Patient centricity is the name of the game. Person-centred approaches continue to deliver and better meet the needs of patients. However, for a significant section of the population, arguably, we have failed.
The UK is one of the richest nations in the world, yet those living in poorer areas are prescribed more medicines, suffer more years of ill health and die younger than those living in wealthier areas.
These health inequalities represent a continuing social injustice and they present a significant cost to the public purse, a drag on the economy, make demands on health and public services and limit people’s, and communities’, capacity to contribute positively to society and the economy.
Health inequalities also negatively impact medicines optimisation and adherence. More needs to be done to address these inequalities and here pharma has a role to play. One proven approach is Health Creation. While disadvantaged communities have the greatest need, health-creating approaches could benefit all those who struggle with medicines adherence.
Dr Michael Dixon OBE, GP, Co-Chair National Clinical Social Prescribing Champion for NHS England and Chair of the College of Medicine.
Health Creation is a route to wellness. It comes about when professionals and people work together as equal partners and focus on what matters to people and their communities.
Heath Creation is a proven approach to improving the health and wellbeing of those that suffer health inequalities, particularly in communities where the incidence of common conditions such as obesity, diabetes, cardiovascular disease, mental health, respiratory disease and some cancers is significantly higher than the general population.
Empowering people to take control of their lives leads to greater willingness and ability to manage their health.
Health Creation is built on Control, Contact and Confidence. When people feel a sense of control over the circumstances of their own life (rather than being dependent upon services), and when they have meaningful and purposeful social contact – including the avoidance of social isolation – they can gain the confidence and self-belief to take action and accept accountability. This empowers them to look after their own health and wellbeing, and to have a positive impact on those around them.
Commenting on Health Creation, Merron Simpson, CEO for the New NHS Alliance (NNHSA), a not-for-profit organisation that is leading the Health Creation movement said, “Health Creation takes patient centricity to a higher level because it focuses on what people and communities have to offer, rather than just focusing on their needs. It is characterised by the adoption of one or more of the five features of health-creating practices, delivering the best outcomes when all five are being practised. When these features are working, it provides the conditions for people to gain Control, make meaningful Contact with others and build Confidence. People need enough of the 3Cs of Health Creation to be well.”
Communities are encouraged to find health solutions that work for them.
Those facing health inequalities have the greatest need for medicines. Yet, arguably, while they are prescribed most medicines, they are least likely to continue to take them.
The reasons for this are complex and they include the negative impact of some of the wider determinants on an individual´s health and wellbeing. These may include health and digital literacy, language barriers, mental health challenges, and disengagement from the system. But, generally, it is related to what they think. These communities also represent some of those people who are the hardest to engage in traditional programmes. As a result, they are often overlooked by pharma within their disease awareness and patient support programmes, although they make up the majority, and not minority, of patients.
However, these people are sitting in full sight. They are going in to the clinic and receiving treatment. Yet, despite this, we fail to understand them and help them to change their behaviour to deliver better health and wellbeing outcomes. In addition, too often pharma companies tell people what they think people want to here, in an order that they believe people should hear it.
Mark Robinson, NNHSA Executive Board Member and medicines optimisation specialist said, “Too often those in need of the greatest support are those who don´t receive it. In supporting those living with conditions associated with health inequalities, the question pharma really needs to ask is ‘how do we reach and engage them?’ And not, ‘why do we need to reach them?’ Health Creation is an answer to the how.
One organisation that has recognised this in support of medicines optimisation and adherence is the Hepatitis C Trust.
Through their partnership work to drive hepatitis C testing and treatment among the drug-using population, they have clearly demonstrated that adopting health-creating practices supports this community to access, and stay on, treatment.
Commenting on the successful programme, Rachel Halford, Deputy Chief Executive said, “Given the challenges faced by this community, our work focussed on increasing the 3Cs of Health Creation – contact, control and confidence. This has resulted in a highly effective peer-buddying programme that ensures and supports easy access to treatment for the most complex and hard-to-reach cases; bringing our goal of the elimination of hepatitis C further within our reach.”
A leading supporter of Health Creation, and the Hepatitis C Trust, is AbbVie. Through its work with NNHSA it continues to advance health-creating practices in supporting patient access and adherence to appropriate treatment. Commenting on the opportunities Health Creation affords pharma, Zoë Horwich, Senior Manager of Sustainable Healthcare at AbbVie said, “For many years AbbVie has focussed on person-centred solutions in support of healthcare professionals and patients. Health Creation is a natural evolution of this work that both complements and enhances our current patient-centric ethos and activities to improving patient outcomes.”
Another organisation advancing the Health Creation movement is health communications consultancy, Trio Health. Its managing director, Nick James, commented, “Health Creation may be new to many in pharma. However, for those focused on disease areas where adherence is a challenge, Health Creation offers another approach to improving patient outcomes. In addition to the individual, community, societal and economic benefits of this, it can also demonstrate the value pharma brings beyond their current medicines and support programmes alone.”
So, what can pharma do to be part of the growing Health Creation movement? The first step is acceptance that current programmes and approaches are not optimising patient outcomes, followed by an assessment of current activities and programmes. The NNHSA offers a Health Creation diagnostic tool that can enable this. With this baseline assessment in place, the next step is to incorporate the five features of health-creating practice. This doesn´t have to be something the industry does alone and there is a diverse range of Health Creation experts available to support pharma to make transformational changes to patient awareness, education and support activities.
Patients’ engagement in their own health and care has been described as the ‘blockbuster drug of the century’, and significant progress has been made in advancing patient-centric practices and delivering patient-centred approaches. However, for many patients, medicines optimisation and adherence remain poor and, among disadvantaged people and communities, very poor.
New thinking and disruptive approaches are urgently needed if medicines outcomes are to be enhanced, with all the people, community, societal and economic benefits this affords.
Health Creation is a route to wellness. Just as pharma innovates in the development of medicines, further innovation in how people access and adhere to them is now needed.
Neil McGregor-Paterson is Senior Consultant, Realitas Consulting and Communication Director for New NHS Alliance.
New NHS Alliance is a movement of people and organisations who are committed to building a sustainable, community-based health and care service. New NHS Alliance focuses on reducing health inequalities and making the practice of Health Creation a core part of the UK healthcare system, alongside a stronger focus on preventing illness.