People Health and Planetary Health Are Inextricably Linked
Sustainable Health For A Sustainable World
Since 2004, Generation has partnered with mission-driven companies to accelerate a global transition to a sustainable economy. We’re honored to work with exceptional teams that are demonstrating it is possible to create value for employees, for the people they serve, for investors and for the planet.
In 2019 we expanded our Growth Equity remit with the launch of our third Growth Equity fund: the $1b Sustainable Solutions Fund III. With this fund we are focused on supporting organizations that engage at the intersection of three major sustainability trends: planetary health, human health and financial inclusion. We did so as we fervently believe companies working at the nexus of these trends are creating valuable businesses now and for the future.
Our Vision for Sustainable Health Systems
As systems thinkers, we believe people health and planetary health are inextricably linked. For example, sound agricultural practices have both people and planetary health implications. More broadly, a healthcare system that ensures quality care for all forms part of the social contract on which a low-carbon transition must be based. Good health is the goal of many United Nations Sustainable Development Goals (e.g. Clean Water & Sanitation, Good Health & Well-being), and a prerequisite for others (Climate Action, Reduced Inequalities, No Poverty).
We see a sustainable health system as one that provides quality care to all who need it at the right time, in the right place, at the right cost. Even in rich countries where there are enough health resources, inequalities and inefficiencies exist: some people are over-treated, while many are under-treated; access to, and cost of, care varies materially by location; healthcare professionals spend more time on data entry than with patients; and the cost of administration per visit continues to rise.
Progress and Promise in Sustainable Healthcare
We are focused on supporting teams who, through business model or technology innovation, are targeting significant challenges in health, such as expanding access to care, realizing meaningful clinical outcomes and stabilizing health system costs.
Here are some examples of sustainable solutions we have come across during our research:
Access
● Among other factors, stigma, clinician shortages and cost prevent many of the 1 in 4 people who suffer poor mental health at some point in their lives from getting the care they need.
● Ginger is addressing some of these structural access issues. Via its app, it delivers 24/7 chat-based mental health support to users, and provides access to video-based psychology and psychiatry sessions as needed. Combining scalable, digital modalities with remote access to human-delivered care strike the right balance between cost, access and outcomes.
● There is a growing awareness of the critical role that social determinants play in healthcare outcomes. In many countries, organisations like food banks and emergency housing that wrap around health services provide a critical care role that can be overlooked. From both a user and care-coordination perspective these services are often hard to navigate, fragmented, and disconnected from one another.
● In the United States, UniteUs has developed state-wide networks connecting healthcare, government and social services. They enable joined-up, holistic and trackable care of individuals, getting people the services they need most while ensuring care happens in the right place, at the right time.
Outcomes
● The dramatic cost-down curve in Next Generation Sequencing technologies has enabled many more patients to benefit from the diagnostic insight that genomic data can provide. Paired with personalised therapies (including new perspectives on the efficacy of existing medicines) not only more accurate diagnoses, but also treatments, are possible.
● Through its diagnostics business line which is India’s largest service, MedGenome, is bringing cutting-edge diagnostics to Indian patients. Its team has developed an extensive in-house bioinformatics capability to better serve the South Asian genome.
● Globally, Sophia Genetics is an example of a company enabling clinicians in >90 countries to leverage genomic, radiomic and other data to diagnose and treat patients across oncology, rare and inherited disease. In December 2018, Generation led the Series E investment in Sophia Genetics.
● The near-ubiquity of smartphones combined with low-cost data plans are enabling convenient and scalable digital care delivery — including of preventive, coach-based interventions which can help avoid poor health outcomes.
● Vida Health is an example of a company providing digital health treatment for chronic disease. Vida’s coaching programme has delivered an average of 3.23% body weight loss reduction among users after 4 months (compared to an average weight gain of 1.81% in a control group). 49% of users improved their blood pressure by a hypertensive stage during this period. These effects among users reduce the likelihood of poor health outcomes, avoiding patient suffering as well as health system cost.
Cost
● Right-sizing healthcare spending is a global issue; but inflated spending is particularly a problem in the US. As leading scholar Dr. Eric Topol recently noted in the American Journal of Managed Care, “Hundreds of billions of dollars a year in the United States [alone] could be saved by eliminating the unnecessary, inappropriate, and wasteful day-to-day practices.”
● The United States spends 17% of its GDP on healthcare: significantly more in percentage terms than countries like Germany (12%), France (11%), the United Kingdom (10%), Australia (9%) and Finland (9%). One of the key drivers of high US healthcare expenditure is administrative burden, with the US spending >$200 billion annually on administration alone. This drives up costs that are ultimately borne by individuals and employers, in the form of insurance premiums, out-of-pocket costs and taxes.
● Olive provides health systems a scalable, learning “digital employee” that automates healthcare’s most costly, high-volume tasks (like prior-authorization management, reporting and invoice processing) working with healthcare employees to reduce system costs.
These are just a few examples of companies working on sustainable healthcare solutions globally.
Healthcare after Covid-19: Building Back Better
The 2020 COVID-19 pandemic has brought these healthcare sustainability imperatives of access, outcomes and costs into even sharper focus.
There are no simple fixes to reduce the strain that COVID-19 has placed on patients and health systems around the World. However, we believe there is a once-in-a-century opportunity — indeed, an obligation — to “build back better” (paywall), putting in place innovation, policy and behaviour change that perpetuates long after this particular threat diminishes.
For example, by:
· Tackling the significant disparities that exist in health outcomes of low income and minority communities by rethinking service design, building teams that represent the patients they serve, and ensuring there is adequate research and data collection to support innovation that works to resolve these disparities
· Rethinking employer-based health insurance provision in a high unemployment context
· Enabling access to remote care modalities, such as telemedicine and teletherapy, to all who can benefit from them
· Equipping health workers with collaboration and communication tools to maximise their effectiveness in providing care
· Drawing on wearables and smartphone data to remotely monitor patients outside high-cost, high-risk care settings
· Supporting healthcare business leaders to put the welfare of their employees first
A Dose of Reality: Ground Truths Inform our Investments
While we are excited about the potential of business models and technology innovation to improve patient outcomes and access while managing system costs, there are three core truths about healthcare that we acknowledge, and which drive our investment theses:
1. Few (if any) simple solutions. Drivers of health outcomes are multifactorial and complicated. Healthcare is human. Despite the promise of technology innovation, healthcare must be “human” in its delivery: for example, A.I.-powered tools are helpful to the extent they empower humans to deliver more accurate and timely care.
2. Inertia fights innovation. Vested interests, dominant incumbents and regulatory capture promote system inertia; so, any innovation must come with the wisdom of how to integrate into the existing paradigm.
3. The long game IS the game. In healthcare, change takes time (a very long time). Unlike other sectors, health and healthcare systems will not be ‘disrupted’ and re-configured in a few months, or even years.
There are no quick, easy, panaceas for healthcare’s afflictions today; but together with outstanding, mission-driven companies we hope to move towards a more sustainable healthcare system: for the long-term, and for all.
Tags: sustainability, sustainable investing, SDGs, healthcare costs, access to care, patient outcomes, future of health, covid-19, build back better
