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

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Since last week’s blog article, I have continued to reflect upon “who I am” as a doctor and what the doctor of the future, working within a more sustainable and equitable healthcare system, might become.


I came across a brand new book; the “Routledge Handbook of Climate Change and Health System Sustainability”.  There is nothing I love more than a new book, so after immediately purchasing the e-version of it I began hopefully browsing.


I found a section enticingly titled “Who are we?”, clicked on it to open and almost immediately my eyes located the following statement:


“Just as the oil industry has stifled our realisation of the lethal harms of carbon consumption, so too has the pharmaceutical industry promoted profitable drug solutions to health conditions, blinding us to “too much medicine” and undermining our collective resilience.”


A statement like this is perhaps designed to be provocative, and provoke it did. When I followed the reference it was to a BMJ opinion article on “overdiagnosis and too much medicine in a world of crisis” which did not reference the pharmaceutical industry as one of the root causes, but did highlight the need for improved medical education to avoid the pitfall of over-medicalisation.


My intention here is not to defend, or to attack, the industry, but rather to dig a little bit deeper. It seems important to face up to an accusation like this and ask – to what extent has the pharmaceutical industry contributed to a culture of over-medicalisation with a negative impact on healthcare resilience? What are the root causes that lie behind this? And in what ways could these root causes be tackled so that the pharmaceutical industry can be more capable of contributing to positive transformative change within sustainable healthcare systems?


If there has been robust systemic research exploring these questions, I would very much like to delve into it.  If there has not – isn’t this a gap? 


There is absolutely no doubt that the pharmaceutical sector has a huge sphere of influence – the number of employees within the industry itself or across its supply chain are likely to run into the millions, and almost every individual worldwide depends upon access to healthcare, upon which access to medicines do have a profound influence.


So, in positive terms, pharmaceutical companies could represent a huge opportunity to catalyse transformative change, helping healthcare reduce its environmental impact and become more resilient.


Having worked in the pharmaceutical sector for over a decade, I know that there is an enormous potential within the organisation's walls - a mountain of expertise, purpose, and passion. As medical affairs leaders, lets do the uncomfortable work of understanding who we currently are, and what we want to become, so that we can help healthcare get back on track towards a flourishing future.

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Over the past few years, and especially since focusing my work on the climate, health and equity intersection, I have found myself wondering about what it means to be a doctor.


I remember in my 20s, when someone asked me what I did for a living, it was so easy to reply “I’m a doctor.”  The person asking would immediately have a sense of what that was - that I was someone with an education in medicine, that I worked in a hospital and did long shifts, and that my work was likely to be a hugely important facet of my life, a calling even.


Since stepping away from clinical medicine it is not so easy to describe what it is I do, or indeed who I am.  I no longer see patients every day, or work night shifts, or wear a stethoscope around my neck. But in many ways my passion for “being a doctor” - for doing work that heals people - has exponentially increased.  I feel more like “a doctor” than I ever have before.


So what lies right at the heart of the vocation to heal? What does it mean, exactly, to be a doctor?  And is it time to rethink how the work of a doctor is commonly perceived or defined?


This is one of the many questions I hope to explore at the Basecamp for Health System Transformation, staring in just a few weeks. Run by the School of Systems Change, it is an exciting opportunity to examine the currently prevailing medical paradigms that have influenced the way our healthcare systems are set up.


And then, beyond that, I hope to explore how the life science sector might be maintaining this out-of-date status quo. I will contemplate what needs to shift or change within the sector so that the interconnected wellbeing of people and the planet is provided with the conditions it needs to flourish and thrive.


And ultimately, I will ask, what is the role of medical affairs within pharmaceutical companies to help pave the way for this much needed transformation of healthcare?


Hope you will join me and follow my reflections over the next few months.

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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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