Health Systems and Their Aims

The content for today focuses on definitional and background material related to health systems.
Efforts have been made to condense information from previous modules into this lecture.
A variety of perspectives on what constitutes a good or poorly performing health system will be discussed.

Health systems aim for multiple objectives, often discussing them in broad and simplified terms.
There is no singular way to define what constitutes health; clarity on different concepts and models is necessary.
Discussion will include:
- The concept of health.
- The biomedical model of health.
- The New Zealand Triple Aim and its evolution to quadruple and quintuple aims.

The anatomy of health systems includes understanding the terms and definitions provided in various readings, especially Roberts, which is recommended for further exploration.
Recognize that discussions on health are complex and do not lend themselves to simplistic definitions.

The dominant perspective views health primarily as the absence of illness or disease.
This notion is encapsulated in the biomedical model:
- Definition: Health is defined as an absence of illness or disease.
- Disease can be defined as a lack of ease in bodily functions, which can manifest in specific organ dysfunctions.

While useful, the biomedical model has shortcomings:
- Mental Health: Issues that do not have identifiable biological markers (e.g., anxiety) are often overlooked as “less real.”
- Patient Agency: Patients are often positioned as victims, limiting their role in decision-making regarding their health.
- Specialists and Systemic Health: Complex diseases that affect multiple organs often lack specific medical champions, leading to inadequate treatment frameworks.
- Historical Contexts: The model’s limitations are often influenced by power dynamics and historical contexts that marginalize certain health conditions.

Shell Shock (PTSD) during WWI:
- Many soldiers returning from combat were not recognized as ill, affecting their access to pensions.
- Failure to acknowledge psychological trauma as a legitimate health issue reveals gaps in the biomedical model.
Chronic Fatigue Syndrome (CFS) and Endometriosis:
- CFS was historically dismissed as “yuppie flu.” Diagnosis remains challenging, often requiring exclusion of other conditions.
- Endometriosis affects women disproportionately with an average diagnosis time of nine years despite its severity.
- Both conditions exemplify how systemic healthcare can often overlook diseases that lack clear biological markers, often affecting women more significantly.

Alternative definitions propose looking at health through functioning, social contexts, and well-being:
- The World Health Organization (WHO) defines health as a state of complete physical, mental, and social well-being, not merely the absence of disease.
- The International Classification of Functioning, Disability and Health (ICF) emphasizes capabilities over disease diagnosis.

A health system is identified as a complex interconnecting mechanism focused on promoting, restoring, or maintaining health.
The functionality and effectiveness of health systems must address multiple interactive components beyond strict medical treatment.

Key objectives derived from WHO definitions include:
1. Improving individual and population health.
2. Protecting against financial risk due to ill health.
3. Responding to public expectations regarding healthcare services.
Emphasis is placed on understanding these objectives at a population level rather than an individual one, recognizing the need for systemic thinking.

The framework of Triple Aims: A rule of three for conceptualizing health system goals:
- Examples of various triple aims include:
  - WHO Objectives: Health status, risk protection, consumer satisfaction.
  - Burbank Model: Improving population health, enhancing care experience, reducing costs per capita.
  - New Zealand Approach: Effective treatments, meeting individual needs, improving health equity, avoiding harm and waste.

Quadruple Aim: Adds the health workforce's experience, acknowledging the importance of healthcare professionals' well-being in sustaining the health system.
Quintuple Aim: Introduces health equity, emphasizing the need to explicitly address disparities in health system performance.

The content emphasizes the importance of understanding health definitions and health systems within their cultural and historical contexts:
- Outcomes are influenced by how health is defined and who is considered a normal participant in the health system.
- Equity must be a prime consideration, as systems that do not accommodate the experiences of all populations lead to significant gaps in care and treatment.

Throughout the course, the interplay between different aims and health system definitions will be examined. It is vital to engage with structures that influence patient and population care and to draw examples to reflect understanding in assessments.