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Alma-Ata, at last
International Affairs Alma-Ata, at Last
T
HE US HEALTH CARE SYSTEM has long been considered an exemplary model for providing highquality health care that relies on the development and application of expensive technology in the treatment of disease and illness. At the same time, this system has been described as one based on inequity. It pays for health care for the poor, the most needy, and those with employerprovided health insurance, but not for those with jobs that do not provide insurance. Most countries around the world have not had the resources to emulate the high-cost US model. Therefore, most have made the provision of basic primary health care services to all citizens the priority. Now we find ourselves in a massive debate about our future health care system, and almost overnight, the language of health care has changed. Terms and phrases Such as primary health care, community-based care, and individual and community responsibility for health care, are fast becoming commonplace. The need no longer exists to defend nurse practitioner and nurse midwifery programs--they are in high demand as are family medicine physicians. It is as if we suddenly have undergone a consciousness-raising experience after years of denial and adherence to the status quo. Those who have worked in and studied international health can finally be honest. For some time, US nurse educators and consultants have exported expertise in nursing curricula and models to other countries, emphasizing acute care in hospital settings, which was what we knew best. In many US schools of nursing, undergraduate community health courses were a small part of the curriculum. Primary health care was seldom mentioned, much less defined. Community health nursing graduate programs were small in number. When visiting international scholars asked to see our primary health care programs, we dashed around to find one. When we visited other countries as consultants, we often felt we were there to learn about primary health care rather than to share the expertise gained in our own educational settings and institutions. So what are we going to say to our international nursing colleagues when they ask what's new in health care? I hope we will answer that community-based primary health care is now a priority. We will explain that this means universal immunizations for children; basic prenatal care; well child care regardless of ability to pay; long-term care for the
MARY V. FENTON, RN, DRPH Dean and Professor The University of Texas School of Nursing at Galveston i I00 Mechanic Galveston, TX 77555-1029 Copyright © 1994 by W.B. Saunders Company 8755-7223/94/1001-0002 $03.00/0
4
elderly; surveillance and prevention of infectious diseases; basic sanitation; clean water and air; adequate housing; health promotion and prevention programs; and education for women. Hopefully, we will describe a system that guarantees universal access, that will not cancel insurance policies or raise premiums because of illness, that will accept both the healthy and the sick, that cannot refuse to cover pre-existing illness, and that will assure health benefits even when jobs change or are lost, all of which are common components of most health care systems around the world. Why has the United States come so late to this concept? Almost 15 years have passed since the World Health Organization issued the declaration in Alma-Ata challenging the world to meet the goal of Health for All Through Primary Health Care by the Year 2000. Two questions should be posed to our leadership in congress, in the executive branch, in state and local government, in nursing, and in medicine. First, what is the effect of this delay in embracing such a reasonable strategy? And second, what is the cost to our economy and our quality of life of not providing basic health care for all citizens? The signs indicate that our health care system is going to change dramatically, and those affected most will be nurses, physicians, and other health care providers. Many will not only change priorities, specialties, and practice areas, but they also will have to prove that what they do leads to a cost-effective, safe, and positive outcome. We will need to study other health care systems that use far fewer resources for the same outcome achieved in the United States. We will need to collaborate with our international nursing colleagues more than ever, if we are to understand basic primary health care and how to teach our students and ensure that they make an even greater impact on the health of communities. One positive outcome that may develop is that nurses who have struggled to promote primary health care in their countries will have a greater nursing audience in the United States. They will have more opportunities to influence US community-based primary care nursing models, thereby achieving more credibility for their own models and, in some situations, greater acceptance in their own countries. There will be more opportunities to share research across countries and cultures. Consultation opportunities will truly become two-way collaborations. I believe that health care reform will turn out to be a reflection of a paradigm shift: we will accept the fact that a healthy population and increased quality of life are prerequisites for a healthy economy and a strong nation. We are entering a time of tremendous relearning and rethinking about new ways of providing health care. More than ever before, we share the global view of primary health care with our international nursing colleagues.
Journal of Professional Nursing, Vol 10, N o 1 (January-February), 1994: p 4
T
HE US HEALTH CARE SYSTEM has long been considered an exemplary model for providing highquality health care that relies on the development and application of expensive technology in the treatment of disease and illness. At the same time, this system has been described as one based on inequity. It pays for health care for the poor, the most needy, and those with employerprovided health insurance, but not for those with jobs that do not provide insurance. Most countries around the world have not had the resources to emulate the high-cost US model. Therefore, most have made the provision of basic primary health care services to all citizens the priority. Now we find ourselves in a massive debate about our future health care system, and almost overnight, the language of health care has changed. Terms and phrases Such as primary health care, community-based care, and individual and community responsibility for health care, are fast becoming commonplace. The need no longer exists to defend nurse practitioner and nurse midwifery programs--they are in high demand as are family medicine physicians. It is as if we suddenly have undergone a consciousness-raising experience after years of denial and adherence to the status quo. Those who have worked in and studied international health can finally be honest. For some time, US nurse educators and consultants have exported expertise in nursing curricula and models to other countries, emphasizing acute care in hospital settings, which was what we knew best. In many US schools of nursing, undergraduate community health courses were a small part of the curriculum. Primary health care was seldom mentioned, much less defined. Community health nursing graduate programs were small in number. When visiting international scholars asked to see our primary health care programs, we dashed around to find one. When we visited other countries as consultants, we often felt we were there to learn about primary health care rather than to share the expertise gained in our own educational settings and institutions. So what are we going to say to our international nursing colleagues when they ask what's new in health care? I hope we will answer that community-based primary health care is now a priority. We will explain that this means universal immunizations for children; basic prenatal care; well child care regardless of ability to pay; long-term care for the
MARY V. FENTON, RN, DRPH Dean and Professor The University of Texas School of Nursing at Galveston i I00 Mechanic Galveston, TX 77555-1029 Copyright © 1994 by W.B. Saunders Company 8755-7223/94/1001-0002 $03.00/0
4
elderly; surveillance and prevention of infectious diseases; basic sanitation; clean water and air; adequate housing; health promotion and prevention programs; and education for women. Hopefully, we will describe a system that guarantees universal access, that will not cancel insurance policies or raise premiums because of illness, that will accept both the healthy and the sick, that cannot refuse to cover pre-existing illness, and that will assure health benefits even when jobs change or are lost, all of which are common components of most health care systems around the world. Why has the United States come so late to this concept? Almost 15 years have passed since the World Health Organization issued the declaration in Alma-Ata challenging the world to meet the goal of Health for All Through Primary Health Care by the Year 2000. Two questions should be posed to our leadership in congress, in the executive branch, in state and local government, in nursing, and in medicine. First, what is the effect of this delay in embracing such a reasonable strategy? And second, what is the cost to our economy and our quality of life of not providing basic health care for all citizens? The signs indicate that our health care system is going to change dramatically, and those affected most will be nurses, physicians, and other health care providers. Many will not only change priorities, specialties, and practice areas, but they also will have to prove that what they do leads to a cost-effective, safe, and positive outcome. We will need to study other health care systems that use far fewer resources for the same outcome achieved in the United States. We will need to collaborate with our international nursing colleagues more than ever, if we are to understand basic primary health care and how to teach our students and ensure that they make an even greater impact on the health of communities. One positive outcome that may develop is that nurses who have struggled to promote primary health care in their countries will have a greater nursing audience in the United States. They will have more opportunities to influence US community-based primary care nursing models, thereby achieving more credibility for their own models and, in some situations, greater acceptance in their own countries. There will be more opportunities to share research across countries and cultures. Consultation opportunities will truly become two-way collaborations. I believe that health care reform will turn out to be a reflection of a paradigm shift: we will accept the fact that a healthy population and increased quality of life are prerequisites for a healthy economy and a strong nation. We are entering a time of tremendous relearning and rethinking about new ways of providing health care. More than ever before, we share the global view of primary health care with our international nursing colleagues.
Journal of Professional Nursing, Vol 10, N o 1 (January-February), 1994: p 4