Universal healthcare in our lifetime? All teach, all learn

The United Nation’s Sustainable Development Goals of achieving universal health coverage (UHC) by 2030 have energized many governments to devise bold strategies and make big investments in their health systems. The global movement around UHC has gathered momentum at blistering speed. Within a few years it has transformed the focus of healthcare in low- and middle-income countries from a few diseases to a comprehensive vision of affordable, accessible, and acceptable care for all. In this chapter, Mark Britnell looks at how Philippines, Vietnam, Kenya, India, Indonesia, Columbia, Costa Rica, Panama, Nigeria, South Africa, Cyprus, islands across the Caribbean, and many others have announced significant UHC reforms since the development goals were passed in 2014, and UHC has been a headline issue in a number of national elections. He analyses UHC across the world, and looks to at the future of healthcare globally.

The professions—on top of their game?

In this chapter, Mark Britnell presents a sharp analysis and criticism of current healthcare systems and argues that we need to change how healthcare workers are treated to encourage them to stay and develop within their profession. He points to the recent global OECD survey of students that found that a career in the health profession was ranked first, suggesting that young people want to become healthcare workers but are often deprived of the support they need to do their job. This chapter is about how we realize that potential—through education, training, teamwork, and technology—and harness the best we can from them as individuals and in teams.

Australia—golden soil and wealth for toil

Australia has set a new world record by enjoying 27 consecutive years of economic growth. It is on the right side of the world at just the right time in history, as Asia rises. It consistently ranks highly in the OECD Better Life Index which looks at the level of well-being in society. Indeed, the title of this chapter takes some of the lyrics out of the Australian national anthem, Advance Australia Fair. Its healthcare staff are well paid and looked after and clinical facilities are often good, but Australia’s workforce challenges are shaped by the vastness of its land and the enduring inequalities in health outcomes of its Aboriginal and Torres Strait Islander people. In this chapter, Mark Britnell takes a closer look at the Australian healthcare system and how it affects the country as a whole.

The Netherlands—zorg in de gemeenschap

The Dutch healthcare system is considered by many to be one of the finest in the world because of its pioneering provision and decent level of funding. ‘Zorg in de gemeenschap’ or ‘care in the community’ is a both a distinguishing and defining feature of the Dutch cure and care system. The Dutch spend around 3.7% of their GDP on long-term care, the highest in the OECD, and offer many examples of innovation in caring for older people in the community and at home. Nearly 13% of the population aged over 65 receive care at home, compared with just 4.9% across the OECD. In this chapter, Mark Britnell looks at the Dutch healthcare system; its structure, funding, future, and much else. He points out that a strength of the Dutch healthcare system is the emphasis placed on well-resourced primary care, and looks at how it affects general care.

China—growth and social cohesion

In China, the growth of the middle class, lifting so many from poverty, is enabled by the very same urbanization and industrialization that is affecting the physical and mental health of many. From cancer to diabetes, obesity to cardiovascular disease, the chronic diseases of wealth are rising rapidly in China, while the health system is failing to keep up with people’s soaring demand for quality healthcare. But it should not be forgotten how far China has already come—implementing the world’s largest basic healthcare coverage. In this chapter, Mark Britnell discusses whether it can pick up the pace in terms of the reach and depth of care provision, with many patients still incurring significant out-of-pocket expenses. Looking forward, he also analyses the developments needed in China to provide healthcare for the growing older population.

Israel—start-up nation

In this chapter, Mark Britnell focuses on Israel’s healthcare system, one of the best-kept secrets in healthcare. He looks at how Israel has achieved a primary care-led health system with four health maintenance organizations (HMOs) providing citizens with both choice and comprehensive cover. Primary and community care spend first exceeded that of secondary and acute care 20 years ago, but it has taken time. Its origins can be traced back to 1911 when an orchard worker had his arm severed and 150 immigrant workers joined together to form a mutual aid healthcare organization called Clalit, a non-governmental, non-profit entity. They knew that to help themselves they had to help each other, and Clalit is now the largest HMO in Israel with 14 hospitals and more than 1,200 primary and specialized clinics. The health system of Israel is not perfect but is highly innovative—not least in its use of patient information—and deserves attention.

Conclusion—why some rabbits outrun foxes

In this chapter Mark Britnell brings together his ideas for solving the global workforce shortage in healthcare. He argues for a total reimagination of how we conduct healthcare and construct healthcare systems to avoid the coming global workforce shortage in healthcare that will harm patients, citizens, and societies. He argues for a more innovative, concerted, and collaborative approach to policies and practice. This way productivity will improve in a key section of the economy and national wealth will increase, helping individual prosperity, families, communities, and social cohesion. He is careful to point out that solving the global workforce crisis in healthcare is a complex problem, but that it can be solved.

Brazil—power to the people

Thirty years ago, Brazil’s health system was patchy and elitist, serving mainly the rich or unionized white-collar workers and neglecting the poorest—those living without access even to clean water, sewage, or housing. Today, the country’s Sistema Ùnico de Saúde (SUS) is one of the largest free universal health systems in the world. Conceived of as the country emerged from a brutal 20-year dictatorship and ushered into being by the same political movement that delivered Brazil back its civil democracy, 79% of Brazil’s population now rely solely on the SUS for health services. In this chapter, Mark Britnell takes a closer look at the Brazilian SUS, and PSF, the family health programme, and argues that both of these need to be protected and championed during these difficult times.

The United Kingdom—the age of austerity

In the United Kingdom, the NHS is considered the proudest achievement of modern society and continues to enjoy satisfaction ratings higher than the Royal Family. The NHS and the quality of healthcare is inextricably linked to the British national consciousness and character. Yet the United Kingdom is going through tectonic challenges and changes as we face Brexit and find our new place in the world order. Naturally, this affects the NHS and the people who work for it. While we have four similar yet distinct health systems across England, Scotland, Wales, and Northern Ireland, the rest of this chapter concentrates solely on the English NHS. In this very current chapter, Mark Britnell illustrates the problems that the British healthcare system faces as a result of Brexit. He also looks at the NHS in relation to national identity, economic growth, and quality of care.

Women’s work? Altogether now

Women make up a large and increasing proportion of the global healthcare workforce. As an industry, healthcare seems to welcome more women than most industries, typically ranking alongside sectors such as education and childcare in female participation rates. Nursing and clerical roles within the sector have been predominately female for some time, so much of the recent growth has been driven by a steady rise in the number of female doctors. This worldwide phenomenon, which began in the 1970s, is dubbed the ‘feminization of medicine’. Yet despite such strong female representation in the health workforce there are wide inequalities between men and women within it. In the face of acute workforce shortages, efforts to tackle these issues to attract, engage, and retain female staff will become increasingly important to both employers and governments. This chapter argues that pursuing gender equality in healthcare is a moral necessity to create a prosperous society. It also argues that there is an overwhelming business case for gender equity in the workplace—countries and companies with greater equity are better off for it.