Can Health Systems Adapt to Global Demographic Changes?

Last week I had the privilege of attending the Global Health Council’s 38^th Annual Conference in Washington, D.C. The conference focused on global demographic changes, which naturally result in a shift in the burden of disease as populations grow older. The key acronym of the week was “NCD,” or non-communicable diseases. As someone who has spent most of his professional life exploring ways to scale up proven interventions to fight infectious diseases in children (some of which are known as “NTDs,” or neglected tropical diseases), my first reaction was that the focus on NCDs would polarize the conference participants – NCDs vs. NTDs. One of my primary concerns was related to the scarce resources for global health and the concern that a focus on NCDs would divert resources – both human and financial – away from infectious diseases. In addition, I assumed that resources for NCDs would go to those who were living longer and more financially secure, which would overlook the poorest and most marginalized populations.
Recognizing the tension between the NCDs and NTDs, one of the conference co-chairs, Dr. Felicia Knaul (Director of the Harvard Global Equity Initiative), redefined the “NCD” acronym to represent the changing burden of disease by referring to “new challenge diseases.” Instead of focusing on the difference between communicable and non-communicable diseases, Dr. Knaul and the other co-chairs urged us to consider common obstacles and solutions that we all face. In particular, one problem that everyone encounters, regardless of the disease, is equitable access to healthcare. Those who are most marginalized have limited access to life-saving treatment and often die from preventable causes. This is true for both communicable and non-communicable diseases. For example, a child who is suffering from acute lymphoblastic leukemia has the same right to healthcare as a child who is suffering from acute diarrhea. Although the type of treatment may be very different, we should not evaluate a child’s right to quality healthcare based on the type illness. There is a need to strengthen health systems to provide quality, affordable, accessible healthcare that benefits all people who are suffering from all types of diseases. However, this will not happen by chance. Equity must be intentional. This is especially true when there are limited resources to address these new challenge diseases without neglecting the existing diseases that cause thousands of preventable deaths every day. We live in a world where the burden of disease is constantly changing and health systems are expected to adapt to these changes. In order to move towards a comprehensive, adaptable approach to health systems strengthening, we need to consider all health system components, processes, and relationships simultaneously and not as disaggregated parts. Although the solutions will be complex, they cannot be ignored.
How does this all apply to sustainable human development? As we consider the sustainability of health systems strengthening interventions, we must consider the fact that health systems, and the populations they serve, are not static. As populations change -- demographically, epidemiologically, and economically -- health systems must be positioned to adapt to the changing health needs of the population in a way that is equitable. This includes the health services provided at the facility-level as well as the household-level. Therefore, adaptive responses by the health facility must be matched by an equivalent response by the community so that treatment and prevention are accessible to all. This will certainly look different as countries go through demographic and epidemiological transitions at different points in time.
--Will