At the beginning of last year, we posed the question, “What will 2018 bring for global public health?” — to experts in global health, with answers ranging from threats to global health financing to the advent of breakthrough technologies.
As we prepare for another year of uncertainty and change, we can be sure that some issues will continue to play center stage in the coming months — pressures on biopharmaceutical pricing; reimbursement and regulation as they relate to the accessibility of new medicines for patients in developed and emerging markets; the struggle of global health funding streams as governments and other donors address a wide range of competing priorities; and the entry of new actors in the healthcare space creating partnerships and coalitions that would have been unexpected even five years ago.
We challenged our team to anticipate what’s in store for the new year. Below are Rabin Martin’s predictions for global health trends to watch in 2019.
The evolving conversation around market access and biopharmaceutical pricing
Companies are increasingly developing products that are highly personalized and have the promise to get the right therapy to the right patient at the right time. As a result, health systems are increasingly focused on cost containment and making decisions based on evidence and value. Biopharmaceutical companies are developing flexible business models to adapt to the changing environment. With so many new breakthrough drugs with high price tags, how will conversations around pricing evolve in 2019? How can companies think differently about access, value and pricing? How will payors balance budget pressures with the imperative to bring innovations to patients in need?
“Companies are facing challenges as they move into precision medicine and genomics, which offer the real potential of cure — but with serious tradeoffs. More companies are now operating at two ends of the global health spectrum — providing more traditional products at scale for diseases like malaria and HIV infection, versus high-cost innovative ‘cures’ for certain cancers and infectious diseases, like hepatitis C.” — Kate Schachern, Managing Director
The rapid growth of non-communicable diseases
With increasing numbers of deaths due to diseases that are largely preventable, NCDs have gained significant political and social momentum. They were put in the spotlight with the Third High-Level Meeting on NCDs at the 71st United Nations General Assembly last September, where heads of state took responsibility for their countries’ efforts to prevent and treat NCDs and renewed their commitment to implementing a series of WHO-recommended policies. A number of initiatives are focused on tackling the growing burden of NCDs, including Access Accelerated, an industry coalition that brings together two dozen biopharmaceutical companies to collaborate on and co-create scalable and sustainable solutions to address NCDs.
“NCDs received an unprecedented level of attention in 2018 thanks to the UN High-Level meeting. While there were gaps in the final Political Declaration and still a massive amount of work to be done to reach global goals, the number of organizations and stakeholders involved in the NCD space is significantly greater than just a few years ago.” — Isabelle Lindenmayer, Senior Vice President
High-level attention on mental health
Global mental health received increased effort and focus in 2018, particularly in the NCD debate. For the first time, September’s UN High-Level Meeting on NCDs recognized mental health as a major contributor to the global chronic disease burden, with stakeholders calling for more concerted global action around the issue. UN Secretary-General António Guterres announced a new initiative, the United Nations System Mental Health and Well-Being Strategy, to provide mental health services and ensure the well-being of UN staff. With one in four people worldwide being affected by a mental disorder at some point in their lives and nearly two-thirds of those with a known disorder never seeking treatment, this newfound attention on mental health is an important and long overdue step forward.
“Innovation and collaboration are keys to addressing the continuing mental health epidemic. With mental health services largely underfunded, more global and local public-private initiatives to address mental health are popping up. One example is Johnson & Johnson’s partnership with Partners in Health and the Government of Rwanda to deliver mental health services as part of a pilot program to expand mental health services across Rwanda and sub-Saharan Africa. This initiative showcases how the private sector can be an important partner for communities in addressing the gap in funding of and access to mental health services.” — Rebecca Hoppy, President
Putting the patient at the center of care
Across sectors, organizations are focusing on how to provide patient-centered care to tackle global health challenges. The patient voice has become a focal point of global health conversations among governments, multilaterals, private companies and NGOs, creating the space for meaningful discussions and recognizing the importance of listening to those who will ultimately benefit from new global health programs and initiatives.
“We’re seeing greater discussions around meaningful inclusion: Who’s at the table? Who’s setting the agenda? Healthcare companies are taking a step back from their traditional way of doing things to pay more attention to the patient voice. They want to know what motivates health-seeking behaviors — there is a real craving for nuance and texture in understanding what people want and why they make the health choices they do.” — Terri Jackson, Senior Vice President
Read more on increasing access to patient-centered care in oncology.
The future of development assistance for health remains uncertain
Following the last two decades of the “golden age” of global health financing, there is now concern around maintaining funding for critical global health programs, particularly around U.S. commitments. As traditional funding streams disappear, the responsibility of financing healthcare access and coverage is shifting to country governments. Worldwide, government health spending per capita will increase by $1,126 between 2014 and 2040. This is in stark contrast to the expected $3.2 per capita increase in development assistance for health in low- and middle- income countries.  Governments must look for creative solutions and unlikely partnerships to ensure access to quality healthcare for their people. A number of new, innovative financing programs are helping governments accomplish that goal. For example, the Utkrisht Impact Bond is the world’s first health and development impact bond focused on improving the quality of maternal and newborn care. Launched in 2018 and led by a public-private partnership involving USAID, the Government of Rajasthan, UBS Optimus Foundation, Palladium, Population Services International, Hindustan Latex Family Planning Promotion Trust and Merck for Mothers, it provides support for 440 health facilities to improve service and adhere to government quality standards in Rajasthan, India.
“Amid the push for universal health coverage worldwide, the funding landscape is changing, and a new era of global health financing is emerging. There are now unique opportunities for country governments to step up and look for innovative and sustainable financing solutions.” — Afua Basoah, Vice President
“The new Utkrisht Impact Bond is a truly innovative form of healthcare financing. By paying only for results — in this case improving the quality of private maternity care in a high-burden state in India — this bond attracts private investors, with the support of the US government, to meet national health priorities. It’s an excellent example of the contribution public-private partnerships can make in filling financing gaps, creating more sustainable ways to address health and development needs, and helping achieve the SDGs.” — Maria Schneider, Executive Vice President
The private sector is helping to fill the gap in meeting global health needs
Private sector companies have discovered new ways to engage with the public sector and civil society to leverage their expertise and resources to fill gaps in healthcare delivery. Unlikely partnerships between private sector companies have also emerged. For example, the Novartis Foundation and Intel Corporation currently serve as co-chairs of the Broadband Commission for Sustainable Development Working Group on Digital Health. Johnson & Johnson and Intel Corporation lead the Private Sector Roundtable on global health security, mobilizing companies from across sectors to support countries in preventing, detecting and responding to global health threats in collaboration with the more than 50 countries that participate in the Global Health Security Agenda. In 2018, Shire, Microsoft and EURORDIS established the Global Commission to End the Diagnostic Odyssey for Children with a Rare Disease, a multidisciplinary group of experts working to eliminate barriers to diagnosis of rare diseases to transform the lives of patients, caregivers and physicians. The Commission report is expected to launch in early 2019.
“This year, we saw increased openness to the role of the private sector in global health, although there is still skepticism, particularly among NGOs and public institutions. To move forward, private sector actors must figure out how to understand public health viewpoints better and to see how their initiatives are contributing to public health goals beyond the bottom line. They need to ask how to fill a niche in public health that isn’t currently being addressed.” — Julie Becker, Executive Vice President
“As companies look toward a more comprehensive approach to addressing health challenges, more and more partnerships between private sector companies are emerging. There is greater need for innovative technology solutions and enhanced recognition that the competencies required for strengthening health systems go beyond the health sector. Collaborations enable companies to leverage their expertise in areas such as technology, logistics and supply chain management to strengthen health systems within the framework of global health security and pandemic preparedness.” — Tina Flores, Vice President
See here for additional insights into the role of the private sector in global health security and universal health coverage.
Health elevated as a global priority through a renewed emphasis on Universal Health Coverage
The World Health Organization estimates that half of the world’s population lacks access to basic health services. Moreover, this staggering number mask inequities that exist between and within countries: gaps between rich and poor, men and women, young and old, and among people of different ethnic backgrounds.
The widespread attention to universal health coverage (UHC) and the resulting multisectoral collaboration in the past year have been unprecedented. Country governments, NGOs, multilaterals, civil society and the private sector are working together to figure out how to achieve Health for All worldwide. But the task of turning this vision into reality poses a significant challenge for countries at all stages of economic development. In the United States, for example, recent discussions have centered around increasing access to health coverage amid uncertainty about the Affordable Care Act, which currently provides coverage for over 20 million people. 
Ahead of the first-ever High-Level Meeting on UHC at the UN General Assembly in September 2019, we are pleased to announce the publication of The Road to Universal Health Coverage: Innovation, Equity and the New Health Economy — a new book from Johns Hopkins University Press. In the book, editors Jeffrey L. Sturchio, Ilona Kickbusch and Louis Galambos, along with their contributors, explore ways in which the private sector is helping countries achieve universal health coverage and opportunities to partner with governments during their process of transition.
“Universal health coverage promises to give people greater access to high-quality health services without the risk of incurring financial hardship. But countries rich and poor alike face significant challenges in achieving this vision. Working and collaborating across sectors, each country will chart its own course to UHC, deciding which health services to cover, who will gain access to those services and how to ensure effective and efficient delivery to provide health for all.” — Jeffrey Sturchio, CEO
We look forward to working with many of you in the year ahead to help shape the conversation around the private sector’s multifaceted role in contributing to UHC.
Read on to learn various perspectives on how countries can chart their own path to UHC using the capabilities of the private sector.
Additional questions we are thinking about in the year ahead: Will the roster of new, consumer-friendly digital tools move the needle on improving patient outcomes? Can we expect to see more innovation at the regional level from the Global South? How will the use of real-world evidence continue to inform the growing field of precision medicine? Are the threats of HIV/AIDS, Ebola and other communicable diseases behind us? What impact will the growing wave of migrants and internally displaced persons around the world — now estimated at some 70 million people — have on health systems? What health impacts will we see as a result of climate change and pollution, and what will it take to bring coordinated global leadership to bear on this issue?
Let us know what you think. What issues are top of mind for you this year? What motivates you in your work? What keeps you up at night? Please drop us a line at [email protected].
 World Health Organization. Mental disorders affect one in four people (2018). https://www.who.int/whr/2001/media_centre/press_release/en/
 Dieleman, Joseph L., Madeline Campbell, Abigail Chapin, Erika Eldrenkamp, Victoria Y. Fan, Annie Haakenstad, Jennifer Kates et al. “Future and potential spending on health 2015–40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries.” The Lancet 389, no. 10083 (May 20, 2017): 2005-2030. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30873-5/fulltext
 Centers for Disease Control and Prevention. Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2016 (2017). https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201705.pdf