In a feature for Now@NEJM, we ask the authors of the Global Health review article series — all with different backgrounds, experiences, and perspectives — the same set of questions.
Answers from Anne Mills, D.H.S.A., Ph.D., of the London School of Hygiene and Tropical Medicine, London
Professor Mills is the author of the February 6, 2014, article, “Health Care Systems in Low- and Middle-Income Countries.”
What do you regard as the most significant triumph in global health within the past decade?
I don’t think it is yet a triumph, but at least there is virtually universal recognition that a health care system exists and is critical for delivering effective preventive and curative health care for the population in low and middle income countries.
Though I don’t think we have done a good enough job of describing what a health care system is and its importance. Anyone growing up in a high-income country appreciates the benefits of a health care system every day. They go to their primary care practitioner; they use their hospitals. They understand the relationship between their hospital and the broader management and regulatory system within which it is located. I struggle to understand how donors in the rich world can be blind to the importance of a health care system in supporting the delivery of specific interventions.
I don’t think we have done a good enough job of describing what a health care system is and its importance.
In the coming decade, which arena of global health do you feel warrants increased attention and awareness?
Of course the health care system! Low- and middle-income countries need to build or strengthen an efficient and effective health care system. We need better knowledge on the best design features for health care systems in differing country contexts. For this we need much greater funding for health system research. This is an important area of scientific enquiry but not yet sufficiently recognised as such.
How can we best harness the revolution in IT to improve health outcomes in the developing world?
IT has a critical role to play in supporting the delivery of health care. It can connect remote practitioners to central sources of advice. It can provide information to patients on how best to manage their condition and it is the basis of management information systems which can help monitor and improve health care delivery.
When American physicians think of global health, many are dissuaded from a global health career because they cannot spend a majority of their time abroad. What are other ways for physicians to contribute to this discipline?
It is critical that global health be “everyone’s business.” To improve health outcomes in the world we need much greater awareness of health disparities across the world, and especially of what can be done to reduce them. Physicians, as highly educated professionals, have a critical role to play in spreading information and encouraging informed debate.