. They found that while the delivery of this new approach did reduce relapse or recurrence by 15%, it could not be considered cost-effective compared to usual treatment. This is critical real-world information that policy makers need in order to decide whether to implement a system change such as this or not.
Working with these world-class research institutions we can tackle bigger problems, working together to combine data, compare different health systems and societal circumstances, and develop innovative solutions. At the Institute for Health Transformation, our purpose is to address the 21st century’s most compelling and complex health challenges through excellence in collaborative research that transforms how we design and deliver prevention and care. These global partnerships give us the best chance to identify the changes that are likely to enhance health and wellbeing for all our citizens.