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INFRASTRUCTURE


l changes in the epidemiological profile of the population.


Changes in the health/disease/healthcare paradigm that positioned healthcare above the treatment of diseases and care have been driven by two simultaneous processes. In the 1960s and 1970s, in some developed countries, but mainly following the Alma-Ata Conference that shaped the Primary Health Care (PHC) Strategy, healthcare systems began to provide less complex policies and resources. These changes led to a focus on health maintenance rather than disease treatment. Based on the need to restrict the increasing costs and demands of healthcare systems, health maintenance rather that disease treatment began to be considered more cost effective.


Other changes In relation to technological developments that modified healthcare patterns, pharmacology allowed the treatment on an outpatient basis of diseases that previously required hospital admission and decreased illness duration as well as eradicating a number of conditions completely. In terms of medical equipment, new diagnosis and treatment devices provide more effective and less invasive outpatient services. Information technology and communication enable remote communication and real time information to be shared, facilitating diagnosis and treatment. Changes have also been seen in the epidemiological profile of the population. At the beginning of the 20th century in developed countries and towards the end of the same century in under developed countries, such as Argentina, there was an epidemiological transition towards the reduction or disappearance of infecto- contagious diseases and the appearance of degenerative diseases. New pathologies emerged as the result of social and environmental conditions. The increase in life expectancy during the 20th century and the changes in standards of living are closely related to the epidemiological transition that is both the driver and the result. Overall, there was an increase in the number of people living with long term conditions that require treatment as outpatients. As a result of these changes, new types of healthcare building have been introduced, such as facilities for complex rehabilitation, the treatment of


A primary care centre in Buenos Aires.


Alzheimer’s disease and palliative care. Even though admissions to these facilities usually have different characteristics to those of hospitals, they continue to be hospitals and an architectural continuity can be established with the medical institutions of the past. By contrast, the biggest transformation has been in ambulatory healthcare buildings, which only provide short stay facilities for a few hours. They can be low complexity for outpatient treatment (such as health centres, primary healthcare, rehabilitation, dentists) or medium complexity for consultation, diagnosis or treatment (such as medical imaging, outpatient surgery, endoscopy, assisted reproductive treatments, labs and blood tests) or may have more than one of these functions. Small or medium scale facilities are


integrated into the community. For example, the public sector of the province of Buenos Aires had 359 inpatient facilities and 2108 outpatient facilities in 2014 and the public health system of the government of the city of Buenos Aires had 30 inpatient facilities and 59 outpatient facilities in 2017. The number and variety of facilities is likely to increase in the future, which can only mean further evolution in the type of healthcare buildings we see in our cities.


Further reading l Abramson L. Healing our Health Care System. US: New York, Grove Weidenfeld, 1990.


New types of healthcare building have been introduced, such as facilities for complex rehabilitation, the treatment of Alzheimer’s disease and palliative care


IFHE DIGEST 2019


l Carrillo R. Contribuciones al Conocimiento Sanitario. Argentina: Buenos Aires, Eudeba, 1974.


l Carrillo R. Plan Esquemático de Salud Pública, 1952-1958. Argentina: Buenos Aires, Ministry of Health, 1951.


l Conrad P, Schneider J. Professionalization, monopoly and the structure of medical practice. In: The Sociology of Health and Illness: Critical perspectives. US: Nueva, St Martin´s Press, 1990.


l Fleury S, Belmartino B, Baris E. Reshaping Health Care in Latin America: A comparative analysis of health care reform in Argentina, Brazil and Mexico. Canada: Ottawa, International Development Research Centre, 2000.


l Foucault M. (1978) Incorporación del hospital en la tecnología moderna.


l Gofin J, Gofin R, Stimpson J. Community- oriented primary care (COPC) and the affordable care act. An opportunity to meet the demands of an evolving health care system. J Prim Care Community Health 2014.


l Institute for the Future. Health and Health Care 2010: The forecast cast, the challenge. US: San Francisco, Jossey-Bass Publishers, 2010.


l Lock M, Nichter M. New Horizons in Medical Anthropology. Essays in honour of Charles Leslie. UK: London, Routledge, 2002.


IFHE


l PHO Panamerican Health Organization. La Renovación de la Atención Primaria de la Salud en las Américas. US: Washington DC, PHO, 2010.


l Roqué F. Como Prevenir las Enfermedades. Ediciones Prehuma SA. Argentina: Buenos Aires, 2006.


l Rovere M. Atención Primaria de la Salud en Debate. Revista Saúde Debate 2012; 36(94).


l Testa M. Atención ‘primaria o primitiva’ de salud. Pensar en Salud, Lugar Editorial, 1993.


l Weiss L. Medicine and Public Health. US: Colorado, Westview Press, 1997.


l World Health Organization. (1978) Alma-Ata International Conference on Primary Health Care Statement.


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