This article is part of the Forum Network series on New Societal Contract
Societies and their healthcare systems are facing profound challenges, and people's needs and expectations are also changing. While other industries have reinvented themselves around the consumer, in health care a gap still exists between people who have one foot in the future and services that are stuck in the past. In a world of increasing complexity – as well as opportunity – our healthcare systems simply must organise around the needs of the service user. A people-centred approach promises to raise quality, reduce inefficiency and, most importantly, improve our health and well-being.
All panellists agreed that there is a need to focus on patients and their continuity of care, and to promote people’s physical and mental good health. Susan Greenfield, a Member of House of Lords, United Kingdom and Senior Research Fellow at the University of Oxford pointed out that as health care systems become a lot more specialised and siloed, they no longer fit with the need for a holistic approach to care. More fundamentally, there is a need to take into consideration the whole context, including a patient’s family, as the impact of health care issues on their mental and physical state is currently under-assessed.
Mental disorders are one of the largest and fastest-growing categories of disease that health systems must cope with, often accounting for more than cardiovascular disease and cancer. A high proportion of the population is affected by mental health issues during their lifetime: 5% of the working-age population has a severe mental health condition and one in two people will experience mental ill-health at some point in their life. Individuals with severe mental illnesses, such as acute depression, bipolar disorder and schizophrenia die 20 years earlier on average than the general population; typically this is due to chronic physical conditions such as cardiovascular disease because they often have a harder time caring for their health.
Chronic diseases such as mental ill-health and poor lifestyle choices can also damage the ability of people to productively engage in the labour market and put a burden on families and informal carers. People with anxiety or depression are twice as likely to be unemployed. They also run a much higher risk of living in poverty and social marginalisation. These circumstances demand strong primary and community services and their broader involvement throughout people’s lives. They will also require strategies to prevent illness and the integration of measures to promote healthy living, both across government agencies and policies and between government and non-governmental actors. Ginette Petitpas Taylor, Parliamentary Secretary to the Minister of Finance of Canada, highlighted that working with local communities is key, but equally so with patients to encourage them to take greater ownership of their healthcare from disease prevention to treatment.
Anne-Sophie Lapointe, Member of the Board of EURORDIS, stressed the importance of greater cross-pollination of best practices and co-operation among all actors involved as there is currently a lack of dialogue to fully take account of the patient’s issues. Treatment includes medication and therapy, but also education of family members and the living and working environment. In order to promote successful outcomes help needs to be sought earlier so that parents, teachers and also employers are better informed of the symptoms, and more is done to address the stigma associated with mental health issues. This kind of approach can help ensure a significant reduction in recurrence of symptoms. Providing non-stigmatising support is key. Echoing this, Jane Griffiths, Company Group Chairman for Europe, Middle East and Africa of Janssen Pharmaceutical Companies of Johnson & Johnson, stressed the need for greater integration of people with mental health issues, including the creation of job opportunities. As she stated, “the way a country cares for people is a mirror on how developed that society is”.
She went further, stating that there is an urgent need to recalibrate health systems and put people squarely at their centre. One essential way to this end is to look at disease prevention and interception. Answering the poll, “Do you think your country spends enough on health?”, 56% of participants said they felt this was not the case. While funding is an issue, it is not just about increasing investment but allocating to more strategic sectors. Through increased focus on enhanced patient-reported outcomes, there is potential to not just treat illness but also maintain people in good health. Echoing this, Mark Pearson, Deputy Director of Employment, Labour and Social Affairs at the OECD, pointed out that it is key to ask people what they want: sometimes this is not longer lives, but better quality lives.
All panellists called on the OECD to help collect better health data to improve care systems and service delivery. The new OECD Patient-Reported Indicators Survey (PaRIS) can help. There is a need to focus on three areas for action: first, models of care that deliver what matters to people and integration with other services, such as school and employment. Too often, clinicians deliver what they think is in the interests of patients, rather than listening to what patients want; for example, less intrusive healthcare. Second, ensure that patients and providers are equipped with the right skills and infrastructure to take advantage of new technologies. Third, the need to understand better what matters to people in their healthcare experiences and outcomes: no longer only assessing health system performance on the basis of what they do – for example, the quantity of operations or appointments – but also on whether medical care leads to people being in less pain, more mobile, and in better physical and mental health.
In closing, Susan Greenfield highlighted that modern life expectations might create an environment that furthers depression and life dissatisfaction. People’s greater sense of isolation, enhanced by social media, needs to be taken into account as carers may be lonelier than ever in providing assistance and support to their loved ones.
- What will it mean in practice to create a people-centred health system? What will be different for patients?
- What should be the priority when redesigning health systems for people with mental illnesses?
- How can the healthcare community integrate the patient’s surroundings and personal choices in its caregiving approach? What if some people prefer living better quality lives, and not longer lives?
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- Hee Kyong Kim, Anchor & Reporter, Deputy Head of International News Department, Newsroom, MBN
- Susan Greenfield, Scientist, Writer, Member, House of Lords; Senior Research Fellow, University of Oxford, United Kingdom @BaronessGreenfi
- Jane Griffiths, Company Group Chairman, Europe, Middle East and Africa, Janssen Pharmaceutical Companies of Johnson & Johnson
- Anne Sophie Lapointe, Member of the Board, EURORDIS @eurordis
- Ginette Petitpas Taylor, Parliamentary Secretary to the Minister of Finance, Canada
- Mark Pearson, Deputy Director, Employment, Labour and Social Affairs, OECD @OECD_Social