Are we part of a global community?
The United States policy community is well known for its almost allergic reaction to considering any lessons from other countries to improve health policy or care delivery. American exceptionalism is alive and well: just ask any policy advisor or Washington insider and they will roll their eyes and caution against any mention of "those" countries where they have "socialized" medicine. Clearly these well-tread tropes are present in our public discourse. Yet, the United States could stand a little humility and openness - after all, we live shorter lives in poorer health compared to other OECD countries. And, as Betsy Bradley has pointed out in her book, The American Health Care Paradox: Why Spending More Is Getting Us Less, when you add up what we and other countries spend on health and social services, it is fairly comparable—we just spend more of it on health care and they spend it on social services.
In my opinion, this insular approach has always been short sighted, but I think it is particularly wrong-headed now, as countries across the globe are grappling with similar issues: how to provide insurance coverage at a sustainable cost, address the burden of chronic disease, build systems of care that can not only deliver reliable, high quality care but also respond to crises such as the Ebola epidemic, and test new workforce models-such as community health workers and task shifting-to deliver more responsive, efficient care. These were all topics at the recent 3rd Global Symposium on Health Systems Research, held in Cape Town, South Africa and sponsored by the now two year old organization Health Systems Global, the first international membership organization fully dedicated to promoting health systems research and knowledge translation. The key themes of the conference are summarized here.
AcademyHealth participated in this conference as part of our efforts to engage more actively in the global health services research community. Over the last few years, the global community has focused far more on building capacity for research to improve health systems (it was the focus of the 2013 WHO report) and this emphasis was evident in Cape Town. There were many sessions on innovative approaches to translating research into policy and practice and a Cape Town statement on implementation research and delivery science was released. This statement was developed by the participants of a series of consultative meetings hosted by the Alliance for Health Policy and Systems Research within the World Health Organization, the United States Agency for International Development (USAID), and the World Bank Group, with the facilitation of the USAID|TRAction Project and Johns Hopkins University. (I participated in one of the meetings last spring.)
Fundamentally, I believe that we have much to learn and much to share with our colleagues in other nations and that our work and our impact will be enhanced by global engagement. Many AcademyHealth members are already active internationally (Vince Mor, Steve Shortell, Ashish Jha to name just a few), but organizationally we have had only an intermittent focus on global engagement. AcademyHealth has sponsored study tours for our members, the most recent of which occurred after the Global Symposium in South Africa and was co-sponsored with the American Public Health Association. We have had invited panels or adjunct meetings at the Annual Research Meeting. And, our methods listserve (the Methods Minute) has 50 percent of its subscribers outside the United States. So in 2013, we established a new International Advisory Board and a new organizational member level for non-U.S. based organizations engaged in HSR. Our strategy is to partner with our sister organizations in other countries to share resources and identify specific topic areas where members in the United States and other countries are active and would benefit from dialogue.
We welcome your suggestions and ideas as we move ahead with our global engagement strategy!