Advertisement

how things ought to be

  • Joachim P. Sturmberg
Chapter

Abstract

Health systems ought to be seamlessly integrated to meet any person’s health needs wherever they live, whenever they fall ill, and whatever the condition might be.

This view is slowly gaining acceptance, and this view is slowly being conceptualised within medical organisations like the WHO. There is a growing recognition that we ought to redesign our health systems around people/patient, and that our health services ought to deliver “good health” (however, what constitutes “good health” is often not defined).

The WHO-Europe has recognised:
  • That there are multiple pathways to good and poor health

  • That these pathways follow nonlinear patterns and therefore make health outcomes hard to predict

  • That health results from complex interactions between many different types of determinants

The literature, economic reality and political necessity consistently point to three key attributes that ought to be evident for a health and healthcare system to become seamlessly integrated:
  • Person-centredness

  • Equity

  • Sustainability

  • Person-centredness

Person-centredness is broader than just the focus on the person, it also requires a focus on his physical and social environments. While some might find the focus on the person, rather than the population, problematic, it ought to be recognised that many of the problems seen in the individual reflect the broader problems in his community.

Person-centred approaches to care embrace the person, his family and his community as interdependent. Therefore solutions to an individual’s issues frequently will require the input of professionals from different sources.
  • Equity

Equity in healthcare assures access to health (and social) services according to a person’s needs.

As Virchow already emphasised—health professionals have a responsibility to make the health system equitable. Fortunately health professional organisations increasingly recognise this responsibility and advocate for equity measures in their policy agendas.

Equity needs to be distinguished from equality. Equity in healthcare “does not mean that everyone receives the same care. Instead, it means that care aims to achieve optimal outcomes for all groups of patients, even if achieving optimal outcomes means that care differs from person to person, and group to group.”

Healthcare needs are nonlinearly distributed across the community—most people are healthy most of the time without the need for any form of healthcare. However, healthcare delivery in most countries remains grossly inequitable. Tudor Hart described it as the “inverse care law”—the availability of good medical care tends to vary inversely with the need of the population served.
  • Sustainability

Achieving sustainability of the health and healthcare system has become an imperative; Nobel laureate economist Robert Fogel predicts that the expenditure on health will reach 20–25% of GDP by the year 2025.

Prevailing tendencies to achieve sustainability by limiting services or redistributing costs for healthcare on those in need of care will ultimately be counter-productive. Sustainability has been defined as the balance between social, environmental and economic concerns. Hence, sustainable solutions must be affordable to individuals and society, acceptable to all constituents and adaptable as needs change over the life trajectory.

Person-centredness and equity have been identified as two key approaches that make health and healthcare systems sustainable.

References

  1. 1.
    Rittel HWJ, Webber MM (1973) Dilemmas in a general theory of planning policy sciences. Pol Sci 4(2):155–169CrossRefGoogle Scholar
  2. 2.
    Rosenthal DI, Verghese A (2016). Meaning and the nature of physicians’ work. N Engl J Med 375(19):1813–1815CrossRefPubMedGoogle Scholar
  3. 3.
    Heath I (2011) Harveian Oration 2011 - divided we fail. Royal College of Physicians, LondonGoogle Scholar
  4. 4.
    Ziegelstein RC (2015). Personomics. JAMA Intern Med 175(6):888–889CrossRefPubMedGoogle Scholar
  5. 5.
    Skrabanek P (1994) The death of humane medicine. London: Social Affairs UnitGoogle Scholar
  6. 6.
    Gilson L, Doherty J, Loewenson R, Francis V (2007) Challenging inequity through health systems. Final Report, Knowledge Network on Health Systems 2007. WHO Commission on the Social Determinants of Health, GenevaGoogle Scholar
  7. 7.
    Fineberg HV (2012) A successful and sustainable health system - how to get there from here. N Engl J Med 366(11):1020–1027CrossRefPubMedGoogle Scholar
  8. 8.
    World Health Organization Regional Office for Europe (2011) Governance for health in the 21st century: a study conducted for the WHO Regional Office for Europe. World Health Organization Regional Office for Europe, CopenhagenGoogle Scholar
  9. 9.
    Sturmberg JP (2009) The personal nature of health. J Eval Clin Pract 15(4):766–769CrossRefPubMedGoogle Scholar
  10. 10.
    Sturmberg JP (2013) Health: a personal complex-adaptive state. In: Sturmberg JP, Martin CM (eds) Handbook of systems and complexity in health. Springer, New York, pp 231–242CrossRefGoogle Scholar
  11. 11.
    Idler EL, Benyamini Y (1997) Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 38(1):21–37CrossRefPubMedGoogle Scholar
  12. 12.
    Jylhä M (2009) What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med 69(3):307–316CrossRefPubMedGoogle Scholar
  13. 13.
    Benyamini Y (2011) Why does self-rated health predict mortality? An update on current knowledge and a research agenda for psychologists. Psychol Health 26(11):1407–1413CrossRefPubMedGoogle Scholar
  14. 14.
    Frenk J (2010) The global health system: strengthening national health systems as the next step for global progress. PLoS Med 7(1):e1000089CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Mooney G, Blackwell S (2004) Whose health service is it anyway? Community values in healthcare. Med J Aust 180(2):76–78PubMedGoogle Scholar
  16. 16.
    Lindstrom RR (2003) Evidence-based decision-making in healthcare: exploring the issues through the lens of complex, adaptive systems theory. HealthcarePapers 3(3):29–35CrossRefPubMedGoogle Scholar
  17. 17.
    Seale J (1962) The health service in an affluent society. Br Med J 2(5304):598–602CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Gwatkin DR, Bhuiya A, Victora CG (2004) Making health systems more equitable. The Lancet 364(9441):1273–1280CrossRefGoogle Scholar
  19. 19.
    Robert Wood Johnson Foundation (2014). A roadmap to reduce racial and ethnic disparities in health care. Available at: http://www.solvingdisparities.org/sites/default/files/Roadmap_StrategyOverview_final_MSLrevisions_11-3-4%20%284%29.pdf.
  20. 20.
    Whitehead M (1985) The concepts and principles of equity and health. Copenhagen: World Health Organization Regional Office for EuropeGoogle Scholar
  21. 21.
    White K, Williams F, Greenberg B (1961) The ecology of medical care. N Engl J Med 265(18):885–892CrossRefPubMedGoogle Scholar
  22. 22.
    Green L, Fryer G, Yawn B, Lanier D, Dovey S (2001) The ecology of medical care revisited. N Engl J Med 344(26):2021–2025CrossRefPubMedGoogle Scholar
  23. 23.
    Johansen ME, Kircher SM, Huerta TR (2016) Reexamining the ecology of medical care. N Engl J Med 374(5):495–496CrossRefPubMedGoogle Scholar
  24. 24.
    Hart J (1971) The inverse care law. Lancet I:405–412Google Scholar
  25. 25.
    Seale JR (1961) Management efficiency in the health service. Lancet 278(7200):476–480CrossRefGoogle Scholar
  26. 26.
    Williams R (1961) The long revolution. Chatto & Windus, LondonGoogle Scholar
  27. 27.
    Fry J (1969) Medicine in three societies: a comparison of medical care in the USSR, USA and UK. Springer, New York.Google Scholar
  28. 28.
    Wong WF, LaVeist TA, Sharfstein JM (2015) Achieving health equity by design. JAMA 313(14):1417–1418CrossRefPubMedGoogle Scholar
  29. 29.
    Association of American Medical Colleges (2016) Achieving health equity: how academic medicine is addressing the social determinants of health. Association of American Medical Colleges, WashingtonGoogle Scholar
  30. 30.
    Starfield B (2011) Politics, primary healthcare and health: was Virchow right? J Epidemiol Community Health 65(8):653–655CrossRefPubMedGoogle Scholar
  31. 31.
    Bertakis KD, Azari R (2011) Patient-centered care is associated with decreased health care utilization. J Am Board Fam Med 24(3):229–239CrossRefPubMedGoogle Scholar
  32. 32.
    Fogel RW (2004) The escape from hunger and premature death. Cambridge University Press, CambridgeCrossRefGoogle Scholar
  33. 33.
    United Nations (2005) 2005 World summit outcome. Resolution adopted by the General Assembly. United Nations. http://data.unaids.org/Topics/UniversalAccess/worldsummitoutcome_resolution_24oct2005_en.pdf Google Scholar
  34. 34.
    Boxall A-M (2011) What are we doing to ensure the sustainability of the health system? Canberra, Australia: Department of Parliamentary Services, Parliament of Australia, 18 November 2011. Report No.: Contract No.: 4 2011-12. Available at: http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp1112/12rp04
  35. 35.
    Prowle M, Harradine D (2015) Sustainable healthcare systems: an international study. ACCA (the Association of Chartered Certified Accountants), London. Available at: http://www.accaglobal.com/an/en/technical-activities/technical-resources-search/2015/february/sustainable-healthcare-systems.html.
  36. 36.
    Coiera E, Hovenga EJ (2007). Building a sustainable health system. Yearb Med Inform 2007:11–8.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Joachim P. Sturmberg
    • 1
  1. 1.University of NewcastleWamberalAustralia

Personalised recommendations