Reimagining health systems as systems for health

While healthcare systems are critical to creating health and well-being, the covid-19 pandemic has exposed an outdated view of healthcare systems. The boundaries of healthcare systems are evolving and expanding rapidly. Social media and digital innovations are revolutionizing the way governments and the private sector engage people and communities. They are also revolutionizing the interaction and engagement of individuals and communities with health systems.1 However, current thinking about health systems remains focused on access to medical services and financial protection, key metrics to measure universal health coverage (UHC), but insufficient to capture the determinants of health. The current covid-19 pandemic has focused global attention on the services needed to ensure and maintain health. This presents an opportunity. We can imagine how health systems can go beyond concentrating on treating diseases. While continuing to provide health treatment services, health systems must reinvent themselves as “systems for health” ensuring health security and fostering healthy populations.

The Alliance for Health Policy and Systems Research Flagship 2022 report focuses on “systems for health.”2 It considers how to develop them and argues against the false dichotomy of investing in health security or healthy populations.3 It defines health systems as those prepared to respond to known and unknown, present and future threats. Effective health systems must anticipate and address the social, economic, environmental, and business drivers of health to promote healthier societies and protect against threats to health. Health systems must coordinate efforts, harness technology, and work with individuals and communities to improve health.

A systems approach to health could accelerate progress by bringing a more holistic approach towards universal health coverage, ensuring health security and creating healthy populations. These goals together make up the World Health Organization’s Triple Billion strategy to achieve the Sustainable Development Goals (SDGs). As the covid-19 pandemic continues to illustrate, the goals are interconnected, all of which require attention to the drivers of human and planetary health and well-being.4 Access to services for the entire population is at the core of universal health care and is critical to ensuring health security.5 However, health security must go beyond simply controlling disease outbreaks to include a much broader scope that encompasses an ever-growing range of threats to humans. Such threats include nuclear proliferation, antimicrobial resistance, and climate change.6 Promotional, preventive, curative, and rehabilitative services are subsystems of universal health care and play a crucial role in ensuring a healthy population, but they must extend beyond the scope of the health care system.

A systemyes for the health framework could potentially allow for broader support in all countries compared to interventions focused solely on health security or healthy populations. For example, health security interventions are sometimes seen within low- and middle-income countries (LMICs) as being imposed by high-income countries (HICs). By contrast, LMIC efforts to rein in commercial drivers of health through taxes on tobacco and sugary drinks routinely face resistance from HIC-based multinational corporations. Interventions that address both health security issues and the adoption of measures to establish healthy populations must reconcile the common interests of high-income and low-income countries.7 A systems approach to health would minimize the parallel programs currently implemented at the national and subnational levels, each of which have their own reporting requirements, funding streams, supply chains, and human resource policies that lead to significant inefficiencies. Replacing parallel agendas would also provide a single entry point for ministries of health to engage in other sectors, which could facilitate multisectoral action.

The Alliance 2022 Flagship Report is a first step towards realizing systems for health. To this end, it provides careful analysis and practical recommendations for policymakers, development partners and communities. We hope the report inspires radical thinking to accelerate the achievement of the United Nations Sustainable Development Goal 3 of health and well-being and the broader sustainable development agenda.