Using co-creation to tackle health inequalities through transformation

Vani Manja is the country MD and head of human pharma at Boehringer Ingelheim UK & Ireland. We recently spoke with Vani about how healthcare leaders can help to tackle the issue of health inequalities, the importance of data and collaboration in this effort, and ultimately how sharing our learnings can help to accelerate system transformation.

How do you view the current disparities in health and well-being in the UK?

Over the past decade, the health of people living in the most deprived areas in the UK has declined, while health inequalities have increased. The issue of health inequalities in the UK is complex and has been exacerbated by the interplay of numerous factors, including socio-economic status and deprivation, discrimination against ethnic minorities, digital exclusion, and geography.ⁱ

People in the most deprived areas of the UK are twice as likely to die from preventable causes. Prevalence of type 2 diabetes (T2D) is 60% more common among individuals in the most deprived areas of England, and children living in areas of deprivation are nearly twice as likely to be overweight or obese at 11 years old compared to those living in the richest communities.^ii,iii Having led our organisation in India through the COVID-19 pandemic, I was struck by the stark contrast in health inequalities that were exposed in the UK, with COVID-19 mortality rates in areas of high deprivation almost double those in the least deprived, and highest among Black and Asian groups.^iv

How can UK healthcare leaders help to tackle the issue of health inequalities?

As the UK leader of an organisation that focuses on how we can help to transform lives, I’m acutely aware of how multifaceted the challenges are when we think about health inequality. As we are acutely aware, it’s one of the many issues facing the NHS this year, as the elective care backlog, A&E waiting times, and workforce challenges are all putting intense pressure on health and care services. On a national level, there has never been a greater focus and opportunity for innovation and transformative ideas to come to the fore. This is led from the front, with increased funding for Life Sciences, Research and Development, including the recent creation of a new Department for Science, Innovation and Technology, and the publication in March 2023 of the UK Science and Technology Framework.^v The recent £650 million Life Sci for Growth package also reinforces the critical importance of the life sciences sector to the overall economy, but funding alone will not solve all these issues.^vi

Following the Hewitt review and the broadly positive response to the findings presented, how do you think Integrated Care Systems can help address health inequalities?

ICSs provide the opportunity for the multiple stakeholders in the health and care ecosystem to break out of organisational siloes to tackle deeply rooted challenges together and address inequalities in health and care access and outcomes. I was encouraged by the findings of the recently published Hewitt Review, which explores how the new NHS setup could be further refined to deliver a more proactive model of care with a greater focus on technology.

The Hewitt report reinforces the need to tackle the disparities in health and wellbeing and the move to a more proactive model of care, calling for greater focus on harnessing technology, in particular data. In my opinion, there has never been a more urgent need to do so, and this transformation must be driven by co-creating through partnerships.

However, I will say this, we need patience. Improving the way we deliver public health will take time to bed in and demonstrate the value and impact of innovative approaches.

Why is harnessing the power of data important in addressing health inequalities, and how can collaboration support this effort?

The Hewitt report recognised that the NHS is one of the best health systems in the world for collecting data. However, I believe the potential of data for driving change is underexploited. Past underinvestment in data to improve public health suggests that the NHS would benefit from strong multi-sectoral support and collaboration to make significant strides in this area. By working in partnership with organisations operating within and across communities, we have a great opportunity and a collective responsibility to accelerate innovation, so that we may serve our patients and people better.

There is scope to deliver place-based interventions that help to prevent ill health, better manage chronic health conditions, and improve patient access, experience, and outcomes. Real change will happen when we work in the spirit of true collaboration, not just between local and national systems, but across systems and industries and sectors, such as health and social care - the two critical determinants of health. Unless we transform the way we work, we cannot transform our model of health and care and we will not achieve the health and wellbeing we want for the communities we serve.

How can collaboration between the NHS and industry make an impact on population health?

Boehringer Ingelheim UK & Ireland support frontline innovation and patient pathway re-design. Our collaborations aim to bridge the gap between industry expertise and frontline insights. By continuing to work hand in hand, we can partner with health professionals and systems to design, pilot, and scale innovative models of care. We are learning along the way and we must share these learnings because approaches can be applied in principles, but success is dependent on the local population and system.

The partnership between Boehringer Ingelheim UK & Ireland and Health Innovation Manchester, as an example, is grounded in a collective ambition to identify the system impact of COVID-19 on the cardiometabolic pathway for patients across Greater Manchester (GM) and identify opportunities for transformation. The GM Care Record brings together patient information from NHS and care services across all ten Greater Manchester boroughs into one joined-up record that is easily accessible by frontline health and care workers at the point of care. This represents a good example of cross-sectoral collaboration to harness data to provide insights into population health towards optimising, inter alia, disease pathways, clinical research, and patient care.

Identifying and prioritising patients most in need of long-term condition management support remains a priority for the NHS. As part of COVID-19 recovery, this collaboration provides a holistic understanding of the complexities of treatment pathways and creates a predictive tool to inform local policymaking, commissioning decisions, and service redesign.

What needs to happen to expedite digital transformation in the UK to help the NHS deliver against its long-term ambitions?

We know that data and digital transformation present a maze of possibilities and challenges, so it is vital that we openly discuss, share learnings, and come together in partnership to accelerate transformation. Fundamentally, the NHS has pockets of excellence in systems around the UK, but it is only collaborative leadership that will create and shape a truly sustainable healthcare system. The determinants of health go way beyond what happens in a hospital or a GP surgery, they include housing, wider care, education, and mental health. By breaking down barriers across systems, industries, public and private sectors, and communities, we have the biggest potential to save lives.