April 2016

Mohammad Anas Wahaj | 07 apr 2016

This year's World Health Day, that falls today (07 April 2016), has the theme 'Beat Diabetes!'. The World Health Organization has singled out tackling diabetes as one of the most critical healthcare challenge but at the same time tried to give a strong message that it is not too hard to manage if people can put their thoughts and actions in the right direction. Alex Jones, health economist at the social enterprise Oxford Policy Management and researcher at University of the West Indies, provides historial perspective on how international health organizations and governments over time have developed and implemented different types of policies in tackling global health issues. Sometimes they have utilized a single disease approach and at others they have been more holistic and tried to improve health systems around the world. He further explores two approaches and provides opinion on their long-term benefits. According to him, 'A quick look back through history reveals a disturbingly cyclical pattern: As an international community we've been flip-flopping between the two approaches - vertical and horizontal - for at least the last century.' He explains, 'As far back as the 1920s, the sector saw the growth of what was known as the 'Social Medicine Movement' - based on the consideration that ill health could actually be a consequence of poor social conditions...Throughout the first half of the 20th century the Rockefeller Foundation became one of the most influential organisations in global health, implementing programmes in over 80 countries...it always kept the aim of combating specific diseases through targeted campaigns. Post-war politics saw the creation of a number of international agencies that pursued similar vertical programmes...The failure of the GMEP (WHO's Global Malaria Eradication Project) and the relative success of Mao Zedong's community-led 'Barefoot Doctors' programme in China both helped to swing the global health pendulum towards a more horizontal 'systems' approach. In 1975, the WHO launched its Primary Health Care strategy and in 1978 (after sustained advocacy from the Soviet Union) the famous Alma-Ata conference was held...this was a pledge to build up basic health systems around the world...and heralded the birth of the 'Health for All'...The beginning of the 80's, however, saw the pendulum swing firmly back towards vertical interventions...the last ten years have seen a swing back to the ideals of Alma-Ata and the mantra of putting people - rather than pathogens - front and centre of health initiatives...In 2012, the United Nations General Assembly formally recognised and unanimously endorsed the idea of Universal Health Coverage (UHC).' While explaining the current state of health policy focus and interventions, he comments, 'Given the benefit of hindsight, there's a strong risk that today's current focus on UHC might not survive the constant push towards seemingly more feasible, targeted interventions. This apparently inevitable swing to the vertical, however, misses the point on two key fronts: First, history shows us that morbidities are integrated, both with each other and with our ways of life. Second, when something new comes along, a health sector built around a few target pathogens simply cannot deal with it.' Finally, he suggests, 'Let's continue to focus resources where significant advances in disease eradication are possible, partnering with those who can make this happen - but let's take care not to do this at the expense of overall systems strengthening.' Read on...

The Financial Times: Healthcare for all: A zero-sum game?
Author: Alex Jones

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