how things ought to be

  • Joachim P. Sturmberg


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.


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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

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

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