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Health as Complete Well-Being: The WHO Definition and Beyond

Thomas schramme.

Department of Philosophy, University of Liverpool, Gillian Howie House, Mulberry Street, Liverpool, L69 7SH, UK

The paper defends the World Health Organisation (WHO) definition of health against widespread criticism. The common objections are due to a possible misinterpretation of the word complete in the descriptor of health as ‘complete physical, mental and social well-being’. Complete here does not necessarily refer to perfect well-being but can alternatively mean exhaustive well-being, that is, containing all its constitutive features. In line with the alternative reading, I argue that the WHO definition puts forward a holistic account, not a notion of perfect health. I use historical and analytical evidence to defend this interpretation. In the second part of the paper, I further investigate the two different notions of health (holistic health and perfect health). I argue that both ideas are relevant but that the holistic interpretation is more adept for political aims.

Introduction

‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ ( World Health Organisation [WHO], 1948 : 100). In this paper, I argue that this famous WHO definition of health is fully adequate. Criticism that has been levied against it is based on a specific interpretation that is not the only alternative. In addition to defending the WHO definition, I will discuss two different meanings of the concept of health, which can lead to confusion if not properly kept apart. This is important, for historical and analytical reasons, because the WHO definition can indeed be interpreted in different ways and because we need to get to grips with the differences between types of definitions of health. My second aim in this paper is hence to explain and to properly keep apart two different conceptualisations of health. 1

As regards the WHO definition, I will claim that critics have read the word complete in the phrase ‘complete physical, mental and social well-being’ in a way that goes against the likely intentions of the draftees of the definition. The common objections, for instance, accusing the WHO definition of utopianism and overreach, are based on an implicit assumption, according to which complete is a quantitative term. In other words, critics assume that the phrase means that health is a state of well-being to the largest degree. I will call this interpretation perfect health . So, the critics claim that the WHO identifies health with the largest degree of well-being, that is, with perfect well-being or—in less technical terms—with happiness.

However, the term complete can also have a qualitative meaning. 2 When we say that something is a complete specimen of its kind, then we mean that it has all the features that are constitutive of it. For instance, a complete dinner is one that contains a starter, a main dish and a dessert. Accordingly, complete well-being might be understood as a state that is exhaustive of all constitutive features of well-being. These are, according to the WHO, physical, mental and social aspects. I will call this holistic health . 3 In brief, I will claim that the WHO endorses a holistic account of health, not a perfectionist account. 4

In the second section, I briefly introduce the most important objections to the WHO definition. They have mainly to do with an alleged confusion of health with happiness, which then purportedly leads to a form of medicalisation of human life. In the third section, I discuss the likely intentions behind the WHO definition. I do this by referring to the two readings mentioned before, perfect health and holistic health. There are systematic and historical reasons as to why the WHO plausibly intended a holistic interpretation of health. In the fourth section, I discuss the two interpretations of health in their own right. I introduce their purposes and some objections to either notion. As is the case with many concepts we use, there is no single right or wrong conceptualisation of health. However, I argue that a holistic concept of health is better suited for the purposes of the WHO and more generally for political and economic agendas.

Criticism of the WHO Definition

The health definition of the WHO has often been dismissed by philosophers of medicine and medical scientists (for an overview, see Leonardi, 2018 ). One of the main reasons has been the alleged confusion of health and happiness, that is, a state of complete well-being. 5 If health is understood as happiness, it has been argued, there are many highly problematic consequences, most importantly the medicalisation of people’s lives. After all, health is also interpreted as a basic human right in the same document: ‘The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition’ ( WHO, 1948 : 100). If people fall short of the ideal of perfection, that is, if they are not in a state of complete well-being, their health ought to be enhanced. With health care being an important instrument to reach health, the lives of people seem to fall under the remit of health-related institutions, especially medicine, in all their aspects. For instance, if someone is sad, they lack health in the sense of complete well-being. Accordingly, following the WHO constitution, they apparently have a justified claim to be made healthy, that is, happy, potentially by using mood-enhancing drugs or other medical means.

A prominent and influential critique of the WHO definition stems from Daniel Callahan: ‘[T]he most specific complaint about the WHO definition is that its very generality, and particularly its association of health and general well-being as a positive ideal, has given rise to a variety of evils. Among them are the cultural tendency to define all social problems, from war to crime in the streets, as “health” problems’ ( Callahan, 1973 : 78; see also Kass, 1975 : 14, for a very similar critique). This is an example of the critique of overreach (cf. Bickenbach, 2017 : 962), that is, of applying a medical concept to areas that pose other types of problems than healthcare problems.

Another problem that has repeatedly been pointed out is the utopianism of the definition. It seems that ‘[t]he requirement for complete health “would leave most of us unhealthy most of the time”’ ( Huber et al ., 2011 : 235; quoting Smith, 2008 ; see also Saracci, 1997 : 1409, 1409; Card, 2017 ). This can specifically be deemed problematic in relation to people with disabilities, chronic diseases and people of advanced age. They would by definition permanently be missing out on health and accordingly on well-being. However, such a view seems to conflict with the perspectives of relevant groups of people themselves ( Fallon and Karlawish, 2019 : 1104).

Despite the widespread criticism from many different disciplinary backgrounds, the WHO never amended their definition of health. It seems that they did not see a need to change their point of view. In the following section, I will argue that the critique is indeed based on a misunderstanding of the WHO’s perspective.

Interpreting the WHO Definition of Health

As explained, I will argue that the WHO defines health as holistic health, not as perfect health. To bolster this claim about the intentions of the institution, I need to consider the history of its constitution. In this section, I will therefore rely on historical documents, which are in the public domain. In addition, I have benefitted from an enormously helpful recent publication by Lars Thorup Larsen (2022) , who gives a detailed account specifically of the genealogy of the WHO definition, based on archival research.

An important fact that supports my reading of the WHO’s intentions is that the word complete was only inserted into the definition at the very final stages of its conception. It is fairly obvious that it was as a form of editorial amendment, not a substantial change, because otherwise it would have required extensive debate. If the word complete would have fixed the intended definition of health to a perfectionist account, this would have either stirred up a debate or would have had to be uncontroversial. However, there is no evidence in the relevant documents that the draftees of the WHO constitution definitely understood health as perfection. The term complete , according to my reading, was rather intended to clarify the phrase ‘physical, mental and social well-being’, the latter of which had been part of the definition since the drafting period. 6 The word complete summarises and jointly describes the three aspects of well-being. It also adds a rhetorical contrast to the second part of the sentence that denies the sufficiency of the absence of disease or infirmity for health. A perhaps better way to express the notion would have been to state that: health is a state of complete well-being, that is, a state that comprises physical, mental and social elements. But this locution would not have worked straightforwardly in a one-sentence definition, which was apparently aimed at by the WHO.

The late arrival of the term complete of course does not present conclusive evidence that the WHO did not intend to push an account of perfect health. The historical records are not sufficient in this respect. The final draft of the constitution, which had been penned by the Technical Preparatory Committee, was discussed at a meeting in New York City in 1946. 7 The relevant draft definition reads: ‘Health is not only the absence of disease, but also a state of physical and mental well-being and fitness resulting from positive factors, such as adequate feeding, housing and training’ ( WHO, 1947 : 58). The final version, which was eventually adopted, had been prepared by the so-called Committee I, which ‘had given careful consideration to amendments submitted by the delegations of South Africa, Mexico, Australia, Belgium, Netherlands, Chile, United Kingdom, Iran, China, Philippines, Poland, Venezuela, United States of America and Canada’ ( WHO, 1948 : 44). Unfortunately, there are no published minutes or other forms of evidence in relation to this decisive period—decisive, as far as the introduction of the term complete is concerned. We simply do not know who added the word. This would have been important, though, to get a better grasp of the intentions behind the addition. 8

Importantly, many members of the Technical Preparatory Committee, who had been involved to different degrees in the drafting of the WHO constitution, came from a public health background ( Farley, 2008 : 12ff.; Cueto et al ., 2019 : 39ff.). Renowned proponents of so-called social medicine, such as Andrija Štampar, René Sand, Karl Evang and Thomas Parran, were leading members of the drafting group. This is significant because public health usually has a different understanding of the concept of health than clinical medicine. Whereas for the latter, health can be defined as absence of disease ( Smith, 2008 ), that is, in absolute terms, health in public health is a multifarious and scalar notion ( Schramme, 2017 ; Valles, 2018 : 31ff.).

In clinical medicine, health is often understood as absence of disease. This makes sense because the focus is on individual patients. These either have a disease or not. Patients might suffer from a more or less severe disease, but that does not mean that they are more or less diseased than others. Similarly, health over and above the absence of disease is not usually the focus of clinical medicine. If there is no disease, then that is sufficient to establish health. There is no need to refer to health in a positive way, that is, to define it in its own terms.

In contrast, public health scientists usually refer to populations. In their parlance, chosen populations can be more or less healthy than comparison groups. For instance, it might be declared that mine workers are less healthy than millionaires. This does not mean that all mine workers acutely suffer from a disease; rather, it means that they are more likely to fall ill, due to their circumstances of life. Public health has traditionally studied the causes of disease and has made big strides in the prevention of disease. Accordingly, its focus is upstream, as it is sometimes put ( Marmot, 2010 : 41; Venkatapuram, 2011 : 189), towards the conditions that make disease more likely. Health becomes a dispositional term that allows for different grades.

From a public health perspective, it is fairly obvious that health is ‘more than the absence of disease’. It is more in the sense of additionally requiring dispositional elements, not because it is a quantitatively better condition than medical normality (i.e. the absence of disease). People who live in destitute circumstances might not suffer from a disease, but they are often lacking in terms of a sufficient disposition to maintain minimal health.

The public health perspective, therefore, is a gradual perspective on health, allowing parlance of more and less health, or being healthier than others. Although such a perspective does not necessarily lead to an account of perfect health, it is nevertheless compatible with the latter. People with a perfect health disposition—marked by a very low probability to fall ill—might accordingly be deemed in a state of perfect health. Importantly, falling below the ideal point of perfection on a scale does not imply having a disease. In other words, not being perfectly healthy would not constitute a condition of being un healthy; it would merely mean being less healthy than others ( Schramme 2019 : 29ff.). This shows that some of the criticism levied against the WHO definition, even if understood as a perfectionist account, is implausible. More specifically, it does not necessarily follow that, for instance, people with disabilities would be constantly deemed unhealthy because they lack perfect health. As explained, health is not a binary term according to the relevant perspective.

So far, I have argued that the WHO definition is supposed to allow for grades of health. For that purpose, it takes its cue from public health perspectives, though I do not want to claim that it is identical to it. After all, the WHO definition still incorporates the traditional medical perspective on health as absence of disease. There are, nevertheless, important qualms to do with the notion of perfect health. The WHO refers to health as a state of well-being and this might itself be deemed problematic. To be sure, the conceptual connection between health and the good life for human beings has long been established ( Temkin, 1973 ). 9 The connection also makes sense from an experiential point of view. Health has indeed to do with how we fare. Still, if we read the definition as a perfectionist account of health, it would define health as perfect well-being. If that were the case, this would apparently lead to the alleged dangerous confusion of health and happiness mentioned earlier. After all, sufficient health but not happiness seems to be the business of welfare state institutions. It is true, of course, that health care from a public health perspective includes vastly more than just medical care, especially aspects to do with work, education and the environment. Yet, we normally see good reasons to restrict the remit of state institutions to a form of needs provision, basic security and enablement of self-determination (cf. Goodin, 1988 : 363ff.). So, if perfect health were the focus of the state, it would probably end up becoming unjustifiably expansive.

I do not believe that the WHO is guilty of this charge. To be sure, there are reasons for thinking that a public health perspective occasionally tends towards an expansive view of health politics (cf. Preda and Voigt, 2015 ). Yet, it is hardly imaginable that a nascent institution—still precarious in its status at the time of drafting its constitution including the health definition—would intend to basically take over the whole established welfare state agenda and indeed even to expand it by making perfect health a political aim. This is even less credible, as one of the global health institutions predating the WHO, the League of Nations Health Organization , had come under fire for its alleged political overreach during these times of increasing national isolationism ( Cueto et al ., 2019 : 20ff.). There were, accordingly, strong political reasons not to endorse a perfectionist health definition, or at least to keep such ambitions hidden from plain view, especially in 1946, with very fresh memories of the dangers of totalitarianism being abundant. 10

A more science-oriented reason as to why the WHO is unlikely to have opted for an account of perfect health is that such an ideal is not measurable. After all, it refers to an abstract point of reference. To quantify the health statuses of populations, scientists need metrics and they need to determine thresholds. In other words, they need to plot health along a scale. If health were only a hypothetical point on a limitless scale, it would hardly be a useful metric for scientific purposes. Again, this is not a decisive reason to reject the perfectionist interpretation of the WHO definition. But there are numerous publications by health scientists who use the WHO definition without running into the mentioned problems ( Breslow, 1972 ; Greenfield and Nelson, 1992 ). So, it seems that many scientists do not assume the perfectionist health interpretation (see also Ware et al ., 1981 : 621). 11

In contrast, the holistic health interpretation leads to the following point of view: Health is seen as a state of well-being with numerous aspects—physical, mental and social. 12 Given these dimensions of well-being, health statuses can be assessed in a combined approach, taking the full range of health-related factors into account. Importantly, health is not a fictional point at the end of the scale, but any point along a scale. Some people might have a comparatively bad health status, some might be in good health; all will be positioned along a spectrum. From the health definition itself, nothing follows as to when health is good enough or so bad that state institutions need to interfere. In other words, important political decisions regarding thresholds of sufficient health are not prejudged if we follow a holistic health definition. Such a perspective is much more amenable to the political remit of the WHO, which ended up with fairly limited interventionist power (cf. Packard, 2016 : 99ff.; Larsen, 2022 : 123ff.).

The overarching focus of the holistic health interpretation is maintenance of health. It is thereby acknowledged that to counter the various threats to health not only medical means are required, but a dynamic level of physical, mental and social assets. This has been an insight of early public health practitioners. For instance, Henry Sigerist, who evidently had a significant indirect influence on the WHO definition via Raymond Gautier’s draft ( Larsen, 2022 : 119), had already been concerned with the aim of health maintenance. 13 This provides a dynamic element in the conceptualisation of health, which is also implicit in the WHO definition, despite its reference to a state , which seemingly suggests a static view. When Sigerist writes that ‘health is more than the absence of disease’ ( Sigerist, 1932 : 293), this is meant as a conclusion to an argument acknowledging the environmental and social determinants of health. His point becomes quite clear in a later quote:

A healthy individual is a man [ sic! ] who is well balanced bodily and mentally, and well adjusted to his physical and social environment. He is in full control of his physical and mental faculties, can adapt to environmental changes, so long as they do not exceed normal limits; and contributes to the welfare of society according to his ability. Health is, therefore, not simply the absence of disease: it is something positive, a joyful attitude toward life, and a cheerful acceptance of the responsibilities that life puts upon the individual ( Sigerist, 1941 : 100). 14

Sigerist’s terminology, referring to being well balanced, adjusted and in full control, is not aiming towards an ideal of perfection. Rather, he is stating several elements of a good human life within the limits of reality. He believes that health enables an affirmative view of individuals towards their life, not unlimited happiness.

In this section, I have discussed the WHO definition partly from an analytical point of view, in that I distinguished two possible interpretations, a perfectionist and a holistic account of health. I have added historical information regarding the drafting period. Both analytical and historical reasons speak in favour of my thesis that the WHO definition should be read as defining health in a holistic way. Health as complete well-being refers to the full range of factors determining a specific disposition of people to prevent ill health (cf. Ware et al ., 1981 ). This ties in nicely with a more recent official statement by the WHO, the Ottawa Charter, which I will cite as final support of my thesis: ‘[H]ealth is a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities’ ( WHO, 1986 ). Health is not the best possible state of well-being but a multifarious instrument, including external as well as internal resources, to pursue a good life.

Why We Need to Distinguish Between Holistic Health and Perfect Health

I have not argued that a conceptualisation of perfect health is wrong-headed or even harmful. Rather, I claimed that perfect health is not the notion that the WHO has been after. It is of import to distinguish between the two notions of health introduced earlier, because confusing them will lead to cross-purposes, not merely in respect to the WHO definition. In this section I will take a closer look at the two health conceptions and discuss the purposes which they can serve. I will also hint at problems with both interpretations that might eventually call for terminological reform.

Holistic health allows to pursue multiple political and economic purposes. For instance, it enables comparisons between groups of people and is especially adept to highlight social inequalities that have an impact on population health. This makes it more pertinent for political purposes than a negative conceptualisation of health as the absence of disease. The latter is absolute or non-comparative and hence does not allow for any interesting information about health-related inequalities between persons.

Importantly, in contrast to perfect health, the scope of holistic health can be contoured by thresholds. As explained, complete well-being can be understood as having all elements that are constitutive of it. What exactly that means in relation to health is of course contested, and I have already insinuated that the WHO did not set a threshold, perhaps intentionally. Still, the required level of holistic health could be determined via political decision-making processes. This makes holistic health open for different substantial interpretations and hence political ambitions.

Despite these advantages, the conceptualisation of health as holistic health has serious drawbacks. 15 Most significantly, the distinction between health conditions and determinants of health becomes blurry ( Bickenbach, 2017 : 968, 968; van Druten et al ., 2022 : 2). 16 Environmental and social determinants of health come with certain probabilities, sometimes unknown, to fall ill or to stay healthy, but they are not constituents of medical conditions themselves; rather, they are their presumed causes ( Whitbeck, 1981 : 617). As we have seen in the previous example of miners’ health, a poor health disposition is not the same as being unhealthy, that is, suffering from disease or illness. 17

The potential confusion between poor health dispositions and disease or illness leads to normative confusion as well, especially when we are assessing claims of justice. Disease has a different normative status than a relatively bad health disposition. Arguably, disease has an immediate urgency in relation to human needs, in terms of threatening or involving harm. A comparatively high propensity to fall ill or membership in a vulnerable population as such does not obviously have such normative urgency. Important normative discussions about health justice are short-circuited if we transfer direct urgency to alleviating relatively poor holistic health statuses without thinking about the impact on the lives of real people and merely consider relative positions.

One way forward would be to acknowledge the basic insights of a holistic conceptualisation of health but to nevertheless distinguish between health as a condition of an individual and health-related traits and circumstances that have an impact on the maintenance of individual and population health. We would accordingly need a more adequate term than health for combining both of these aspects—an organismic condition, that is, health in the more narrowly medical sense, and a set of health-related resources. Such a revisionary conceptual perspective can only be alluded to here (see Davies and Schramme, 2022 ).

Accounts of perfect health have a different purpose than accounts of holistic health. The former set an ideal; an ambitious target for individual or social aspiration. According to this perspective, a person can always be potentially healthier, because there is no fixed point on a scale which suffices for health. It seems to me that such an interpretation of health is fully adequate for specific purposes, for instance, introducing a utopian goal and to stop people from becoming complacent about an important element of a good human life. Perfect health shares features with traditional accounts of the virtues, although it is not itself supposed to be a virtue. Virtues are similar to perfect health in that they describe human excellences. Virtues are excellences of character, or perfect dispositions to act fully adequately; health is excellence in relation to well-being, or a perfect organismic disposition to keep harmful and disadvantageous conditions at bay. Becoming virtuous can be an aspiration for human beings and so can becoming perfectly healthy.

However, there is a danger of imposing such an ideal on everyone. If we always have to strive for more health, then we might lose sight of other values, such as pursuing friendships, taking risks or enjoying unhealthy choices. This is a real risk in many modern societies, where health has been turned into a kind of religion and individual mission ( Katz, 1997 ). Socially, similar developments can be studied in relation to so-called ‘healthism’ and generally the moralisation of health ( Conrad, 1992 ). 18 The problems intensify if health dispositions and risk factors are not clearly distinguished from health conditions. Every single action a person pursues might have an impact on their health, according to the perfectionist health account. Hence, if combined with a prescriptive reading of the ideal—as something to be sought—then health can turn into a totalitarian imperative. This would clearly undermine the initial purpose of setting an ideal.

Whether perfect health will fail to meet its purposes will be established by experience and through history. It is not a necessary feature of the account. As mentioned, there are warning signs. However, more importantly, there is a need to clearly distinguish between holistic health and perfect health because perfect health, in contrast to holistic health, should never be the remit of state institutions.

Conclusions

‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ ( WHO, 1948 : 100). This definition allows for two different interpretations. A perfectionist account, where health describes a hypothetical, perfect state of well-being, or a holistic account, where health is a state of exhaustive well-being, including all relevant dimensions of its constitutive elements. I have argued that the WHO intended to support a holistic account. I provided analytical and historical reasons for this point of view.

To distinguish between the two interpretations of health is important for systematic reasons as well, not merely in relation to the proper interpretation of the WHO’s definition of health. The two different accounts serve different purposes and run into different types of problems, as I have highlighted in this paper. Still, both are perfectly valid notions of health.

Acknowledgements

I would like to thank Lars Thorup Larsen and one of the two anonymous reviewers for helpful comments.

1 There can, of course, be even more than just these two conceptualisations of health. For instance, many would probably define health simply in terms of the absence of disease or illness. Indeed, one of the reasons why the WHO definition has raised concerns is probably due to its explicit diversion from the widespread conceptualisation in negative terms, that is, as absence of something.

2 The Oxford Dictionary of English (2015) entry on the adjective forms of complete states: ‘1. having all the necessary or appropriate parts: a complete list of courses offered by the university | no woman’s wardrobe is complete without this pretty top ( … ) 2. [attributive] (often used for emphasis) to the greatest extent or degree; total: a complete ban on smoking | their marriage came as a complete surprise to me ’.

3 The term holistic has been used in relation to health by Lennart Nordenfelt (see Nordenfelt, 1995 : 12ff., 35ff.). By using this term, I do not want to claim that Nordenfelt endorses the WHO definition.

4 A slightly different distinction between two meanings of the concept of complete— complete in an ‘all-or-nothing sense’ and in a sense that ‘admits of degrees’—has been drawn by Sissela Bok in relation to the WHO definition ( Bok, 2008 : 592). In passing, I also want to note that the label perfectionist is of course not supposed to refer to perfectionism in value theory, where it denotes an objective theory of the good.

5 Possibly the first philosopher of medicine to take note of this feature and the likely consequences was Owsei Temkin: ‘I do not think that I read too much into this formula [the WHO definition] if I believe that it tends to include moral values and to identify health with happiness. ( … ) But is the pursuit of happiness itself wholly a medical matter? Our life has many values and ( … ) happiness can sometimes be achieved at the sacrifice of health. ( … ) [I]f health is defined so broadly as to include morality, then the danger exists that the physician will also be burdened with all the duties of the medieval priest’ ( Temkin, 1949 : 20).

6 This needs to be qualified, because the term social was introduced fairly late in the drafting process. However, the point I am making here is to do with the fact that elements of well-being had been listed for some time during the drafting period and that the word complete was added to characterise these elements jointly.

7 The Technical Preparatory Committee itself relied on earlier drafts of senior members of related institutional bodies, especially the League of Nations Health Organization ( Larsen, 2022 ). Larsen gives a detailed account of the origins of the WHO definition, tracing it back to Henry Sigerist’s influential publications in the history, sociology and philosophy of medicine, dating mainly from the 1930ies. Sigerist’s ideas were not revisionary or highly original, though, at least not in its focus on positive health. The idea that health includes elements that cannot be captured by the phrase ‘absence of disease’ goes back to antiquity. Especially the notion of health as a form of equilibrium and—in modern terms—resilience has been known for centuries ( Edelstein, 1967 : 303ff.). So, even if Sigerist’s work probably had a role in finding the relevant formulations, the underlying ideas had been prevalent.

8 One of the members of the Technical Preparatory Committee, Szeming Sze, recalled 40 years later that James H.S. Gear ‘improved the wording’ ( WHO, 1988 : 33). However, there is no identifiable evidence to corroborate Sze’s recollection.

9 The notion of well-being here is a state of a person including their circumstances. It should not be interpreted as a mental state only, that is, as a kind of feeling.

10 It should also not be forgotten that the early focus of public health institutions, including the precursors of the WHO, was on the prevention of diseases, specifically communicable diseases. This speaks against assuming a focus on health enhancement.

11 Indeed, numerous researchers claim that although the WHO definition sets a political ambition, its main purpose is to set a framework that makes health measurable ( Salomon et al ., 2003 ; Rubinelli et al ., 2018 ; cf. Chatterji et al ., 2002 ).

12 In line with this reading, in more recent years, there was also a discussion in the WHO whether to add spiritual well-being to the definition ( WHO, 1997 : 2; cf. Larson, 1996 ; Nordenfelt, 2016 : 214). The discussion around a fourth aspect of well-being did not lead to official changes, though.

13 Bok also mentions that Sigerist was a close friend of Štampar’s, who was—as mentioned earlier—a member of the drafting group ( Bok, 2008 : 594).

14 Georges Canguilhem similarly declared that ‘[h]ealth is a set of securities and assurances ( … ), securities in the present, assurances for the future’ ( Canguilhem, 1966 : 198).

15 Surely not everyone would see the political negotiability of adequate health thresholds as an advantage. However, I am here concerned with a relative advantage over the perfectionist account of health.

16 Once the determinants of health are confused with health itself, there is an additional danger of conceptualising immorality and incivility as forms of health disruptions (cf. Farley 2008 : 56). WHO officials were not immune to this problem. For instance, in a memorandum called International Health of the Future (1943), Gautier wrote: ‘For health is more than the absence of illness; the word health implies something positive, namely physical, mental, and moral fitness. This is the goal to be reached’ ( Larsen, 2022 : 117; see also Chisholm, 1946 : 16; cf. Cueto et al ., 2019 : 33).

17 The otherwise philosophically important distinction between disease and illness does not matter for the purposes of my essay. I use the terms interchangeably for ease of reading.

18 An important and still highly recommendable early critique of the utopian standard of health is Rene Dubos’s Mirage of Health ( Dubos, 1959) .

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World Health Organisation and Globalisation Evaluation Essay

Introduction, globalisation and health, brief historical aspect, effects of who on globalisation, effects of globalisation on who, evaluation of the who roles.

The world has turned into a global village that is characterised by the evident globalisation of aspects of daily living such as trade, disease, communication, transport, and travel. Global health has also matured, with health being a key factor in the globalisation arena. The health sector has also become pleural, with many sectors and individuals being involved directly and indirectly in the same.

One of the organisations that play a major role in the development of global health policies and their implementation is the World Health Organisation. The organisation has an extensive role in the monitoring of health and diseases together with their governance. It also enacts norms in the health sector internationally besides acting as a coordinator for the various local and international actors to uphold the expected norms.

The World Health Organisation therefore has a special role in globalisation by ensuring worldwide harmonisation of health services and standards. It remains the single largest health body in the world with branches in almost all the world nations and operations on various health fields. It also works in consent with other global bodies such as the United Nations Food and Agriculture Organisation and other UN bodies to facilitate health delivery.

The purpose of this essay is to evaluate the role of the World Health Organisation in globalisation. Does the organisation have a role in the facilitation of globalisation? If so, what role does it have? The question is one of the issues that the essay will target to investigate. The WHO has been in existence for decades now. The essay will also evaluate the major developments in the health sector in relation to globalisation since the inception of the WHO.

The essay is divided into four main sections. An evaluation of globalisation and health will be presented in the first section. The second section will address the historical aspects of the WHO. The third section will then follow with an evaluation of the roles of the WHO. The fourth section will address the challenges that the organisation faces together with the global aspect of the WHO.

Health is no longer a confine for a single organisation or nation, but rather a global responsibility. Globalisation has changed the way people view and manage heath issues. It has offered new challenges and opportunities for health (Alemanno 2011). Various aspects of globalisation such as improved transport and communication have led to the rapid spread of diseases and conditions that would traditionally be restricted to certain areas.

The same aspects have facilitated the improvement of health, with the transfer of personnel and medical supplies being easier and faster. It emerges that globalisation has affected health and its provision both positively and negatively (Brassett et al. 2009).

Some of the other ways in which globalisation has affected health include the sharing of the best practices across the globe, the provision of a specialised medical treatment that is widely accessible to most of the patients, and the sharing of scientific knowledge.

Several bodies have dominated the health sector in the provision of services, with the universal bodies setting the pace for the many organisations. The existence of global bodies such as the WHO has also been significant in the standardisation of medical therapies, with the same bodies stating the global norms in the industry.

Some of the infections that have been able to spread rapidly as an attribute of globalisation include the Severe Acute Respiratory Syndrome (SARS). This infection was able to spread within days to a number of countries and cause deaths. The advent of globalisation has created inequalities.

It has also exposed the existing ones, which social, financial, and economic aspects (Bailey et al., 2008). With the outbreak of SARS, for example, well-equipped countries were able to adequately screen and identify the possible areas for prevention of morbidity. The poor countries were not adequately prepared. They only benefited from the global effort to fight the disease.

The delivery of healthcare for all humanity requires international collaboration. Globalisation of health services is one ways to ensure that this collaboration happens. Some of the challenges in the health sector are too grave and big to be handled by individual nations.

The required resources may not be locally available. The bridging of the services requires the existence of an international body, which is exemplified by the WHO. The World Health Organisation has created several norms in the health sector. Various members have adopted them.

Examples of the components of global health that are linked to globalisation include disease surveillance, global disease advocacy, and human rights information transfer (Thompson 2008). Several international bodies have been linked with healthcare, either directly or indirectly.

These were mainly active before the creation of the WHO, with others working in concert with the organisation (Beck, 1999; Beck, 2000). Some of the organisations mentioned to have a special role in the global health include the United Nations Children’s Fund (UNICEF) and the Rockefeller Foundation (Scholte 1997).The other institutions that are important to both globalisation and health include the World Bank (Scholte 1997).

One of the major breakthroughs in globalisation was the creation of the United Nations (UN), with the body coming into existence in 1945 (Hay 2000). One of the subsidiaries that were suggested during the meeting to form this international body is the World Health Organisation.

The development led to the establishment of WHO in1948, with the exact date of inception being the seventh of April of 1948 (Scholte 1997). This day has been celebrated over time as the World Health Day that marks the establishment of the WHO and plotting the future of health.

In June of the year that the health body was established, delegates had an assembly that prioritised the health problems that existed at the time (Scholte 1997). These were mainly nutritional health concerns and the environmental sanitation and child health. The organisation has since grown from the original 55-member countries to constitute almost all nations in the world. The priorities have also been more global, with a focus on the global pandemics in health (Scholte 1997).

The globalisation of disease required the classification of the major causes of death and morbidity. There had been a list since mid-19 th century with these diseases. With the inception of the WHO, the mandate of classifying diseases was left to it, with this measure being effectively referred to as the International Classification of Disease (ICD).

This strategy is among the first measure of globalisation that the UN body undertook, with the nations being required to standardise their disease classification. Globalisation is a means of achieving universal standards, and requires global participation (Giddens 1999).

In 1952, the WHO was able to develop one of the vaccines that are regarded as a major success: the polio vaccine. This vaccine is currently in use in many countries around the world. It acts as a measure of health globalisation (Taylor 2000).The developer, Dr Jonas Salk, developed the vaccine amidst a global health crisis that was precipitated by the polio virus.

The virus was a significant cause of morbidity, with millions of children being handicapped after the infection. With the development of the vaccine, the number of children with the same ailment has significantly reduced, with most countries clearing the infection (Taylor 2000).

Some of the other developments in the history of the organisation that have contributed to globalisation include the eradication of yaws (Scheytt et al. 1998, p. 1333). The current heart transplant programme that goes on in many countries around the world was a result of globalisation efforts of the WHO, with the first heart transplant being carried out in 1967 by a surgeon in South Africa (Goldblatt 2010).

The other successful globalisation of health services that the World Health Organisation has embarked on and managed successfully is the Expanded Programme on Immunisation (Goldblatt 2010). In 1974, the WHO established the programme that has provided vaccines against some of the global health programs to children. In many countries around the world, the expanded programme on Immunisation has set up bases to provide free and cheap vaccines.

The WHO coordinates them, with the main suppliers being the companies contracted by the organisation. The vaccination of children has led to the eradication of the common diseases that afflicted children before the creation of the WHO, with these being eradicated altogether.

The World health organisation has had significant effects on globalisation. As indicated above, the global nature of disease proved to be a bother to the international community, especially with the advent of global trade and travel. Diseases could be transmitted easily from one place to the other at different parts of the world, and populations could be wiped in a matter of days. With the entry of WHO, there was the development of policies to guard against the spread of these diseases (Mythen 2008).

The standardisation of medical practices, training, and disease control made possible internationally through the WHO means people can no longer worry about diseases or healthcare in general in the different parts of the world. As a result, one could conclude that the establishment of WHO has contributed positively towards globalisation.

Health has also been regarded as one of the major contributors of globalisation. Through the WHO, the globalisation has easily been realised. Health professionals are able to work in different parts of the word, with labour in the health sector being universally distributed and sought (Giddens 1990).

Globalisation has long been recognised as a major factor influencing the distribution and provision of medical services. As a major player in global health, WHO has experienced the effects of the globalisation in total. These have been both beneficial and adverse to the operation of the international institution as stated above.

Among the major influence that globalisation has had on the WHO include the easy distribution of labour globally, allowing it to attain the much needed health services (Scott 2000; Butler 2008). Globalisation has also meant that WHO formulates global policies with consideration of all the health players in the world (Brown & Harman 2011; Milward & Provan, 2000).

Many researchers have analysed the performance of the WHO and evaluated its achievement of the set goals and objectives. Some of researchers have criticised the performance of the organisation, with others crediting it with good performance. Some of the people who have been strong critiques of the organisation include Fiona Godlee who critically evaluated “the effectiveness of the organisation and its policies, the administration, regional negotiations, and many other aspects of WHO” (1994a; 1994b; 1995, p. 111).

In their research, Dean Jamison, Julio Frenk, and Felicia Knaul concluded that the WHO had core and supplementary functions, which are demanded by the global heath actors (1998, p. 516). The carrying out of the major functions of the World Health Organisation is through the subsidiary bodies in the various countries and regions. The debate is whether they are effective in the management of the global aspects of health.

The functions of the WHO have constantly been revised. According to Ruger and Derek Yach, “in 1996-1997, the WHO Executive Board held 6 special meetings to review the Constitution, recommending rewriting WHO’s core functions to emphasise coordination, health policy development, norms and standards, advocating health for all, and advice and technical cooperation” (2009, p. 3)

The World Health Organisation has a number of challenges facing it in its quest for global health like any other global organisation in the world seeking globalisation (Adam, 2000). One of the major problems that face the organisation is the inequality that is occasioned by the different economic status of her member states. The WHO relies on the provision of funding from its major members as well as from the United Nations.

This funding is not sufficient to meet the budget for the programmes that it carries out. This insufficiency is one of the largest inhibitors to the provision of free medical care for some of the chronic conditions such as the AIDS pandemic (Clark, 1997; Thompson 2008).

Over the last few decades, the organisation has witnessed the development of major health concerns, with these affecting the provision of health services. These have been propagated by globalisation (Goldblatt2010; Taylor 2000; Scholte 1997). The outbreak of diseases in one part of the world easily spreads to the other.

The global transport network that allows the transit of goods and services at a fast speed (Goldblatt 2010; Sassen 1998) is responsible for this case. The advent of globalisation also means that patients are able to take diseases from one area to the other, with this making it hard for the WHO to institute measures aimed at controlling its spread.

The WHO has also run into difficulties in the eradication of some of the universal pandemics due to the complicated nature of the management. The major countries that fund the organisation have control over the organisation’s spending. This situation has affected the financial outlook of the organisation. Some competitive organisations such as the Centre for Disease Control have taken up some of the roles of the WHO in disease surveillance. Most of the funding has been diverted to these organisations.

Other challenges that the organisation faces include the poor research and technical capacity that exist in some of the member states compared to others. This situation creates competitive advantage in some nations and dependence in others. This means that the organisation’s funds are used more in some nations compared to others.

The WHO is an international organisation that deals with the health of all the earth’s population. Some problems have traditionally been restricted in certain areas. The best example is the nutritional factors such as obesity. In the current global village, these conditions have become universal with the onset of obesity in children who were traditionally not prone to it.

The organisation also faces administration issues and the shifting of focus from the global health concerns. Ruger and Derek Yach reveal, “Trends at WHO in the last several years however suggest a shift in priorities, evidenced also by the emergence of other entities in academia” (2009, p. 6).The above challenges are attributable to globalisation and can be easily resolved.

In conclusion, the current age is the age of globalisation. Many international institutions are at the forefront of facilitating globalisation. Trade, politics, and health are some of the sectors that have significantly been affected by globalisation. Communication and trade top the list. The advent of globalisation has however created some challenges and opportunities for the health sector. One of the most important bodies in the globalisation of health services is the World Health Organisation.

The world Health Organisation, as discussed, has its roots in the formation of the United Nations. The major mandate is the formation of international standards in health. According to the literature and information on the organisation, globalisation continues to challenge its existence.

One of the points that come out is that health is currently beyond individual countries or individuals, and thus the need for an international body. The standardisation of health services in the world is at an advanced stage under the WHO. However, several challenges are evident in the effort to achieve these standards.

In the essay, it is established that the WHO has core functions and subsidiary roles. The provision of standardised medical services universally is a core function of the WHO and a facilitation of globalisation. The various achievements that the WHO has had in the context of globalisation have also been highlighted. These include the eradication of some of the major illnesses that caused the death of millions of the world’s population.

The organisation has also been able to set up an international standards list, with all the member countries using this to classify the medical conditions and diseases. Another achievement is the control of major pandemics such as the HIV/AIDS that is currently ongoing.

The main challenges evaluated and assessed to have a major impact on the functioning of the organisation include financial shortage and management issues, as well as globalisation itself. In globalisation, the easy spread of diseases from one area to another and copying of practices from one area to another means that the organisation has a lot to do to curb the spread.

However, globalisation and health have coexisted, with globalisation allowing easy transfer of medical services and information from one corner of the planet to the other, thus enhancing accessibility of such services by all people around the globe.

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How to build a better health system: 8 expert essays

We need to focus on keeping people healthy, not just treating them when they're sick Image:  REUTERS/Rupak De Chowdhuri

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Introduction

By Francesca Colombo , Head, Health Division, Organisation for Economic Co-operation and Development (OECD) and Helen E. Clark , Prime Minister of New Zealand (1999-2008), The Helen Clark Foundation

Our healthy future cannot be achieved without putting the health and wellbeing of populations at the centre of public policy.

Ill health worsens an individual’s economic prospects throughout the lifecycle. For young infants and children, ill health affects their capacity to acumulate human capital; for adults, ill health lowers quality of life and labour market outcomes, and disadvantage compounds over the course of a lifetime.

And, yet, with all the robust evidence available that good health is beneficial to economies and societies, it is striking to see how health systems across the globe struggled to maximise the health of populations even before the COVID-19 pandemic – a crisis that has further exposed the stresses and weaknesses of our health systems. These must be addressed to make populations healthier and more resilient to future shocks.

Each one of us, at least once in our lives, is likely to have been frustrated with care that was inflexible, impersonal and bureaucratic. At the system level, these individual experiences add up to poor safety, poor care coordination and inefficiencies – costing millions of lives and enormous expense to societies.

This state of affairs contributes to slowing down the progress towards achieving the sustainable development goals to which all societies, regardless of their level of economic development, have committed.

Many of the conditions that can make change possible are in place. For example, ample evidence exists that investing in public health and primary prevention delivers significant health and economic dividends. Likewise, digital technology has made many services and products across different sectors safe, fast and seamless. There is no reason why, with the right policies, this should not happen in health systems as well. Think, for example, of the opportunities to bring high quality and specialised care to previously underserved populations. COVID-19 has accelerated the development and use of digital health technologies. There are opportunities to further nurture their use to improve public health and disease surveillance, clinical care, research and innovation.

To encourage reform towards health systems that are more resilient, better centred around what people need and sustainable over time, the Global Future Council on Health and Health Care has developed a series of stories illustrating why change must happen, and why this is eminently possible today. While the COVID-19 crisis is severally challenging health systems today, our healthy future is – with the right investments – within reach.

1. Five changes for sustainable health systems that put people first

The COVID-19 crisis has affected more than 188 countries and regions worldwide, causing large-scale loss of life and severe human suffering. The crisis poses a major threat to the global economy, with drops in activity, employment, and consumption worse than those seen during the 2008 financial crisis . COVID-19 has also exposed weaknesses in our health systems that must be addressed. How?

For a start, greater investment in population health would make people, particularly vulnerable population groups, more resilient to health risks. The health and socio-economic consequences of the virus are felt more acutely among disadvantaged populations, stretching a social fabric already challenged by high levels of inequalities. The crisis demonstrates the consequences of poor investment in addressing wider social determinants of health, including poverty, low education and unhealthy lifestyles. Despite much talk of the importance of health promotion, even across the richer OECD countries barely 3% of total health spending is devoted to prevention . Building resilience for populations also requires a greater focus on solidarity and redistribution in social protection systems to address underlying structural inequalities and poverty.

Beyond creating greater resilience in populations, health systems must be strengthened.

High-quality universal health coverage (UHC) is paramount. High levels of household out-of-pocket payments for health goods and services deter people from seeking early diagnosis and treatment at the very moment they need it most. Facing the COVID-19 crisis, many countries have strengthened access to health care, including coverage for diagnostic testing. Yet others do not have strong UHC arrangements. The pandemic reinforced the importance of commitments made in international fora, such as the 2019 High-Level Meeting on Universal Health Coverage , that well-functioning health systems require a deliberate focus on high-quality UHC. Such systems protect people from health threats, impoverishing health spending, and unexpected surges in demand for care.

Second, primary and elder care must be reinforced. COVID-19 presents a double threat for people with chronic conditions. Not only are they at greater risk of severe complications and death due to COVID-19; but also the crisis creates unintended health harm if they forgo usual care, whether because of disruption in services, fear of infections, or worries about burdening the health system. Strong primary health care maintains care continuity for these groups. With some 94% of deaths caused by COVID-19 among people aged over 60 in high-income countries, the elder care sector is also particularly vulnerable, calling for efforts to enhance control of infections, support and protect care workers and better coordinate medical and social care for frail elderly.

Third, the crisis demonstrates the importance of equipping health systems with both reserve capacity and agility. There is an historic underinvestment in the health workforce, with estimated global shortages of 18 million health professionals worldwide , mostly in low- and middle-income countries. Beyond sheer numbers, rigid health labour markets make it difficult to respond rapidly to demand and supply shocks. One way to address this is by creating a “reserve army” of health professionals that can be quickly mobilised. Some countries have allowed medical students in their last year of training to start working immediately, fast-tracked licenses and provided exceptional training. Others have mobilised pharmacists and care assistants. Storing a reserve capacity of supplies such as personal protection equipment, and maintaining care beds that can be quickly transformed into critical care beds, is similarly important.

Fourth, stronger health data systems are needed. The crisis has accelerated innovative digital solutions and uses of digital data, smartphone applications to monitor quarantine, robotic devices, and artificial intelligence to track the virus and predict where it may appear next. Access to telemedicine has been made easier. Yet more can be done to leverage standardised national electronic health records to extract routine data for real-time disease surveillance, clinical trials, and health system management. Barriers to full deployment of telemedicine, the lack of real-time data, of interoperable clinical record data, of data linkage capability and sharing within health and with other sectors remain to be addressed.

Fifth, an effective vaccine and successful vaccination of populations around the globe will provide the only real exit strategy. Success is not guaranteed and there are many policy issues yet to be resolved. International cooperation is vital. Multilateral commitments to pay for successful candidates would give manufacturers certainty so that they can scale production and have vaccine doses ready as quickly as possible following marketing authorisation, but could also help ensure that vaccines go first to where they are most effective in ending the pandemic. Whilst leaders face political pressure to put the health of their citizens first, it is more effective to allocate vaccines based on need. More support is needed for multilateral access mechanisms that contain licensing commitments and ensure that intellectual property is no barrier to access, commitments to technology transfer for local production, and allocation of scarce doses based on need.

The pandemic offers huge opportunities to learn lessons for health system preparedness and resilience. Greater focus on anticipating responses, solidarity within and across countries, agility in managing responses, and renewed efforts for collaborative actions will be a better normal for the future.

OECD Economic Outlook 2020 , Volume 2020 Issue 1, No. 107, OECD Publishing, Paris

OECD Employment Outlook 2020 : Worker Security and the COVID-19 Crisis, OECD Publishing, Paris

OECD Health at a Glance 2019, OECD Publishing, Paris

https://www.un.org/pga/73/wp-content/uploads/sites/53/2019/07/FINAL-draft-UHC-Political-Declaration.pdf

OECD (2020), Who Cares? Attracting and Retaining Care Workers for the Elderly, OECD Health Policy Studies, OECD Publishing, Paris

Working for Health and Growth: investing in the health workforce . Report of the High-Level Commission on Health Employment and Economic Growth, Geneva.

Colombo F., Oderkirk J., Slawomirski L. (2020) Health Information Systems, Electronic Medical Records, and Big Data in Global Healthcare: Progress and Challenges in OECD Countries . In: Haring R., Kickbusch I., Ganten D., Moeti M. (eds) Handbook of Global Health. Springer, Cham.

2. Improving population health and building healthy societies in times of COVID-19

By Helena Legido-Quigley , Associate Professor, London School of Hygiene and Tropical Medicine

The COVID-19 pandemic has been a stark reminder of the fragility of population health worldwide; at time of writing, more than 1 million people have died from the disease. The pandemic has already made evident that those suffering most from COVID-19 belong to disadvantaged populations and marginalised communities. Deep-rooted inequalities have contributed adversely to the health status of different populations within and between countries. Besides the direct and indirect health impacts of COVID-19 and the decimation of health systems, restrictions on population movement and lockdowns introduced to combat the pandemic are expected to have economic and social consequences on an unprecedented scale .

Population health – and addressing the consequences of COVID-19 – is about improving the physical and mental health outcomes and wellbeing of populations locally, regionally and nationally, while reducing health inequalities.¹ Moreover, there is an increasing recognition that societal and environmental factors, such as climate change and food insecurity, can also influence population health outcomes.

The experiences of Maria, David, and Ruben – as told by Spanish public broadcaster RTVE – exemplify the real challenges that people living in densely populated urban areas have faced when being exposed to COVID-19.¹

Maria is a Mexican migrant who has just returned from Connecticut to the Bronx. Her partner Jorge died in Connecticut from COVID-19. She now has no income and is looking for an apartment for herself and her three children. When Jorge became ill, she took him to the hospital, but they would not admit him and he was sent away to be cared for by Maria at home with their children. When an ambulance eventually took him to hospital, it was too late. He died that same night, alone in hospital. She thinks he had diabetes, but he was never diagnosed. They only had enough income to pay the basic bills. Maria is depressed, she is alone, but she knows she must carry on for her children. Her 10-year old child says that if he could help her, he would work. After three months, she finds an apartment.

David works as a hairdresser and takes an overcrowded train every day from Leganés to Chamberi in the centre of Madrid. He lives in a small flat in San Nicasio, one of the poorest working-class areas of Madrid with one of the largest ageing populations in Spain. The apartments are very small, making it difficult to be in confinement, and all of David’s neighbours know somebody who has been a victim of COVID-19. His father was also a hairdresser. David's father was not feeling well; he was taken to hospital by ambulance, and he died three days later. David was not able to say goodbye to his father. Unemployment has increased in that area; small local shops are losing their customers, and many more people are expecting to lose their jobs.

Ruben lives in Iztapalapa in Mexico City with three children, a daughter-in-law and five grandchildren. Their small apartment has few amenities, and no running water during the evening. At three o’clock every morning, he walks 45 minutes with his mobile stall to sell fruit juices near the hospital. His daily earnings keep the family. He goes to the central market to buy fruit, taking a packed dirty bus. He thinks the city's central market was contaminated at the beginning of the pandemic, but it could not be closed as it is the main source of food in the country. He has no health insurance, and he knows that as a diabetic he is at risk, but medication for his condition is too expensive. He has no alternative but to go to work every day: "We die of hunger or we die of COVID."

These real stories highlight the issues that must be addressed to reduce persistent health inequalities and achieve health outcomes focusing on population health. The examples of Maria, David and Ruben show the terrible outcomes COVID-19 has had for people living in poverty and social deprivation, older people, and those with co-morbidities and/or pre-existing health conditions. All three live in densely populated urban areas with poor housing, and have to travel long distances in overcrowded transport. Maria’s loss of income has had consequences for her housing security and access to healthcare and health insurance, which will most likely lead to worse health conditions for her and her children. Furthermore, all three experienced high levels of stress, which is magnified in the cases of Maria and David who were unable to be present when their loved ones died.

The COVID-19 pandemic has made it evident that to improve the health of the population and build healthy societies, there is a need to shift the focus from illness to health and wellness in order to address the social, political and commercial determinants of health; to promote healthy behaviours and lifestyles; and to foster universal health coverage.² Citizens all over the world are demanding that health systems be strengthened and for governments to protect the most vulnerable. A better future could be possible with leadership that is able to carefully consider the long-term health, economic and social policies that are needed.

In order to design and implement population health-friendly policies, there are three prerequisites. First, there is a need to improve understanding of the factors that influence health inequalities and the interconnections between the economic, social and health impacts. Second, broader policies should be considered not only within the health sector, but also in other sectors such as education, employment, transport and infrastructure, agriculture, water and sanitation. Third, the proposed policies need to be designed through involving the community, addressing the health of vulnerable groups, and fostering inter-sectoral action and partnerships.

Finally, within the UN's Agenda 2030 , Sustainable Development Goal (SDG) 3 sets out a forward-looking strategy for health whose main goal is to attain healthier lives and wellbeing. The 17 interdependent SDGs offer an opportunity to contribute to healthier, fairer and more equitable societies from which both communities and the environment can benefit.

The stories of Maria, David and Ruben are real stories featured in the Documentary: The impact of COVID19 in urban outskirts, Directed by Jose A Guardiola. Available here. Permission has been granted to narrate these stories.

Buck, D., Baylis, A., Dougall, D. and Robertson, R. (2018). A vision for population health: Towards a healthier future . [online] London: The King's Fund. [Accessed 20 Sept. 2020]

Wilton Park. (2020). Healthy societies, healthy populations (WP1734). Wiston House, Steyning. Retrieved from https://www.wiltonpark.org.uk/event/wp1734/ Cohen B. E. (2006). Population health as a framework for public health practice: a Canadian perspective. American journal of public health , 96 (9), 1574–1576.

3. Imagine a 'well-care' system that invests in keeping people healthy

By Maliha Hashmi , Executive Director, Health and Well-Being and Biotech, NEOM, and Jan Kimpen , Global Chief Medical Officer, Philips

Imagine a patient named Emily. Emily is aged 32 and I’m her doctor.

Emily was 65lb (29kg) above her ideal body weight, pre-diabetic and had high cholesterol. My initial visit with Emily was taken up with counselling on lifestyle changes, mainly diet and exercise; typical advice from one’s doctor in a time-pressured 15-minute visit. I had no other additional resources, incentives or systems to support me or Emily to help her turn her lifestyle around.

I saw Emily eight months later, not in my office, but in the hospital emergency room. Her husband accompanied her – she was vomiting, very weak and confused. She was admitted to the intensive care unit, connected to an insulin drip to lower her blood sugar, and diagnosed with type 2 diabetes. I talked to Emily then, emphasizing that the new medications for diabetes would only control the sugars, but she still had time to reverse things if she changed her lifestyle. She received further counselling from a nutritionist.

Over the years, Emily continued to gain weight, necessitating higher doses of her diabetes medication. More emergency room visits for high blood sugars ensued, she developed infections of her skin and feet, and ultimately, she developed kidney disease because of the uncontrolled diabetes. Ten years after I met Emily, she is 78lb (35kg) above her ideal body weight; she is blind and cannot feel her feet due to nerve damage from the high blood sugars; and she will soon need dialysis for her failing kidneys. Emily’s deteriorating health has carried a high financial cost both for herself and the healthcare system. We have prevented her from dying and extended her life with our interventions, but each interaction with the medical system has come at significant cost – and those costs will only rise. But we have also failed Emily by allowing her diabetes to progress. We know how to prevent this, but neither the right investments nor incentives are in place.

Emily could have been a real patient of mine. Her sad story will be familiar to all doctors caring for chronically ill patients. Unfortunately, patients like Emily are neglected by health systems across the world today. The burden of chronic disease is increasing at alarming rates. Across the OECD nearly 33% of those over 15 years live with one or more chronic condition, rising to 60% for over-65s. Approximately 50% of chronic disease deaths are attributed to cardiovascular disease (CVD). In the coming decades, obesity, will claim 92 million lives in the OECD while obesity-related diseases will cut life expectancy by three years by 2050.

These diseases can be largely prevented by primary prevention, an approach that emphasizes vaccinations, lifestyle behaviour modification and the regulation of unhealthy substances. Preventative interventions have been efficacious. For obesity, countries have effectively employed public awareness campaigns, health professionals training, and encouragement of dietary change (for example, limits on unhealthy foods, taxes and nutrition labelling).⁴,⁵ Other interventions, such as workplace health-promotion programmes, while showing some promise, still need to demonstrate their efficacy.

The COVID-19 crisis provides the ultimate incentive to double down on the prevention of chronic disease. Most people dying from COVID-19 have one or more chronic disease, including obesity, CVD, diabetes or respiratory problems – diseases that are preventable with a healthy lifestyle. COVID-19 has highlighted structural weaknesses in our health systems such as the neglect of prevention and primary care.

While the utility of primary prevention is understood and supported by a growing evidence base, its implementation has been thwarted by chronic underinvestment, indicating a lack of societal and governmental prioritization. On average, OECD countries only invest 2.8% of health spending on public health and prevention. The underlying drivers include decreased allocation to prevention research, lack of awareness in populations, the belief that long-run prevention may be more costly than treatment, and a lack of commitment by and incentives for healthcare professionals. Furthermore, public health is often viewed in a silo separate from the overall health system rather than a foundational component.

Health benefits aside, increasing investment in primary prevention presents a strong economic imperative. For example, obesity contributes to the treatment costs of many other diseases: 70% of diabetes costs, 23% for CVD and 9% for cancers. Economic losses further extend to absenteeism and decreased productivity.

Fee-for-service models that remunerate physicians based on the number of sick patients they see, regardless the quality and outcome, dominate healthcare systems worldwide. Primary prevention mandates a payment system that reimburses healthcare professionals and patients for preventive actions. Ministries of health and governmental leaders need to challenge skepticism around preventive interventions, realign incentives towards preventive actions and those that promote healthy choices by people. Primary prevention will eventually reduce the burden of chronic diseases on the healthcare system.

As I reflect back on Emily and her life, I wonder what our healthcare system could have done differently. What if our healthcare system was a well-care system instead of a sick-care system? Imagine a different scenario: Emily, a 32 year old pre-diabetic, had access to a nutritionist, an exercise coach or health coach and nurse who followed her closely at the time of her first visit with me. Imagine if Emily joined group exercise classes, learned where to find healthy foods and how to cook them, and had access to spaces in which to exercise and be active. Imagine Emily being better educated about her diabetes and empowered in her healthcare and staying healthy. In reality, it is much more complicated than this, but if our healthcare systems began to incentivize and invest in prevention and even rewarded Emily for weight loss and healthy behavioural changes, the outcome might have been different. Imagine Emily losing weight and continuing to be an active and contributing member of society. Imagine if we invested in keeping people healthy rather than waiting for people to get sick, and then treating them. Imagine a well-care system.

Anderson, G. (2011). Responding to the growing cost and prevalence of people with multiple chronic conditions . Retrieved from OECD.

Institute for Health Metrics and Evaluation. GBD Data Visualizations. Retrieved here.

OECD (2019), The Heavy Burden of Obesity: The Economics of Prevention, OECD Health Policy Studies, OECD Publishing, Paris.

OECD. (2017). Obesity Update . Retrieved here.

Malik, V. S., Willett, W. C., & Hu, F. B. (2013). Global obesity: trends, risk factors and policy implications. Nature Reviews Endocrinology , 9 (1), 13-27.

Lang, J., Cluff, L., Payne, J., Matson-Koffman, D., & Hampton, J. (2017). The centers for disease control and prevention: findings from the national healthy worksite program. Journal of occupational and environmental medicine , 59 (7), 631.

Gmeinder, M., Morgan, D., & Mueller, M. (2017). How much do OECD countries spend on prevention? Retrieved from OECD.

Jordan RE, Adab P, Cheng KK. Covid-19: risk factors for severe disease and death. BMJ. 2020;368:m1198.

Richardson, A. K. (2012). Investing in public health: barriers and possible solutions. Journal of Public Health , 34 (3), 322-327.

Yong, P. L., Saunders, R. S., & Olsen, L. (2010). Missed Prevention Opportunities The healthcare imperative: lowering costs and improving outcomes: workshop series summary (Vol. 852): National Academies Press Washington, DC.

OECD. (2019). The Heavy Burden of Obesity: The Economics of Prevention. Retrieved here .

McDaid, D., F. Sassi and S. Merkur (Eds.) (2015a), “Promoting Health, Preventing Disease: The Economic Case ”, Open University Press, New York.

OECD. (2019). The Heavy Burden of Obesity: The Economics of Prevention. Retrieved from OECD.

4. Why e arly detection and diagnosis is critical

By Paul Murray , Head of Life and Health Products, Swiss Re, and André Goy , Chairman and Executive Director & Chief of Lymphoma, John Theurer Cancer Center, Hackensack University Medical Center

Although healthcare systems around the world follow a common and simple principle and goal – that is, access to affordable high-quality healthcare – they vary significantly, and it is becoming increasingly costly to provide this access, due to ageing populations, the increasing burden of chronic diseases and the price of new innovations.

Governments are challenged by how best to provide care to their populations and make their systems sustainable. Neither universal health, single payer systems, hybrid systems, nor the variety of systems used throughout the US have yet provided a solution. However, systems that are ranked higher in numerous studies, such as a 2017 report by the Commonwealth Fund , typically include strong prevention care and early-detection programmes. This alone does not guarantee a good outcome as measured by either high or healthy life expectancy. But there should be no doubt that prevention and early detection can contribute to a more sustainable system by reducing the risk of serious diseases or disorders, and that investing in and operationalizing earlier detection and diagnosis of key conditions can lead to better patient outcomes and lower long-term costs.

To discuss early detection in a constructive manner it makes sense to describe its activities and scope. Early detection includes pre-symptomatic screening and treatment immediately or shortly after first symptoms are diagnosed. Programmes may include searching for a specific disease (for example, HIV/AIDS or breast cancer), or be more ubiquitous. Prevention, which is not the focus of this blog, can be interpreted as any activities undertaken to avoid diseases, such as information programmes, education, immunization or health monitoring.

Expenditures for prevention and early detection vary by country and typically range between 1-5% of total health expenditures.¹ During the 2008 global financial crisis, many countries reduced preventive spending. In the past few years, however, a number of countries have introduced reforms to strengthen and promote prevention and early detection. Possibly the most prominent example in recent years was the introduction of the Affordable Care Act in the US, which placed a special focus on providing a wide range of preventive and screening services. It lists 63 distinct services that must be covered without any copayment, co-insurance or having to pay a deductible.

Whilst logic dictates that investment in early detection should be encouraged, there are a few hurdles and challenges that need to be overcome and considered. We set out a few key criteria and requirements for an efficient early detection program:

1. Accessibility The healthcare system needs to provide access to a balanced distribution of physicians, both geographically (such as accessibility in rural areas), and by specialty. Patients should be able to access the system promptly without excessive waiting times for diagnoses or elective treatments. This helps mitigate conditions or diseases that are already quite advanced or have been incubating for months or even years before a clinical diagnosis. Access to physicians varies significantly across the globe from below one to more than 60 physicians per 10,000 people.² One important innovation for mitigating access deficiencies is telehealth. This should give individuals easier access to health-related services, not only in cases of sickness but also to supplement primary care.

2. Early symptoms and initial diagnosis Inaccurate or delayed initial diagnoses present a risk to the health of patients, can lead to inappropriate or unnecessary testing and treatment, and represents a significant share of total health expenditures. A medical second opinion service, especially for serious medical diagnoses, which can occur remotely, can help improve healthcare outcomes. Moreover, studies show that early and correct diagnosis opens up a greater range of curative treatment options and can reduce costs (e.g. for colon cancer, stage-four treatment costs are a multiple of stage-one treatment costs).³

3. New technology New early detection technologies can improve the ability to identify symptoms and diseases early: i. Advances in medical monitoring devices and wearable health technology, such as ECG and blood pressure monitors and biosensors, enable patients to take control of their own health and physical condition. This is an important trend that is expected to positively contribute to early detection, for example in atrial fibrillation and Alzheimers’ disease. ii. Diagnostic tools, using new biomarkers such as liquid biopsies or volatile organic compounds, together with the implementation of machine learning, can play an increasing role in areas such as oncology or infectious diseases.⁴

4. Regulation and Intervention Government regulation and intervention will be necessary to set ranges of normality, to prohibit or discourage overdiagnosis and to reduce incentives for providers to overtreat patients or to follow patients' inappropriate requests. In some countries, such as the US, there has been some success through capitation models and value-based care. Governments might also need to intervene to de-risk the innovation paradigm, such that private providers of capital feel able to invest more in the development of new detection technologies, in addition to proven business models in novel therapeutics.

OECD Health Working Papers No. 101 "How much do OECD countries spend on prevention" , 2017

World Health Organization; Global Health Observatory (GHO) data; https://www.who.int/gho/health_workforce/physicians_density/en/

Saving lives, averting costs; A report for Cancer Research UK, by Incisive Health, September 2014

Liquid Biopsy: Market Drivers And Obstacles; by Divyaa Ravishankar, Frost & Sullivan, January 21, 2019

Liquid Biopsies Become Cheap and Easy with New Microfluidic Device; February 26, 2019

How America’s 5 Top Hospitals are Using Machine Learning Today; by Kumba Sennaar, February 19, 2019

5. The business case for private investment in healthcare for all

Pascal Fröhlicher, Primary Care Innovation Scholar, Harvard Medical School, and Ian Wijaya, Managing Director in Lazard’s Global Healthcare Group

Faith, a mother of two, has just lost another customer. Some households where she is employed to clean, in a small town in South Africa, have little understanding of her medical needs. As a type 2 diabetes patient, this Zimbabwean woman visits the public clinic regularly, sometimes on short notice. At her last visit, after spending hours in a queue, she was finally told that the doctor could not see her. To avoid losing another day of work, she went to the local general practitioner to get her script, paying more than three daily wages for consultation and medication. Sadly, this fictional person reflects a reality for many people in middle-income countries.

Achieving universal health coverage by 2030, a key UN Sustainable Development Goal (SDG), is at risk. The World Bank has identified a $176 billion funding gap , increasing every year due to the growing needs of an ageing population, with the health burden shifting towards non-communicable diseases (NCDs), now the major cause of death in emerging markets . Traditional sources of healthcare funding struggle to increase budgets sufficiently to cover this gap and only about 4% of private health care investments focus on diseases that primarily affect low- and middle-income countries.

In middle-income countries, private investors often focus on extending established businesses, including developing private hospital capacity, targeting consumers already benefiting from quality healthcare. As a result, an insufficient amount of private capital is invested in strengthening healthcare systems for everyone.

Why is this the case? We discussed with senior health executives investing in Lower and Middle Income Countries (LMIC) and the following reasons emerged:

• Small market size . Scaling innovations in healthcare requires dealing with country-specific regulatory frameworks and competing interest groups, resulting in high market entry cost.
• Talent . Several LMICs are losing nurses and doctors but also business and finance professionals to European and North American markets due to the lack of local opportunities and a significant difference in salaries.
• Untested business models with relatively low gross margins. Providing healthcare requires innovative business models where consumers’ willingness to pay often needs to be demonstrated over a significant period of time. Additionally, relatively low gross margins drive the need for scale to leverage administrative costs, which increases risk.
• Government Relations. The main buyer of health-related products and services is government; yet the relationship between public and private sectors often lacks trust, creating barriers to successful collaboration. Add to that significant political risk, as contracts can be cancelled by incoming administrations after elections. Many countries also lack comprehensive technology strategies to successfully manage technological innovation.
• Complexity of donor funding. A significant portion of healthcare is funded by private donors, whose priorities might not always be congruent with the health priorities of the government.

Notwithstanding these barriers, healthcare, specifically in middle-income settings, could present an attractive value proposition for private investors:

• Economic growth rates . A growing middle class is expanding the potential market for healthcare products and services.
• Alignment of incentives . A high ratio of out-of-pocket payments for healthcare services is often associated with low quality. However, innovative business models can turn out of pocket payments into the basis for a customer-centric value proposition, as the provider is required to compete for a share of disposable income.
• Emergence of National Health Insurance Schemes . South Africa, Ghana, Nigeria and others are building national health insurance schemes, increasing a population’s ability to fund healthcare services and products .
• Increased prevalence of NCDs. Given the increasing incidence of chronic diseases and the potential of using technology to address these diseases, new business opportunities for private investment exist.

Based on the context above, several areas in healthcare delivery can present compelling opportunities for private companies.

• Aggregation of existing players.
• Leveraging primary care infrastructure. Retail companies can leverage their real estate, infrastructure and supply chains to deploy primary care services at greater scale than is currently the case.
• Telemedicine . Telecommunications providers can leverage their existing infrastructure and customer base to provide payment mechanisms and telehealth services at scale. As seen during the COVID-19 pandemic, investment in telemedicine can ensure that patients receive timely and continuous care in spite of restrictions and lockdowns.
• Cost effective diagnostics . Diagnostic tools operated by frontline workers and combined with the expertise of specialists can provide timely and efficient care.

To fully realize these opportunities, government must incentivise innovation, provide clear regulatory frameworks and, most importantly, ensure that health priorities are adequately addressed.

Venture capital and private equity firms as well as large international corporations can identify the most commercially viable solutions and scale them into new markets. The ubiquity of NCDs and the requirement to reduce costs globally provides innovators with the opportunity to scale their tested solutions from LMICs to higher income environments.

Successful investment exits in LMICs and other private sector success stories will attract more private capital. Governments that enable and support private investment in their healthcare systems would, with appropriate governance and guidance, generate benefits to their populations and economies. The economic value of healthy populations has been proven repeatedly , and in the face of COVID-19, private sector investment can promote innovation and the development of responsible, sustainable solutions.

Faith – the diabetic mother we introduced at the beginning of this article - could keep her client. As a stable patient, she could measure her glucose level at home and enter the results in an app on her phone, part of her monthly diabetes programme with the company that runs the health centre. She visits the nurse-led facility at the local taxi stand on her way to work when her app suggests it. The nurse in charge of the centre treats Faith efficiently, and, if necessary, communicates with a primary care physician or even a specialist through the telemedicine functionality of her electronic health system.

Improving LMIC health systems is not only a business opportunity, but a moral imperative for public and private leaders. With the appropriate technology and political will, this can become a reality.

6. How could COVID-19 change the way we pay for health services?

John E. Ataguba, Associate Professor and Director, University of Cape Town and Matthew Guilford, Co-Founder and Chief Executive Officer, Common Health

The emergence of the new severe acute respiratory syndrome coronavirus (SARS-Cov-2), causing the coronavirus disease 2019 (COVID-19), has challenged both developing and developed countries.

Countries have approached the management of infections differently. Many people are curious to understand their health system’s performance on COVID-19, both at the national level and compared to international peers. Alongside limited resources for health, many developing countries may have weak health systems that can make it challenging to respond adequately to the pandemic.

Even before COVID-19, high rates of out-of-pocket spending on health meant that every year, 800 million people faced catastrophic healthcare costs ,100 million families were pushed into poverty, and millions more simply avoided care for critical conditions because they could not afford to pay for it.

The pandemic and its economic fallout have caused household incomes to decline at the same time as healthcare risks are rising. In some countries with insurance schemes, and especially for private health insurance, the following questions have arisen: How large is the co-payment for a COVID-19 test? If my doctor’s office is closed, will the telemedicine consultation be covered by my insurance? Will my coronavirus care be paid for regardless of how I contracted the virus? These and other doubts can prevent people from seeking medical care in some countries.

In Nigeria, like many other countries in Africa, the government bears the costs associated with testing and treating COVID-19 irrespective of the individual’s insurance status. In the public health sector, where COVID-19 cases are treated, health workers are paid monthly salaries while budgets are allocated to health facilities for other services. Hospitals continue to receive budget allocations to finance all health services including the management and treatment of COVID-19. That implies that funds allocated to address other health needs are reduced and that in turn could affect the availability and quality of health services.

Although health workers providing care for COVID-19 patients in isolation and treatment centres in Nigeria are paid salaries that are augmented with a special incentive package, the degree of impact on the quality improvement of services remains unclear. The traditional and historical allocation of budgets does not always address the needs of the whole population and could result in poor health services and under-provision of health services for COVID-19 patients.

In some countries, the reliance on out-of-pocket funding is hardly better for private providers, who encounter brand risks, operational difficulties, and – in extreme cases – the risk of creating “debtor prisons” as they seek to collect payment from patients. Ironically, despite the huge demand for medical services to diagnose and treat COVID-19, large healthcare institutions and individual healthcare practitioners alike are facing financial distress.

Dependence on a steady stream of fee-for-service payments for outpatient consultations and elective procedures is leading to pay cuts for doctors in India , forfeited Eid bonuses for nurses in Indonesia , and hospital bankruptcies in the United States . In a recent McKinsey & Company survey, 77% of physicians reported that their business would suffer in 2020 , and 46% were concerned about their practice surviving the coronavirus pandemic.

COVID-19 is exposing how fee-for-service, historical budget allocation and out-of-pocket financing methods can hinder the performance of the health system. Some providers and health systems that deployed “value-based” models prior to the pandemic have reported that these approaches have improved financial resilience during COVID-19 and may support better results for patients. Nevertheless, these types of innovations do not represent the dominant payment model in any country.

How health service providers are paid has implications for whether service users can get needed health services in a timely fashion, and at an appropriate quality and an affordable cost. By shifting from fee-for-service reimbursements to fixed "capitation" and performance-based payments, these models incentivize providers to improve quality and coordination while also guaranteeing a baseline income level, even during times of disruption.

Health service providers could be paid either in the form of salaries, a fee for services they provide, by capitation (whether adjusted or straightforward), through global budgets, or by using a case-based payment system (for example, the diagnostics-related groups), among others. Because there are different incentives to consider when adopting any of the methods, they could be combined to achieve a specific goal. For example, in some countries, health workers are paid salaries , and some specific services are paid on a fee-for-service basis.

Ideally, health services could be purchased strategically , incorporating aspects of provider performance in transferring funds to providers and accounting for the health needs of the population they serve.

In this regard, strategic purchasing for health has been advocated and should be highlighted as crucial with the emergence of the COVID-19 pandemic. There is a need to ensure value in the way health providers are paid, inter alia to increase efficiency, ensure equity, and improve access to needed health services. Value-based payment methods, although not new in many countries, provide an avenue to encourage long-term value for money, better quality, and strategic purchasing for health, helping to build a healthier, more resilient world.

7. L essons in integrated care from the COVID-19 pandemic

Sarah Ziegler, Postdoctoral Researcher, Department of Epidemiology and Biostatistics, University of Zurich, and Ninie Wang, Founder & CEO, Pinetree Care Group.

Since the start of the COVID-19 pandemic, people suffering non-communicable diseases (NCDs) have been at higher risk of becoming severely ill or dying. In Italy, 96.2% of people who died of COVID-19 lived with two or more chronic conditions.

Beyond the pandemic, cardiovascular disease, cancer, respiratory disease and diabetes are the leading burden of disease, with 41 million annual deaths. People with multimorbidity - a number of different conditions - often experience difficulties in accessing timely and coordinated healthcare, made worse when health systems are busy fighting against the pandemic.

Here is what happened in China with Lee, aged 62, who has been living with Chronic Obstructive Pulmonary Disease (COPD) for the past five years.

Before the pandemic, Lee’s care manager coordinated a multi-disciplinary team of physicians, nurses, pulmonary rehabilitation therapists, psychologists and social workers to put together a personalized care plan for her. Following the care plan, Lee stopped smoking and paid special attention to her diet, sleep and physical exercises, as well as sticking to her medication and follow-up visits. She participated in a weekly community-based physical activity program to meet other COPD patients, including short walks and exchange experiences. A mobile care team supported her with weekly cleaning and grocery shopping.

Together with her family, Lee had follow-up visits to ensure her care plan reflected her recovery and to modify the plan if needed. These integrated care services brought pieces of care together, centered around Lee’s needs, and provided a continuum of care that helped keep Lee in the community with a good quality of life for as long as possible.

Since the COVID-19 outbreak, such NCD services have been disrupted by lockdowns, the cancellation of elective care and the fear of visiting care service . These factors particularly affected people living with NCDs like Lee. As such, Lee was not able to follow her care plan anymore. The mobile care team was unable to visit her weekly as they were deployed to provide COVID-19 relief. Lee couldn’t participate in her community-based program, follow up on her daily activities, or see her family or psychologists. This negatively affected Lee’s COPD management and led to poor management of her physical activity and healthy diet.

The pandemic highlights the need for a flexible and reliable integrated care system to enable healthcare delivery to all people no matter where they live, uzilizing approaches such as telemedicine and effective triaging to overcome care disruptions.

Lee’s care manager created short videos to assist her family through each step of her care and called daily to check in on the implementation of the plan and answer questions. Lee received tele-consultations, and was invited to the weekly webcast series that supported COPD patient communities. When her uncle passed away because of pneumonia complications from COVID-19 in early April, Lee’s care manager arranged a palliative care provider to support the family through the difficult time of bereavement and provided food and supplies during quarantine. Lee could even continue with her physical activity program with an online training coach. There were a total of 38 exercise videos for strengthening and stretching arms, legs and trunk, which she could complete at different levels of difficulty and with different numbers of repetitions.

Lee’s case demonstrates that early detection, prevention, and management of NCDs play a crucial role in a global pandemic response. It shows how we need to shift away from health systems designed around single diseases towards health systems designed for the multidimensional needs of individuals. As part of the pandemic responses, addressing and managing risks related to NCDs and prevention of their complications are critical to improve outcomes for vulnerable people like Lee.

How to design and deliver successful integrated care

The challenge for the successful transformation of healthcare is to tailor care system-wide to population needs. A 2016 WHO Framework on integrated people-centered health services developed a set of five general strategies for countries to progress towards people-centered and sustainable health systems, calling for a fundamental transformation not only in the way health services are delivered, but also in the way they are financed and managed . These strategies call for countries to:

• Engage and empower people / communities: an integrated care system must mobilize everyone to work together using all available resources, especially when continuity of essential health and community services for NCDs are at risk of being undermined.
• Strengthen governance and accountability, so that integration emphasizes rather than weakens leadership in every part of the system, and ensure that NCDs are included in national COVID-19 plans and future essential health services.
• Reorient the model of care to put the needs and perspectives of each person / family at the center of care planning and outcome measurement, rather than institutions.
• Coordinate services within and across sectors, for example, integrate inter-disciplinary medical care with social care, addressing wider socio-economic, environmental and behavioral determinants of health.
• Create an enabling environment, with clear objectives, supportive financing, regulations and insurance coverage for integrated care, including the development and use of systemic digital health care solutions.

Whether due to an unexpected pandemic or a gradual increase in the burden of NCDs, each person could face many health threats across the life-course.

Only systems that dynamically assess each person’s complex health needs and address them through a timely, well-coordinated and tailored mix of health and social care services will be able to deliver desired health outcomes over the longer term, ensuring an uninterrupted good quality of life for Lee and many others like her.

• Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY) 2020;12: 6049–57.
• WHO. Noncommunicable diseases in emergencies. Geneva: World Health Organization, 2016.
• WHO. COVID-19 significantly impacts health services for noncommunicable diseases. June 2020.
• Kluge HHP, Wickramasinghe K, Rippin HL, et al. Prevention and control of non-communicalbe diseases in the COVID-19 response. The Lancet. 2020. 395:1678-1680
• WHO. Framework on integrated people-centred health services. Geneva: World Health Organization, 2016.

8 . Why access to healthcare alone will not save lives

Donald Berwick, President Emeritus and Senior Fellow, Institute for Healthcare Improvement; Nicola Bedlington, Special Adviser, European Patient Forum; and David Duong, Director, Program in Global Primary Care and Social Change, Harvard Medical School.

Joyce lies next to 10 other women in bare single beds in the post-partum recovery room at a rural hospital in Uganda. Just an hour ago, Joyce gave birth to a healthy baby boy. She is now struggling with abdominal pain. A nurse walks by, and Joyce tries to call out, but the nurse was too busy to attend to her; she was the only nurse looking after 20 patients.

Another hour passes, and Joyce is shaking and sweating profusely. Joyce’s husband runs into the corridor to find a nurse to come and evaluate her. The nurse notices Joyce’s critical condition - a high fever and a low blood pressure - and she quickly calls the doctor. The medical team rushes Joyce to the intensive care unit. Joyce has a very severe blood stream infection. It takes another hour before antibiotics are started - too late. Joyce dies, leaving behind a newborn son and a husband. Joyce, like many before her, falls victim to a pervasive global threat: poor quality of care.

Adopted by United Nations (UN) in 2015, the Sustainable Development Goals (SDG) are a universal call to action to end poverty, protect the planet and ensure that all enjoy peace and prosperity by 2030. SDG 3 aims to ensure healthy lives and promote wellbeing for all. The 2019 UN General Assembly High Level Meeting on Universal Health Coverage (UHC) reaffirmed the need for the highest level of political commitment to health care for all.

However, progress towards UHC, often measured in terms of access, not outcomes, does not guarantee better health, as we can see from Joyce’s tragedy. This is also evident with the COVID-19 response. The rapidly evolving nature of the COVID-19 pandemic has highlighted long-term structural inefficiencies and inequities in health systems and societies trying to mitigate the contagion and loss of life.

Systems are straining under significant pressure to ensure standards of care for both COVID-19 patients and other patients that run the risk of not receiving timely and appropriate care. Although poor quality of care has been a long-standing issue, it is imperative now more than ever that systems implement high-quality services as part of their efforts toward UHC.

Poor quality healthcare remains a challenge for countries at all levels of economic development: 10% of hospitalized patients acquire an infection during their hospitalization in low-and-middle income countries (LMIC), whereas 7% do in high-income countries. Poor quality healthcare disproportionally affects the poor and those in LMICs. Of the approximately 8.6 million deaths per year in 137 LMICs, 3.6 million are people who did not access the health system, whereas 5 million are people who sought and had access to services but received poor-quality care.

Joyce’s story is all too familiar; poor quality of care results in deaths from treatable diseases and conditions. Although the causes of death are often multifactorial, deaths and increased morbidity from treatable conditions are often a reflection of defects in the quality of care.

The large number of deaths and avoidable complications are also accompanied by substantial economic costs. In 2015 alone, 130 LMICs faced US $6 trillion in economic losses. Although there is concern that implementing quality measures may be a costly endeavor, it is clear that the economic toll associated with a lack of quality of care is far more troublesome and further stunts the socio-economic development of LMICs, made apparent with the COVID-19 pandemic.

Poor-quality care not only leads to adverse outcomes in terms of high morbidity and mortality, but it also impacts patient experience and patient confidence in health systems. Less than one-quarter of people in LMICs and approximately half of people in high-income countries believe that their health systems work well.

A lack of application and availability of evidenced-based guidelines is one key driver of poor-quality care. The rapidly changing landscape of medical knowledge and guidelines requires healthcare workers to have immediate access to current clinical resources. Despite our "information age", health providers are not accessing clinical guidelines or do not have access to the latest practical, lifesaving information.

Getting information to health workers in the places where it is most needed is a delivery challenge. Indeed, adherence to clinical practice guidelines in eight LMICs was below 50%, and in OECD countries, despite being a part of national guidelines, 19-53% of women aged 50-69 years did not receive mammography screening.4 The evidence in LMICs and HICs suggest that application of evidence-based guidelines lead to reduction in mortality and improved health outcomes.

Equally, the failure to change and continually improve the processes in health systems that support the workforce takes a high toll on quality of care. During the initial wave of the COVID-19 pandemic, countries such as Taiwan, Hong Kong, Singapore and Vietnam, which adapted and improved their health systems after the SARS and H1N1 outbreaks, were able to rapidly mobilize a large-scale quarantine and contact tracing strategy, supported with effective and coordinated mass communication.

These countries not only mitigated the economic and mortality damage, but also prevented their health systems and workforce from enduring extreme burden and inability to maintain critical medical supplies. In all nations, investing in healthcare organizations to enable them to become true “learning health care systems,” aiming at continual quality improvement, would yield major population health and health system gains.

The COVID-19 pandemic underscores the importance for health systems to be learning systems. Once the dust settles, we need to focus, collectively, on learning from this experience and adapting our health systems to be more resilient for the next one. This implies a need for commitment to and investment in global health cooperation, improvement in health care leadership, and change management.

With strong political and financial commitment to UHC, and its demonstrable effect in addressing crises such as COVID-19, for the first time, the world has a viable chance of UHC becoming a reality. However, without an equally strong political, managerial, and financial commitment to continually improving, high-quality health services, UHC will remain an empty promise.

1. United Nations General Assembly. Political declaration of the high-level meeting on universal health coverage. New York, NY2019.

2. Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. Health equity in England: the Marmot review 10 years on. Institute of Health Equity;2020.

3. National Academies of Sciences, Engineering, and Medicine: Committee on Improving the Quality of Health Care Globally. Crossing the global quality chasm: Improving health care worldwide. Washington, DC: National Academies Press;2018.

4. World Health Organization, Organization for Economic Co-operation and Development, World Bank Group. Delivering quality health services: a global imperative for universal health coverage. World Health Organization; 2018.

5. Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. The Lancet Global Health. 2018;6(11):e1196-e1252.

6. Ricci-Cabello I, Violán C, Foguet-Boreu Q, Mounce LT, Valderas JM. Impact of multi-morbidity on quality of healthcare and its implications for health policy, research and clinical practice. A scoping review. European Journal of General Practice. 2015;21(3):192-202.

7. Valtis YK, Rosenberg J, Bhandari S, et al. Evidence-based medicine for all: what we can learn from a programme providing free access to an online clinical resource to health workers in resource-limited settings. BMJ global health. 2016;1(1).

8. Institute of Medicine. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America . Washington, DC: National Academies Press 2012.

Essay on World Health Day for Students and Children

Essay on world health day.

World Health Organization celebrates global health day every year on 7th April worldwide to create awareness on the benefits of being healthy. On this day numerous programs and arrangements are curated by the World Health Organisation. World Health Day was first time celebrated worldwide in the year 1950. It is universal: “Health is Wealth”. It is the utmost important aspect of our existence which can’t be denied. We all know various types of diseases prevail in the environment due to which people suffer. It is necessary to spread awareness among people and to impart knowledge about health.

World Health Day – History

Every year, the World Health Organisation observes World Health Day on 7 April to draw the attention of the masses towards the importance of global health. World Health Organisation was formed in 1948 in Geneva. This day World Health Assembly was held the first time and it was decided to celebrate 7th April as World Health Day. On this day, various events with a particular theme are organized by Who at the international and national level.

Get the huge list of more than 500 Essay Topics and Ideas

World Health Day: Activities

• At the global level, this day targets all the issues related to health and for this several programs are organized on a yearly basis by the WHO.
• It is celebrated worldwide by the government of all participant countries, NGO’s and other organizations.
• Health authorities from different countries participate in the celebrations with their pledges to support on the health issues worldwide.
• It acts as a reminder to people about the establishment of WHO and to spread awareness among people about major health issues in the world.
• WHO has worked on eradicating various serious health issues in developing countries like chickenpox, polio, smallpox, TB, leprosy, etc.

Themes of World Health Day since the year 2000

• 2000 – Safe Blood Start with me
• 2001 – Mental Health: Stop Exclusion, Dare to Care
• 2002 – Move for Health
• 2003 – Shape the Future of Life: Healthy Environments for Children
• 2004 – Road safety
• 2005 – Make every mother and child count
• 2006 – Working together for health
• 2007 – International health security
• 2008 – Protecting Health from the Adverse Effects of Climate Change
• 2009 – Save Lives, Make Hospitals Safe in Emergencies
• 2010 – Urbanization and Health: Make Cities Healthier
• 2011 – Antimicrobial Resistance: No Action Today, No Cure Tomorrow
• 2012 – Good Health Adds Life to Years
• 2013 – Hypertension: Silent Killer, Global Public Health Crisis
• 2014 – Vector-borne diseases
• 2015 – Food safety
• 2016 – Diabetes: Scale up prevention, strengthen care, and enhance surveillance
• 2017 – Depression: Let’s talk
• 2018 – Universal Health Coverage: everyone, everywhere

It is said that good Health provides better capabilities to work as per the requirements of the growing World and hence is very important. World Health Organisation (WHO)’s foundation was laid on the principle that all humans realize their right to the highest possible level of health. A slogan of “Health for all” is for more than seven decades old and works as a guiding vision.

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World Health Organization - List of Essay Samples And Topic Ideas

The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. Essays could discuss the role of WHO in global health governance, its major achievements and challenges, its response to global health crises, and the political and financial dynamics influencing WHO’s operations. We have collected a large number of free essay examples about World Health Organization you can find at Papersowl. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

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Tobacco has been used for centuries, even before Christopher Columbus brought it back to Europe. The widespread use of tobacco for smoking cigarettes grew in popularity throughout the early 20th century partially propagated by the widespread distribution of cigarettes during world wars (Cancer Council NSW, 2015).  The Centers for Disease Control (CDC) defines a smoker as someone who has ever smoked >100 cigarettes in his lifetime and who currently smokes cigarettes every day or some days (CDC, 2017; Belbeisi et […]

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Comparing Social Determinant and Prevalence of HIV/AIDS in the Southern States (USA) and South Africa HIV prevalence is an issue of concern, World Health Organization lists HIV among the most risk health problem across the globe. Like some killer diseases, the high rate of spread associated with HIV concern critical health determinants that vary across the globe. Notably, HIV infection varies along vulnerability and health determinants. Commonly noted vulnerable groups experience the problem with respect to gender, sex, age, economic […]

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How organisations contribute to improving the quality of healthcare

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• How organisations contribute to improving the quality of healthcare - July 03, 2019
• Naomi J Fulop , professor of healthcare organisation and management ,
• Angus I G Ramsay , NIHR knowledge mobilisation research fellow
• UCL Department of Applied Health Research, London, UK
• Correspondence to: N J Fulop n.fulop{at}ucl.ac.uk

Naomi Fulop and Angus Ramsay argue that we should focus more on how organisations and organisational leaders can contribute to improving the quality of healthcare

Key messages

The contribution of healthcare organisations to improving quality is not fully understood or considered sufficiently

Organisations can facilitate improvement by developing and implementing an organisation-wide strategy for improving quality

Organisational leaders need to support system-wide staff engagement in improvement activity and, where necessary, challenge professional interests and resistance

Leaders need to be outward facing, to learn from others, and to manage external influences. Strong clinical representation and challenge from independent voices are key components of effective leadership for improving quality

Regulators can facilitate healthcare organisations’ contribution by minimising regulatory overload and contradictory demands

Improving the quality of healthcare is complex. 1 2 Frontline staff are often seen as the key to improving quality—for instance, by identifying where it can be improved and developing creative solutions. 3 4 However, research and reviews of major healthcare scandals acknowledge the contributions of other stakeholders in improving quality, including regulators, policy makers, service users, and organisations providing healthcare. 5 6

Policies on the role of organisations in improving quality have tended to focus on how they might be better structured or regulated. However, greater consideration is required of how organisations and their leaders can contribute to improving quality: organisations vary in both how they act to support improvement 7 8 and the degree to which they provide high quality healthcare. 9

Some earlier studies suggest that high performing organisations share several features reflecting organisational commitment to improving quality. These include creating a supportive culture, building an appropriate infrastructure, and embedding systems for education and training. 10 11 Subsequent reviews of quality inspections 12 and reviews of evidence on factors influencing quality improvement, 9 and board contributions 13 indicate that organisational leadership is crucial in delivering high quality care.

We discuss how organisational processes such as development of a strategy and use of data can be used to drive improvement, the characteristics of organisations that are good at improvement, and what to consider when thinking about how organisations can help improve quality of healthcare and patient outcomes.

We present evidence on the role of organisations in improvement drawn from acute hospital settings in the UK and other countries. Although contexts may vary—for example, in whether health policy is made at regional or national level, or in the form and function of healthcare organisations—the lessons have potential relevance to all settings.

Placing healthcare organisations in their context

Health systems operate at three inter-related levels: macro, meso, and micro ( box 1 ). Research suggests that an organisation—through its leadership and processes—can bridge these levels to influence the quality of care delivered at the front line. 14 15 16

Macro, meso, and micro contributions to the quality of healthcare 14

Macro (national health systems).

Regulatory system

National priorities and policies

Accreditation

Meso (hospitals)

Micro (departments, teams).

Relational issues

Communication

Professional work

A key macro influence on organisations performing their role in improving quality is the way the healthcare system is governed and regulated. Regulation provides accountability to the wider system and therefore has a potentially strong influence on how healthcare organisations approach improvement. For example, multiple regulators in healthcare systems, as is the case in England, can lead to “regulatory overload,” 17 making it hard for organisations to focus on quality improvement rather than quality assurance 18 because of the need to respond to different (and potentially conflicting) regulatory approaches, priorities, incentives, and sanctions. 17 19 20

How can organisations contribute to improving quality?

Organisations can use various levers and processes to translate external inputs (such as policy and regulatory incentives) and internal inputs (such as local assurance systems providing data on performance and capacity) to support quality improvement. 7 18 21 Organisations can facilitate improvement by developing and implementing an organisation-wide quality improvement strategy 9 22 23 that includes the following actions:

Using appropriate data to measure and monitor performance 20 21 22

Linking incentives (both carrot and stick) with performance on quality 16 22

Recruiting, developing, maintaining, and supporting a quality proficient workforce 21

Ensuring sufficient technical resources and building a culture that supports improvement. 9 16

Many of the key organisational activities important to improving quality, such as setting strategy and agreeing performance measures, are defined at organisational level by the board. 13 Bottom-up, clinician-led improvement is often seen as the answer to the quality challenge, and it is an important part of successful quality improvement. 3 24 However, relying solely on frontline staff to lead improvement is risky because professional self interest can shape or limit the focus of improvement activity. 22 25 26 Furthermore, lack of system-wide or organisation-wide agreement on objectives might result in variations at system level, reflecting localised priorities rather than what is likely to provide the best care for patients. As well as empowering staff and supporting system-wide staff engagement in activity around improving quality 4 20 organisational leaders must challenge localised professional interests, tribalism, and resistance to change. 18 22

The reorganisation of acute stroke services in the UK ( fig 1 ) shows how leadership can play a pivotal role in managing professional and organisational resistance to changes that aim to improve quality of care. Importantly in this case, leaders cited external organisations’ priorities and public consultation responses when holding the line against local resistance to change. 25

Leading and implementing system-wide change across organisations: centralising acute stroke services in London and Greater Manchester 25 27 28

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The culture of organisations is commonly considered important in improving quality, as discussed elsewhere in this series. 20 29 30 Although the relation between culture and quality is complex, organisations can use formal and informal managerial processes to influence culture and thus improve quality of care. 30

What helps organisations contribute to quality?

As set out in box 1 , the relationship between a healthcare organisation and its external environment (especially regulators) is important in that organisation’s contribution to quality. 18 23 A qualitative study of hospitals and their external environments in five European countries showed how some were better able to align multiple financial and quality demands. 7 Figure 2 shows contrasting organisational responses to external demands and the features of both the external demands and the organisations that contributed to these different responses.

How hospitals respond to external finance and quality demands 7

Organisations can also contribute to improving quality through participation in (or leading) major system change, working beyond their own catchment areas across their local system—for example, integrating health and social care services 31 or centralising specialist acute services across multiple hospitals in a given area. 32 33 Evidence suggests that how such changes are led and implemented influences the impact of the changes, including on patient outcomes ( fig 1 ).

What do organisations that do well in improving quality look like?

Research suggests that organisations that deliver high quality care show high commitment to improving quality, reflected for instance in how organisations are led (eg, senior management involvement) and managed (eg, use of data and standards). As an illustration, fig 3 contrasts the approaches taken by US organisations with high patient mortality from acute myocardial infarction with those that have low mortality.

Contrasting organisational approaches in US healthcare organisations with the top and bottom 5% risk standardised mortality for acute myocardial infarction in 2017 8

Some recent research has developed the concept of maturity in relation to how boards of organisations govern for quality improvement and what organisational processes accomplish and sustain it. 18

More mature boards tend to use data to drive improvements in quality rather than merely for external assurance, 18 20 and they combine hard quantitative data on performance with soft data on personal experiences to make the case for improvement. 22 They also engage with relevant stakeholders (including patients 18 and the public), translate this into strategic priorities, 9 10 11 and have processes for managing and communicating information with stakeholders. 8 9 18 They value learning and development 4 7 22 34 —for example, drawing on external examples of good practice to achieve initial improvement then focusing on local, creative problem solving for continued improvement. 34 Finally, these organisations are outward facing, engaging with and managing their wider environment, including payers and other provider organisations. 7 13 29 34

By contrast, organisations with lower levels of such capabilities (such as lack of coherent mission, high turnover of leadership, and poor external relationships) appear to slow or limit improvement. 18 35 36 Some interventions have been identified to help organisations struggling to improve quality. 35 Furthermore, research on organisational turnaround provides evidence of organisational leaders harnessing crises, such as major safety issues or financial difficulties, to drive radical change and improvement. 36 37 Key changes to turn round organisations have included refocused accountability systems (eg, making quality a key performance indicator, devolving accountability to clinical teams 11 38 ), introducing processes to facilitate improvement (eg, dedicated improvement roles, 36 38 increased training opportunities, and sharing timely data on quality and cost with clinical teams 11 36 38 ), supporting culture change (eg, increasing collaboration between clinicians and management 11 36 38 with clinicians leading on quality and management supporting them), and learning from the experience of other organisations. 11 36 38 However, for such interventions to have a chance of success, organisations need both sufficient space to think and the people to make change happen. 23

The composition of senior leadership seems to influence how well organisations deliver on quality. Having clinicians on the board has been associated with better organisational performance, 23 39 through enhanced decision making, increased credibility with local clinicians (facilitating frontline uptake of policy), and making organisations more likely to attract talented clinicians. 39 Active discussion of strategy is enhanced by independent challenge by non-executives who are well versed in quality issues; this is likely to enhance focus on quality at board level, ensuring it is at the heart of an organisation’s vision and strategy. 13 As noted elsewhere, focus is growing on service users guiding improvement. 40 However, it has been challenging to involve service users meaningfully at senior leadership level. 41

What can we conclude?

Although organisations are central to improving quality, there is much variation in how they contribute, both locally and at system level. We have described ways in which organisations can contribute to improvement in terms of their processes (such as how they develop strategy and use data to drive improvements in quality), their leadership (such as how leaders engage with and manage both their external context and local professional interests), and underlying features (including coherence of external demands and leadership stability). Box 2 summarises these themes. However, the balance of priorities among these is unclear: organisations will want to analyse how they can maximise their contribution to improving quality taking account of their particular context.

Organisational process

An organisation-wide quality strategy to shift from external assurance to prioritising improvement

Combine hard and soft data to drive quality

Engage and communicate with stakeholders, including patients and carers, staff, and external partners

Build culture of trust, supporting innovation and problem solving

Organisational leadership

Support system-wide staff engagement in improving quality

Be outward facing, to learn from and manage external context

Challenge local professional interests where necessary

Feature a strong clinical voice and independent challenge, especially on the board

Underlying features

Space to think about improving quality

Resources to implement improvements

Coherent external requirements: avoid regulatory overload and contradictory demands

Stability of leadership

Regulators and policy makers also need to consider how they can better facilitate healthcare organisations’ role in improving quality. Organisations are more likely to deliver quality improvement effectively if externally set objectives are clear and manageable, and there is time and resources with which to meet these. Regulators should seek to avoid generating regulatory overload and contradictory demands; and they should strengthen organisational leadership’s hand by giving them headspace to look beyond compliance and prioritise improving quality.

Competing interests: We have read and understood BMJ policy on declaration of interests and declare that NJF is an NIHR senior investigator and was in part supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

Contributors and sources: Both authors made substantial contributions to the conception and design of the work; to the acquisition, analysis, and interpretation of data; and to drafting the work and revising it critically for important intellectual content. NJF is the guarantor.

This article is part of a series commissioned by The BMJ based on ideas generated by a joint editorial group with members from the Health Foundation and The BMJ , including a patient/carer. The BMJ retained full editorial control over external peer review, editing, and publication. Open access fees and The BMJ ’s quality improvement editor post are funded by the Health Foundation

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

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An Essay Example On World Health Organization

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• Author Sandra W.

World Health Organization Essay

The World Health organization (WHO) is the leading organization in the world that devotes itself towards the improvement of an individual’s health of nearly seven billion people. This public organization is an affiliate of the UN or the United Nations with headquarters in Geneva Switzerland. Likewise, it’s the directing and coordinating authority for health matters within the system of the United Nations. WHO is responsible for the provision of health matters across the globe, shaping the health research agenda, and provide technical support to nations as well as to monitor and assess health trends. Based on World Health Organization this essay focuses on the analysis of the organizational job analysis process and its impact on the organization HRM (WHO, 2014).

Job analysis is a significant prerequisite for the effective administration of the human resources of an organization. This process involves gathering of information about a job. It actually specifies the tasks involved in a given job as well as the factors that affect the presentation of that job. The policy of WHO is to promote human resources development and health was established in 1976. The overwhelming majority of the healthcare organizations expenditures is for wages, salaries, training, benefits and supervision of workers. Thus the productivity and performance of these institutions depends upon the workers and the conditions of work performance. Two of the forces considered for major reforms in personnel subsystems in a healthcare setting in this organization is accountability and humanism (Siddique, 2004). Accountability can be defined as the processes to provide evidence that the expenditures for attainment of the set goals in healthcare actually achieves those set objectives or otherwise makes available the measurements of deficits and implementation of plans for improvement. Alternatively humanism means that healthcare should be concerned about the whole being of human beings rather than a cluster of presentation of symptoms, disabilities or diseases (Moore, 1999).

Job analysis process impacts the organizations HRM positively as it highlights on the need to have an approach for reformations which goes beyond the simple characterization of the work content or workers performance based upon systems that acknowledge the interrelatedness of each subsystem and its contribution towards the overall system performance. Otherwise, Task analysis based upon the functional job analysis well suits these requirements in Human resource management (Moore, 1999).

Moore, F. I. (1999).  Guidelines for Task Analysis and Job Design.  San Antonio, Texas: University of Texas-Houston Health Science Center.

Siddique, C. (2004). Job analysis: a strategic human resource management practice.  Int. J. of Human Resource Management   , 15  (1), 219–244.

WHO. (2014).  About WHO . Retrieved January 7, 2014, from World Health Organisation

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1002 words sample essay on World Health Organization

The Constitution of the World Health Organization (WHO) came into force on 7 April 1948. Since then, WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence- based policy options, providing technical support to countries and monitoring and assessing health trends. In the 21st century, health is being considered a shared responsibility that involves equitable access to essential care and collective defence against transnational threats.

With the boundaries of public health action becoming blurred, WHO is increasingly operating in a complex and rapidly changing landscape that extends into other sectors that influence health opportunities and outcomes. WHO responds to these challenges using a six-point agenda that addresses two health objectives, two strategic needs, and two operational approaches. The six points in the agenda are promoting development; fostering health security; strengthening health systems; harnessing research, information and evidence; enhancing partnerships; and improving performance.

WHO’s agenda of health development is directed by the ethical principle of equity: Access to life-saving or health-promoting interventions should not be denied for unfair reasons, including those with economic or social roots. WHO activities aimed at health development give priority to health outcomes in poor, disadvantaged or vulnerable groups.

Its health and development agenda includes attainment of the health-related Millennium Development Goals, preventing and treating chronic diseases and addressing the neglected tropical diseases. It has fostered health security by strengthening the world’s ability to defend itself collectively against outbreaks by enforcing the revised International Health Regulations since June 2007.

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Strengthening of health systems is a high priority for WHO and it ensures that health systems reach poor and underserved populations of the world. It addresses areas such as the provision of adequate numbers of appropriately trained staff, sufficient financing, suitable systems for collecting vital statistics, and access to appropriate technology including essential drugs. It generates authoritative health information, in consultation with leading experts, to set norms and standards, articulate evidence-based policy options and monitor the evolving global heath situation.

WHO carries out its work with the support and collaboration of many partners, including UN agencies and other international organizations, donors, civil society and the private sector. By using the strategic power of evidence, WHO encourages partners implementing programmes within countries to align their activities with best technical guidelines and practices, as well as with the priorities established by countries.

As a means of improving its performance, WHO participates in ongoing reforms aimed at improving its efficiency and effectiveness, both at the international level and within countries.

Entitled “Engaging for Health”, the 11th General Programme of Work provides the framework for organization-wide programme of work, budget, resources and results for the 10-year period from 2006 to 2015. The General Programme of Work sets out core functions of WHO as: providing leadership on matters critical to health and engaging in partnerships where joint action is needed; shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge; setting norms and standards and promoting and monitoring their implementation; articulating ethical and evidence-based policy options; providing technical support, catalyzing change, and building sustainable institutional capacity; and monitoring the health situation and assessing health trends.

WHO’s objective, as set out in its Constitution, is the attainment by all peoples of the highest possible level of health. The Constitution defines health as a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity. The World Health Assembly the supreme decision-making body for WHO meets each year in May in Geneva, and is attended by delegations from all 193 Member States. While the headquarters of WHO are in Geneva, Switzerland, it has six regional offices and 147 country offices in which more than 8000 people from more than 150 countries work.

In addition to medical doctors, public health specialists, scientists and epidemiologists, WHO staff include people trained to manage administrative, financial, and information systems, as well as experts in the fields of health statistics, economics and emergency relief.

To mark the founding of the World Health Organization, a “World Health Day” has been celebrated on the 7th of April annually since 1950. Each year a theme is selected for World Health Day that highlights a priority area of concern for WHO. The celebration is a worldwide opportunity to focus on key public health issues that affect the international community. On this day, WHO launches longer-term advocacy programmes that continue well beyond 7 April.

The themes adopted by WHO since 2001 were: mental health, move for health, shape the future of life, road safety, make every mother and child count, working together for health, international health security, protecting health from climate change, and make hospitals safe in emergencies.

World Health Day 2010 focuses on urbanization and health. The theme was selected in recognition of the effect urbanization has on our collective health globally and for us all individually. Some facts on urbanization, released by WHO are: over 3 billion people live in cities; In 2007, the world’s population living in cities surpassed 50 per cent for the first time in history; and by 2030, six out of every 10 people will be city dwellers, rising to seven out of every 10 people by 2050.

With the campaign “1000 cities 1000 lives”, WHO has given a call for a global movement to make cities healthier. Events are being organized worldwide calling on cities to open up streets for health activities. Stories of urban health champions are being gathered to illustrate what people are doing to improve health in their cities.

The global goal of the campaign is to open up public spaces to health, whether it be activities in parks, town hall meetings, clean-up campaigns, or closing off portions of streets to motorized vehicles in 1000 cities. Another goal is to collect 1000 stories of urban health champions who have taken action and had a significant impact on health in their cities.

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What makes an organization ‘healthy’?

In this episode of the McKinsey Podcast , Simon London speaks with McKinsey partners Rajesh Krishnan and Brooke Weddle about the ins and outs of organizational health .

Podcast transcript

Simon London: Hello, and welcome to this episode of the McKinsey Podcast , with me, Simon London. Today we’re going to be talking about health—organizational health. But before you reach for your yoga mat, no, this isn’t about health and wellness. Instead, we’ll be talking about organizations that are healthy in the sense of being high functioning and high performing over the long term .

The concept is based on 15 years of research into the management practices of enduring, successful organizations. To understand more, I spoke with Brooke Weddle and Rajesh Krishnan, McKinsey partners who spend a lot of time with clients working to improve their performance by focusing on their health. So, Brooke and Rajesh, welcome to the podcast.

Brooke Weddle: Great to be here, Simon.

Rajesh Krishnan: Likewise, Simon. Thank you for giving us the opportunity to do this.

Simon London: Brooke, when I hear the words “organizational health,” the first thing that comes to mind for me is Zumba classes and fitness trackers. But that’s not what we’re going to be talking about, right?

Brooke Weddle: No. It’s not. But I think the metaphor, in some ways, helps. Organizational health is about the way in which you run your organization to effectively deliver against your performance goals, much as you would with physical health. You want to have an exercise regime that allows you to achieve a level of mental and physical health to be able to deliver against your own ambition levels as an individual. Organizations need to do the same thing.

There’s a technical definition associated with this as well. We like to say that organizational health is composed of three things. One is how well the organization aligns around a common strategy. Two, how the strategy then translates down into the work environment—how well the organization executes against its strategy and its ambition. Three is how well it renews itself over time, which basically means two things: one, looking outside, staying in tune with the customer or its clients, and two, having an internal innovation engine so that you can allow those insights to be brought into the organization and turned into something useful in terms of driving innovation and new capabilities.

Simon London: That all sounds very reasonable, but how did we decide that these are the things—alignment, execution, and renewal—that define a healthy organization?

Brooke Weddle: The research dates back over 15 years, Simon. Initially, we were trying to understand what set apart organizations that performed for long periods of time. Many of us have seen the data from the S&P 500 where the tenure of the average company is decreasing.

The idea is that the organizations that lasted focused on what we later called organizational health as much as they did on performance [Exhibit 1]. When you break it down, you see that there are nine outcomes and 37 management practices. Those are the things that organizations do to drive the outcome.

Simon London: I’m feeling a little bit slow today, Brooke. So, just make sure I understand this distinction between outcomes and practices.

Brooke Weddle: Let’s take motivation. What do you do to motivate your employees? You pay them. You give them career opportunities. You reward them, and you recognize them using nonfinancial tools and levers. You want to help them find meaning in their work. We’ve all seen that research. And you need to lead them by being inspirational.

Those are exactly the practices that sit behind the motivation outcome. When we look at those levels of data, we can help an organization understand what the levers are that they’re using to drive motivation. What is working well? What is not working well from an impact standpoint on that outcome?

Simon London: And just to clarify, the data about practices that companies are using and whether people are indeed motivated, aligned, and so on: How do we get it?

Brooke Weddle: Well, it’s actually quite simple. We ask employees. So, all of our organizational health data comes from the tool, the Organizational Health Index  [OHI]. It’s a survey that we generally deploy to the entire organization. We ask for their views and perspectives on the nine outcomes that we talked about and the 37 management practices.

We have over six million respondents in the database. I think we’re up to two thousand companies that have deployed the OHI—25 percent of the Fortune 500. We like to say that when you add it all up, we have a billion data points on organizational health. The interesting thing about doing it in this way is that, of course, you hear directly from employees, and that’s important. But the other things that you see through the data are differences.

One that frequently comes up is that leaders in the company have a very biased view of their organization’s health. They have an overly positive view of it. We’ve been in many eye-opening conversations with leadership teams where we show them the difference in perception between the front line and the leadership team. It’s a real moment of clarity, looking at how people are seeing the way in which the place is run, compared to the way you see it, and the blind spots that that suggests.

Simon London: And then, of course, you can link the health goals back to performance metrics, which is where the rubber hits the road.

Brooke Weddle: That’s right. We have research that looks at outcome measures that are related to total returns to shareholders to productivity measures in a call center and even to patient-error rates in a hospital. We’re able to look at a diverse set of performance outcomes and link that back to organizational health in terms of positive correlations.

Simon London: Rajesh, let me bring you in here. I know a lot of your work is with organizations going through performance transformations. Just to play devil’s advocate: Why are you interested in all this soft stuff about management practices and behaviors?

Rajesh Krishnan: It is definitely the behaviors. But I wouldn’t characterize it as soft stuff. When we talk about transformations , we’re talking about dramatic change in the performance of that organization, which means that the organization is underperforming right now. Something needs to materially change so that it can do better—better margins, better revenues, whatever the metric might be. They’re unlikely to do that unless they fundamentally look at what’s not working today and changing the way that’s done.

Ripping costs out, for example, is not a transformation. If you go in somewhere, you can always find things you can stop buying, but you haven’t fundamentally changed the issue that got that company to underperform in the first place.

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Looking at the company holistically, running the OHI, which is our instrument to measure health, we understand the behaviors that are getting people in that organization stuck in the first place. We then figure out why that’s happening and fix them. This is a commitment you have to make if you want to transform.

When you run the OHI, you might find out, for example, that there’s poor consequence management. That people often sign up for goals and targets, but they miss them, and when they miss them, they’re not held accountable. Well, if that behavior persists—even if you choose to set a transformation and you have a big aspiration—chances are, people will continue to fail. As a result, you will never get out of the hole you’re in.

We think the key is being holistic. Looking at performance: Where do we think there are opportunities, whether from a sales standpoint, an operations standpoint, or a function standpoint? And then looking at health in performance: What is a behavior we need to emphasize and reinforce? We think these two together give you an answer that’ll allow you to get to the end state that you want as a company or as an institution.

The ‘recipes’ for strengthening organizational health

Simon London: This sounds mighty complicated. I think Brooke mentioned earlier that there are, what, 37 different management practices underpinning the OHI? I mean, surely, in any context, that’s too many for managers to hold in their heads.

Rajesh Krishnan: We don’t recommend that people focus on 37. In fact, we know that if you try focusing on all 37, you will fail. What is important to understand is that when you look at your team, or when you look at your unit, as a manager, you want to get a sense of what’s not working well, or as well as you would like it to, and what is important for your success.

And then we would recommend that you prioritize a manageable set of behaviors that will help you go after the performance improvement that you want to unlock. For the transformation contexts that I serve, that number is typically around eight to 12 things, because these are companies or organizations that are looking to drive a material performance gain. For them to do that, there are a number of things they need to change about the way they run their places.

On the other hand, there are some organizations that are quite well run. Maybe it’s just a handful, three to five things, that they want to focus on. So, just like when you go to the doctor, there might be a couple of things that look out of whack, and you might want to focus on those and make sure they are under control. This is a true diagnostic. It helps identify the areas of opportunity. Then you should prioritize them, and that becomes the right thing for you to focus on.

Brooke Weddle: To build on what Rajesh is saying, we use a concept called the “recipes” to help organizations prioritize the management practices that they’re going to focus on, knowing that they shouldn’t focus on all 37. The way that we develop the recipes is that we say that it’s not good enough to have the perspective that all 37 management practices are created equal. We should look at the data and see what the topperforming companies in our database, from a health perspective, are doing when it comes to prioritizing these different practices.

When we did a cluster analysis, there were four recipes that emerged. We’ve done this twice now. The recipes have remained the same in terms of the general clustering. The four recipes are “Leadership Factory,” “Market Shaper,” “Execution Edge”—or “Continuous Improvement Engine”—and “Talent/Knowledge Core” [Exhibit 2].

Simon London: And just to clarify, each of these recipes describes a kind of management philosophy or an archetype, right? A bundle of different practices.

Brooke Weddle: That’s right. Leadership Factory would be about deriving a competitive advantage from building a strong leadership advantage. When you look at iconic companies that are doing this, you see them overinvesting in leadership development—in talent programs that put leaders in stretch opportunities and stretch roles—to try to enable that development to happen more quickly, and deriving a competitive advantage.

For Market Shaper, you see companies that have an outsize emphasis on shaping the market, shaping customer preferences, and building goods and services to meet those needs—and even creating goods and services not only to meet a need but also to actually create something that customers didn’t even know they needed in the first place.

Third, the Execution Edge is a group of companies deriving competitive advantage from getting better every day. This is where you would see some of the classic lean principles playing out. The heart of the Execution Edge recipe is the group of management practices that focus on innovation—bottom-up innovation, top-down innovation—and leverage the full power of the workforce. You see employee involvement, you see performance transparency—holding people accountable in visible ways.

Finally, you have Talent/Knowledge Core. That’s the only recipe that emerges more as an industry-specific type. Here you would find companies that are involved in professional services, R&D. In some cases, you see some of the sciences show up here. Innovation.

The companies here are focused on getting the best talent and expertise and cultivating that in ways that allow them to stay ahead of the competition. Giving people great career opportunities. Of course, paying them very well, in some cases. Rewarding and recognizing them. And ensuring that their recruiting engines are always best in class.

Simon London: Rajesh, just to bring us home, maybe give us a concrete example. What are the kind of management practices that underpin one of these recipes? Pick any one you like.

Rajesh Krishnan: Let’s say you’re a manufacturing organization and you have picked the Execution Edge, or the Continuous Improvement Engine, recipe. The practice that is probably the most important to that recipe is performance transparency, which is, very simply put, how to make results in an individual, in a unit, easily accessible and widely available for people to look at, with the belief that if that information is made available, good things happen.

Let’s say you’re a manufacturing plant and your yields are low. You’re not producing as many units as you would like. Providing performance transparency in that instance, taking the time to say, “Let’s have a dashboard that shows—for every single line that we have in this plant—how many units we are producing and how many units have quality defects, or whatever the metric is. And let’s just make that available across all the different teams that we have.”

What tends to happen in those situations, instantly, is everyone always anchors on who’s at the top and if it is possible for them to get from where they are to where they can be, because you made these results accessible. If that line can operate at 96 percent utilization, why are you operating at 72 percent utilization? People try and understand. They’re motivated to do better. But they also understand, perhaps, what is allowing that line to operate at its best. And they make changes to their maintenance schedules. They bring in more knowledgeable people to fix things. And it gets better.

Similarly, let’s say you’re a sales manager who has to sell the products of this plant. And you have a number of salespeople, and your margins have been declining, even though your sales have remained flat. Providing transparency, not just on revenues but also on margins generated by salespeople, often helps, because salespeople tend to be a competitive bunch.

The performance transparency you’re providing here is not a culture exercise that’s happening on the side. It is a management behavior that allows us to get better by learning what the other person is doing, and just knowing where to aspire to. That’s why we don’t think these things are separate or that health often is at the detriment of near-term performance. If anything, it is used to accelerate and provide performance gains when used in the right way.

Simon London: Presumably, when you open this conversation with clients, most management teams have a fairly clear idea of the recipe or the management philosophy that they’re pursuing. And, therefore, the management practices that they should be prioritizing.

Brooke Weddle: A lot of the companies that Rajesh and I work with actually don’t have at least a common understanding of the recipe or management philosophy that they are pursuing. This causes a lot of cognitive dissonance in the organization about how to run the place: Where should I be spending my time if I have an incremental hour? Should I be on the front line trying to get an hour’s worth of improvement out of the frontline crew there? Or, should I spend an hour of my time investing in and trying to understand the next generation of insights from a customer focus group?

It has significant implications for the alignment around a common way to run the place, when you think about this recipe. But most companies wouldn’t be able to clearly articulate what that is. The organizational-health discussion allows them to have a clearer conversation about that using a common language.

Rajesh Krishnan: You want to constantly—not every year, but every two, three, five years—reevaluate where you are, what recipe you have selected, and what is likely to lead you to success. We think the recipes are useful to get a sense of what sets of behaviors work.

But the recipe, to me as a manager, is not that helpful. What I want to know is, What are the things that my teams think we’re not doing as well as others are? Where is there room for improvement? If, for example, you say there are not enough career opportunities, there are not enough rewards or recognition, or that I’m not being a supportive leader, that’s helpful for me, because I know what behaviors can help overcome that.

If I’m overanchoring on challenging or authoritative leadership, what are the behavior changes that I need to bring in, so that I’m seen as a balanced leader who’s able to get the most out of my team? If there’s a lack of role clarity, it’s clear that I probably need to have discussions with all my team members and make it clear who’s responsible for what and who they need to go to for help.

Once you move the expectations from “let’s follow a recipe for success” to the behavior being the unit at which change occurs, it just makes it tangible. I can get specific actions. If I act, I will improve the health of my team. As the statistics say, when that happens, the performance improves as well.

The importance of organizational health in performance transformations

Simon London: Let’s talk a bit more about companies going through real performance transformations, which was the topic for the article “ The yin and yang of organizational health .” What are some of the considerations in a transformation context in particular? What does the data tell us about what works?

Rajesh Krishnan: When we looked at a set of transformations that we worked on over the past few years, there were four themes that emerged, with eight practices, in particular, that led to material improvements in health and in performance. The four themes were, one, making sure there’s a clear direction for the transformation. What are we trying to achieve? Is there a vision that all of us can rally around? Is there strategic clarity in terms of all the business units, the teams, and everyone knowing what the goals are that we’re going for? What are the milestones? When do we need to accomplish them?

Two, that cascades down to providing clarity and meaning for employees. Does every individual employee know their role in delivering this vision that the company has? Do people feel engaged? Are employees involved in being able to set the direction for themselves? In doing so, do they look for ideas, and do they look for innovations?

Three is about capturing external ideas—looking outside, from your suppliers, from your customers, from other parties that you engage with. Can you bring innovations in that you can try? It is also about encouraging bottom-up innovation, which is asking your front line to think about how they can provide input that changes the way in which work gets done.

Finally, there is making sure there’s a strong performance cadence. The transformations that we undertake have a strong infrastructure that makes sure that you’re operationally disciplined, that you live up to the commitments that you have made, and that you deliver on time and in value. But the theme also includes making sure that that’s supplemented by supportive leadership, so that if there are genuine reasons why we couldn’t perform at the level we wanted to, there is an environment that allows for us to care about the employees’ welfare and that gives them a chance to be able to come back and do better.

These are the four things that we think of, when they come together, that are powerful in having a direction, making sure that there is clarity for the individual, that we have ideas that we bring in to spark the transformation, that we have an infrastructure that allows for us to be disciplined. But at the same time, they allow for support and welfare to be priorities that leadership focuses on.

Brooke Weddle: The research was interesting—because it was interesting to see operationally disciplined leadership side by side with supportive leadership. Those seemed to be, in some ways, not opposite, but working against each other. How can you be a supportive leader but also have a fair amount of discipline?

When we looked at the other practices, we again saw this theme of balance across the two elements. So, yes, strategic clarity. But that’s not enough. You also need to create this more kind of qualitative shared vision. In the case of sparking ideas and innovation, it was about, yes, the bottom-up innovation inside the organization, but the only way to do that well is to look outside and to capture those external ideas.

That’s why we ended up calling the article “yin and yang,” because there was a sense of balance between the two elements. I think that resonated with us in terms of our own personal experience, because even if you go back to the physical-health analogy, you can see that just doing the hard lifting every day would probably not enable you to achieve your health goals. You also have to balance that with stretching, with doing some yoga, with some of the softer elements of exercise. It was interesting the way that that research played out.

Rajesh Krishnan: One of the clients that I served made a strong point to emphasize innovating from within. When it had to design new safety equipment, it went to its front line and said, “Well, what do you need? And can we get your input in making sure that we design the best possible visor for you?”

In terms of capturing external ideas, it was a very siloed organization. It was very insular. There was a “not invented here” syndrome, because at some point in time, it had been the best at what it was doing. But then it completely turned around. For any new hire who joined the organization, it spent a few days to a week trying to understand how stuff happened in the old job. Even if the industry was different. Could those ideas have relevance for how this organization worked?

In one of its Asian markets, it found out that there were ways to manage trade, to access different markets, and to manage the regulatory system. This was immensely helpful for unlocking new ways of doing things. These things combined can become powerful.

Simon London: What I love about that example is that it’s intensely practical. It really answers the question, “What should we be doing differently as a management team today?”

Brooke Weddle: I think the point, linking it back to behaviors, is that the recipes can help you, alongside the transformation practices, in focusing on a short set of management practices to focus on. But from there, it is about basically running workouts. You need to build some new muscles. That’s when behaviors, and frankly the mind-sets that underlie them, come into play.

This is not about just talking at the level of “we need better role clarity.” It’s about understanding: “Well, what’s the mind-set holding us back from not having straightforward conversations about my role versus yours?” Maybe that feels uncomfortable. Maybe there’s an issue around power and me wanting to keep doing this part of the job because I get a lot of recognition for it. Without going and doing that deeper work, you won’t be able to make those behavioral shifts that we know are critical to driving improvements in health.

Simon London: What are some of the dos and don’ts for getting substantive, sustainable improvements in organizational health? What are some of the failure modes? What are some of the things not to do?

Rajesh Krishnan: Probably the most important thing that we’ve found is that you shouldn’t do this on the side. This is not a culture program for a culture’s sake. This is not about trust falls and doing cartwheels and singing “Kumbaya.” This is about “if we look at how we get work done, what do we need to do better?”

You need a top team that is committed to making the change happen. Because, as with everything, role modeling is the single most important thing to do. In general, there are people who don’t know what is being asked of them. Or there are multiple people doing the same thing. It often tends to be because the top team has overlapping responsibilities or has a misunderstanding of who’s actually responsible for what outcome.

Fixing those issues means getting those people to be clear in terms of: Who’s responsible for what? Who do they need to go to for authority? By when do they need to get things done? Who else do they need to get input from? If that role modeling is done by the top, we find that that flows down across all the ranks of the organization. Having the CEO and the top team bought into the types of change that you’re bringing about is important.

Brooke Weddle: I think the common trap here is that when working on organizational health—because it is perceived to be, and in some sense rightly so, a way to change the culture of the organization—it is seen to be an HR topic only. I think Rajesh and I would both say, based on our experiences, that keeping it only in the realm of HR significantly limits the potential of the organization to drive health.

Rajesh mentioned the need to have the top team fully bought in and role modeling the organizational-health behaviors. When it’s seen as something on the side, something driven only by HR, the impact of role modeling is that it doesn’t happen or is that it doesn’t happen as well.

Simon London: On that note, I’m sorry to say we are out of time for today. Brooke and Rajesh, thanks for your patience putting up with a lot of basic questions. It was enlightening and great fun talking to you.

Brooke Weddle: Thanks, Simon. It was a lot of fun to be here.

Rajesh Krishnan: Thanks. We appreciate your questions, and hopefully, we can do this again at some point.

Simon London: Thanks, as always, to you, our listeners, for tuning in. To learn more about organizational health, OHI, and the link between performance and health, please visit McKinsey.com.

Rajesh Krishnan is a partner in McKinsey’s New York office, and Brooke Weddle is a partner in the Washington, DC, office. Simon London, a member of McKinsey Publishing, is based in McKinsey’s Silicon Valley office.

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The Effects of Mental Health Interventions on Labor Market Outcomes in Low- and Middle-Income Countries

Mental health conditions are prevalent but rarely treated in low- and middle-income countries (LMICs). Little is known about how these conditions affect economic participation. This paper shows that treating mental health conditions substantially improves recipients’ capacity to work in these contexts. First, we perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) ever conducted that evaluate treatments for mental ill-health and measure economic outcomes in LMICs. On average, treating common mental disorders like depression with psychotherapy improves an aggregate of labor market outcomes made up of employment, time spent working, capacity to work and job search by 0.16 standard deviations. Treating severe mental disorders, like schizophrenia, improves the aggregate by 0.30 standard deviations, but effects are noisily estimated. Second, we build a new dataset, pooling all available microdata from RCTs using the most common trial design: studies of psychotherapy in LMICs that treated depression and measured days participants were unable to work in the past month. We observe comparable treatment effects on mental health and work outcomes in this sub-sample of highly similar studies. We also show evidence consistent with mental health being the mechanism through which psychotherapy improves work outcomes.

The three authors listed first (Crick Lund, Kate Orkin, and Marc Witte) are jointly the first author. This study was funded by the Wellspring Philanthropic Fund. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

Vikram Patel acknowledges research support from the NIMH, Wellcome Trust, Grand Challenges Canada and the Medical Research Council. He also receives funding from the Lone Star Prize and serves as a consultant to Modern Health and Johnson & Johnson.

MARC RIS BibTeΧ

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