Seven rules for getting the politics right
From reducing the ever-growing burdens of disease to recognising health as a driver of economic development, there is a roadmap we can follow to achieve Health For All
Here are seven rules for getting the politics right to ensure Health For All.
1. Know where you are going.
The politics of government tend to be shortsighted due to the limits imposed by political cycles. Moreover, bureaucracy tends to perpetuate trends. Just like the Titanic, turning a health system around is slow and meets with resistance. Therefore, those who have the power to implement reforms must understand that the current standard model of healthcare governance is bluntly wrong. Most countries possess systems that simply react when the health of each individual person is affected, thus leading to ever-growing burdens of disease. Leaders need to promote long-term strategies focused on the quality of life and well-being as the main endpoints of all political activity. Living needs to be more than simply surviving. All reforms must be implemented based on this vision.
2. Be proactive, not reactive.
Political leaders need to transform the current ‘disease reaction systems’ into governance models capable of proactively promoting the well-being of all citizens. Every time a healthcare worker treats a person with a disease that could have been avoided, or diagnosed earlier, represents a failure of that health system. New governance models must be more efficient at: a) promoting lifestyles and environments that generate well-being, including mental health; b) implementing measurable indicators of compassion and humanism as main pillars of the healthcare system architecture; c) avoiding preventable diseases; d) ensuring timely diagnosis; d) curing all curable conditions; e) controlling chronic diseases; and f) minimising suffering and malaise when no other options are available. Naturally, for governments to proactively move in the right direction, based on science and real-time evidence, data must be used as an ally, sustained by an underlying technological infrastructure across the health ecosystem.
3. Stop treating health care as if it is charity.
Historically, health care has been embraced as part of the social response provided by government to citizens. This is the main reason why health is always perceived by finance ministers (and most of government) as a cost and not an investment. The evidence is clear that when a system is capable of generating better clinical and social outcomes, health becomes a driving force for economic development. The opportunity cost of not reforming or investing in health is the inevitable decline in people’s quality of life and an increase in all forms of social inequities. Investing in health, including in research and development, provides citizens greater opportunities to rise up the social ladder and, for all, from rich to poor, to provide a better future for generations to come.
4. Measure, compare, incentivise, reward.
Political leaders have no idea what the return is from their expenditure in health systems. Every year, trillions of dollars are poured into hospitals and clinics around the world, yet few can say if their patients are better or worse off than when they first stepped through the door. Governments are driving blindfolded at high speed on a curvy highway, at the expense of the taxes and health of the people they serve. This needs to end. Any major health reform needs to focus on the capacity of health systems to collect data and apply analytics to measure clinical and social outcomes. Digital technologies are critical in ensuring access to this information in real time, paving the way to developing new financial models that incentivise healthcare workers and institutions to provide better care. A wider application of such technologies will foster comparability in tools so those with worse outcomes can learn from the best. Reward mechanisms can drive performance in communities focusing on prevention and health promotion that can lead to measurable health outcomes. With such an approach, well-being can be a concrete, measurable goal achievable by all. In that spirit, one must acknowledge that at a global level, using gross domestic product to measure development and economic growth leaves out factors such as the quality of life of citizens and inequities within each country. It is time to change the macroeconomic metrics to focus on the well-being of all people.
5. Create an ecosystem for health and well-being.
Due to the siloed organisation of most governments across the globe, health ministers tend to focus exclusively on the services provided by conventional health institutions. But this approach is outdated and insufficient if the broader vision of ‘health and well-being for all’ is to be achieved. Governments need to involve all resources available in their cities and regions – whether managed by public, private or social initiatives – to optimise all policies. By building partnerships that involve and interconnect all stakeholders in each community, governments can generate a health-friendly environment that promotes the well-being and improvement of the quality of life of
all citizens.
6. Get sustainable.
The current healthcare model leads to increasing burdens of disease and, inevitably, costs to a point where health systems will be financially unsustainable. Recalibrating the whole health ecosystem to focus on making people healthier, happier and more prosperous can avoid such a dim future. Beyond the aforementioned overarching reforms, concrete transformations to be implemented within the health system should each be designed to fix a clearly defined problem. A ‘key in hand’ approach is ideal so ideas become reality. Decision makers must answer for each initiative: who does what, where, when, how, with whom, with what technology (if applicable), where does the money to finance the initiative come from, and how to ensure funding in the years to come. Pilot projects should be designed so it is clear how and when to scale up, if the goals are met.
7. Power to the people.
The people who politicians represent and swear to serve are the direct beneficiaries of such reforms and investments in health. To achieve the ambitious goals of Health For All, governments and parliamentarians must ensure that citizens are not only heard, but also empowered and are part of decision-making. It is not enough to say that patients have a voice. Mechanisms need to ensure that patients have real power when it comes to deciding on policies that will affect their lives. True change can only happen if grassroot bottom-up movements are engaged and capable of keeping governments accountable. This means governments and political leaders must be willing to make processes more transparent and open to participation. In sum, politicians, to better serve the people, need to give power to those same people who got them elected. It is about time.
