CMPI’s first foray into global health issues took place this week with a policy roundtable lunch in Geneva, Switzerland, home of the World Health Organization (WHO) and other international health bodies.
The topic up for discussion was how to deal with the growing burden of non-communicable diseases such as cancer, diabetes and heart problems in developing countries, which now cause up to 50% of deaths in these regions, and will be the subject of a high level UN summit in NYC in September. Our guest speaker was Dr Eric de Roodenbeke, the head of the International Hospitals Federation, an economist and health systems expert with over 25 years experience. The audience: senior diplomats and health policy makers from all over the world, including the US.
Dr de Roodenbeke immediately rejected standard Geneva-think on this topic, which puts a heavy emphasis on the strategies used over the last decade for communicable diseases, which revolve around regulation, communication and primary care interventions. They will certainly not harm but will only have a short term impact on the problem, as these diseases are at the centre of a complex interplay of demography, cultural factors and human behaviours that are very hard to modify. It may be very risky to over-promise results for political purpose, as this will backfire on the credibility of the health sector.
Dr de Roodenbeke pointed out that the rise of these diseases in poorer parts of the world is due to changing demographics and economic growth. There is a need to change the paradigm to address chronic conditions which will occur regardless of measures taken to reduce their incidence. Better act now than later. Promoting quick fix will only let the deep cause unaddressed making wake up even more difficult.
The response that is gradually taking shape in Geneva is also a concern, not least because it looks set to repeat the shortcomings around the Millennium Development Goals and HIV/AIDS intervention strategies in the last decade. There, a disease-centric, public health approach lead to different diseases being siloed within health systems, resulting in funding competition, duplication and short-term progress that is only sustainable as long as the foreign aid faucets are kept on. The recent shift toward health systems has come late and is still very timid.
So what should be done instead? The best hope for tackling this problem is a revolution of research and innovation. The current trend of increase in Alzheimer’s, for example, threatens to overwhelm health systems in OECD countries because not much can be done beyond labour-intensive care. If a cure were invented, this huge economic burden would be reduced at a stroke. Remember that tuberculosis used to be an incurable major chronic disease until the invention of treatments.
The question that should be discussed today in international arena is the modalities for access to new treatments in low-income countries. What has been done for vaccine after the H1N1 crisis opens up a way forward.
Second, health systems need to get smarter: (i) Payment systems need to be less focused on outputs and more on individual patients; (ii) Health professional education should be more holistic; (iii) the delivery system will have to dramatically reform to take advantage of new e-health technologies; (iv) the partnership between social services and health services will have to become closer, and (v) health systems need to be decentralised as far as possible to the local level – thus making it easier to deal with complexity of multi-chronic conditions
To that end, it may be that the World Health Organization has come to a crossroads, because in its current guise it is not well suited to help countries facing these challenges.
Reform of the WHO? That sounds like just the topic for CMPI’s next round table in the Fall. Watch this space.
