The OECD’s 23 February report Ready for the Next Crisis? Investing in Health System Resilience is as prescient as it is factual, adding to the long list of issues where the OECD performs critical analysis. It sets forth powerful ideas and shares valuable policy guidance with its member countries, which represent 63% of global GDP and 75% of world trade. While the report is prompted by the acute crisis of COVID-19, it is clear that like so much else the pandemic accelerated trends already well underway as a result of globally aging populations. As longevity increases and we live well into our eighties and nineties, the conditions and diseases of aging profoundly increase both in real terms and as a percentage of overall budgets and economies.

This is the next health crisis, and it’s already here. Health systems are now at a tipping point and require focused policy reform, given the pandemic has put health systems under extreme stress with long-lasting health impacts and enormous economic disruption. While we must consider the potential for acute global health crises—like another pandemic or antimicrobial resistance—health systems are, in fact, already contending with the “slow-burn” crisis of age-related health challenges: from Alzheimer’s, osteoporosis and fragility fractures; to diabetes and cardiovascular disease; and oncology and elder caregiving

OECD governments must redouble their support for intellectual property rights—patent protection for biomedical and technology innovation—and ensure value-based pricing for health innovation.

Indeed, planning for a pandemic-like shock is only the tip of the iceberg. Just consider the growing friction in the United Kingdom over its NHS; the political arguments exploding in the United States over the impending doom of its Medicare programme; or the more ingrained challenges in Japan related to its super-aging status. Systems across the OECD that were invented in the post-war era must now adapt to the realities of 21^st-century aging.

We must act, focusing on three areas to ensure health system resilience not only for the “next crisis” but for the one already with us resulting from health needs for modern aging societies:

1. Demand policies that support health innovation. As the Global Coalition on Aging’s newly-created Alliance for Health Innovation suggests, OECD governments must redouble their support for intellectual property rights—patent protection for biomedical and technology innovation—and ensure value-based pricing for health innovation. Basic reforms of the regulatory systems from the United States, Europe, United Kingdom and Japan can build upon the streamlined and patient-friendly approval processes created out of necessity during COVID-19. Solving for the crisis already here in cognitive decline—Alzheimer’s and other dementia that are on a trajectory to bankrupt us—will require the incentives to find innovative cures. A resilient health system must have biomedical and technological tools to solve for Alzheimer’s.
2. Shift from the 20^th century acute care model to a 21^st century “predict and prevent” model. In the latter, we invest in prevention strategies and earlier detection and diagnosis. Just as childhood immunisation was one of the cornerstones of 20^th-century longevity, we now need life-course immunisation that reaches into our later decades and across vaccine-preventable diseases. This will deliver important individual and health system benefits. Influenza vaccination, for example, reduces the risk of cardiovascular mortality by 56%, dementia by 36% (in certain cases) and stroke by 13%, resulting in both better health and lower systemic burden of care. Extend to shingles, pneumococcal pneumonia and regular and ongoing COVID-19 vaccinations to drive the greatest benefits.

Rather than the 20^th century acute care model, we must implement proactive measures to promote healthy habits from nutrition to exercise, and including medication adherence.

There must also be a willingness to spend today on early detection and diagnosis for age-related conditions, from osteoporosis, which left unchecked leads to costly, life-threatening fragility fractures, to cardiovascular disease, cancer and diabetes. Super-aging Japan changed their reimbursement policies for Fracture Liaison Services to help avoid second fragility fractures, which are what causes pain, unhealthy aging, death and billions more in spending. There are proven economic benefits: according to a 2021 WHO report on healthy aging in the Western Pacific region, a 5% improvement in 2017 disability rates would result in 55 percentage points more GDP per person by the end of the century in Korea; 53 percentage points in Japan; and more than 40 percentage points in Vietnam, New Zealand and Australia.

3. Build on the lessons from COVID-19 highlighted by the OECD campaign “Beyond Applause”. From elder caregiving to pragmatic but effective community health creativity, COVID-19 revealed that hospital- and traditional healthcare personnel-based health infrastructure is not up to the current crisis. Indeed, gaps and burdens on the health workforce poses one of the biggest threats to resilient health systems. Rather than the 20^th century acute care model, we must implement proactive measures to promote healthy habits from nutrition to exercise, and including medication adherence (particularly an issue with older adults among whom polypharmacy is more common). New and innovative technologies can also drive earlier detection and diagnosis, positively impacting quality of life and cost for everything from bone health and heart valve disease to diabetes and oncology.

While the OECD’s Ready for the Next Crisis? Investing in Health System Resilience is geared toward such real challenges as “pandemic preparedness” there is a health system crisis already here—amplified and laid bare by COVID-19’s challenges. We must enact substantial change to strengthen health systems for the needs of aging 21^st-century OECD societies.