Dear Friends,

It is our pleasure to share with you the latest edition of the RA&A Lab briefing. This edition takes a look at Big Tech's latest healthcare moves, explores what the decision to recognize a sustainable environment as a human right means for climate litigation, and pays homage to one of history’s most steadfast leaders, whose life and legacy will inspire generations to come.

Designed as the content incubator for RA&A, the Lab’s mission is to track the trends shaping the global economy and to identify the key levers of action that can help you drive impact on the issues that matter most. We hope you enjoy these insights on some of today's most important topics.

Kindest regards, 

Richard Attias

Executive Chairman

Richard Attias & Associates

Elie Chachoua 

Director

RA&A Lab

BIG TECH TAKES ON BIG HEALTH

Amazon’s $3.9 billion acquisition of One Medical, a network of primary care clinics serving nearly 800,000 people across the US, is the latest, largest step into healthcare from the Seattle-based ‘everything store’. The deal is Amazon’s largest healthcare acquisition to date and the first since Andy Jassey took over the reins from Jeff Bezos. Amazon’s healthcare interests include an own-brand fitness wearable, a thriving cloud service business tailored to hospitals and clinics from Spain to Indonesia, and a drug delivery arm through Amazon Pharmacy.

The acquisition is still pending FTC review, but it is far from being the only Big Tech push in the healthcare space. A week after the One Medical deal, Alphabet’s AI subsidiary DeepMind ‘transformed biology’ by announcing a new tool that could predict the structure of nearly all known proteins, a feat that promises to accelerate drug development and revolutionize basic science research. DeepMind released the tool via a free open access platform, describing it as a ‘Google search’ for protein structures.

These two stories highlight how comprehensive the impact of tech on the healthcare continuum will be. DeepMind’s contribution will be felt upstream in laboratories and R&D units tackling problems including antimicrobial resistance, plastic pollution or tropical diseases, while Amazon’s will be felt in the humdrum logistics of delivering care to patients. Alibaba and Uber are also both venturing into healthcare logistics.

The sector desperately needs more - and better - technology. DeepMind’s protein tool gives researchers a powerful weapon to push back a long-term decline in biomedical innovation productivity, helping tackle stubborn diseases like cancer and dementia which are yet to yield to a cure despite billions of research spending. For its part, Amazon’s unrivaled ability to simplify complexity, please customers, and lower costs could be good news for a sector that consumes up to a fifth of GDP in the US, where per capita spending is far higher than any other OECD country even as US life expectancy keeps falling. Four in ten US adults say they have delayed or gone without medical care in the last year due to cost.

It is not the only OECD country struggling. Backlogs and delays in non-emergency healthcare caused by the COVID-19 pandemic have left millions of people without care in virtually all EU countries, according to a recent study by the WHO. In England, the backlog has risen so fast in some segments (up to 365x in two years) that the government had to increase taxes to pay for the investments needed.

Big Tech companies have the tools to help. Cloud computing services enable hospitals and clinics to modernize their legacy IT infrastructures and reduce data silos that lead to unnecessary bureaucracy and errors, for example. Clinical trials can be optimized with AI, which can scour data like electronic health records to select the most appropriate patient cohort, while consumer electronics are becoming clinical research assets – witness for example the Johnson & Johnson trial of the iPhone to detect atrial fibrillation, just one of many smartphone-based clinical investigations into diagnostics.

But the sector’s complexity has obstructed Big Tech forays in the past. The launch of Haven back in 2018, an ambiguous but high profile initiative to ‘lower healthcare costs’ in partnership with Berkshire Hathaway, JP Morgan and Amazon caused healthcare stocks to swoon at first for fear a disruption was coming. It disbanded three years later, rebuffed by a sector deemed too entrenched (as well as some rumored management failings). Amazon Care, a virtual health service initially developed for the company’s workforce and subsequently extended to external clients like the hotel chain Hilton, will also shut down at the end of this year.

Social considerations also abound. Google Health sparked controversy last year when patient data protocols were breached during the testing of Streams, a clinician support app; the collaboration was discontinued. Equally important are the equity considerations of applying a gig economy model to something as critical as healthcare.

Yet the challenges facing healthcare call for best-in-class capabilities in the frontiers of AI, cloud computing and digital technology. At times, public opposition to the tech industry’s involvement is caused by misinformation, poor communication, and lack of transparency, rather than a hidden agenda. DeepMind’s decision to release their new tool on an open access basis, even though the company was loss making till last year and Alphabet is looking to cut costs, is a sign of a company committed to a societal rather than financial mission. The key question is how countries, regulators, and the public balance the dire need for better tech with the ever-expanding power of the companies that built it. 

ENVIRONMENT MEETS HUMAN RIGHTS

This summer, with 161 yes’s and 8 abstentions, the UN General Assembly adopted a resolution recognizing a clean, healthy, and sustainable environment as a Human Right, to be included in the Universal Declaration of Human Rights. As such it will be afforded all the protections and recourse granted to human rights under international law, treaties, and the UN Guiding Principles on Business and Human Rights.  With an increase in extreme climate-related disasters where both the damage and victim status are clear, what kind of impact will this resolution have on the fight for climate?

The first thing to note is that the link between human rights and environment is not new. Take for example the PSB et al. v. Brazil case where the Brazilian courts ruled that the Paris Climate agreement — which Brazil is a signatory to — is a human rights treaty and hence supersedes national law; forcing the government to reactivate Brazil’s climate fund. Likewise, the European Court of Human Rights had multiple climate ligations pending prior the UN resolution being adopted.

What the decision does, however, is to increase the avenues of recourse for climate action and increase the standing of existing litigation efforts linking climate action to human rights. As of 2021, for instance, most of the human rights–based environmental litigations in Latin America – a rising region for climate litigation – used climate change as an ancillary argument. Given the impact that climate change has on our environment, the resolution might help bring climate closer to the center stage of right-based cases.

Whether it helps human rights become a major avenue for litigation remains to be seen. The number of climate litigation cases globally has more than doubled since the adoption of the Paris Agreement, with the US accounting for 71% of the 2002 active cases globally — vs. just 4.5% in the developing world. This growth has come with a diversification of strategies, only about 6% of which used some form of rights-based approach — though the number of cases is expected to grow as a result of the focus on achieving a just transition to net-zero.

While most defendants of right-based litigations are public institutions, there are at least two reasons why private sector should take note of the resolution. The first is that this will inevitably bring the Social and the Environmental part of ESG closer together, notably on the disclosure front. Some of that conceptualization is already under way in the EU, where discussions around the Corporate Sustainability Reporting Directive and minimum safeguards under the EU green taxonomy both make explicit references to human rights. Efforts to develop human rights and environmental due diligence law are also under consideration in other countries such Canada, Luxembourg and Sweden – a momentum the UN has tried to support through the publication of guidance for establishing such laws. 

Another reason is that the global nature of the resolution, combined with the progress in attribution science (the science of attributing a specific event to climate change), will also expand the geographical reach of plaintiffs with a legitimate case. A critical lawsuit to watch in this regard is Luciano Lliuya v. RWE AG, where a Peruvian farmer sued German electricity RWE, claiming their emissions had contributed to the melting of the glacier that resulted in floods in his home village. The case, though not rights-based and currently on appeal, could set a major precedence in terms of attribution litigation, opening the door to many more others.

It is, of course, too early to evaluate which of these avenues will be pursued first, let alone whether they will be successful (less than half of right-based climate litigations are). But if the legal action will take time to develop, the advocacy trajectory set forth by the resolution is clear and will be a powerful moral argument for advocates to use in their efforts to push for urgent alignment with the Paris Agreement. As the German constitutional court noted in its 2021 landmark decision, acting on climate now not only protects the environment, it safeguards the freedom guaranteed by fundamental rights. 

RAY OF HOPE: A LEGACY OF LEADERSHIP

For the people of the United Kingdom, and for many across the world, this week marked the end of an era. On Sept 8th 2022, Queen Elizabeth II, the UK’s longest-serving monarch, passed away at the age of 96.

In her 70 years of service, she became both an icon of leadership and a link to key moments of world history. Her reign saw leaders and empires come and go – including her own – and witnessed the transformation of the economy from the ashes of World War II into today’s globally connected world. As a Queen, she met with 14 United States presidents and held weekly audiences with 15 UK prime ministers – from Winston Churchill to Liz Truss, whom she appointed just two days before her death. A steady embodiment of duty and of resolution, she was a global reminder that hard times, no matter how hard, always pass, and that courage and determination always prevail.

“I know of no single formula for success,” the Queen observed in her 2010 address to the United Nations, “but over the years I have observed that some attributes of leadership are universal, and are often about finding ways of encouraging people to combine their efforts, their talents, their insights, their enthusiasm and their inspiration, to work together.” We dedicate this ray of hope to one of history’s most steadfast leaders, whose life and legacy will inspire generations to come.

Here are some of the things on the Lab's radar over the next few weeks: 

• September 13-27: 77^th Session of the United Nations General Assembly 
• September 19-25: Climate Week 
• September 22: FII Institute's Priority Summit in NYC
• Oct 10-16: World bank and IMF annual meetings 
• Oct 26: G20 Tourism Ministerial meeting

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