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  • Writer's pictureEmma Iovoli

Health is a process not just an outcome

Have you heard the popular and somewhat cliched quote “life is a journey, not a destination?” This is certainly true in my lived experience. The medical degree I got at the age of 23 felt like a significant high point in my life, but it was the experience of actually working as a doctor within the NHS that was far more valuable and rewarding.

Today was the first session along our 4 month journey into health systems transformation at the School for Systems Change and it got me thinking; how often do life science businesses prioritise the “journey” of the lived experience of employees, customers and communities over the “destination” of its financial bottom line? In an ideal system, these two things would go hand in hand.

A business needs to make a good return on its investment, but there are many other non-outcome related aspects of a business that hold value - from the continuous growth and development of its employees, to the space for creative sharing of ideas that spark unexpected innovations and the fostering of multi-cultural diverse communities. A healthy business also considers these process orientated dimensions, not just its measurable and reportable outcomes.

Lets take another relevant example from the life science sector – clinical trials. We usually design trials to evaluate the benefit of a medicine or vaccine on health related outcomes in a pre-specified population. The focus is predominantly on the health outcome - the data that will convince regulators, clinicians and patients that the medical innovation has a benefit that is worth the risk. We might look for ways to measure an outcome that is more “patient centric”, but it is still the outcome that matters most.

Yet something we have known for a very long time is that many people derive a benefit from being part of the process of a trial, even beyond the medication they receive – the so-called placebo effect. Participants have access to medical care that exceeds the usual standards and receive more intensive support when they have symptoms or concerns. Expanding access to trials to ensure diverse representation of populations in need therefore contributes to the broader healthcare shift to equitable models of health.  

On the other hand, the process of delivering the clinical trial could involve recruiting patients from very large geographical distances, especially if it’s a rare disease. The transport required to get them to clinic visits could generate greenhouse gas emissions that contribute to worsening climate change with negative impacts on public health. The process of the trial could then influence health negatively, a risk that might not be worth the benefit at population levels.

This type of complexity is what the practice, process and outcomes of systems change helps us to navigate. I look forward to sharing more as the week unfolds.

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