STR 2021
04 Health & Wellbeing
4.1 Key trends
4.2 Wellbeing and mental health in the wake of COVID-19
4.3 New breakthroughs with huge potential to save lives

Mental health and wellbeing has always been important, but the pandemic has given new impetus to action by companies, governments and individuals. More research is needed to evaluate the claims made around wellbeing and mental health by companies. In part obscured by our focus on the pandemic, important healthcare innovations are coming through that promise to save many lives.

The pandemic had very unequal health impacts

The pandemic has been a public-health disaster. According to the best estimates the pandemic has led to 10m extra deaths so far. Many more will follow.

These costs were not shared equally. Take the example of California, on which there is high-quality research. The average working-age Californian saw their risk of death rise by 22% during the pandemic. Line cooks saw their risk of death rise by 60%, while bakers saw their risk rise by 50%.

Figure 118: Risk ratios for mortality, pandemic time vs non-pandemic time, California

Among California residents 18–65 years of age, by occupational sector and race/ethnicity, March to October 2020.

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Continuing a longstanding trend of health inequalities

Many countries have longstanding health inequalities, whereby people of different races/ethnicities, and different income groups, have different life expectancies.

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Before COVID-19, access to healthcare was broadening at a global level, but the trend was reversing in some countries

A growing share of Americans, even before the pandemic, reported that they were putting off medical treatment for economic reasons. In part because of demographic reasons, health-care spending globally continues to rise.

Figure 120: Health spending relative to GDP, global, by country-income level, 2000-2018

Percentage of people who have put off treatment for serious condition

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2020 was not the first year that life expectancy fell in some countries

Increases in rich-world life expectancy have slowed or even reversed in recent years.

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Some COVID-19-induced changes will be permanent and could help improve health outcomes

Following the pandemic, telehealth is at a tipping point. It will see permanent changes, with higher usage and adoption. This will in turn help improve access to healthcare for underserved populations.

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Long-term investment in scientific research has allowed the development of effective COVID-19 vaccines

Live virus-neutralising antibody activity is strong for both main UK vaccines in relation to different variants, though single doses appear less effective against the Delta variant.

Figure 126: Reduction in efficacy of different vaccines against COVID-19 variants

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Ensuring vaccine availability in developing countries is a global priority

As the virus rages in poor countries, ensuring vulnerable groups in poorer countries get access to vaccines is a global priority.

In addition to the devastating human cost from COVID-19, failure to mount a major international vaccine response could cast a long shadow over climate negotiations later this year.

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The path to mental recovery will be long and difficult

Mental health was an underappreciated but crucial issue long before the pandemic. COVID-19, however, had led to a tipping point in societal recognition of its importance. The mental health effects of the pandemic are likely to last for some time, with unpredictable consequences.

Figure 128: Prevalence of moderate to severe symptoms of mental illness, Great Britain, 2019-2020

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There is rising incidence of anxiety and depression
Figure 129: Prevalence of symptoms of mental illness as a result of the pandemic, global, 2020
Figure 130: American adults reporting symptoms of anxiety disorder and/or depressive disorder, 2019-2021

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Younger people have been more deeply affected, especially in poor families

Many millions of children have missed out on vast amounts of education in the past year. Access to online learning was stratified by income group. The burdens of child care, and subsequent mental-health challenges, fell disproportionately on women/mothers, which may have reversed some of their economic gains.

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One bright spot is that suicides fell in many countries in the pandemic

Not all countries saw a decline in suicides in 2020, but many did. The data below covers Queensland, Australia, which has especially reliable data.

Experts are however concerned that this may be a temporary effect and many risk factors remain. In some countries, such as Japan, there has been a rise in suicides in later phases of the pandemic.

“Parity of esteem” between physical and mental health is one way to think about the gaps

Many countries have strategies that point to the need to invest a greater share of healthcare spending on mental health, as opposed to physical health.

The evidence suggests that spending across many types of mental health interventions is a cost-effective way to improve patient outcomes. Preventative interventions, including school-based learning programmes, appear to be particularly beneficial.

Figure 133: Percentage of people affected by depression with various illnesses, UK
Figure 134: Mental and physical health, contribution to morbidity and expenditure, UK

Mental health accounts for 28% of morbidity but only gets 13% of expenditure

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Parity of esteem is a long way off in the vast majority of countries

Few countries spend very much on provision of mental-health services. The median spend on mental health is about 2% of total healthcare spending. Even in wealthier countries, the share is typically below 10%.

There is minimal provision of mental-health services in most poor countries.

Figure 135: Mental-health expenditure (as share of total health expenditure) and gross national income
People have rising expectations over access to mental-health services

In the United States, about 15% of people consider mental health to be the top health issue facing the country, a figure which has doubled in the past five years.

Figure 136: “What would you say is the single-biggest health issue facing the nation?“, US, 2012-20

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There is growing interest in solutions that promise to enhance wellbeing

Deal volumes have continued to increase in the mental-health space and total funding has risen sharply.

It is important to verify the effectiveness of these solutions as they continue to scale.

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The corporate sector is also taking employee wellness more seriously

Corporates were offering new wellness programmes in the lead-up to the pandemic. Digital and mental-health offerings are the next frontier for 2021 and beyond. The question is whether these programmes are making a meaningful difference to employees' wellbeing, or whether they are merely PR.

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Vaccines against COVID-19 were developed very rapidly

There are nearly 300 COVID-19 vaccines in pre-clinical or clinical development. The scale-up of manufacturing capacity and roll-out of vaccinations has not been as fast as we would have liked, but was nonetheless an impressive achievement.

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mRNA technology will have uses far beyond COVID-19

COVID-19 is of course the focus at the moment, but the technology is being applied to many other health challenges too.

And mRNA trials are trending up

The total number of mRNA trials is near an all-time high

Medical breakthroughs are proliferating

This index tracking global medical innovations has risen strongly in recent months.

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There were other big health wins in 2020

In 2020 wild polio was eradicated in Africa, though pockets of concern do still remain.

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Breakthroughs in “protein folding” and malaria vaccines are also hugely promising

Researchers from the University of Oxford reported findings from a Phase IIb trial of a candidate malaria vaccine, R21/Matrix-M, which demonstrated high-level efficacy of 77% over 12-months of follow-up.

Breakthroughs were made elsewhere. Unfolded or misfolded proteins contribute to the pathology of many diseases. But accuracy of protein-folding massively improved last year.

The main metric used by CASP to measure the accuracy of predictions is the Global Distance Test (GDT) which ranges from 0-100. In simple terms, GDT can be approximately thought of as the percentage of amino acid residues (beads in the protein chain) within a threshold distance from the correct position.

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Liquid biopsy continues to take off

Liquid biopsy refers to the sampling and molecular analysis of the biofluids of circulating tumor cells, extracellular vesicles, nucleic acids, and so forth. The ability to detect and characterise tumours in a minimally invasive and repeatable way could have huge clinical implications, in particular in terms of early cancer diagnosis.

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Personalised medicine is also growing rapidly

Personalised medicines continue to grow rapidly, allowing treatments to be more targeted to individuals.

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Will COVID-19 set new precedents for technology cooperation on other diseases, and beyond healthcare?

There have been calls from international organisations and some governments to address trade-related obstacles to vaccine production and access, to save lives and accelerate the economic recovery.

Director-General Okonjo-Iweala has called on WTO members, other international organisations and vaccine manufacturers to address trade-related barriers in the scale up of vaccine production and distribution.

Image: WTO

This is a global health crisis, and the extraordinary circumstances of the COVID-19 pandemic call for extraordinary measures

US Trade Representative, Katherine Tai