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Healthcare Management

also still far from being adequately controlled. Demographic concentra- tion, global exchanges and deteriora- tion of the environment, are leading to the emergence of new epidemics. Recent epidemics of preventable infectious diseases - including swine flu, SARS and, most of all, HIV - have caused enormous human suffering. They have also heavily burdened our economies and jeopardized social networks and global communication and exchange. There is an urgent need to find new approaches to tackle the origin of novel human infections, to predict the routes of their global spreading, and to improve strategic means of their control. The World Health Organization has to have not only governmental support, but also an increasing for help from the private sector to be able to continu- ously improve the strategies, systems, networks and interventions to detect, assess and control the spread of epidemic and emerging diseases at the global level and to help countries to reach the Millennium Development Goals (MDG). The Millennium Development

Goals have been declared as a mile- stone in international cooperation with the aim of inspiring efforts to improve the lives of billions of people on this globe. But many chal- lenges remain to achieve the MDGs. If the scale of investments in global health is not maintained, worldwide improvements achieved at great cost by the joint efforts of the scientific community, governments, industry and the civil society are at risk. Many diseases may have already been controlled satisfactorily by available measures, provided that adequate financial resources have been made available. Others still cannot be controlled efficiently by available measures and therefore depend on increased research and develop- ment. To improve the supply of avail- able intervention measures, stronger

support for public-private partner- ships, such as GAVI and the Global Fund ATM, is needed. In addition, we need to raise public awareness that better control of poverty-related diseases in the developing countries will also benefit the industrialized countries at several different levels. Developing countries have not only

the burden of these poverty-related diseases but also the rising prevalence rates of non-communicable diseases. Climate change is also likely to have a great range of impact on human health, mostly adverse and primarily in the developing world. These include: increases in heat-related deaths, health effects of floods and droughts, increases in water-related diseases and malnutrition and changes in the distribution of vector and rodent- borne diseases. Societies worldwide need to adapt in order to reduce the projected adverse impact. Strength- ening public health infrastructure is one necessary component of effective approaches to adaptation. Appropriate greenhouse gas reduction strategies and technologies in sectors such as transport, electricity generation, food and agriculture and household energy will themselves have additional and independent effects on health, mostly beneficial. A lower carbon and more

sustainable economy could therefore result in substantial improvements in public health both in developed and developing countries. To improve health conditions

and to reduce existing inequalities, people must have access to the mate- rial resources and social goods neces- sary for a healthy life. Effective social protection, prevention, and healthcare systems are crucial for the security of populations in vulnerable countries. Universal coverage has to be pursued as a means of reducing inequities in access and outcomes. Improved health- care delivery models and governance, financing mechanisms, social empow- erment of patients, access to essen- tial medicines, health information and technologies, the strengthening of the workforce and the adaptation to the local culture are all aspects of the system needing to be addressed in order to make the health system more appropriate to health needs and to reduce inequalities in access. Inno- vation must be focused not only on discovering and developing new drugs or inventing new devices. It must be extended much further to include under-examined areas, such as health information, communication, financ- ing, and especially more efficient delivery models.

These models are urgently needed as we are faced with the challenge of ever increasing healthcare costs. Obstacles with regard to improved efficiency and quality still exist. High prices will often not reflect value while over and misprovision of care also pose substantial challenges. Partly, healthcare is allocated ineffectively and inefficiently based on deficits in professional, organizational and geographical structures, shown by a high level of unexplained variation. The right indicators to measure and improve the productivity and effectivity of health systems need to be found whilst maintaining and improving the qual- ity of services. Actions can be taken at three levels: the system level, the organizational level, and the individual level. Systems of informa- tion, incentives and governance all need to be put in place to ensure organizations, teams and individual practitioners are given the motiva- tion and means to pursue efficiency objectives. In addition, we should never forget the well-known saying: “If you think prevention is expen- sive, try disease!”


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