Proceedings of the 52nd Annual Meeting of the ISSS - 2008, Madison, Wisconsin, Proceedings of the 52nd Annual Meeting of the ISSS

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A Difficult Balance: Decisions in Health Care

Marilyn A Metcalf

Abstract


As humans, we have a number of basic needs: air, water, food, shelter. While these needs have not changed, our ways of meeting them have evolved with our societal arrangements. These changes in the ways our needs are met require infrastructure. Secondary to the emerging infrastructure that has come with increasing urbanization have been additional capabilities. Many people have come to see the provision of these capabilities as needs or rights. Among them is healthcare. While this author is in complete agreement with the ideal of making access to healthcare universal, the concept of what that means bears closer examination.

The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Such a broad definition may encompass any number of what will be referred to here as emerging needs, including the healthcare referenced above, as well as education, security and certain personal, political or religious freedoms, among many others. This state of physical, mental, and social well-being is also not likely to be defined in the same way for each individual, group, or culture. The balance in this system becomes difficult because there are multiple perspectives on what would constitute an ideal healthcare system, and perspectives may naturally change with circumstances.

The needs range across a very broad spectrum. We are entering a time of incredible divergence in our medical capabilities. On one hand we are moving toward an era of personalized medicine, in which we hope to provide medications for a specific genetic make-up. On the other hand, we are battling new or more resilient outbreaks of old foes such as cholera, dengue fever, and malaria. For participants in the healthcare system, including healthcare providers, public health practitioners, non-governmental organizations, and pharmaceutical companies, these questions and needs must be addressed on a global scale. As suggested by the WHO, we are a single planet whose populations have become interconnected enough to require the participation of all players in preventing disease and promoting health. The movement toward public-private partnerships, with implementation through grassroots organizations is likely to bring us the farthest in hearing the voices of the many, and understanding how to define, prioritize, and meet those needs. It is also important to consider the broader context within which that healthcare system works on a global scale. This paper will suggest ways in which systems thinking can “make a difference,” to echo the conference theme, by helping the various efforts in public health and individual health see the impact of multiple efforts together, so that they can be more complementary, or at the very least not work at cross-purposes.

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