vol46.1 LR.pdf - International Hospital Federation

Opinion matters
Health technologies, health
systems, and health outcomes
in the 21st century
DR CARISSA ETIENNE
ASSISTANT DIRECTOR GENERAL FOR HEALTH SYSTEMS AND SERVICES,
WORLD HEALTH ORGANIZATION
With every year that passes, more new, exciting, and
potentially life-saving health technologies appear –
ranging from advances in new vaccines and better
medicines to more appropriate medical devices. At the same time,
our ability to store, manage and share information accelerates and
expands.
Indeed, as Margaret Chan, Director General of WHO has
pointed out: “the world has never possessed such a sophisticated
arsenal of interventions and technologies for curing disease and
prolonging life. Yet the gaps in health outcomes continue to
widen… [because] the power of existing interventions is not
matched by the power of health systems to deliver them to those
in greatest need, in a comprehensive way, and on an adequate
scale.”1
The task today is to harness all these new developments to
strengthen health systems and services and improve health
outcomes – now and in the future.
Five years from the target date for the Millennium Development
Goals, it is increasingly evident that the world’s ability to improve
health outcomes – specifically to improve maternal and child
health and combat AIDS, tuberculosis and malaria – is directly
related to the strength of its health systems and the quality of the
services those systems provide. It is no coincidence, for example,
that progress on maternal health is slowest in sub-Saharan Africa
and South Asia where years of under-investment have left many
countries’ health systems and services fragile and ill-equipped.
At the same time, health systems all over the world, in rich and
poor countries alike, face new challenges on a number of fronts.
First, the epidemiological situation is evolving rapidly. In 2004,
the leading causes of global disease burden were lower respiratory
infections and diarrhoea. In 20 years’ time, respiratory infections
are likely to have been replaced by chronic non-communicable
The task today is to harness all
these new developments to
strengthen health systems and
services and improve health
outcomes – now and in the future
diseases – notably depression and heart disease. HIV/AIDS will
have dropped from fifth to ninth place in the list of global causes
of death.
Second, and closely linked with this, is the fact that populations
all over the world are ageing. High income countries have got used
to the fact that people are living longer, and that fewer children are
being born. Low and middle-income countries are going through
the demographic transition – often at a faster rate and over a
shorter period of time. By 2050, it is estimated that one in five
people living in developing countries will be over 60 – a trend that
will be accompanied by increased incidence of cardiovascular
diseases and chronic illnesses.
Third, populations are, increasingly, urban. By 2035, it is
estimated that more than half the population of low and middle
income countries will be living in urban areas. Urban environments
present their own health challenges, particularly those linked to
water and sanitation and air pollution, and close physical proximity
which can accelerate the spread of communicable diseases.
Meanwhile, those who remain in rural areas find themselves living
in increasingly isolated, and under-served, communities. As more
people gravitate to towns and cities, it becomes more difficult to
get health workers to live and work in rural areas, and many
hospitals and healthcare facilities in developed countries have
been closed.
Strong health systems have to keep abreast not only of new
developments like these, but ahead of them, and to ensure that
they respond to people’s real needs and expectations.
First and foremost, people need to be able to access medical
devices, vaccines, and drugs that work – whoever they are,
wherever they live – and be able to afford to use them.
Second, they need to be treated with dignity and respect, and
without getting lost between the various parts or levels of the
system. They need to be able to consult healthcare workers who
are knowledgeable, caring and who listen to them as individuals –
and don’t just treat them as cases. As William Osler, one of the
founders of modern medicine, pointed out: “It is much more
important to know what sort of patient has a disease than what
sort of disease a patient has.” 2
Technology has a part to play in making all this a reality – in rich
and poor countries alike.
Simple rapid tests for HIV and TB can and do speed up
diagnosis and treatment, lengthening millions of people’s lives.
04 World Hospitals and Health Services Vol. 46 No. 1