Crossed perspectives on CSR in healthcare: key challenges around the 3 pillars of CSR

CSR environmental pillar: the health sector is growing aware of its responsibility towards the environment, accelerating its initiatives and seeking more multi-stakeholder collaboration

Healthcare players have become aware of this impact and are starting to act.

While the impact of climate change and of ecosystem destruction on human health is well known and studied, the other way around is less so. Yet this impact is significant: the healthcare sector accounted for 5% of global CO2 emissions in 2018, which would make it the 5th largest emitter in the world if it were a country.
Healthcare players have become aware of this impact and are beginning to act. The eco-design approach, which aims to consider the entire lifecycle of a product or service in order to reduce its environmental impact, has been taken up by all the players and reflects this momentum.

On the industrial side, healthcare products’ eco-design makes it possible to target the priority actions to be undertaken to reduce the ecological footprint of a medicine. This can be done at all stages, from the choice of raw materials, through packaging and industrial processes, to end-of-life management and recycling of the medicine. This approach is leading pharmaceutical companies to rethink the design of their healthcare products, as illustrated by Sanofi’s reusable insulin pens and GSK’s low-carbon inhalers.

Eco-design also applies to care, in a broader perspective. With nearly 380,000 beds in France, hospitals must now recognise their “predation on the environment”, as Nathalie Ronzière describes it, and take steps to reduce their environmental impact. And this can and must begin with a comprehensive carbon assessment of hospitals. Although mandatory today, too few hospitals undertake it and when they do, it is often incomplete, as it does not take into account indirect CO2 emissions (scope 3). The experience of the Cannes Hospital is pioneering and valuable in this perspective. For example, conducting a complete carbon assessment enabled them to identify the significant share (17%) of nitrous oxide, an anaesthetic gas, in the greenhouse gases (GHG) emitted by the hospital, and led to the decision of suppressing it. This effort required the involvement of many actors to review and transform anaesthesia and surgery practices.

Finally, dialogue is now needed between health system actors to optimise and align their efforts on environmental issues. For example, pharmaceutical companies must coordinate and collaborate to define common indicators for measuring the environmental footprint of a drug. This would synchronise their efforts and ensure that decision-making processes are more ‘calibrated to incorporate environmental considerations’, as Elise Pape advocates. A dialogue must also be created with all stakeholders, and in particular a dialogue that integrates patients’ point of view on the environmental question. Indeed, Nicolas Naiditch highlights the growing importance that patients give to the environmental impact of their care and medicines. With insulin pens, for example, there is a need to open a dialogue on how environmental sustainability (e.g., recyclable pens, with longer-lasting insulin) can be combined with safety and comfort for patients.

CSR economic pillar: the management of healthcare expenditure must include criteria of performance, appropriateness, and access to care

Improving the performance of hospitals is a key issue, which relies in particular on the agility of healthcare facilities.

While there is general agreement on the need to make healthcare accessible, there is no consensus or easy answer to the question of “how” we can do it. The cost of health care is a central challenge of the ‘economic’ pillar of the health sector.

Controlling healthcare expenditure, which currently represents 9% of French GDP, is crucial as it determines our ability to access innovation, as well as the ability of future generations to access the same healthcare system as we have today. Improving the performance of hospitals is therefore a key issue, which relies notably on the agility of health facilities. In fact, the Cannes Hospital, like many other facilities, has made significant reorganisation efforts in order to embrace the ambulatory approach. This allowed, for instance, to reduce the number of beds in the surgical department from 90 to 50 and to reduce the average length of a patient’s stay in the hospital while maintaining the same quality of care. These “individual” efforts will have to be combined with collective efforts at regional level, in order to move away from the current model in which health facilities are in a competitive situation. The implementation of genuine group strategies will lead to real savings in addition to better coordination of care. Environmental issues can also have an impact on the economic considerations of health organisations; the decrease in available resources and the associated cost explosion accentuate the need for resilience and sobriety, in order to preserve and transform the healthcare system.

The appropriateness of care is linked to the issue of performance. Delivering and receiving the “right care” is a reflection that involves all stakeholders and will ultimately ensure a more optimised distribution of health expenditure. The issue of care reimbursement by health insurance (public and/or private) is also part of this. In particular, reviewing the nature of reimbursed care, in order to give more attention to secondary prevention for example, would help to avoid complications leading to over-consumption of care, while improving patient care. It is particularly true for diabetes, where non-drug treatments such as consultations on adapted physical activity or nutrition, are not sufficiently compensated even though they play a crucial role in preventing diabetes complications.

Finally, a last important aspect of this economic pillar, which is also linked to the social pillar discussed below, is the question of access to care, which is intrinsically linked to the price of care.

This issue is being addressed by pharmaceutical manufacturers, which, as providers of health products (and services), have a societal responsibility regarding access to health. This responsibility is tracked and encouraged by the Access To Medicine Foundation, which publishes an annual ranking of pharmaceutical companies according to their strategy and efforts regarding access to health in low- and middle-income countries, as well as recommendations and examples of good practices. As Cécilia de Foucaucourt – whose company GSK is ranked first in the ATM Foundation index – points out, the question of access is complex, as it is multi-dimensional and does not only deal with the price of medicines, but also with the development of appropriate health structures, the training of health care providers and patient education. This is why, in addition to implementing differentiated pricing policies, pharmaceutical companies are also seeking to build real access programmes in these countries through partnerships with multiple actors: governments, NGOs, local private partners and other pharmaceutical companies. Concrete initiatives are now underway, such as the access to medicines programmes of ViiV Healthcare – GSK’s 100% HIV-dedicated affiliate – which currently benefit 138 countries, or the creation of the Global Health Unit at Sanofi, a structure that is dedicated to implementing sustainable solutions for access to non-communicable diseases’ medicines in lower income countries.

To find out more, download our position paper: 5 activities to strengthen the societal commitment of the healthcare industries.

CSR social pillar: social inequalities in health and healthcare professionals’ working conditions are at the heart of the healthcare sector’s social challenges

We mentioned the question of ‘access to care’ in the economic pillar, and here we shall examine the social aspect of it. In particular, we can look at the situation in France. For 25 years in France, the differences in life expectancy between social categories have remained steady, with an average of 6.5 extra years for a white-collar male compared to a blue-collar worker of the same age, and 3 years difference for women. The link between the social status and health status of a person, called the ‘social gradient of health’, is based on what we call ‘social determinants of health’, which are the social and economic factors that influence people’s health. These determinants include income, of course, but also access to basic resources such as food, housing and education. For Nicolas Naiditch, there are even three levels of social inequalities in health that must be considered:

• The “macro level”, which relates to public policies and investments (e.g. education policies are a lever to improve health).
• The “mezzo level”, or “everyday sociology”, which reflects the existence of different perspectives and modes of understanding depending on the social category people belong to. This is an important factor to take into account especially for healthcare professionals interacting with their patients, who will not have the same standards depending on their social background (level of education, dietary habits, etc.).
• The “micro level”, at the level of the patient-doctor interaction in consultation, related to the existence of two cultures which may be different, the patient’s and the doctor’s, and correlated to the social background, which may lead to a bias in judgement from the doctor’s point of view (for example, a doctor may have a different interpretation of the same behaviour: “this person A coming to a consultation in a tracksuit is depressed and does not take care of himself/herself vs. this person B coming to a consultation in a tracksuit is athletic”)

Patient-Reported Outcomes (PROs) are interesting tools to assess and understand patients without value judgement, for the benefit of improving their care. Pharmaceutical companies are embracing this approach and seek to improve the integration of the patient’s point of view in clinical studies as well as in the optimisation of care pathways.

Learn more about the challenges of optimising care pathways >

In addition to patients, social challenges in healthcare are also affecting healthcare professionals and medical staff, whose working conditions remain difficult. The strong tension surrounding the recruitment of medical staff, accentuated by the Covid crisis, means that hospitals have to work hard to attract and retain healthcare professionals. According to Emeline Flinois, there are four key levers for a hospital:

• Work on a more collaborative management system that is less vertical and gives more voice to the medical teams in tackling everyday issues
• Support the changes and evolutions that could exist in the profession of certain healthcare professionals, for example by providing them with training in new techniques for imaging manipulations, etc.
• Train healthcare supervisors in the management of working time, to improve the anticipation, definition and adherence to schedules
• Develop a CSR approach, with a strategy endorsed and driven by the management and a collective engagement of the teams, which is a real answer to the expectations of the younger generations and new employees.

This conference illustrated the willingness of healthcare players, who have different and complementary profiles and roles, to address environmental, economic and social challenges in a synergistic way. Hence, the room for progress and the heterogeneous level of maturity of healthcare stakeholders make sustainable development a challenge for which an alignment – around a common ambition and for implementation – is key. Therefore, experimentation and commitment of stakeholders are necessary for the implementation of a relevant and concrete sustainable development approach. Alcimed can support you in your CSR projects. Don’t hesitate to contact our team!

Sources :

https://www.thelancet.com/action/showPdf?pii=S0140-6736%2821%2901787-6

https://noharm-global.org/sites/default/files/documents-files/5961/HealthCaresClimateFootprint_092319.pdf

https://drees.solidarites-sante.gouv.fr/publications-documents-de-reference-communique-de-presse/panoramas-de-la-drees/CNS2022#:~:text=Elle%20s’%C3%A9l%C3%A8ve%20%C3%A0%20226,les%20mesures%20de%20restriction%20sanitaires.

https://accesstomedicinefoundation.org/

https://www.inegalites.fr/Les-inegalites-d-esperance-de-vie-entre-les-categories-sociales-se-maintiennent

https://www.oecd.org/fr/education/ceri/leducationunlevierpourameliorerlasanteetlacohesionsociale.htm

About the author, 

Chloé, Senior Consultant of the Healthcare team in Paris at Alcimed