If one posed the question of what is needed to live in different places
around the
world,basic needs of food,shelter,and clothing may be common denominators.
Being healthy or having access to health care also might be identified.Yet,as
the
political systems advance in the twenty-first century with democratic
elections,other
issues rise in voters ’agendas.For example,in the recent U.S.election
security and
moral values were major voting issues.
Clearly,as the field of health communication ’s foundation has
rhetorical roots,
political events warrant thinking and dialogue.Are we at a stage in
history where we
should reflect on the moral subjectivity that values might have over
rights,wealth
over health,and ‘‘sense ’’over science?
Of course,limits exist in how far survey evidence can shed light on
complex issues
such as choices of armed conflict to advance peace,costs for providing
access to health
for all,or embryonic stem cell research for treating incurable disease
and calamities.
The current trend toward evidence-based medicine necessitates qualitative,ethno-
graphic,and quantitative evidence;yet,limited subjective ethical discourse
with debate
and dialogue may be not be adequate to address the complex moral issues
of the day.
A recent paper entitled ‘‘Enabling Good Health for All —A
Reflection Process for a New EU Health Strategy ’’written
by EU Health Commissioner David Byrne ’s Reflection on Health
in Europe proclaimed that their 450 million citizens should have
equal access to affordable,high-quality health care and a ‘‘system
’’that is backed by clear and reliable information on health,illness,and
treatment options.While Europe works to ensure that policies,financial
resources,and modern technologies are aligned toward good health,the
United States grapples with how best to pay for health.The health ‘‘system
’’evolves with roughly 45 million Americans currently without
health insurance.
While health communication researchers may have varying roles on the
impor-
tance of their area of research in making a difference,a holistic approach
is neces-
sary.Explaining how economic,organizational,and social factors relate
to health
outcomes for the general public may be impossible.Population-based models
often
make scientific sense but have limited diffusion to the individual.
Some people only think about health when they consider themselves ‘‘patients,’’
a term that has connotations of people being sick.A recent study in
five countries
in Europe highlighted that only 26 %of those surveyed in the general
population
viewed themselves as patients,despite the fact that they had sought
the care
of a physician within the past 12 months or were taking medicines.How
the ‘‘nonpatients ’’perceive the importance of health
challenges the provision of salient
health information to be at the forefront of prevention,diagnosis,and
treatment.
The discourse on health as an imperative should engage everyone as we
all have been
and one day will be a ‘‘patient.’’
As strategy is the art of allocating scarce resources for clear purposes,a
health
strategy will require a clear vision that ought to be holistic in approach.An
ethical,
effective,and favorable environment ensuring access to innovative therapies
for
patients of all ages should be in line with the desired goals of improving
public
health.The following are some of the areas to be addressed.
Position Health Expenditure as an Investment, not a Cost
It should be recognized that investing in health brings substantial
benefits for the economy.Health expenditure should not be viewed as
a short-term cost, but rather as a long-term investment.To this effect,
health systems need to be effective and cost efficient.
Explore Solutions to Current Financing Schemes
Most health care expenditures are budgeted in silos hindering holistic
approaches that contribute to health.Financial resource allocation should
be explored between health and social care budgets, hospital to home,
creating incentives and leveraging new life-saving, life-enhancing,
cost-effective technologies.
Enhance Access to Prevention, Diagnostics, and Treatments
Government could act as a guardian for citizens ’and patients
’health and as an advocate of state-of-the-art prevention, detection,
and treatment, along the lines of its function as guardian in the area
of public finance.In this context, alternative ways of financing health
care should be considered, as well as the need to break away from traditional
structures in health care provision and related budgets.
Shift from Treating Ill Health to Promoting Good Health
Good health must become a driving force behind all policymaking.To
achieve good health for all and to narrow the existing health gaps,
fundamental determinants such as poverty, social exclusion, and health
care access need to be addressed in a coherent and consistent manner.
Provide Information as a Crucial Element in Improving Health
Outcomes
Different actors must work together to foster good health.Citizens
need reliable and
user-friendly information about how to stay in good health and the effects
of lifestyle
on health.
View Chronic Illness as not Only Lifestyle Modification and Prevention
Health promotion,prevention,and providing support for individuals to
make healthy choices are important objectives. Many of the most serious
and threatening diseases, however, are not a consequence of lifestyle
or unhealthy choices. Rather, they occur in individuals and leave those
affected and those who care for them with little room to maneuver.In
these cases treatment with care over cure should be considered.
Develop Appropriate Treatment Provisions for Chronic Illness
There should be assessment of the degree of under-or suboptimal treatment
or treatment that conflicts with established professional and evidence-based
treatment guidelines.The most striking examples can be found in the
area of mental illness. These patients are mostly unemployed; live alone;
have limited access to integrated care structures; receive fragmented
and noncontinuous care; face difficult personal, financial, and familial
situations; and are not informed about treatment options. As a result,
they are often not in a position to have access to the ‘‘system
’’or to state-of-the-art support and treatment.
Provide Treatment Options on Benefits, not Just Based on Economics
Good health obviously is key to economic growth. The economic impact
of treatment, however, should not dictate the desirability of and access
to treatment options. In the case of chronic illness, improved treatment
may bring worthwhile but incremental benefits to patients and caregivers
but might not entail a measurable economic benefit. A health improvement
intervention should be measured on the basis of its efficiency and effectiveness
in reaching its intrinsic goal, that is, improving health, life expectancy,
or quality of life.
Promote Actively Better Informed Patients
When ill, patient need information about their condition and treatment
options. Better-informed patients should be one of the cornerstones
of a healthier society. Informed patients make good economic and health
sense and contribute to the reduction of unnecessary health care spending.
Research has shown that the first step toward improving the quality
of health care is information on how to stay healthy, get better, or
live with disease.
Invest in Research —from Bench, to Beach... to Bedside
The future requires research not only in the laboratory, but also in
places where people make health decisions. While breakthroughs in drug
treatment, disease detection, and technological tailoring are the hope
for the future,a much clearer ‘‘vision ’’ with regard
to how to embrace and exploit the full extent of health research and
technology is tantamount.
Advance Understanding of Implications of More Individualized
Health Care
Developments in diagnostics, genomics,and tissue engineering allow
for more customized patient health care.The potential of new, more complex
generations of medical technologies,and services and new developments
such as computer-assisted technologies and telemedicine will test the
limits of our current thinking and ethical and social constructs.
Address Epidemics Both at Home and Abroad: HIV/AIDS,Tuberculosis,and
Other Neglected Diseases
One of the tragedies of the twentieth century is the escalation of
HIV, while other neglected diseases continue at the same pace. As smallpox
and polio are nearly eradicated,commitment to global public health with
twenty-first century approaches should be a cornerstone of health and
human rights policies.
Today these challenges are great as politicians and ‘‘systems
’’respond to the
rising expectations for universal access to health care and to innovative
treatment
to improve health care quality and to respond to the needs of an ageing
population.
These are some areas for a timely discourse on health —proclaiming
the moral values
and certitude necessary at this important historical juncture —suggesting
the
development of a ‘‘blueprint ’’for future health
action.
_____
Scott C. Ratzan MD, MPA, MA is Editor-in-Chief of the Journal
of Health Communication: International Perspectives. He also is
Vice President, Government Affairs, Europe for Johnson & Johnson
with academic appointments at George Washington University School of
Public Health, Tufts University School of Medicine, Yale University
School of Medicine, The College of Europe, and University of Cambridge.
