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Beyond the pill, when medicines and technologies alone do not achieve expected health outcomes

by Jason Donohue, Principal and Healthcare Practice Lead, i-propeller

Medications and technologies have advanced significantly to prevent the spread of infectious diseases, to precisely target therapies and to deliver a personalized healthy lifestyle via our smartphones. Despite the availability of the necessary medical knowledge and technology, more than 1 out of every 4 deaths occurring in Belgium is identified as potentially avoidable. We have observed two main structural barriers to achieving desired health outcomes when the technologies are available: access to and design of the care experience.

Access – both physically and financially – has been actively addressed, improved and supported over the last decades for a great part thanks to our strong social welfare system. A patient living with HIV in Belgium can access antiretroviral medications free of charge and receive treatment at eleven specialty care centers across the country. Despite free and physically accessible treatment, only an estimated 73% of people living with HIV in Belgium actually follow treatment.

Beyond access, we encounter a much more challenging barrier to address: the design of how we experience these technologies. Of particular concern is how we as individuals act and take decisions in relation to our maladies and their respective treatments.

Thanks in part to a growing evidence base in behavioral sciences, we can now recognize recurring patterns for how the design of our environments influences the choices we take in regard to our personal health and wellbeing. Stigma influences our willingness to talk openly about our medical conditions, social norms influence whether we find it necessary to take preventative measures such as diagnostic tests or exams, and our bias towards short-term benefits can derail our long-term healthy intentions. Ultimately, these and other behavioral barriers prevent us from optimal uptake and the use of available technologies.

Behavioral sciences have recently been recognized as important to policy at the regional level with the establishment of the Flemish Nudge Unit and at the federal level with the resolution recently introduced in the Belgian Parliament to leverage behavioral sciences in policymaking to overcome such issues as the overprescription of antibiotics and the underprescription of generics.

We need to better understand and adapt our care systems with an increased focus on how both healthcare professionals and patients experience them and consequently act. Understanding the entirety of the experience is complex and engages many actors. Take our experience of a medical diagnosis - we are influenced not only by doctors who give us the initial diagnosis or lab results, but also by the staff who bring us into the room, the developers of the forms we must complete and the diagnostic report itself, and the post-diagnosis support network we have access to among others.

If we want to tackle these complex issues around our healthcare experience, we cannot do this in isolation. We must be able to bring in new perspectives through collaboration. We must break down the silos that persist across our healthcare systems and work together to address the challenges that the limitations of our own competencies prevent us from overcoming alone - whether as an individual pharma company or medical device manufacturer, an investor in healthcare or a policymaker, among others.