Blog24th November 2025

Put ethics first to create equitable and inclusive health futures

Sarah Cunningham-Burley

Professor Sarah Cunningham Burley, Chair of the Nuffield Council on Bioethics, summarises what she reflected on in her keynote speech at the 2025 NIHR Innovation Observatory Horizon Scanning, Foresight and Futures conference.

For close to 35 years, the Nuffield Council on Bioethics (NCOB) has identified and tackled some of the most complex and controversial issues facing societies across the globe.

I am proud our work in areas ranging from public health and assisted reproduction has helped to shift public understanding and led to lasting policy change in the UK and internationally.

But the world is changing at pace, and governance is failing to keep up with the technological and scientific breakthroughs many see as solutions to societal problems.

This absence of robust safeguards risks further exacerbating the inequities of innovation and eroding the public’s trust in research. Which is why the NCOB has committed to strengthening its ability to anticipate – because we believe getting ahead of these issues has become more important than ever before.

In the past two years, we have upskilled in foresight and future methodologies, and we have enhanced the analysis of our horizon scans, using them to estimate when an ethical implication of technology is most likely to happen. We have also started exploring how we can meaningfully incorporate international insights into our anticipatory work.

As a bioethics council, we want people to understand, first and foremost that there will always be social and ethical issues and inevitable trade-offs to consider when reaching to technology as a way to solve societal challenges. And we want them to be better equipped to know when the ethical tipping points of innovation are coming.

This is why we attempt to present the development of innovation through an ethical lens, including consideration of social needs and societal values.  It is our hope that in doing this, and by providing our horizon scans in this way, decision-makers will be better informed and supported to develop policies that have ethical exploration at their centre therefore ensuring innovation is fair and equitable.

A question that has formed in my mind during our anticipatory expansion, is whether we could do more to bring the publics into our work at an early stage.

Working to surface, explore and better understand the public’s views and opinions on innovation is part of what we do at the NCOB – ethical exploration and public participation go hand in glove. And by working in this way we have been able to ensure decision-makers can proportionately regulate research and design policies that sensitively encompass wants, needs and values.

For example, the work we did to understand the future of ageing and how innovation can support older adults to live well in later life was hailed by the Chief Medical Officer, Professor Chris Whitty in 2023 for its importance.

This large piece of public deliberation focused on research areas like health apps and data driven detection of age-related conditions, which are assumed to have potential to support people to flourish in older age, but could also raise significant ethical questions about how ageing is perceived, and how older adults are valued in our society.

The people-centred-insight we gathered, alongside our ethical analysis,enabled us to propose an ‘ethical framework’ to help everyone involved in conducting research relating to ageing think through the ethical implications of their work. And as a direct result of our recommendation to have a stronger representation of older people in research, major UK research funders have committed to seeking a greater inclusion rate.

This is a great example whereby bringing ethical exploration and public participation in early, we can align our research ecosystem with those who stand to benefit from it. But could we bring publics in even sooner than this, before we have a project question in mind?

Research does not operate in a social and ethical vacuum. Publics can participate in research and innovation in many different ways, ensuring their voice is heard. This might be through direct participation in research, joining a focus group, completing a survey or engaging in deliberative engagement such as Citizens’ Juries or Assemblies. And we regularly seek views on how advancing science capabilities could be used to drive innovative answers or transform our health and how we deliver care. However, they are not and should not been seen as the only solutions.

And despite these efforts, we are still finding science and innovation can misalign with what the public want and what society most needs. For example, some have hailed AI chat bots to be a way to cure loneliness for older people. But a 2023 poll of 1000 people aged over 65 found that while the older generation is comfortable using Google Maps and WhatsApp – they do not wish to talk to an AI. So, how have we allowed a tech-possibility to push us towards a solution the public is telling us they do not want or feel ready for?

Something isn’t working. And this is what we are pondering at the NCOB.

How can we capture the public want and then use it to meaningfully direct early innovation? Helping it to align with societal values from the start, ensuring its efforts is something people support, will promote trustworthy research and innovation.  This will help build a future that everyone is agreed will have equitable benefits. 

Could bringing public voices into our anticipation be a way to do this? Would it help ensure that it is not only our society needs that shape the horizon, but its values too?

We are two years into our anticipatory evolution – making progress and seeing the benefits. But in some ways we have barely scratched the surface in what we could be differently. And this question, on when and how we involve the public is something we are keen to get into.

Next year, our 14-day human embryo rule project will offer us some insight into how publics can engage with Future scenarios and use them to inform their views. And in 2027 we will seek to bring the public voice into our timeframed horizon scan.

While it is clear that effective horizon scanning can help us anticipate future scientific developments and the opportunities and risks these may bring. We believe it can also be used to alert us to a range of ethical concerns and to how and whether these are being taken into account at all stages of innovation trajectory. 

When used in this way, horizon scanning that is sensitive to technological and ethical trade-offs and informed by public values can support the navigation towards equitable and inclusive health futures.