Evolution of Health Systems

Health Systems Evolution

The institutions a society creates for dealing with health inevitably reflect the times they are created in. They inevitably evolve over time in response to society’s changing body of scientific and medical knowledge, its accepted approaches to management, the given health challenges at hand, the available technology and resources, the organization and scale of the given society and many other factors. Just as whole societies go through macro-processes of change so to their health systems reflect those changes in organizational paradigm. As people’s health and safety improve, life expectancy increases and lifestyles change so to the demands on the health system change resulting in a need for new approaches and structures within the system.

One of the most effective models for interpreting this macro process of change is the model invented by Abdel Omran in 1971, called the epidemiological transition. The theory of epidemiological transition focuses on the complex changing pattern of health and disease and the interaction between disease patterns. This theory traces the changes in health systems from infectious and parasitic diseases to congenital and degenerative diseases, mapping this to parallel changes in the age structure of mortality, with a corresponding increase in the average age at death.

The first of these stages corresponds to what we might call a premodern society – what Omran called The Age of Pestilence and Famine. Our human ancestors were hunter-gatherers and foragers, a lifestyle partly enabled by a small and dispersed population, however unreliable and seasonal food sources put communities at risk for periods of malnutrition. At this time human population sustains low-growth that was up-and-down due to wars, famine, epidemic outbreaks, as well as periods of abundance. This period can be seen to prevail from prehistory to the mid 18th century where infectious disease was the major cause of death, especially once people started living in close proximity in city-states. Travel and trade between city-states allowed for diseases like the plague to have a devastating effect on the population.

In this paradigm mortality rates are high and fluctuating, preventing sustained long-term population growth, with low and variable life expectancy, somewhere between 20 and 40 years. Its characterized by an increase in infectious diseases, malnutrition and famine. Today, this first phase to health and demographics can be witnessed in many Sub-Saharan African nations where infant mortality is still high and life expectancy typically doesn’t exceed 60 years of age.

Second Phase

The second phase – which may be loosely equated to the emergence of modern science and modern social structures – is called The Age of Receding Pandemics which involves improved nutrition as a product of stable food production along with advances in medicine and the development of formal healthcare systems.  With the Industrial Revolution came improved nutrition sanitation and medical care, this resulted in a massive reduction in the spread of infectious diseases and epidemics.

For example in Western Europe and North America mortality rates were halved during the 1800s due to the development of public water and sewage utilities. At the same time, an overall reduction in malnutrition enabled populations to better resist infectious disease and advances in medicines made many diseases newly curable. For example, one important breakthrough treatment was the discovery of penicillin in the mid 20th century which led to widespread and major declines in death rates from previously serious diseases. Average life expectancy increases steadily over this time, as population growth is sustained and begins to grow rapidly with population growth rates surging in the 1950s, 1960’s and 1970’s – as the world added an extra 2 billion people between 1950 and the 1980s alone.1

Great achievements in healthcare were made over the past 200 years, largely as a function of the development of national healthcare systems. As the nation-state developed to become the social infrastructure of the modern world so too it took on the role of managing the health of its people. As the British social reformer and economist William Beveridge noted “restoration of a sick person to health is a duty of the state.” Throughout the 20th century, large public centralized health systems developed in Europe and the US and then around the world. The British NHS is a good illustration of this expansion of the national health system. In 1948 there were 16,864 GPs in the systems today that is 41,817. Likewise in 1948 the budget was 437 million pounds in 2017/18 110 billion pounds will be spent on day to day running of the NHS. A national health system like the NHS now treats more than 1.4 million patients every 24 hours.2

The third phase in this macro transformation of health systems occurs when a country completes the process of modernization to become a post-industrial society. The developments of modern healthcare and medicines – like antibiotics – drastically reduce infant mortality rates and extends average life expectancy which, coupled with subsequent declines in fertility rates, results in a transition to chronic and degenerative diseases which become more important causes of death. A key indicator of this third stage can be seen in the population’s demographics as birth rates significantly decline from highly positive replacement numbers to stable replacement rates.

This transition may also be connected with the sociological adaptations brought about due to demographic movements to urban areas, and a shift from agriculture and labor based production output to information and service-based economies. Change in culture and norms likewise influence the health system, for example, psychological or emotional factors, where society as a whole changes its rationale and opinion on family size and parental energies are redirected to qualitative aspects of child-raising.

Third Phase

The third phase is strongly associated with degenerative diseases. As of the middle of the 20th century, due to vaccines, antibiotics, and improvement in the social determinants of health we’ve seen an increase in life expectancy and with that we’ve seen an increase in the diseases that are prevalent amongst the elderly, health issues like heart disease, stroke cancer and other chronic diseases. A more sedentary lifestyle together with dietary changes have also contributed to an increase in obesity.

This shift in demographic and disease profiles is currently underway in most developing nations at a fast pace, however every country is unique in its transition based on a myriad of geographical and socio-political factors. The question of how we are going to transition into a world where the demographics and health requirements of societies around the world looks very different is still an open one. .fusion-accordian #accordion-47949-2 .panel-title a .fa-fusion-box{ color: #ffffff;}.fusion-accordian #accordion-47949-2 .panel-title a .fa-fusion-box:before{ font-size: 13px; width: 13px;}.fusion-accordian #accordion-47949-2 .panel-title a{font-size:13px;}.fusion-accordian #accordion-47949-2 .fa-fusion-box { background-color: #333333;border-color: #333333;}.fusion-accordian #accordion-47949-2 .panel-title a:hover, #accordion-47949-2 .fusion-toggle-boxed-mode:hover .panel-title a { color: #1a80b6;}.fusion-accordian #accordion-47949-2 .panel-title .active .fa-fusion-box,.fusion-accordian #accordion-47949-2 .panel-title a:hover .fa-fusion-box { background-color: #1a80b6!important;border-color: #1a80b6!important;}


1. https://goo.gl/MkaVmz

2. https://goo.gl/XRNXdE

Systems Innovation

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