Working with multinational employers around the world, as they develop employee health and benefits programs, provides the opportunity to track the impact of the macro forces identified in the World Economic Forum report and also to observe some initial stakeholder responses. While it is too early to identify a sustainable trend, there is evidence that we are headed toward a hybrid of “The winners and the rest” and “You are on your own” scenarios explored in the report.

This is neither a comfortable nor a reassuring glimpse into the future. If the short-term responses are a true guide to longer-term reality, the future health of the global workforce looks at best uncertain, and at worst in dangerous decline, driven by uncontrolled health risks and preventative and curative care that will be available only to those who can afford to pay for it.

Arguably, the true winners will be the businesses that come to understand the key role they will increasingly play in the health of their global workforces, and the likely impact that health will have on global economic growth. Are they ready to use their influence to shape the future?

Macro forces’ impact on the health of the global workforce

Demographic shift

Changing demographics and an increase in the dependency ratio mean that there will be fewer people who will do more work for more years. In longer-established economies, where populations are ageing faster, the problem has been well understood for some time. It is, therefore, all the more surprising that, even in these economies, employers do not seem to have seriously considered the potential implications and invested in structured programs that prevent chronic disease, reduce health risk and promote wellness - and, as a result, productivity. This is not an arena that governments are likely to fill willingly, and if they do, it will only be to reduce their own public health burdens.

Though growth of chronic disease has been, until now, a burden of established economies, the World Health Organization has shown that the prevalence of chronic disease is now, sadly, growing faster in emerging economies and in younger populations, meaning that with the rapid demographic changes, this will soon be a global problem. Enlightened employers have recognized this as an opportunity to adopt tried and tested approaches from elsewhere, appropriately focused and adapted to new cultures, to drive real health improvement as part of achieving corporate financial objectives

Global economic performance and investment return

There is massive (and well-documented) variation in spending on health care across the world. When comparators are viewed on a per capita basis, it is clear that available funding is far too low to provide quality health care, irrespective of how efficiently it might be delivered. In many cases, the infrastructure is underdeveloped and delivery is significantly impaired. The graph below demonstrates this lack of infrastructure investment with a comparison of the level of health care professionals per 100,000 of population in some key geographies.

Organizations are becoming increasingly concerned about the impact of the increased burden of health care they are being asked to carry. Governments almost universally are shifting the responsibility for funding and in some cases, provision, to employers or individuals. In less affluent, emerging geographies, employers, and multinationals specifically, are seen to have the deeper pockets and therefore become tempting government targets for “contribution.” Indeed, the likelihood of such a shift in health care cost burdens to the private sector is such that many organizations are building the higher increased cost of health provision into due diligence models, prior to making decisions on market entry.

Given this trend, they will need to decide how much responsibility they are prepared to take for health care provision and, potentially, the involvement they may want in its effective delivery.

In the future, if regulation allows, multinationals may choose to use their combined influence to shape the health care markets and even to control the cost and accessibility of health care.

Income and wealth distribution in emerging markets

In many geographies, a significant amount of health care is funded through individual out-of-pocket expenses – ranging from 20 percent in Japan to 75 percent in India. This has a significant effect on individual behaviors when accessing services and expectations of quality and compliance with treatment, and makes quality health care a priority for the emerging middle class.

In almost all emerging geographies there is limited proactive, preventative medicine and clinical gatekeeping or primary care.  Governments are starting to focus on these areas, but limited availability of care remains one of the main reasons for an increasing infectious/chronic disease burden affecting utilization and cost of care. Care is often fragmented and/or delayed, in turn affecting the clinical outcomes’ effectiveness.
 
Two-tier systems are emerging - with a base-level public system and a broader, higher-quality, service for those who can pay. Health tourism is playing a part. On one hand, it is creating a new, high-quality infrastructure. On the other, it can divert resources from public provision and further broaden the health care divide.

Changing patterns of chronic and infectious disease

Chronic disease is increasing and accounts for 60 percent of deaths worldwide. Some 70 to 90 percent of cases of chronic disease are influenced by lifestyle factors. Westernization has brought with it the negative aspects of poor diet, smoking, alcohol, lack of exercise and a high-pressure, stressful lifestyle.

Experience in the US has shown the effectiveness of well-targeted risk management programs. But development of culturally adapted programs is slow.

Some US and European multinationals are looking to extend their home country programs to other geographies, but many are experiencing problems with local adaptation. Where businesses are getting this right, the gains are visible, positive and in some cases dramatic.

In some emerging countries there is also a change in attitude to the coverage of dread diseases under medical plans. In countries such as Russia and India, serious endemic diseases are excluded from medical plans, for example, AIDS/HIV, leprosy and TB in India. In Russia, supplementary insurance coverage is starting to emerge, albeit with limited coverage.

Climate change and environmental degradation

Disease is shifting with climate change. Malaria and dengue fever zones track temperature rise and increased humidity. Employers are seeing increasing medical plan utilization for infectious diseases. Most are infections related to pollution of both air and water. Incidence of asthma in the young as well as low-grade / longer-term digestive conditions are increasing.

Employers with large, mobile work forces are already aware of the cumulative effects of exposure to adverse climates and the long-term impact on health, though few have done much yet to address this potential time bomb.

Drought and floods are affecting the very fundamentals of life, with food shortages a very real and current danger to health in poorer countries, and, longer term, an emerging problem in the wider global economy.

Bird flu made everyone aware of the potential for a global health catastrophe. Many organizations admit that their preparedness for such an event is not adequate, and the public sector response is, in many cases, woefully inadequate.

Urbanization

The speed of urbanization in emerging geographies has been far faster than anticipated. Infrastructure lags, and living conditions include overcrowding, poor sanitation, increasing animal and human proximity, poor air quality, massive traffic management issues and high accident and fatality levels. It is from communities deeply affected by some or all of these environmental factors that multinationals recruit, and the effect on health, resilience and productivity of these recruits is very visible. Increasingly, employers are seeing the need to address these issues to achieve effective employee management as well as to demonstrate good global corporate citizenship.

Current stakeholder reactions

In the table below we have explored various stakeholders’ current reaction to the macro forces. There is little, if any, visible collaboration among the stakeholders, and there is a clear emergence in some geographies of a two-tier health system.

The “We are in this together” approach appears to confront major barriers, and its implementation may be a distant aspiration.

Stakeholder Forces and Current Changes in the above table are shaped on information in the World Economic Forum report.

Future prospects

This paper paints a somewhat bleak picture. A continuation of current trends will lead to a fragmented approach to the health of the global workforce, where, to a greater or lesser degree, access to appropriate quality health care will be a benefit rather than a right.

It seems likely that the funding and provision of health care will become increasingly the responsibility of the private sector and that multinational employers in particular will be forced to play a large and potentially crucial role. If that prospect becomes an inescapable burden, the private sector will have a real motive to address the problems in a thoughtful and effective way.

Additional reading:

Global health management: discovering value and savings 

Throughout the world, rising health care costs have caused many multinationals to explore health management on a global level. This article takes a look at what companies need to do when developing a global health care strategy.