Achieving health equity – the state, or goal, of ensuring that everyone has a fair and just opportunity to attain their highest level of health – can deliver benefits for wider society, most notably an increased productive life expectancy.
Globally, the relationship between income and health outcomes has long been well understood. How much money you earn impacts your life expectancy and causes of death (see Exhibits 1 and 2).
This is also true on a national level. In the US, for example, the richest males live an average of 15 years longer than their poorest counterparts; for females, the difference is 10 years. In England, there is a 19-year gap between the most and least affluent areas of the country.
While we would agree that improving access to healthcare matters for diminishing these disparities, we also believe that attention must be paid to the social determinants of health (SDOH) – non-medical factors that influence health outcomes. These include the environment in which people live, their gender or race, and their educational attainment.
The interconnected nature of these factors is one of the challenges facing investors wishing to address health equity. For one, many of the companies negatively impacting health outcomes tend to operate outside of the health sector.
They include utilities which are among the causes of local and global pollution and food companies that sell unhealthy foods to vulnerable populations. Addressing health equity thus requires a cross-sectoral and interdisciplinary approach.
How to improve health equity?
Legislation can help to tackle some of the social determinants. For instance, sugar-sweetened drinks can contribute to obesity and obesity-related conditions such as diabetes and cardiovascular disease, thus raising public health costs. Their pricing can be said to be a factor in the harm caused, often more so to low-income groups.
Taxes on such drinks can encourage people to cut their consumption. They can “[mobilize] revenue for countries that could be used to realize universal health coverage”, according to the World Health Organization.
Health can also be improved where measures are taken to reduce pollution. Research shows that air pollution disproportionately affects low-income communities and communities of colour – often due to their proximity to fossil fuel burning facilities – making them more vulnerable to associated health problems.
The link between health equity and broader sustainability is reflected in the UN Sustainable Development Goals.
For instance, SDG 11.6 – “By 2030, reduce the adverse per capita environmental impact of cities, including by paying special attention to air quality and municipal and other waste management”. The aim is to reduce particulate matter pollution because “these particles are able to penetrate deeply into the respiratory tract and therefore constitute a risk for health …”
There is a direct link with SDG 3.4. This aims to “reduce by one third premature mortality from non-communicable diseases [by 2030]”.
Private sector solutions
Stopping harmful activity can be part of the solution. But there are also many positive actions which companies and investors can support to tackle the challenge:
- Invest in companies developing the production of novel foods which may serve as like-for-like replacements for unhealthy ingredients
- Invest in technology companies focused on healthier habits using behavioural patterning
- Invest in companies supporting the development of affordable housing.
- Invest in companies focused on value-based care
- Invest in companies supporting telehealth, which can help provide care for underserved populations
- Invest in companies developing novel drug development or delivery mechanisms which improve access to medicines (e.g., by making them easier to administer or more stable for transport to hard-to-reach areas)
- Invest in companies developing low-cost generics and biosimilars which can make treatments more cost-effective and accessible.
- Support proactive policies to make healthy foods cheaper, perhaps paying for these subsidies via taxes on unhealthy foods/substances.
- Encourage more pharmaceutical companies to adopt best practices in clinical trial transparency and to increase diversity in their testing to ensure better representation of effectivity of drugs
A focus on innovation
Our ecosystem restoration strategy focuses on investing in companies solving environmental problems, many of which are linked to the food system and the circular economy. Many of these companies also produce outputs which improve health outcomes.
Our healthcare innovation strategy is built around the premise that health demand is already, and will continue to be, growing at a faster pace than the broad economy on the back of megatrends such as world population growth and ageing, lifestyle changes and rising wealth in emerging markets. We believe innovation in healthcare can bring transformative benefits to society and the economy.
 What is Health Equity? (cdc.gov)
 It should be noted that the US is somewhat of an outlier on a global level
 New thinking points that low supply of healthy food is less responsible for the issue than high demand for unhealthy food. What Really Happens When a Grocery Store Opens in a ‘Food Desert’? (nyu.edu)