What's the Problem with Today's Health System?
The Need for a Shift in Thinking
When most people think of a “health system,” they think of doctors and nurses in hospitals and clinics, or maybe a public health department. It’s actually much larger than that. When we think of a health system, we should consider everything that impacts our well-being.
Our education, health policies, and programs all use an insufficient approach called reductionism: start with the assumption that we already understand how a health system and all of its parts should operate, and then create a detailed plan to ensure that all the parts are in the right place, doing the right thing. With that assumption, we make more medications to treat AIDS; train more doctors; develop a program to encourage obese people to exercise; memorize more organic chemistry; react to the latest infectious disease outbreak. And if we do all of this, then the system will work and we will have healthy communities.
There’s only problem with this approach.
It doesn’t work in the real world.
Reductionism would work if the world were a machine with parts that didn’t change over time and learn from each other. But there are no isolated programs, diseases, or health workers. Detailed plans must adapt over time to unique local needs. What worked 20 years ago will rarely work today. Interventions have unintended consequences like antibiotic resistance. Forces that impact our health are much broader than doctors and nurses; they include a wide array of economic, political, educational, and social forces. Humanitarian activities too often lose sight of what they are most interested in—empowering locals and strengthening capacity. People around the world, from Brooklyn to Mozambique, suffer and die needlessly because the way that we think about health and its delivery, reductionism, is inadequate.
What can we do?
There is no silver bullet, but we believe there is a better way—a way that can be more efficient, more fair, and more effective. Applying complex systems thinking (CST) to health is different than our current approach. A CST approach fosters a shared vision of the healthy future we want and encourages unique solutions to emerge.