I want the answer without similarity at all, and Conceptual and professional, they’re important.
Chapter 29
CHALLENGES AND
OPPORTUNITIES
Chapter 29: Overview
• Major Challenges
• Response to Major Challenges
• International Health Policy, Globalization, and
Privatization
• Decentralization
• Major Issues
• Conclusion
Major Challenges: Health systems in
the 21st century
• Aging populations with increasingly complex
medical conditions
• Global labor shortage of skilled professionals
• Facilities are in need of repair or upgrading
• Improvements in efficiency, effectiveness, and
equity remain elusive
• Financial resources are often in short supply
Response to Major Challenges:
Sustainable Development Goals (SDG)
• By 2020:
– Halve the number of global deaths and injuries
from road traffic accidents
• By 2030:
– Reduce the global maternal mortality ratio to less
than 70 per 100,000 live births
– End preventable deaths of newborns and children
under 5 years of age
Response to Major Challenges:
Sustainable Development Goals (SDG)
• By 2030:
– End the epidemics of AIDS, tuberculosis, malaria,
and neglected tropical diseases and combat
hepatitis, waterborne diseases and other
communicable diseases
– Reduce by 1/3 premature mortality from
noncommunicable diseases with prevention and
treatment
• Promote mental health & well-being
Response to Major Challenges:
Sustainable Development Goals (SDG)
• Strengthen prevention and treatment of
substance abuse
• Ensure universal access to sexual and
reproductive healthcare services
• Achieve universal health coverage
• Substantially reduce the number of deaths and
illnesses from hazardous chemicals and air,
water, and soil pollution and contamination
Response to Major Challenges:
Sustainable Development Goals (SDG)
• Strengthen implementation of the WHO
Framework Convention on Tobacco Control in
all countries
• Support the research and development of
vaccines and medicines for the communicable
and noncommunicable diseases that primarily
affect developing countries
Response to Major Challenges:
Sustainable Development Goals (SDG)
• Substantially increased health financing and
recruitment, development, training, and
retention of the health workforce in developing
countries
• Strengthen the capacity of all countries for
early warning, risk reduction, and management
of national and global health risks
International Health Policy,
Globalization, and Privatization
• Current policies promote competition,
privatization, and marketing
– Most international funding organizations
encourage developing countries to move to
privatization of healthcare systems
– Multinational corporations are marketing to
developing countries
– Policies are consistent with creating competition in
economies and consistent with push for free trade
International Health Policy,
Globalization, and Privatization
• Problems with privatization and competition
– Most people do not want to purchase this service
– People purchasing health care do so with serious
information inequality
– No one wants a bargain; everyone wants premium
services
– Other services not bought by a third-party payer
– Outcomes are difficult to measure
International Health Policy,
Globalization, and Privatization
• Impact
– Can lead to inequities in healthcare access and
services and to a two-tiered system of care—those
with insurance and those without
– Healthcare practitioners migrate to the private
International Health Policy,
Globalization, and Privatization
• Barriers to privatization
– Installation and maintenance of advanced
information systems
– Health information collection is requires
– Unionization would increase or resist
– Leaves poor to fend for them selves
International Health Policy,
Globalization, and Privatization
• Solution: Government Pays
– Places vulnerable populations in the health
insurance risk pool with the entire population
– Gives access to same quality of health services as
working population; allows for privatization
– Reduces probability of creating a two-tiered
system; promotes concept of a true risk pool,
where risk is spread across an entire population
Decentralization
• Trends in Decentralization
– Most countries are attempting to decentralize their
healthcare systems
– Political reform designed to reduce extent of
central influence and promote local autonomy
– Praised as an instrument for improving efficiency
and quality
Decentralization
• Downsides of decentralization
– Needed funding and other resources do not
necessarily accompany responsibility or mandate
– Information asymmetry, local politics, capability
of local officials, poortax base, keeping the same
values, and difficulty in coordinating services
– Lack of training to find resources, decide on their
use, and provide range of health services while
diverse needs of the population being served
Decentralization
• To be successful at all levels of healthcare
system management
– Must understand financing, work design,
information systems, policy, and human resources,
as well as the basics of medicine and science
– Melding of the skills of business managers,
politicians, and medical practitioners is not easy
Decentralization
• Risks of decentralization
– Quality of decision making at these lower levels of
the healthcare system may not be as good
– Complexities of providing health care at a local
level often result in ineffectiveness and waste
– Person making the healthcare decisions must work
within the framework of local politics
• Local health administrators may work for politicians
– Potential for diversion of funds and graft higher
Major Issues
Healthcare as and Increasing Portion of
GDP
• Expenditures are rising
• The healthcare industry is a desired component
of local economy
Injuries and Violence
• Increase in global violence
• Deprivation of basic needs as a by-product of
violence
Injuries and Violence
• Consequences of violence
• Causes of violence
• Responses to violence
Mental Illness
• Burden of mental illness
• Recognition and treatment of causes of mental
illness and substance abuse
• Development of resources
Aging Population
• An emerging issue globally
• Increased demand for services
• Dependency ratio
Environmental Impact/Climate Change
• Impact on food scarcity and political stability
• Strain on healthcare infrastructure and delivery
Refugees, Displaced People, and
Humanitarian Crisis
• Medical challenges include common problems
but with a higher incidence and prevalence
– Lack of hygiene facilities
– Clean water supplies
– Increased psychosocial disorders
– Loss of continuity in their health care
– Food supplies are uncertain
Refugees, Displaced People, and
Humanitarian Crisis
• At any given time, many healthcare systems in
countries worldwide are challenged
• Incumbent on donor nations, international
agencies, and NGOs to meet these challenges
• Need for humanitarian aid is varied and
constantly required
Refugees, Displaced People, and
Humanitarian Crisis
• World Health Organization (WHO) built new
Health Emergencies Program
– Help nations build their capacities to manage
health emergency risks, assist when national
capacities are overwhelmed, and coordinate
international health response
– To be separate agency: common structures, budget
and planning mechanisms, single workforce,
standards and processes, and clear accountability
Conclusion
• Health systems around the globe will be
challenged in ways never before considered
• Governments and private sectors will have to
work in partnership to ensure the sustainability
• Health systems will need to realize their
interconnectedness with the rest of the world
• Leaders will need to figure out how to create
sustainability & generate healthier populations
This Section Reserved
for Instructors
Suggested Discussion or Research
Questions
General Question Categories
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•
•
•
•
•
•
•
•
Structure and Evaluation Healthcare Services and Systems
Global Burden of Disease
Cultural Influences
Medical Travel and Tourism and Off Shoring
Health Communication, Marketing, Social Marketing
Data and Measurement
Policy, Strategy, and the Regulatory Environment
Global Health Leadership
International Best Practices
Discussion or Research Questions
• What are the main venues for development of global health
policy and strategy? What key organizations are involved?
What are their capabilities? What are their interests?
• As part of a global health policy and strategy, what initiatives,
agreements, and mechanisms need to be improved in order to
move forward?
• How are the policies of international funding organizations
influencing the funding and costs of healthcare in developing
countries?
Discussion or Research Questions
• What are the global health policy and strategies created by the
World Health Organization? Economic Union? East African
Union?
• What issues are raised by privatization and competition in
healthcare services?
• What are some of the cultural and diversity challenges
associated with advancing a global health policy and strategy?
Achieving the millennial development challenges?
Discussion or Research Questions
• Emerging and waning health threats continue. Polio and HIV
are two of the most devastating diseases of our time – but
they’re waning or, in the case of polio, on the verge of
eradication. At the same time, Zika virus, Ebola flare-ups and
other unexpected threats will make headlines. Why do these
health threats pose challenges to global health security?
• What barriers exist in developing countries that make
privatization difficult?
• What difficulties arise in countries that are attempting to
decentralize their healthcare systems?
•
Discussion or Research Questions
• Discuss a challenge and a potential unintended consequence
associated with a proposed global health policy under
development. Discuss the interdependence and
interconnectedness of the proposed policy?
• As the portion of GDP attributed to healthcare spending
increases across the globe, is there a point where the
percentage is too high?
• Discuss the challenges that those with mental illness face in
accessing care in most healthcare systems.
Discussion or Research Questions
• Select a country in diplomatic, economic, or military crises.
What is the potential impact on the health sector? Be specific.
• What impact does the growth of the older population have on
the cost and funding of healthcare services?
• Why do global health policies result from a specific crises?
Why aren’t country leaders and health leaders more proactive
in anticipatory in development of risk mitigation strategies
associated with global health?
Discussion or Research Questions
• There are more than 59.5 million refugees today. The
movement of people – not just of those exiting Syria, but of all
who are on the move worldwide – has huge implications for
health systems around the world. What are the challenges of
providing care to so many who’ve been displaced? And what
about the families and friends they’ve left behind?
Suggested Topic Areas To Use When Facilitating
Discussions, Projects, or Case Studies
• Engagement of stakeholders
• Effectively working in and managing teams
• Learning how to get in front of the problem or identify
opportunities
• Learning to communicate effectively
• Assessment of solutions that fit the country
• Embracing systems thinking
• Recognize and embrace diversity
• Sustaining the mission of health as well as health care
Links to Suggested Images
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http://esa.un.org/unpd/wpp/index.htm
http://www.who.int/mediacentre/factsheets/fs310/en/
http://www.globalhealthaction.net/index.php/gha/article/view/25366/0
www.cdc.gov/diabetes
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