Occasionally, we introduce some of our team members, offering insights into the minds leading Invest4Health. Our interviews feature key team members, uncovering the stories, roles, and unique perspectives that bring the Invest4Health project to life.
Meet one of our researchers, Maureen Rutten, who leads Work Package 2 on Framing and communicating Smart Capacitating Investments. She is the leader of one of our Invest4Health research teams that is developing a theoretical framework to better understand Smart Capacitating Investments (SCIs), which have the potential to provide innovative financial resources for health promotion and disease prevention. The research team explores various novel financing approaches to pool resources to support prevention actions from multiple sources and proposes study designs to assess their effectiveness. The insights gained support our four Invest4Health regional test beds in implementing effective SCIs and will help policymakers design better financing strategies.
Their paper on the concept of SCIs for mobilising novel finance models for collaborative health promotion and disease prevention initiatives has just been submitted. It nicely follows the paper by Lane et al. about the entire Invest4health project protocol, which has just been published.
Maureen Rutten-van Mölken
Prof. of Economic Evaluation of Innovations for Health, Erasmus School of Health Policy & Management
Dear Maureen, Please share a bit about yourself, your background, and Erasmus University’s interest in Invest4Health.
I have been working in the field of Health Technology Assessment (HTA) for more than 35 years now, since 2011 as a full professor of Economic Evaluation of Innovations for Health at the Erasmus School of Health Policy & Management of Erasmus University Rotterdam. I lead the HTA department of around 50 researchers, renowned for their economic evaluation-, outcomes-, and preference research, with a great emphasis on methodological thinking and positive societal impact. We have developed a range of widely used methods, instruments, questionnaires, tools, and guidelines to enable value assessments from a broad societal perspective and support reimbursement decision-making. With respect to prevention, I have personally worked mainly on secondary prevention, like pharmacogenetic testing prior to prescribing medication (Horizon Europe project HEcoPerMed), and tertiary prevention, like integrated care programs to support people with multimorbidity. The latter is in my role as coordinator of the Horizon 2020 project SELFIE. I have done some work in primary prevention, such as smoking cessation programs, still one of the most cost-effective interventions.
Besides Invest4Health, I’m currently working on the application of polygenic risk scores for the prevention of cardiovascular disease in the Horizon Europe project TeamPerMed. I do believe that we should invest much more in primary prevention to increase the proportion of our life expectancy that we spend in good health, and we should start early in life. That also helps us to address challenges like the ever-increasing healthcare costs, the shortage of healthcare staff and the high ecological footprint of the healthcare sector. However, we should only invest in prevention initiatives that really provide value for money.
Value should be defined very broadly and not only in terms of health gains and reduction in healthcare costs. It should also include, for example, impact on productivity, reduction in informal care burden, reduced health inequalities, and other societal benefits outside the healthcare sector. However, the main question is how we can expand the funding dedicated to prevention. One answer might be through more Smart Capacitating Investments (SCI). Understanding the pros and cons of these investments is one of my main interests in Invest4Health.
You lead a research team that defines Smart Capacitating Investments. What is the biggest challenge in this work, and what achievements are you the most proud of or think are the most valuable?
To be honest, when I started to work on Invest4Health, I found SCI a rather vague term. It had been used in a 2018 report by the High-Level Task Force on Investing in Social Infrastructure in Europe, where it referred to the critical role of public and private investments in areas such as education and lifelong learning, health and long-term care, and affordable housing for fostering inclusive growth and improving well-being. It was rather loosely used in some other policy documents thereafter. So, we really needed a consensus on what we meant by the term, at least among the consortium members of Invest4Health. So, we started studying the published and grey literature, did a horizon scanning of recent and emerging examples of SCI on the websites of investors, and talked to investors and funding experts. Demarcating the topic was a big challenge because the term SCI seemed so broad, and prevention is also complex, including primary, secondary as well as tertiary prevention. It was a great achievement that we, after much deliberation, agreed on the following definition:
Smart Capacitating Investment involves unconventional investments, financial or non-financial, in health promotion and disease prevention. These investments, mostly made by social impact investors, philanthropists, public authorities and community members, aim to enhance individual and community capacity for healthier behaviours, address health determinants, and promote sustainable change while reducing health inequalities. The investments may consist of new resources or resources reallocated towards enhancing health promotion and disease prevention.
I admit that it may not be an easy definition, but there are no simple definitions for complex concepts. It is good to understand that SCI often involves a cross-sectoral partnership between public, private, and third-sector (i.e., voluntary sector) organizations that bond, bridge, connect and combine resources to pursue their aligned interests and goals. Furthermore, ‘unconventional’ in the context of public funding refers to the combination and integration of funds across different levels of government or repurposing the allocation of mainstream public funds.
Perhaps a bigger achievement than the definition is the flowchart and typology of the possible SCI models for health promotion and disease prevention that we developed. Those tools really help you to see the forest through the trees and provide a systematic description of the characteristics of SCI models. They help you understand the differences between the various forms of social impact investments. We submitted our scientific paper with much more details on the concept of SCI.
How has your work in Invest4Health influenced your perspective on the present or future of health investments, particularly in health promotion and disease prevention?
Yes, it has. It made me realize much more that, in HTA, we are usually evaluating very expensive innovative medicines, devices and other technologies in the healthcare sector, whereas population health is probably much more determined by policies beyond the health sector, such as actions to improve education and employment, economic development, living and residential environment, income, transport, and climate. The ‘Health in All Policies’ concept is now much more appealing to me. However, shifting resources from treatment to prevention and from one sector to another has proven to be very difficult, so we really need to explore creative solutions like SCI to raise the prevention budget.
Do you have any final thoughts on the Invest4Health project or the partnership?
Invest4health has been a great learning journey for me. It is very rewarding to collaborate with so many great colleagues from different countries who have complementary expertise and experience. I was especially inspired by the life course approach advocated by Prof. Rhiannon Tudor-Edwards from Bangor University and her ‘Well-being and Well-becoming Wheel’. I do hope we can overcome practical challenges in the implementation of the new financial models in the test beds so that we can evaluate their impact.
Thank you very much, Maureen, for sharing your insights and experiences. We truly appreciate your time and perspective.
