A systems perspective on the importance of global health strategy developments for accomplishing today’s Sustainable Development Goals
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Date
2019-07-30
Journal Title
Journal ISSN
Volume Title
Publisher
Oxford University Press
Abstract
Priority setting within health systems has not led to accountable, fair and sustainable solutions to
improving population health. Providers, users and other stakeholders each have their own health
and service priorities based on selected evidence, own values, expertise and preferences. Based
on a historical account, this article analyses if contemporary health systems are appropriate to optimize
population health within the framework of cross cutting targets of the Sustainable
Development Goals (SDGs). We applied a scoping review approach to identify and review literature
of scientific databases and other programmatic web and library-based documents on historical
and contemporary health systems policies and strategies at the global level. Early literature
supported the 1977 launching of the global target of Health for All by the year 2000. Reviewed literature
was used to provide a historical overview of systems components of global health strategies
through describing the conceptualizations of health determinants, user involvement and
mechanisms of priority setting over time, and analysing the importance of historical developments
on barriers and opportunities to accomplish the SDGs. Definitions, scope and application of health
systems-associated priority setting fluctuated and main health determinants and user influence on
global health systems and priority setting remained limited. In exploring reasons for the identified
lack of SDG-associated health systems and priority setting processes, we discuss issues
of accountability, vested interests, ethics and democratic legitimacy as conditional for future
sustainability of population health. To accomplish the SDGs health systems must engage beyond
their own sector boundary. New approaches to Health in All Policies and One Health may be conducive for scaling up more democratic and inclusive priority setting processes based on
proper process guidelines from successful pilots. Sustainable development depends on population
preferences supported by technical and managerial expertise.
Description
Keywords
Accountability, Democracy, determinants, developing countries, ethics, health systems, organizational change, outcomes, participation, priority setting