The boundary of Health and Care

Today is World Health Day! The 7th of April 2023 marks the 75th anniversary of the World Health Organisation since its founding in 1948. 

The theme for 2023 is “Health for All”

It is a chance for the Cynefin Centre Health and Care Programme team to reflect on what health means to us and how we hope to shape the world going forward. This blog post explores the boundary of Health and Care – from healthcare professional and patient settings all the way to the effects of inequality, global debts, and climate change. The evidence is too hard to ignore: investment in health not only improves our day to day wellbeing but has knock on effects on labour, economic, and educational productivity (Jamison et al., 2013). Similarly, investment in economic productivity, equality, and climate change has a positive effect on health (Tinson, Major & Finch, 2022). Never before has there been a greater need to expand the boundary of health and care, and invest in all its spheres, to truly ensure health for all. 

Some populations are young and growing, others are older or shrinking, technology use in healthcare is expanding, and comorbidities are increasing (World Economic Forum, 2019). The milieu for health professionals and clinical settings is under pressure to adapt to our changing populations. Not to mention the COVID-19 pandemic that exposed and exacerbated pressure on health workers, hospitals, and care facilities all over the world (Kaye et al., 2021). Chronic healthcare professional understaffing, poor retention, insufficient funding, and long patient waiting times are just some of the situations we have found ourselves in today that affect our ability to provide healthcare to all (British Medical Association, 2022)

It is useful to also reflect on how health affects and is affected by, factors beyond clinical healthcare settings. For example, greater income inequality in a society is significantly correlated with a host of other mental and physical health problems. In England, men in the most deprived areas are expected to live almost 10 years less, and women almost 8 years less, than those in the wealthiest areas – with those in the most deprived areas living 19 fewer years in good health (Gregory, 2022). Prof Richard Wilkinson, a British social epidemiologist, outlined how societies with greater inequality also often have weakened social cohesion which affects how people protect and uplift others – with worsening health effects for all (Wilkinson, 2002).

“Increased inequality imposes a psychological burden which reduces the wellbeing of the whole society.” (Wilkinson, 2002) 

Debt Justice, a UK based company campaigning to restructure and end global debt, argues that the negative health effects of inequality are not just within countries, but also between countries. For example, despite the Ukraine government experiencing excessive pressure to provide food and medicine to its citizens, it is still having to pay upwards of $7 billion of its national budget to lenders (Phelps, 2022). Due to high interest rates, it was estimated that in 2021, one in five low- and middle-income countries were paying more money to debt repayments than health, education, and social protection sectors combined (International Development Alliance, 2022).

The Health Foundation, an independent health charity in the UK, similarly outlined the link between inequality, reduced economic activity, and health – with increasing ill-health leading to decreased labour and decreased economic growth (Tinson, Major & Finch, 2022). In addition, they are sounding the alarm about the links between health and climate change – both requiring a long-term, prevention approach that spans across government departments and society groups on a global scale.

“The complex systems of determinants and impacts of health and climate change are interconnected, and climate change is adversely harming human health, through both direct and indirect impacts.” (Marshall & Allen, 2023) 

Health and care encompasses almost all systems and processes around us, and only with this in mind, can we truly work towards health for all.

Happy #WorldHealthDay, everyone.

P.S. We need evidence to make informed decisions. Gapminder is an independent foundation that aims to help us gather global statistics and present them in an understandable way. I’d highly recommend taking their misconceptions quiz and watch their video on how the world is faring in the Sustainable Development Goals. Spoiler alert, these goals are highly connected and require collaborative approaches.

And for evidence when it comes to complexity? There is of course always Cynefin Co!

____________________________________________________________________________________________________________________

Banner image my own, a chance to show off my home town, Cape Town. In-text image courtesy of WHO campaign page.