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Why medical affairs has a role to play in climate, health and equity.

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It has been a busy year in 2023.  Here are my seven key insights on climate, health and equity and the role of medical affairs. 


Insight #1 – A paradigm shift not another priority

Climate, health and equity is not another business priority, it is a paradigm shift that will help us to be more successful to deliver against our existing priorities.  Once the penny drops, triple win business opportunities start flooding in. 

Three examples of this are: 1) Reducing the carbon footprint of clinical trials reduces financial costs and improves diversity through equitable access.  2) Identifying populations with unmet medical need and poor access to healthcare uncovers new business opportunities through increased market size, market share and return on investment.  3) Integrating health outcomes into climate action programs and vice versa realises benefits on outcomes for people and the planet meaning more impact for the same investment. 


Insight #2 – There is a unique role for each of us

The work for each of us as individuals and as representatives of our organisations is to identify what it is that we uniquely contribute towards the challenge of climate change and its impact on health and equity, in our role as citizens and as professionals.  This means deciding what we are not doing, as much as what we are. This sounds so simple, but in reality it is extremely difficult. 

I recently got asked a question during a public presentation about the dangers of non-renewable minerals being depleted in order to manufacture solar energy panels.  As I was someone who had deliberately got up on a stage as an “expert” in climate change, I could have felt ashamed that I did not know the answer. 

Instead, I realised that although this was a critical issue, it was not an issue that I was well qualified to solve.  I had to trust that other people better qualified than me were already working on it.  I re-focused the conversation to the topic I had come to speak on – the impact of climate change on human health and equity, and the role of pharmaceutical physicians. 


Insight #3 – Medical affairs are well placed to catalyse sustainable healthcare transformation

Medical affairs leaders act as ecosystem connecters both internally within the business and externally across the healthcare sector, and as such are well played to influence systemic change within the healthcare sector at scale. 

However, systemic silos might be stopping us from finding new opportunities.  Much of the work of sustainability in pharma has been conducted at a corporate level, without influencing or impacting core business operations.  For environmental action commitments to be met, and for true impact, this must change.  Medical affairs could be the key to unlocking this potential. 


Insight #4 – Sometimes we have to slow down to speed up

Untangling complex so-called “wicked” problems like climate, health and equity sometimes means slowing down to speed to.  Using systems change approaches to design effective interventions can help to make sure that the actions we take today do not have negative downstream consequences tomorrow. However, this takes time to reflect and think more deeply about the problems we are trying to solve.

A personal practice I am finding helpful is to carve out dedicated time each week for reflection and “being” rather than delivering and “doing”. Getting out into nature with my dog (beloved black Labrador called Molly!) helps me to get clear on where I need to focus.


Insight #5 – Language matters

Stepping outside the corporate environment for a while has given me an opportunity to examine the cultural language that we use, and see more clearly when that language could be counter-productive. 

For example, instead of “stakeholder engagement”, perhaps we can learn how to build genuine respectful relationships. This means listening, seeking to understand, finding shared goals, being open to new ways of thinking and doing, and letting go of our own agenda in order to find an even better way forward.


Insight #6 – Solutions must cater to the minority

Centralised global strategies and interventions run the risk that they cater to the needs of the “average” person in the “average” neighbourhood.  This average person is pure fiction. 

Real interventions means working with real people in real communities.  We have to design innovations and interventions that meet the needs of all the people we want to serve, including the most vulnerable and marginalised.   

Impactful actions that drive improvements in health for populations and the planet also mean working at a grass roots level with communities and in partnership with empowered community leaders. 


Insight #7 – Looking over the hill

An old mentor and boss of mine once said that medical affairs only do their job well when they are able to “look over the hill” and anticipate what is coming in the future.  Doing this well meant building strategies and evidence plans that meet the needs of people living in the world we are moving towards rather than the world we currently live in.

Medical affairs engage with healthcare professionals to gather insights on a daily basis, but those insights come from people who are generally not looking over the hill.  To complement these insights, medical need to build new skills in strategic foresight in order to look anticipate what is coming, identify measurable indicators of change within the healthcare sector, and get clearer on future unmet needs. 


If you enjoyed reading these insights and would like to learn more, please contact me at emma@iovoli.ch.




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Why did you join a pharmaceutical company? Was it to escape the pressures of the front lines of the healthcare system, or was it because you believed that you could make a difference?

I remember writing an article in BMJ careers around the time I switched careers from clinician academic to MSL. I fiercely justified the choice I made, confident that I could act as the ethical voice for the organisation and impact public health at scale for the rest of my career.


Over a decade later, I realised that I had failed utterly in my mission. I had been caught up in organisational politics, commercial strategies and business acronyms. I talked about patient centricity, but did not really know what that meant. I had the posture of a medical leader, but I usually did what I was told. I believed I had the power to change things, but spent a lot of time agreeing with people around me.


Yet as medical affairs leaders, we do have far more power than we give ourselves credit for. Through our wide network of established relationships we can influence not only the pharmaceutical company itself, but also the wider healthcare system. So why don't we?


Right now there are two huge movements happening in healthcare. One is the process of system wide decarbonisation, within the healthcare sector itself and across the pharmaceutical industry. Every unit of carbon saved also improves public health globally, especially for the world’s most vulnerable communities and neighbourhoods. The other is an increasing focus on health equity. Medical affairs naturally sit at the intersection of both of these movements and are well positioned to create huge system wide impact.


So what is stopping us? Have we got lost in business bureaucracy? Or are we still holding true to our original purpose?




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Updated: Jun 2, 2023

A new paradigm in modern healthcare is emerging. A paradigm in which a healthy planet is emphasised as an essential cornerstone for healthy people.


The pharmaceutical industry is already embracing the shift in focus from treatment of disease to promotion of health. However, a growing movement known as planetary health or "healthy planet, healthy people", challenges assumptions about what health promotion means, and places strong emphasis on the fundamental basics of a healthy environment.


One practical implication of this trend is that pharmaceutical companies with a vision to improve human health must develop an integrated strategy in climate and health. Carbon emissions that the industry releases are contributing to global warming, which in turn is directly and indirectly adversely impacting human health. The world’s leading expert scientists at the Intergovernmental Panel on Climate Change (IPCC) state with high confidence that "climate change and related extreme weather events will significantly increase ill health and premature deaths from the near to the long-term."


The health co-benefits of climate action are well evidenced and according to the World Health Organisation offer strong arguments for transformative change. However, climate strategies and activities within pharmaceutical companies remain focused within corporate sustainability, publicly disclosed through ESG reports.


Despite the urgency for the health sector to stop releasing carbon and prepare vulnerable communities to be resilient to climate-related health impacts, core business functions such as medical affairs are not yet being systematically engaged. Companies are therefore not fully realising the business opportunity to tackle the climate crisis and improve health outcomes for patients and the planet.


The opportunity for medical affairs agency goes beyond important but small scale individual actions, such as recycling plastic or eating vegan. Established medical affairs knowledge, skills and capabilities within evidence generation, medical education, patient centricity, digital healthcare and health equity can be applied to the challenge of climate change in ways that will transform patient care and realise business opportunity.


You can read more about the why medical affairs can play a key role in climate and health and explore practical actions in our new report which can be downloaded here https://aud-com.com/MedicalAffairs.




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