Submission by: Santosh Kumar Mishra
Organization: SNDT Women's University
Innovation, Research and Technology for Improving Sustainable Health and Care System All Ensuring healthy lives and promoting the well-being for all at all ages is essential to sustainable development. Significant strides have been made in increasing life expectancy and reducing some of the common killers associated with child and maternal mortality. Major progress has been made on increasing access to clean water and sanitation, reducing malaria, tuberculosis, polio and the spread of HIV/AIDS. However, many more efforts are needed to fully eradicate a wide range of diseases and address many different persistent and emerging health issues. It is in this context that the Sustainable Development Goal (SDG)-3 emphasizes: “ensure healthy lives and promote well-being for all at all ages”. In order to achieve this goal, it is essential that the health and care system routinely uses innovation, technology, and research and development (R&D). Sound sustainable development policy and practice is embedded across the system generating more value from the available financial, environmental and social resources. Innovative approaches should be systematically encouraged and the spread of good practice and wider adoption significantly accelerated. Nevertheless, there are several challenges in caring for a changing population with limited resources. This paper aims to address issues related to gaps in research and barriers to innovation and implementation. The importance of empowering patients and the public through technology for the future plan of the health system has also been looked into. In terms of methodology employed in this presentation, secondary data (which are primarily qualitative in nature) have been used and they have been analyzed using descriptive research method. The paper concludes that innovation to reduce environmental impact, enhance social value, reduce cost and improve quality of care is an integral part of the planning, development and delivery of services.
Key Words: Innovation, Research and Development (R&D), Technology, Sustainable Development Goal (SDG), and Sustainable Health.
Innovation, Research and Technology for Improving Sustainable Health and Care System All
Health is fundamental to human development. All people, regardless of social status, consistently rank good health as a top priority, and healthy people are critical to sustaining societies (John Helliwell, Richard Layard and Jeffrey Sachs, 2012). Ensuring healthy lives and promoting the well-being for all at all ages is essential to sustainable development. Significant strides have been made in increasing life expectancy and reducing some of the common killers associated with child and maternal mortality. Major progress has been made on increasing access to clean water and sanitation, reducing malaria, tuberculosis, polio and the spread of HIV/AIDS (World Organization of the Scout Movement, 2016). However, many more efforts are needed to fully eradicate a wide range of diseases and address many different persistent and emerging health issues. It is in this context that the Sustainable Development Goal (SDG)-3 emphasizes: “ensure healthy lives and promote well-being for all at all ages”. In order to achieve this goal, it is essential that the health and care system routinely uses innovation, technology, and research and development (R&D). Technology has the power to improve access to health care services (Karten Taylor, 2015). Sound sustainable development policy and practice is embedded across the system generating more value from the available financial, environmental and social resources. Innovative approaches should be systematically encouraged and the spread of good practice and wider adoption significantly accelerated (Sustainable Development Unit, 2015). Nevertheless, there are several challenges in caring for a changing population with limited resources.
2. Objectives and Methodology Employed:
This paper aims to address issues related to gaps in research and barriers to innovation and implementation. The importance of empowering patients and the public through technology for the future plan of the health system has also been looked into. In terms of methodology employed in this presentation, secondary data (which are primarily qualitative in nature) have been used and they have been analyzed using descriptive research method.
3. Impact on Remedying Policy Incoherence:
The healthcare industry has experienced a proliferation of innovations aimed at enhancing life expectancy, quality of life, diagnostic and treatment options, as well as the efficiency and cost effectiveness of the healthcare system. Information technology has played a vital role in the innovation of healthcare systems. Despite the surge in innovation, theoretical research on the art and science of healthcare innovation has been limited. One of the driving forces in research is a conceptual framework that provides researchers with the foundation upon which their studies are built (Vincent K. Omachonu and Norman G. Einspruch, 2010).
4. Impact on Public Health:
Good public health ensures an efficient work force. Organizations can ensure a prominent position on the global stage by staying on the leading edge of technological development. Public health and technological innovation are vital elements of prosperous economies. It is important to understand how these elements affect each other (Preetinder Singh Gill, 2013). New technologies have the potential to extend the reach of health professionals while improving quality and efficiency and reducing costs.
5. Impact on Human Rights:
Too often, governments neglect the health of the world’s most marginalized people. And yet it is these very people – such as women, the poor, people engaged in the sex trade, men who have sex with men, migrants and refugees, drug users and prisoners – who are most affected by disease and poor health. World’s most serious epidemics and health challenges cannot be successfully addressed unless the rights of these communities to health care are protected and health programs are designed to meet their specific needs. Thus, innovation, research and technology in public health are linked with human rights in many ways. Violations of human rights can have serious health consequences; unfairly administered health policies or programs can violate human rights. Protecting human rights can reduce individuals' vulnerability to ill health and its effects (Mary Whisner, 2015).
Public health has been a priority for global action for many years. The right of everyone to the enjoyment of the highest attainable standard of physical and mental health is a universal human right, just as the burden of disease is shared by all humanity. The constitution of the World Health Organization (WHO) underscores that achievements by any state in the promotion and protection of health are of value to all. In the age of globalization, progress made in public health in one country has an impact on the international community as a whole. Consequently, a compelling case can be made for effective international cooperation in public health, and such cooperation is an essential foundation for sustainable development.
Public health and medical technologies are an important focus of the international system, including in the system-wide work of the United Nations – most notably in the Millennium Development Goals (MDGs). The very founding objective of the WHO is the attainment by all peoples of the highest possible level of health (World Health Organization, World Intellectual Property Organization and World Trade Organization, 2013).
For the purpose of implementation, vision should be: “a health and care system where innovation, technology, and research and development (R&D) are routinely used to improve health and care by ensuring environmental and social sustainability” (Sustainable Development Unit, 2015). Innovative approaches should be systematically encouraged and the spread of good practice and wider adoption should be significantly accelerated. Further, a more sustainable health and care system should harness three important opportunities: Innovation, Technology and R&D; particularly where they act as catalysts for each other and the rest of the system. Brief description of these three key terms (Innovation, Technology, and R&D) in the context of sustainable health is presented below:
o Innovation: Innovation means using existing and new knowledge, techniques and technologies more creatively, systematically and ambitiously, to improve health outcomes. It means rapidly implementing what is known to work so that it becomes the norm. Sustainability needs to be a core dimension of the quality agenda and, like any area of quality improvement, should accelerate the spread and adoption of improved policies and practices that deliver better outcomes within environmental limits. Innovation is a natural part of sustainability and should not always be considered complex or expensive.
o Technology: Technology refers to the collection of tools, processes, interventions and procedures used to improve health by professionals, and increasingly by patients and the public. This includes drugs, guidelines, decision support, near patient diagnostic and monitoring equipment, used not just by health professionals but also by patients, carers, and the public. Technology has the power to transform health and wellbeing by improving how the health and care system interacts with patients, service users and communities. It supports how information and control are shared, how health and illness are monitored, and how interventions are delivered and judged to be effective or otherwise. Empowering patients and public to take much more control over their own care and treatment is a key principle. “Tele-health”, for example, has huge potential to give people much more understanding and control over how their own health is shaped and their care is provided. Technologies significantly affect (and often improve) our ability to understand, protect, control and improve our health and the environmental, social and political causes of health. Sustainable technologies can save money, reduce waste and pollution, and improve the care environment (David Pencheon and Sonia Roschnik, 2015).
o Research and development (R&D): Research is central to understanding the more systematic use of scientific and technological advances to improve prevention, care and outcomes. This includes changing behaviours, more effective forms of governance and use of resources, and better ways of developing future proof policies. This needs to match the stark picture that research has already generated about the unsustainability of the ways in which we define our health, live our lives, protect our families and communities, and organize our care. The traditional model of research in health and care has largely followed a medical model using a predominantly technocratic and problem solving approach: identify the problem and its cause and implement the “technical solution”. A more diverse and integrated set of research approaches will be needed to manage a safe and secure transition to a sustainable future.
The health and care system has never benefitted from so many technological and social opportunities whilst facing so many emerging environmental and financial challenges. The rate of increase in new research and technology is outstripping capacity to implement and innovate to improve health outcomes. We risk over-dependence on historical research, implementation techniques, and attitudes, whilst forgetting that the core values of the health and care system should support better research implementation and innovation that will help address the future fairly, and sustainably. Failing to harness the opportunities of better integrated research and innovation means we also fail to improve the system at the scale and pace that is demanded by service users and the public, needed by the science and required by the law.
The following themes highlight three areas where progress can be made:
(a) Using what we know now: Many effective ways to reduce carbon emissions and improve outcomes already exist. However, these interventions need to be implemented more widely, more ambitiously and more innovatively across the whole system now. For instance, phasing out ineffective, inefficient and inconvenient interventions and models of care, helping improve lifestyles and community resilience, reducing waste, investing in renewables and recycling all add both financial and social value into ways of working. The actions that are evidenced and need to be more widely adopted everywhere now are summarized below:
- Decarbonise estate, energy, and beyond: First we need to reduce demand for energy particularly by designing estate and infrastructure around systems of prevention and care, not vice versa. Secondly, we should ensure the very highest efficiency in the ways we use energy everywhere. Thirdly the health and care system needs to be highly visible investors in renewable energy giving both the energy markets and the public confidence that, this is a crucial action needed for a sustainable energy system.
- Invest in flexible, adaptable and resilient infrastructure: Sustainable and cost effective use of health system resources depends on a much more flexible approach to physical resources. This means using buildings to their maximum potential and not limiting their use to one purpose and for only some of the time. This principle also applies to the human resources within the health system, with a much more flexible approach to skill mix to address needs and develop personal and community assets. For instance, we need to increase resilience across the system by adapting models of care in specific settings.
- Reduce waste: The most effective way to reduce waste is to ensure, where possible, preventable conditions are prevented. This involves using the best research consistently to stop all ineffective, unnecessary and unsustainable interventions (“reducing over diagnosis” and “over treatment”). We should make use of alternative interventions that improve the experience and outcomes for people such as better technology, supported self-care closer to home and better models of care.
(b) Innovative models of care: New technology, new methods of co-operation and novel business models are already exploiting the significant potential to improve health. The power of technology needs to be harnessed to connect people and organizations better in order to protect and improve health. The explosion of new technology is advancing as rapidly in the hands of the public as those of large organizations, enabling different models of health protection, improvement and care. Similarly, better ways of helping people design their own models of care can significantly increase outcomes with fewer environmental consequences with reduced cost. For instance, using multi-disciplinary teams across organizations to design and deliver mental health services in the community can help support people to stay healthy and avoid the need for hospital care. Breaking down barriers between organizations has been recognized as a crucial opportunity to improve care for people using services.
(c) Interdisciplinary research: Integrating research from different disciplines and perspectives can increase its power to improve policy, practice and health outcomes. For example, combining the research that helps us understand climate change, chemical pollution, biodiversity loss and the spread of antibiotic resistance, helps us to re-assess and reshape a more strategic approach to health and care. Evidence and understanding help innovate completely new business, clinical, and partnership models for protecting and improving health. Considering any research or implementation approach in isolation misses the significant advantage of addressing them together. Current mechanisms of assessing health or funding research too often ignore a broad system-wide approach. Interdisciplinary research, implementation and policy needs to work in the following areas:
- Biological and social linkages: Sustainable health and care depends on exploiting the links between the biological and social causes of ill health. This can help drive more personalized healthcare that is tailored to individual needs and focuses on early intervention.
- Use of technology: Technology used by the health system, carers or service users can help shape more sustainable models of care. For instance, people living with bipolar disorder can support themselves with the use of mobile phone technology through earlier and self-identified interactions with professionals.
- Economic factors: Economic mechanisms can help address a more balanced approach to investment over longer time periods, for instance incentivizing outcomes rather than service activity. Historical economic discounting techniques can encourage short term decisions which may be costly to redress in the future. Whole lifecycle assessments also support a more realistic approach by considering costs and impacts from raw products, to manufacture, distribution and disposal.
- Systems: Many interventions that offer long term health and sustainability also add immediate and broader health and social value benefits and help address other major health related issues. For instance ensuring and enabling sustainable food systems also promotes better health at an individual level addressing obesity, diabetes, heart disease and many cancers. The same applies to transport and air quality systems.
- Behavioural/Social: Much health is won or lost outside the formal health care system, hence the importance of collaborative working across the sector, with citizens and community groups. Innovative engagement techniques can help service providers understand the assets, needs and wishes at a local level to help develop more adaptable, flexible and resilient systems and communities.
The following proposals should help support the delivery of sustainable health for all in the decades to come:
o Organizational support: Every organization should have access to sound information on proven innovative technologies and techniques which help reduce the cost and adverse health effects of the system’s environmental impacts. Organizations can use their Sustainable Development Management Plans (SDMPs) or other strategic plans to provide the evidence and data to formulate the business cases for such developments within their organizations and across their local areas.
o Innovative approaches: The development of innovative models of care that consider environmental and social improvements and promote illness prevention, health protection and health improvement needs to be encouraged at all levels. Every organization can align this approach with organizational and strategic plans. Commissioners can develop outcome based commissioning with partner agencies and service users. Regulators can refer to these approaches in their requirements, giving confidence to others, and providers can exploit the multiple environmental, social and financial benefits.
o National group: The health and care system will be supported by regularly convening key research policy, innovation and practice leaders. This national group will help monitor progress, review opportunities and barriers, ensure that key gaps are addressed, implement evidence and stimulate and encourage innovative solutions.
In summary, the following twelve areas of action are proposed to help achieve these measures of success (Sustainable Development Unit, 2015):
- Measuring, monitor and incentivize waste reduction in products and processes;
- Improve cleaner and more efficient energy use;
- Increase the use of less environmentally damaging products;
- Increase the use of data about patient preferences and outcomes to improve sustainable models of care;
- Reduce travel related pollution from the health system;
- Radically decarbonize the energy use of the health and care sector;
- Make more sustainable and flexible use of health service estate;
- Innovate new models of care by embedding sustainability into commissioning;
- Exploit every opportunity to empower service users with technology;
- Exploit every opportunity to empower the system with technology;
- Use innovative low carbon technologies to improve access to timely care; and
- Ensure interdisciplinary research on health and sustainability shapes better policy.
7. Concluding Remarks:
Building a sustainable global response to the demand both for innovations in medical technology and for effective and equitable access to needed technologies is a complex and constantly evolving challenge. While it is often expressed in abstract or political terms, the effort fundamentally concerns how to deliver improved health outcomes. Creating new medical technologies, assessing these technologies, providing for their effective distribution and ensuring that they are used rationally are, ultimately, practical processes. These processes range from the work of laboratory research scientists to the care provided by nurses in a field clinic. However, key measures for success in long-term sustainable public health programs are:
a) Recognized and tested technologies that provide innovative low carbon solutions, helping mitigate the sector’s environmental impacts, are readily identified and organizations are incentivized to adopt them.
b) Gaps in research and barriers to innovation and implementation are addressed systematically and in a multi-disciplinary way to ensure that progress is based on a sound and growing body of evidence.
c) Innovation to reduce environmental impact, enhance social value, reduce cost and improve quality of care is an integral part of the planning, development and delivery of services. It is visible in all elements of the system including the models of care, illness prevention, facilities management, financial mechanisms, and workforce development.
To sum up, one important part of developing a health care system that is fit for the future means using what we already know to shape better policy. It is also important to develop a belief among staff and patients locally that they have the ability to bring about transformational change.
Bibliography and References
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