Human health is more than just the absence of illness. The World Health Organization (WHO) defines it as “a state of complete physical, mental and social well-being”, shaped by wider factors such as poverty, education and clean water.1 Improving health therefore means looking beyond treatment alone, which is why prevention, screening and education at community level matter.
Access is a significant part of this: the World Bank reports that two billion people in low- and middle-income countries remain uncovered or inadequately covered by social protection1 – the set of public measures that protect individuals and families against economic and social distress.2 The need is also substantial, as long-term conditions such as heart disease, diabetes and chronic lung disease, known as noncommunicable diseases, were the cause of death for at least 43 million people in 2021, with 73% of these deaths occurring in low- and middle-income countries.3
The implications are not only human but economic. When people are healthier and better protected against financial shocks, communities are more resilient, businesses are more productive and economies are better placed to grow, all of which are linked to long-term investment returns.1
As investment managers and long-term stewards of our clients’ capital, we see stewardship as a practical tool for identifying vulnerabilities in the companies in which we invest, helping to strengthen business models and support long-term value creation.4 We also recognise that robust economies depend on healthy people, in workplaces, supply chains and communities. How a company contributes to the communities it serves is therefore relevant to our understanding of its resilience and longevity within those economies.
Private companies, alongside governments, can play a part in scaling health solutions.5 Investing in community health helps to safeguard human capital – the health, knowledge and skills people bring to society – and supports shared prosperity and well-being. The economic benefits can be substantial: for example, the World Bank estimates that for every $1 spent on nutrition, up to $23 is generated in returns through better health outcomes and increased productivity.6
Many pharmaceutical groups run programmes that aim to widen access to care and education where health systems are under strain. These often combine screening, education and treatment, and are delivered with local partners. Companies usually report their progress as the number of people “reached”, however specific programmes can differ in terms of activities, timeframes and approach, and so it is important to define “reach” in the context of each company initiative.
AstraZeneca, for example, runs programmes such as Healthy Heart Africa, the Young Health Programme and Healthy Lung. It set itself a target of reaching 50 million people through its access-to-healthcare initiatives, and now reports a cumulative 108 million people reached in 2025.6 Eli Lilly takes a slightly different approach with its "30x30" goal, which is to improve access to quality healthcare for 30 million people in resource-limited settings every year by 2030. It reports approximately 40 million people reached in 2025.7
Programmes of this kind may reach people who would otherwise miss out on prevention and treatment. They can also educate and empower people within their own communities, through local screening, health education and the training of frontline workers, to become advocates for their own health and for that of others.
In our recent engagement with Novartis, the company noted that the pharmaceutical industry has an inherently social mission. As a business, it is moving from asking which programmes it can run to how they can help deliver its wider mission across innovation and access, and it describes improving community health as "both a responsibility and a sustainable business strategy".8
Much of this work starts with understanding the communities themselves, and Novartis considers access to medicines early, at the research and design stage, rather than waiting until launch. In the US, the company’s Inclusive Health Accelerators work through trusted local organisations to provide education, free screening and follow-up care for prostate and breast cancer and reach people where they already live, worship and gather.8 Novartis plans to expand its community programmes from 11 to more than 30 countries by 2030.9
The same principle applies in lower- and middle-income countries, where community health programmes are running in Vietnam, Rwanda and Bolivia. In Rwanda, the aim includes training 5,500 frontline providers, including community health workers, which builds local capacity as well as delivering care.8 In rural Vietnam, an 18-month pilot run with the government screened 400,000 people, linked 35,000 to local treatment and doubled control rates for high blood pressure. Novartis presents the programme as a blueprint for other countries.8
Community health is, at its heart, a question of resilience: healthier people build stronger communities, and stronger communities support the economies in which we invest. Programmes like those run by Novartis, AstraZeneca and Eli Lilly show how companies can contribute, and our role is to understand how their programmes work, what they achieve and how they support the companies’ long-term resilience.
That means asking for clear definitions of "reach", consistent reporting from year to year, and evidence of how outcomes are measured, not just how many people are reached. For our clients, this forms part of building a fuller picture of the companies we hold: not only what they sell, but how they contribute to the communities and markets on which they depend.
This is not simply a question of social responsibility; it is relevant to how we understand the risks and opportunities facing the companies in which we invest on our clients’ behalf. Through patient, long-term stewardship, we aim to support the financial objectives of our clients by encouraging corporate practices that can strengthen companies, contribute to more resilient economies and support long-term investment returns.
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