Current health systems are not set up to meet the needs of the poor; the part of the world that needs it the most. Here is a brief review of some of the challenges that prevent the sophisticated treatment methods from being introduced into the developing world.
Socioeconomic determinants of health
Access to health services is not equal and therefore health outcomes are not equal. Most health systems are set up for the wealthy nations. The best and most up-to-date treatment options are found in the large cities. You will not see the newest advances performed in rural sub-Saharan areas, or even rural Australia. No, these are performed in the centres which have been equipped with a system that serves those who can afford it. But even then, the system has to be cost efficient. The newest and latest advances are not cheap. So how do we get the latest technology to the developing regions? Urgent radical system change is necessary because of the epidemiological transition that is taking place and we need it now.
We know that the most important and changeable predictors of mortality and morbidity in developing nations include:
- Vaccines to prevent child mortality
- Malaria prophylaxis during pregnancy to prevent stillbirth
- Maternal education to improve life expectancy of women and their children
- Skilled birth attendants to prevent maternal mortality
- Use of modern contraception for family planning
- Access to intravenous and oral hydrating solutions
- Access to anti-retroviral medication to control HIV
Yet, millions of people still die of these preventable circumstances. Two out of three people with HIV have no access to anti-retroviral medications. Closer to home we find that infant mortality rates are higher among Aboriginal people compared to the rest of the population. These are simple measures yet the current systems are not able to deliver them. How then can we expect a new technology to be introduced? How do we structure a cost-effective system that delivers the appropriate health care to those who need it most?
Bridge understanding and deliver a health system that cares
Our patients need to understand what we are delivering in order to increase demand and compliance. While I was working in India, Thailand and rural Australia I found that in order for me to deliver the care I wanted to provide I had to speak the language of my patients. But not in the form of words. It was from a place of understanding. I had to understand my patients’ beliefs in order to adjust the way I interacted with them. To some, beliefs are such an integrated part of their self that a lack of understanding of their beliefs meant a lack of understanding of them, which is a major recipe for disaster. We need to understand the beliefs of the communities and we need to explain what we are doing in a way that they can understand us so as not to simply treat people as a disease.
An example of a health system in rural developing countries is where Traditional Healers are often the main providers of service. It is unreasonable to assume that people would turn to western medicine when traditional healing had been their main source of help. It would be more beneficial for the population if western health systems worked together with the Traditional Healers in order to reach the population that we are hoping to help. If we use breast cancer as an example, it would be working with Traditional Healer in educating the population about the importance of self breast examinations. These measures require investment in understanding the belief system and development of a health system that is respectful of the culture while introducing most up-to-date and cost-effective medical and surgical management for that specific population. The World Health Organisation (WHO) identified four important factors in the delivery of health care:
- What is the problem?
- Where and why investment is needed?
- What will happen as a result of an intervention?
- How do we monitor the change?
It is not an easy task but it is a necessary task and we, as a developed country, have a social and ethical responsibility to assist those in need.
Finally…
I’d like to acknowledge the University of Newcastle, Department of Public Health for their contribution to my understanding of the public health systems in the developed and developing world. Also, for more information please visit the WHO website www.who.int
Until next time.