health systems & illness systems

In a few days I will mark my one month anniversary as an intern at the World Health Organization in Geneva. I'm still very much on the steep part of the learning curve here in many ways-- from unfamiliarity with the local language (French) to the WHO process to even the content of my work. That's not a bad thing, I like being in places where there's a lot to learn.

The WHO (and Geneva in some respects) looks at problems from 30,000 feet and tries to produce recommendations and guidelines to solve them from that high. At 30,000 feet (where the air is a bit thin and the horizon a bit fuzzy) problems become harder to get your arms around and the interconnectedness of our world really becomes more evident. From up that high, boundaries are difficult to differentiate. And I haven't yet even started my policy course with Dr. Anthony So yet, a man famous for framing and attempting to solve some unbelievably complex global health problems. The course starts next week, and I'll be sure to post about it.

I found myself in consultative group meeting on Monday and Tuesday of this week with representative experts on medical education from around the world. The WHO had convened this group around the issue of health worker education and how disconnected it has become from the health systems in many parts of the world. In other words, we have made a 100 year push to make medical/health education more science-oriented and evidence-based. And in many respects we have succeeded. In the meantime, we may have lost sight of the fact that a lot more than science is needed to actually make people healthy.

One way to look at medical schools is to think of them as factories. They are factories that produce doctors as their product. Once out of the factory, the product then enters a health system where it either wildly succeeds in making people healthier or miserably fails or (more likely) somewhere in between. In this drastically over-simplified view of the health workforce, if the products are malaligned with either the health system or the population's burden of disease, they will not succeed in the big-picture (30,000 feet) goal: making people healthy.

At the crux of this issue, according to this panel of experts, is whether we are training doctors (and health workers in general) to be part of an illness system that is good at fixing illnesses or training them to be part of a health system that is good at keeping people healthy. Very different training is needed for each.

Personally, it seems like we need a balance between the two.

Aaron Stoertz is in the Master of Global Health program at Duke University. He is participating in the Global Health Track of the Duke Program in Global Policy and Governance and is working as a human resources for health intern at the World Health Organization.