FROM SICK-CARE TO WELL-CARE: PRAGMATIC SOLUTIONS TO BUILD RESILIENT POPULATIONS TODAY.

• Author: Foster, Daniella

INTRODUCTION

"Healthcare in crisis," "structural inequities," "transformation needed." These emboldened words spark much of the conversation about the state of healthcare systems around the world today. According to the Deloitte 2022 Global Health Care Outlook,

The COVID-19 pandemic has shifted the dynamics of public health. The scope and persistence of this global crisis have exposed vulnerabilities in countries' public health systems and impacted their ability to effectively detect and respond to the continually shifting emergency in a multidimensional way that could have mitigated its impact. Despite some successes, many nations' systems for disease surveillance, outbreak management, and contact tracing and tracking have proved inadequate for the scale of the pandemic's initial and subsequent outbreak. Most stakeholders agree: sweeping change is needed. This type of change takes time. It will take 20, 40, maybe even 60 years to rebuild our healthcare systems. This is time many people, particularly those in underserved communities, just don't have.

Even before the pandemic, half the world didn't have access to basic and essential healthcare services. (2) No access to hospitals. Little access to healthcare providers. Lack of health education. This problem has been magnified due to world events, exacerbating existing inequalities and inequities. Why? These communities often have higher rates of homelessness or housing insecurity, coupled with low wage work, leaving them without access to healthcare or the resources needed to take care of themselves well. These and many other social determinants of health put them at greater risk for health issues, including COVID-19 and many non-communicable diseases such as cardiovascular disease, asthma, and cancer.

A recent editorial in the Journal of the American Medical Association (JAMA), written by U.S. Secretary of State Antony Blinken and Health and Human Services Secretary Xavier Becerra, said it well: "The goal must be to design a global health security regime that will reduce morbidity and mortality and improve well-being across all populations in all countries. It is the right thing to do, and it is in the enlightened self-interest of each nation because viruses like SARS-CoV-2 do not stop at borders. Without an equitable and fully inclusive approach, every country and every person is vulnerable." (3) While there's certainly merit to a long-term view towards rebuilding health systems, people in these communities need and deserve a more pragmatic solution so they can have healthier, better lives today.

Health systems play a critical role in addressing the basic health needs of citizens. But according to the United Nations Development Program's Human Development Index, 90 percent of the 191 countries examined failed to achieve a better, healthier, more secure life for their people in 2020 and 2021. (4) In both developed and developing nations, current health systems are inadequate in meeting basic needs. For instance, even in the United States, more than 45 percent of consumers experience at least one unmet basic healthcare need. (5) Yet inequities have been magnified in the face of COVID-19, with women and children in low- and middle-income countries seeing the biggest impact. According to a recent analysis by the World Health Organization (WHO), "the pandemic's long-term impact on the health and well-being of women, children and adolescents is becoming evident: their chances for healthy and productive lives have declined sharply." (6)

BUILDING RESILIENCY

In order to meet these basic needs, behavioral change is needed--both on societal and individual levels. To drive collective change, governments that set up health systems prioritizing preventative care will build resiliency. And resiliency is set to win in the face of geopolitical headwinds and global pandemics which have highlighted the importance of supply chains, logistics, availability of healthcare workers, effective infrastructure, accurate information, and health literacy.

Healthy populations are critical to economic competitiveness. This is particularly relevant given that the rate of deaths from noncommunicable causes, such as heart disease, stroke, and injuries, is rapidly rising with an early impact on already-underserved communities. Noncommunicable diseases are largely based on lifestyle (e.g. diet, behavior, environment) and can be mitigated with preventative care and health education. Societal change will help empower individuals to change, because they'll be armed with the know-how and tools to take better care of themselves and their families. Several existing programs already inspiring action and change are outlined in subsequent sections of this article.

Below are five practical ways to start the transition towards more resilient populations and health systems. Countries that invest in these practical solutions--a focus on preventative care, health education programs to drive healthy behavior change, expanding where health happens to include community hot spots, building a cadre of community care workers, and ensuring regulations enable access to...