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Health as a transformative policy domain

Article-Health as a transformative policy domain

The national strategic significance of health policy.

No policy domain or sector of the economy is more fundamentally human, of strategic importance or evolving more rapidly than health. This intensity of its impact is universal – touching the entire population without exception. Moreover, the level of government expenditure injected into the healthcare industry make it a top of mind and highly sensitive political issue globally.

There has been enormous progress in global health trends over the last several decades: child mortality rates decreased by over 50 per cent, antiretroviral therapy has driven a 48 per cent decline in HIV-related deaths, and tuberculosis incidence declined 19 per cent in 15 years. However, rising healthcare expenditure increases pressure on all governments in GCC. KSA’s national health expenditure rose from 3.5 per cent of GDP in 2010 to 5.8 per cent in 2015, UAE’s health expenditure rose from 3.3 per cent of GDP in 2010 to 4.7 per cent in 2017, and the upward trajectory is only increasing. Global healthcare spending is projected to rise at an annual rate of 4.1 per cent between 2017-2021, up from 1.3 per cent over the preceding five years.

Other challenges persist in an increasing complex environment, with the advance of science and technology, shifting demographic patterns, and the fiscal pressures facing governments around the world driving new approaches to handle care. Saying this, there are several fundamental and interrelated forces that are driving the transformation of the health policy landscape.

From cure to prevention

Historically, the focus of most health systems was on curing the sick. The model was driven by supply rather than demand; however, it quickly became financially unsustainable. Today, we are seeing a fundamental shift in thinking, enabling proactive health management rather than reactive attempts to cure illness. As health systems have developed the ability to treat acute crises and prevent communicable diseases, the focus has shifted to preventing chronic diseases (many of which are associated with modern sedentary lifestyles and food consumption patterns) which the World Health Organization (WHO) estimates now account for 50 per cent of the global burden of disease. 

The continued monitoring and care that chronic diseases require has driven the emergence of holistic approaches focused on cultivating healthy lifestyles, consistent monitoring, early diagnoses, and targeted treatment that can prevent minor ailments from developing into critical conditions. Increasingly, the orienting objective is to keep patients out of the hospital both before they are ever admitted and by minimising return visits through effective post-treatment community care. Key to this shift has been altering the incentive system such that providers are paid based on the health of patients, or alternatively paid a flat rate for patients subscribed, whether they receive any treatment or not.

Expanding reach and inclusion

The focus on expanding the reach of the healthcare system is no longer centred on building more hospitals and training more doctors, instead, it is being redefined by the ability of individuals to access the right care at the right time. Precise, rapid triage and referral systems optimise the location of treatment. Common cases are treated in primary care close to home, while rare, complex cases are attended to in specialised hospitals that are best-suited to patient needs, even if they are in another region of the country.

In addition, National Healthcare Systems across the world are working to make high-cost therapies equally available for the entire population, including rural areas, through development of National Treatment Standards and subsidising regions based on their needs. Taken together, these measures are emerging as solutions to the “post-code lottery” in which superior care is more available to those in major cities than those living in rural regions.

There has been enormous progress in global health trends over the last several decades: child mortality rates decreased by over 50 per cent, antiretroviral therapy has driven a 48 per cent decline in HIV-related deaths, and tuberculosis incidence declined 19 per cent in 15 years.

Digitally enabled self-care

New technologies that enable individuals to monitor their own health conditions, from fitness trackers to condition-specific mechanisms such as continuous glucose monitors, are aiding the transition to preventative care. As the affordability of these devices increases, more citizens are gaining access to the tools that can enable them to take charge of their own health. In addition, the advent of high-quality digital and virtual communication tools in the health sector serves to close the gap between rural and urban provision of care.

With these technologies, preventative care becomes ever-more accessible for the individual. As a result, the roles of doctors and nurses will necessarily change. The specialised knowledge of doctors can become better leveraged, while the need for nurses becomes even more critical in cases of continuing and long-term monitoring and care. The increasingly important role of healthcare policymakers is to facilitate the growth and affordability of such solutions, while ensuring their efficacy, efficiency and proper use.

Accelerating scientific and technological advance

The application of next-generation technologies and scientific understanding in healthcare is further transforming the health landscape. Advances in understanding and addressing health challenges from the earliest indications of health risk to the final stages of treatment are dramatically altering the effectiveness of preventative and curative treatments; from chatbots to diagnose common ailments to machine learning and Artificial Intelligence that can recognise cancerous tissue or correct gaps and errors in diagnosing illnesses. Meanwhile, advances in detecting and recognising early indicators of disease are helping to proactively identify individuals most at risk for poor health outcomes so that they may monitor, catch, and address diseases effectively.

Finally, in the context of new genetic and genomic understanding, the ability to treat individuals with tailored medications and methods is becoming an ever-greater possibility. As the advance of technology and our understanding of biology accelerate, the opportunities for their application in the health sector are increasing exponentially. At the same time, the proliferation of technology requires careful assessment and effective government regulation, to ensure that the quality and safety of care meet the strictest standards. A key challenge in realising this transformation of health is the complex set of trade-offs between quality, cost, and accessibility.

For example, intergenerational equity in the provision of healthcare will continue to gain prominence as a central political issue – as birth rates have fallen and life expectancy has grown, the proportion of the population experiencing medical challenges associated with advanced age continues to rise. Nevertheless, the potential benefits of intelligent reform in terms of cost savings and economic growth are potentially of a magnitude that can make even these difficult trade-offs more manageable.

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