Friday, March 9, 2012

How to Transform a Global Health System

The Woman: Paula Johnson, Chief, Division of Women's Health, Brigham and Women's Hospital; Associate Professor of Medicine, Harvard Medical School

The Talk: Women's Health and Health System Reform: The Route to Transformational Development?

The Question: How do we transform a global health system that neglects gender?

As women continue to lag behind men in health and preventative care, the need for a health system transformation could not be greater. Yet, health access for women also requires recognition of the intricate relationship between politics, economics, education and current health systems. Fundamentally, the advancement of women hinges on improving their state of health and similarly, better outcomes for global health call for a gender-focused approach.

Women as mothers, individuals, and citizens

Dr. Johnson started her lecture with an overlooked angle to the question about improving health. As women, who are we and how do our multiple identities factor into global health? As mothers, Johnson says, women’s health needs will be neo-natal and maternal health services. As individuals, girls and women require reproductive and general health education catered to them. Women often act as family caregivers, providing “about 80 percent of the home health care”.

According to Johnson, health care systems must also treat women as citizens, who have risk for different kinds of diseases than men and who disproportionately bear the burden of disease. For example, women have a higher incidence of chronic diseases and a higher likelihood to suffer from anxiety and depression. Upper respiratory illness, often from exposure in kitchen spaces, also impacts more women around the world.

The roles of women and their distinctive health needs reinforce why health care changes must have targeted programs for women. The equity argument set aside, improving health circumstances for women can have a ripple effect. Johnson cites how Turkey and Sri Lanka developed female-focused health programs that may have resulted in higher national income, lower poverty rates, and increased global competitiveness.

Accountability in programs and public discourse

How do we create better health care access for women? Johnson answer: “data”. Policies such as the U.S. Affordable Care Act require a “mechanism to ensure that the policies do what they are supposed to do.” This means collecting data that is aggregated by gender and race, program monitoring with data analysis, and framing debate the about health policies with numbers.

Public discourse and political debate are key to reforms. Yet, at least for the United States, “Political divisions limit the conversation to abortion and contraception, making it extremely difficult to elevate other issues.” Johnson suggests “setting aside advocacy and the ideological arguments” for those based on numbered reasoning. She reminisced about a previous visit to the Kennedy School, where a debate on controversial topics in health took place. Ideology controlled, both sides were asked how they would improve women’s health.

Brooke Davis is a MPP1 at the Harvard Kennedy School and a State Department foreign affairs fellow.

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