Abstract
Health systems throughout the world face many challenges. These challenges include the rising prevalence of chronic diseases such as diabetes; a rise in unhealthy behaviours and risk factors for poor health outcomes, such as physical inactivity, calorie-rich diets and obesity; increasing difficulty in maintaining expenditure on health services and funding new, high-cost treatments; maintaining the population's access to healthcare while at the same time curtailing this growth in healthcare spending; and determining the most appropriate balance between primary care and specialist services. 1
Other key areas include making the most effective use of new technology, and addressing issues of patient safety and quality of care. 2 Added to these challenges, in many countries and in Europe in particular, is the impact that financial austerity is now having on health services. 3 In countries such as Spain and Greece, we are now seeing major cutbacks in health and social care services. Elsewhere in the world, expectations of prosperity and political reforms go hand in hand with a desire for better public services. In many Arab countries, for example, we are now seeing public expectations of increased political freedoms and greater economic prosperity, as well as a desire for improved access to health, education and social care services. In low-income countries, such as much of sub-Saharan Africa, poverty, weak health systems, neglected tropical diseases and a rising burden of chronic diseases, all contribute to poor health outcomes and high rates of premature mortality.
A new series of health policy reviews in the JRSM will report on these issues and how health systems are aiming to address key health policy challenges. Traditionally, research and debate in these areas has been very nation-specific, with relatively few attempts to carry out cross-national studies. However, if many of the challenges faced by healthcare systems are similar, then it is likely that countries can draw upon each other's experiences in developing methods of dealing with these challenges.
The first review in this series discusses the role of non-medical community health workers in improving access to care. 4 The use of such workers is seen as one way of improving access to health services in a cost-effective manner. Another review will discuss the state of health research and development in the World Health Organization Eastern Mediterranean Region. This is a region that is currently going through considerable political change and where – because of the strategic importance of the region – the results of these changes will have an impact on many other countries. Future articles will discuss the feasibility of defining ‘ambulatory care sensitive conditions’ that can act as markers of high-quality delivery of primary care services, and initiatives to limit the harms caused by excessive alcohol consumption.
Although some of the early articles will focus on the challenges facing England's National Health Service, in future articles, the range of topics and also of countries and regions covered will increase. The aim will be to cover important areas of health policy and provide evidence that clinicians, managers and policy-makers can use in helping them to meet the many challenges that the health systems they work in are currently facing. Articles will generally have authors from at least two different countries to ensure that their lessons are widely applicable and not overly focused on one particular country. Ideas for articles for the series and potential authors are welcome and can be sent to either the Editor of the JRSM or to Azeem Majeed at Imperial College.
DECLARATIONS
Competing interests
None declared
Funding
AM's academic post is funded by the Higher Education Funding Council for England. No separate funding was received for this article
Ethical approval
Written informed consent to publish the article was obtained from the patient or next of kin
Guarantor
AM
Contributorship
AM and KA jointly conceived the content of this article
Acknowledgements
The Department of Primary Care & Public Health at Imperial College London is grateful for support from the NIHR Collaboration for Leadership in Applied Health Research & Care (CLAHRC) Scheme, the NIHR Biomedical Research Centre scheme, and the Imperial Centre for Patient Safety and Service Quality