The Governance Report 2019
Faculty leads: Klaus Hurrelmann, Mujaheed Shaikh and Claus Wendt (University of Siegen)
Publisher: Oxford University Press (Published October 2019)
The 2019 edition demonstrates how health governance can support efforts to meet the many social, political, and economic challenges facing modern health systems. Looking at local, national and global levels, the Report explores how health governance, i.e. the means used to achieve collective solutions for the maintenance and promotion of health as a common good, can ensure accountability, reconcile the interests of different institutions and build effective patient-oriented structures.
Contributors: Clare Bambra, Elodie Besnier, Anna Bezruki, Piet Bracke, Terje Andreas Eikemo, Robin Gauld, Ellen M. Immergut, Ilona Kickbusch, Austin Liu, Suerie Moon, Andra Roescu, Björn Rönnerstrand, Hanna Schwander, Christian Traxler, André J. van Rensburg
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The Governance Report 2019 is funded by the Robert Bosch Stiftung GmbH
Issues in focus
Inequalities in health and healthcare
Tremendous progress has been made in recent decades in reducing the global burden of many communicable diseases, resulting in a remarkable rise in global life expectancy. At the same time, the burden of non-communicable diseases has grown, as has the number of years people live in poor health. While inequalities exist between countries, resulting in quite different health system challenges, they persist as well within countries in terms of level of health and access to healthcare. Targeting the social determinants of health, be it access to education, working conditions, or housing, can have as much impact as health-specific policies on reducing inequalities. More accurate and timely measures of population health (as well as enhanced data literacy) are essential to inform health governance.
National and transnational health security
Global health threats must be addressed through global governance mechanisms. Though global health has become one of the most crowded and diverse fields of global activity, governance gaps remain, including weak commitment between crises, inconsistent, often sluggish knowledge-sharing platforms, competing or non-existent financing and accountability mechanisms, and overall lack of coherence. Efforts are needed to enhance country capacity for outbreak preparedness, response, and containment, to promote community participation in these processes, to establish a systematic monitoring and accountability system, to develop an overarching framework for knowledge-sharing and coordination, and to fill gaps in financing and, above all, national and global leadership. This is the minimum required to ensure that the global health system adds up to more than the sum of its parts.
Health policy and politics
Promotion of the population’s health and well-being are important functions of the state and other governance actors. Health governance is highly political, entailing strategic interaction between actors within and outside the governance discourse. A prime example is posed by the emergence of and response to the opioid crisis in the United States, which involved not only politicians and policy-makers, but also corporations, physicians, citizens and patients with competing interests and varying power. Politics aside, health policy merits closer integration in broader social policy-making and particularly in social investment approaches that emphasise human capital development, activation, and social inclusion. Such investment turns the vicious circle linking poverty, poor education, and ill health into a virtuous one linking well-being and social and economic participation.
Patient-centred delivery and receipt of healthcare
Few countries have succeeded in establishing an effective user-oriented and user-centred healthcare structure. The highly complex and fragmented healthcare systems still focus primarily on the people and institutions that provide care rather than on the needs of patients and users. However, the current wave of healthcare reforms is moving in the right direction, shifting from market management in healthcare governance to democratic management and greater emphasis on patient rights, quality of care, and transparency. Furthermore, insights drawn from behavioural economics research offer ideas for appropriate incentives and mechanisms that engage both patients and providers in moving towards successful, patient-oriented delivery and receipt of care. Because they are context-specific, such ideas must, however, be tested, adapted and re-tested to ensure good results.
Digital health holds considerable promise to solve many coordination and delivery challenges—globally through the exchange of timely information in the event of a health crisis, nationally through implementation of electronic health records, and individually through personal health records involving the patient in the care pathway. Digital health also raises important governance dilemmas. Besides patient data protection, ownership, and control, other issues include access to digital technologies, cross-border regulatory concerns, global fit of locally developed digital solutions, and need for expertise to assess and operate technology. A global digital health charter is needed to set standards of ethics, accountability, and audit, among others.
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