Marisa MiraldoThis interview is an excerpt from Imperial Business, the Business School’s magazine. To see the full edition click here.

Please can you tell us about your background and current research?
I am a health economist, with particular expertise in the economics and policy of medical and pharmaceutical innovation; the evaluation of the impact of health policies on institutional strategies and performance; and the behavioural dimensions of decision making in health.

An exciting project I am working on at the moment looks at the adoption of cancer treatment innovation. Due to the high complexity of medical treatment decisions, as well as preferences of the patient, variations in what innovations are available to patients through clinical practice are inherent to the healthcare delivery, leading to a substantial variation on the extent to which innovative cancer treatment is available to patients in the NHS.

This research will provide insight on the determinants of clinicians’ decision-making that hinders the adoption of innovation in cancer care, and inform relevant policies. These policies will improve equality in treatment, foster the usage of innovations that save money for health systems, but more importantly, improve the health of the population. A comparable National Stroke Strategy has been projected to lead to a net benefit to the NHS of £391m – £613m p.a, and a cost saving to social services of £95m, so this type of research has real economic significance.

Bridging the divide between policy, research and practice has been at the core of my motivation for having embarked upon this career

What drew you to work in this area?
The naïve, but still true, initial motivation was to “change the world” by improving people’s lives. A more refined answer is that bridging the divide between policy, research and practice has been at the core of my motivation for having embarked upon this career. All my research is driven either by existing policy or a policy challenge that needs to be addressed in health systems. What makes me passionate about my job is precisely the possibility of having a positive impact on health systems organisation and ultimately societal wellbeing.

One of my key objectives has always been working closer with policy makers in policy design and implementation, bridging the gap between academic research and policy-making.

Please can you talk about the importance and interconnectivity of economics and policy on healthcare provision in the UK?
The UK is at the forefront of research in publicly funded healthcare systems. In my opinion, that is because of two interlinked reasons: firstly, it has traditionally invested in resources that enable research; and secondly, there is a genuine interest on evidencebased policy and interventions by policy makers and other key stakeholders in the health system. The UK has been a pioneer in using economics in the analysis of health policies, leading to the establishment of health economics as a field of research.

How important is a good healthcare system for the economy?
I always say to my students that the healthcare system is the single most important sector in an economy. If people are ill they can’t work, they cost a fortune to society when they require treatment, and in the case of certain conditions, they probably end up dying and don’t consume goods in the economy.

We all tend to take ‘being healthy’ for granted, but with an ageing population and an increase in ‘health risky’ behaviour (such as smoking, excessive eating etc), people are increasingly suffering from multiple chronic conditions that impact their quality of life, their productivity, and put at risk the financial sustainability of healthcare systems, imposing a significant burden on the economy. Another way to look at the relevance of the healthcare sector is to think that in high-income countries,  pharmaceutical Research & Development (R&D) is responsible for around one-third of total private R&D expenditure across the whole economy.

On average, member countries of the Organisation for Economic Co-operation and Development, spend around 9% of their GDP on healthcare, with the US spending  around 16%. The healthcare system is one of the biggest employers in an economy; for example the NHS employs more than 1.5 million people in the UK. With such a big economic and societal relevance, managing the resources invested in the healthcare system is of key importance for any society. I find it quite surprising that so few business schools develop healthcare related research.

How important is innovative policy with such fastpaced technological developments in the healthcare sector?
More than innovative policy I would say evidence based policy. Many policies globally are launched with very little evidence on whether they work or not. There is still an excessive delay in embedding innovation for which there is evidence of value in practice. Our project in innovative cancer treatment, for example, aims at bridging that gap. The complexity of decision-making in healthcare means that this gap is particularly large, but it is also the sector in which this gap is susceptible to having a big impact on society through poor health of the population, inequalities and even inefficiency.

On average, member countries of the Organisation for Economic Co-operation and Development, spend around 9% of their GDP on healthcare, with the US spending  around 16%. The healthcare system is one of the biggest employers in an economy; for example the NHS employs more than 1.5 million people in the UK. With such a big economic and societal relevance, managing the resources invested in the healthcare system is of key importance for any society. I find it quite surprising that so few business schools develop healthcare related research.

You have been involved with the Business School’s gender diversity committee, what does this committee hope to achieve, and why is this such an important issue in academia?
I have been elected the Chair of the Gender Equity Committee at the Business School. This is something that I am truly passionate about because just like in the example above on clinical practice, employment discriminatory practices lead to inequalities. Inequitable treatment of women not only is unfair, but it leads to low motivation, hinders the realisation of the potential of talented women, and leads to a poorer performance of organisations. Many women quit academic careers because of it.

One of the biggest drivers of discriminatory practices is related to the organisational culture, which is why the committee’s key objective is to support the Business School and Imperial College in building an inclusive culture based on diversity, by raising awareness and providing recommendations towards eliminating practices that disadvantage female faculty disproportionally.

We have come a long way in the past year, with 45 recommendations from the committee being implemented across many areas, such as recruitment and retention of talented female faculty, more flexibility on maternity and paternity leave, and fairer performance assessment rules. Another exciting initiative is the first of several annual assessments of unconscious biases of faculty to produce an annual indicator on how healthy our organisation is with regards to diversity.

I am convinced that with committed leadership the Business School will become a role model on what concerns diversity.

To read more about Dr Miraldo’s research, visit: imperial.ac.uk/people/m.miraldo