A New Societal Contract for a New Era: Why it’s time to rethink health systems
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This article is part of a series in which OECD experts and thought leaders — from around the world and all parts of society — address the COVID-19 crisis, discussing and developing solutions now and for the future. Aiming to foster the fruitful exchange of expertise and perspectives across fields to help us rise to this critical challenge, opinions expressed do not necessarily represent the views of the OECD.
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By Marion Birnstill and Ben Davies – Johnson & Johnson Center for Health Worker Innovation.
There is no doubt about it: COVID-19 has caused the most significant threat to global health in the 21st century.
COVID-19 has created a “burning platform” for change and innovation, providing a new impetus to rethink the value of health and its delivery. While we are focused on the immediate needs, we also need to hold space for complexity, for raising difficult and complex questions, to set ourselves on a journey of collective transformation to re-imagine the future trajectory of health for humanity. So what have we learnt?
The pandemic emerged against a backdrop of existing obstacles that illuminated existing gaps in social protection, rampant structural inequalities and health workforce issues. These crises within the crisis were felt everywhere, persisting in the world’s most sophisticated health systems to the least resourced alike. As UN Secretary General António Guterres highlighted, COVID-19 is a human tragedy. But it has also created a generational opportunity. An opportunity to write a new societal contract—and build forward towards a more equal and sustainable world.
COVID-19 forces us to acknowledge the way we approach health overall and the deep-seated inequalities becoming more apparent because of the pandemic. It points us towards the fact that health systems have historically been designed to respond to diseases (reactive) not to reach out to people (proactive). It shows us unequivocally how deeply interconnected health is to all facets of our lives. How social determinants such as poverty, education, racial and social injustice, and economic instability all play a role in our health and the resilience of population health overall. So what are some of the ways we can shift our focus from curing diseases to sustaining good health so that the COVID-19 pandemic does not increase health inequalities for future generations?
At the Johnson & Johnson Center for Health Worker Innovation, we recognise that frontline health workers are the backbone of strong community and primary care systems. They have demonstrated strong presence and leadership—whether it’s in the ICU where COVID-19 patients have been fighting for their lives; in the community where diligent contact tracing is taking place; or at the primary care clinic where the vaccine will eventually be administered. At every turn, the importance of strong and well-resourced community and primary care has been demonstrated as a key ingredient to the response to the pandemic. Countries and regions whose health systems were already strongly reliant on community health and primary care systems have demonstrated more agility in responding to the pandemic. So we must ask ourselves, how will these lessons be included in the journey to restore our communities and for us to be better prepared for the future?
More on the Forum Network: How COVID-19 has reversed longer-term trends in the social contract in OECD countries, at least for now by James Manyika and Anu Madgavkar, McKinsey Global Institute
Rooted in strong community and primary care
While the global nature of the pandemic required a globally co-ordinated response, we believe the blueprint for recovery must start with the community. COVID-19 has shown that while our health systems can respond to diseases, the current facility-based, fee-for-service model of healthcare delivery is not optimised to actively promote holistic, community-based health, deliver health equity or to respond with agility to new situations. Investing in community health allows us to embody a more holistic system that is grounded in long-term wellness and community resilience, taking into account health needs at the local and individual level. For example, recent economic modelling made in Sub-Saharan Africa proved that USD 1 invested in community health resulted in USD 10 saved for the health system1.
The root causes of health inequality are complex and require a holistic approach
We must eradicate inequity by enabling health workers not only to respond to immediate causes or surface-level sicknesses, but the whole range of deeper, systemic challenges including social determinants and other elements needed to cultivate resilience. It therefore means that we need to expand our definition of health and health delivery to ground ourselves in the capacity to promote well-being and resilience while addressing the multi-faceted determinants of health.
The fight against COVID-19 is not over. But now is the time to ask difficult and complex questions that will guide us to re-imagine the trajectory of health for humanity.
Multi-level perspectives can break down silos and lead to sustainable, meaningful transformation
As painful as it has been, COVID-19 has brought health back into the minds and hands of communities and individuals. Now with an empowered and deeply aware public, we must all take on a role in shaping what comes next. Our health systems must be recentred around people—as opposed to around diseases—to break down silos and welcome the complexity and nuance that is crucial to fostering systemic transformation.
The fight against COVID-19 is not over. But now is the time to ask difficult and complex questions that will guide us to reimagine the trajectory of health for humanity. We know these systems must be reimagined, and it’s on all of us to ensure they are rebuilt more responsive, human-centred and community-oriented. We now have the duty to rethink some of these key elements including the design principles of successful community health systems, how to sustain good health and cultivate resilience, and consequently how to rethink health across the value chain of individual, communities and the health systems as a whole.
Whatever your role as innovator, investor, policy maker or entrepreneur, we encourage you to undertake this exercise as well and ask yourself: how will I and my organisation uphold our new societal contract to build forward better after COVID-19? The Johnson & Johnson Center for Health Worker Innovation is dedicated to contributing to this collective journey to transform the trajectory of health for humanity. We hope to collaborate across stakeholder groups on this important journey.
1 Community-level Human Resources for Health: Return on Investment and Pathway to Universal Health Coverage in Sub-Saharan Africa, Henry B. Perry, MD, PhD, MPH1 Sennen Hounton, MD, PhD, MPH2 John Hopkins School of Public Health
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