Since the start of this century, the world has witnessed dramatic demographic and economic changes. Rapid and unplanned urbanisation and rising income levels in many countries have had profound knock-on effects in terms of diet and lifestyle for hundreds of millions of people.
Those changes have significant implications for the health of populations and the challenges that health systems are facing. Rising income levels have given people greater access to health services, but conversely have led to more sedentary lifestyles and increased consumption of unhealthy products. People are living longer, but not necessarily healthier lives. As a result, non-communicable illnesses like heart disease, cancer and diabetes have overtaken infectious diseases as the biggest killers worldwide.
Part of the Sustainable Development Goals
These shifting lifestyles and behaviours place new demands on health systems, many of which have historically been built to manage the burden of communicable diseases. It is clear that health systems must evolve to respond to disease patterns and to cope with the ever-increasing costs of providing care for people living longer, sicker lives.
At the same time infectious diseases continue to be a challenge for health systems: the Ebola outbreak demonstrated all too tragically that weak health systems don’t just expose one country’s population to danger; they are a threat to global health security. Last year’s G7 summit in Germany emphasised that well-functioning health systems are the first line of defence against emerging and re-emerging infectious diseases, and a bulwark against health threats of all kinds, whether they be outbreaks, natural disasters or conflicts.
The inclusion of universal health coverage (UHC) as one of the 169 targets adopted by world leaders last year as part of the Sustainable Development Goals was a significant acknowledgment that the health challenges of the twenty-first century cannot be addressed by programmes that focus on single diseases. Among the health-related targets, UHC is the one that, if achieved, will help deliver the other targets through health systems based on strong primary care that make people, not diseases, the focus of care, and which offer services that are free of user charges at the point of delivery.
Rich dividends for employment and economic growth
But UHC will not be achieved with a snap of the fingers. Among other challenges, building the health systems of the future will require a transformation of the global health workforce. Governments can no longer see their health workers as a cost to be managed, but as an investment that will pay rich dividends not only for health, but also for employment, economic growth, security and the empowerment of women, who in some countries make up 75 per cent of the health workforce.
Strong health systems that deliver universal health coverage aren’t a luxury for rich countries; they are the bedrock of fairer, safer and more prosperous nations. But health systems cannot be expected to solve modern health challenges in isolation. Safeguarding the health of populations will require an approach across the whole government that creates healthy environments, promotes social determinants of health and addresses the root causes of chronic disease. After all, prevention isn’t just better than a cure, it’s cheaper.
Margaret Chan was appointed Director-General of the World Health Organization (WHO) in 2006. Born in Hong Kong, her particular interest lies in building strong health systems.
published in akzente 3/16