Public Health 2018: Democratic priority setting in health systems as an ethical imperative for sustainability of population health - Jens Byskov - University of Copenhagen

Introduction: The ever-increasing evidence and technical developments supporting population health have not yet reached the goal of health for all. The decision making for population health has not led to optimally accountable, fair and sustainable solutions. Technical experts, politicians, managers, service providers, community members, and beneficiaries each have their own values, expertise and preferences, to be considered for necessary buy-in and sustainability. Some of these are well recognized and partly addressed, but those not addressed or hidden constitute vested interests that may be the main constraint for achieving population health. The increase of mortal conflict and environmental degradation are the main longer term threat to population health. Can the health sector advise on control of those health determinants? Within the context of the Sustainable Development Goals we aimed to assess and strengthen health systems outcomes and impact on population health and reviewed health systems literature by open web and PubMed searches. Findings: We identified main characteristics of Health Systems developments from their first well documented develop. The One Health approach and Accountability for Reasonableness type of process guidance can lead towards addressing a broader range of health determinants. Global health depends on health of the globe to date. 1. Hospital Services and Hygiene focused Public Health in the 1950´s but coverage was poor 2. Better coverage by extended primary contact level services in the 1960´s 3. Comprehensive health systems WHO technical guidance in 1974  Global health system by Primary Health Care from 1978 based on five principles - Equity, Cross Sector Collaboration, Appropriate Technology, Community Participation, Focus on Prevention 5. Fragmentation into selective primary contact level programs in the late 1980´s Service and intervention efficiency from 1993 based on Disability Adjusted Life Years. 7. Sector wide and uniform global programs being main donor approaches from around 2000 8. Localized developments to include values, ethics and more user inclusive priority setting in early 2000´s. Accountability for Reasonableness conditions of relevance, publicity, appeals and revisions. 9. Provision improvements from about 2010 by Systems Thinking and Universal Health Coverage 10. Sustainable Development Goals by 2016 associated with One Health for humans, animals and the environment and with Health in All Policies.

 Conclusions: Based on findings key themes emerged which need to be addressed for the health sector to optimally support achievement of not only the health targets of SDG three, but also health related targets of other SDGs. They are: Accountability in priority setting, control of vested interests, ethics imperative for population health of similar or higher importance than individual care ethics, and sustainability by applying more democratic mutually committing processes throughout societies and internationally.

Author(s): Jens Byskov

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