Healthcare infrastructure is understood as the “nerve center of the public health system.” It encompasses the capacity of a governing system on the issues of disease prevention, health promotion, and the ability to respond to both acute and urgent emergencies. A solid infrastructure is imperative in evaluating health needs and appropriately delivering and improving the public health of a given area. Collectively, public health and various health systems work to achieve a higher standard for global health. Global health is important and impacts everyone, as global health is imperative for global security and the security of individual populations. Without a solid foundation, individual populations are susceptible to weak public health, which can have a domino effect in the greater scheme of global health and endanger the health of others.
Healthcare is a hot-button issue, something that’s incredibly evident in the United States (U.S.) domestic politics; policymakers and concerned citizens often wrangle with conflicting ideas about what constitutes an adequate healthcare system. It is easy to scapegoat some forms of healthcare as socialism, but what is often ignored is the nuanced nature of healthcare systems. One of the primary issues posed to various healthcare systems is disease prevention and vaccination and in the time of anti-vaxxers, disease prevention is of paramount importance when considering public health risks.
One could examine countless cases and healthcare discourses in order to explore and understand the intricate manner in which healthcare systems exist and operate, but some particularly intriguing cases include Sweden, Brazil, the U.S., and Pakistan. These countries not only reflect regional healthcare differences but also highlight different ‘successes’ and ‘failures’ of each respective health system.
Sweden
Sweden’s healthcare system follows a decentralized model, which means that Sweden is broken down into 290 municipalities and 20 city councils. These city councils or other forms of local government are responsible for overseeing healthcare administration. Each city council has the ability to set the tax rates which fund the healthcare system in tandem with patient fees and selling services.
Fortunately, Sweden currently sustains high vaccination rates, with approximately 97 percent of its citizens receiving three doses of two major vaccinations intended to prevent diphtheria, pertussis--also known as whooping cough--and tetanus, as well as measles, mumps, and rubella. While these vaccination rates seem high, there are still issues of individual cases and sporadic outbreaks of these vaccine-preventable diseases. Aside from vaccinations, Sweden has implemented a national standard for disease prevention, with three types of prevention exercises revolving around counseling: brief advice, counseling, and advances counseling.
Sweden is typically revered for its high health standards. Sweden’s 97 percent major vaccination rate is high, and certainly worthy of praise. However, some consider Sweden’s healthcare system weak in their prevention methods, such as counseling. Counseling is seen as a method to mitigate the primary challenge around the world: health literacy. Health literacy is considered to be an adequate understanding of healthcare instruction and one’s ability to protect their health and wellness. While disease prevention counseling is useful, it doesn’t account for patients that are less proactive in relation to health, or for those patients that live in rural areas and face accessibility issues. Sweden can make improvements to their already solid health system by promoting more effective prevention tactics, to prevent outbreaks of preventable diseases. However, the country’s main area of concern, which can be seen in other nations, is addressing the issue of accessibility. Greater accessibility would allow rural populations to receive the same resources that more central locations are afforded. Without a greater awareness for people that live far from cities, nations like Sweden cannot achieve the highest standard of health, which is something all governments should strive for.
While other healthcare systems, like those in Brazil, do not share the same high rates of vaccination, there have been more advances toward increasing these vaccine rates, which benefits the overall population of the nation.
Brazil
Brazil’s healthcare infrastructure accounts for the largest healthcare market in all of Latin America. However, the vast majority of healthcare administration in Brazil is owned by private providers, which leaves most of Brazil with few public options. The public option in Brazil is typically regarded as underfunded and without adequate equipment, which motivates most Brazilian people to gravitate toward the private option. In order to bridge this issue, the public option has been receiving investments from private options. This privatizes healthcare and allows providers to operate regionally.
Brazil, similar to many other countries, also has a mandate within its legal policy that requires citizens to receive specific vaccinations. However, due to their weak public health infrastructure, many of these vaccinations are not easily obtainable. Most individuals must, therefore, seek these vaccinations by a private option. Many regions in Brazil are susceptible to yellow fever, rabies, typhoid fever, dengue fever, malaria, and Chagas Disease. There are also ongoing incidents of measles, mumps, rubella, hepatitis A/B, tetanus, and diphtheria. Some vaccinations, if deemed necessary, are mandated by the Brazilian government and parents that do not get their children vaccinated are susceptible to legal charges. These vaccinations are strongly recommended to tourists, contingent on where they are visiting, as certain areas are more susceptible to transmissible diseases than others. Though the Brazilian government is attempting to enforce these vaccinations, approximately 1 in 5 children in Brazil die from vaccine-preventable diseases. Regarding disease prevention, there has been a push for an increase in testing for HIV/AIDS, which remains as one of the top ten causes of death in Brazil.
Brazil’s strengths can be seen in recent action toward increased testing and prevention measures for HIV/AIDS. Additionally, another strong element of Brazilian healthcare is its government-mandated vaccinations. The Brazilian government has the ability to charge parents who do not vaccinate their children with child abuse, which reaffirms the government’s commitment to disease prevention and eradication. The primary weaknesses of this system are a lack of an adequate of a public option, which leaves many people in Brazil with an inability to access vaccinations that are typically monopolized by the private sector. This reveals the undertone of power dynamics, and how that has contributed toward inequalities in Brazilian healthcare.
Brazil has exemplified a strong implementation of better preventative measures, but the first step toward improvements in Brazil should be increasing health equity. This can be achieved by the Brazilian government promoting and improving public options for health, which would allow more people to access healthcare, rather than by exploring expensive private options that are unlikely to reach rural areas. If healthcare in Brazil were higher on the list of the government’s priorities, Brazil would be able to avoid future public health crises and begin to alleviate the issue of healthcare acting as a means to segregation. Unfortunately, inequality and power dynamics occur in many other health systems, like the United States.
The United States
Currently, the United States operates under a market-based insurance system. This allows for high insurance prices, which leaves many people unable to obtain insurance or face high deductibles that disincentivize people from seeking care. While public options do exist, most resources come from private options, which are either purchased through an independent insurance agency or a benefit through certain jobs. Private options allow these private providers to curate their facilities in specific fashions, such as in specific locations or with specific deductibles.
Approximately 90 percent of children in the United States have received vaccines that are responsible for the prevention of measles, mumps, and rubella, as well as tetanus and diphtheria. The American Academy of Pediatrics has also released guidelines intended to encourage parents to vaccinate their children and prevent sixteen easily preventable diseases. While vaccination methods are effective, there is still a portion of people against vaccinations, which counts for less than 10 percent of the U.S. population. Disease prevention is typically contingent on the primary care provider, but the Center for Disease Control, which is a federal agency under the Department of Health and Human Services tasked with supporting health promotion, prevention/preparedness, and promoting public health, does make a conscious effort to release disease prevention guidelines.
The United States has a strong ability to access vaccines and various technologies that make disease prevention and control feasible, as well as an adequate resource of vaccinations. The primary weakness exemplified in this healthcare system is the evident barriers between healthcare provision that leaves many both uninsured or underinsured. Additionally, free-market systems have the ability to allow private healthcare providers to be more selective about who they serve, and therefore perpetuate racial, gender, socioeconomic and other types of disparities that propagate discrimination in various forms. Similar to Brazil, the United States is responsible for utilizing healthcare as a means of segregation. Many populations are left marginalized by a free-market health system. The first step toward mending the health system in the United States would require limiting the drug lobby that is responsible for price gouging and pigeonholing many Americans into seeing healthcare as a privilege, rather than a right. The next step would be to break up private corporations that are responsible for hospital closures and inadequate healthcare in segregated areas. Overall, the United States has the means to achieve a high standard of healthcare, but the primary issues come from lobbyists that promote keeping prices high, and lowering the quality of care for patients.
While the United States has generally well-developed health mechanisms, other nations like Pakistan face the issue of a shattered health workforce, which weakens the overall infrastructure and inhibits positive growth.
Pakistan
Similar to Brazil, Pakistan has a large private health sector, with a dwindling public health sector. Public options and their regulations are handled by provincial governments, except for certain federally regulated areas. Healthcare is typically handled through disease-specific agencies, in some instances. However, healthcare in Pakistan is not easily accessible for certain regions or groups. Additionally, the healthcare system is becoming increasingly weak due to a shortage of healthcare professionals.
Pakistan has one of the highest mortality rates among children in the world. This can be partially attributed to the vaccination system that has vaccinated between 56-88 percent of children vaccinated, depending on which vaccination. This is the same system that has been unable to eradicate certain diseases, such as polio, Most disease prevention tactics are left to a primary care provider. Therefore, there seems to be a lack of prevention measures taking place within the medical system, in both public and private options. This is likely due to health systems focusing more on increasing accessibility for healthcare in rural areas, promoting a better healthcare workforce, and increasing nutrition information. In order for Pakistan to achieve a stronger health system, Pakistan should prioritize education. By utilizing education as a means, more people will be inclined to be proactive when it comes to their health. This will create a stronger healthcare workforce, which will set the stage for a stronger health infrastructure at large.
Pakistan’s stance on disease-specific agencies is a strength within its healthcare because it allows specialists to care for patients, based on their own specialties. Weaknesses include general disorganization and inconsistencies among the healthcare infrastructure, which has allowed easily preventable diseases to run rampant, a disparity of healthcare workers, and an extreme lack of health literacy.
Concluding Remarks
While each case is vastly different and depends on the goals of governments, the status quo, and access to resources, the common trend of the weaknesses of each system has to do with the power dynamics in each respective nation. This goes to show that as much as various topics within the fabric of international relations and affairs that these topics are often tied to power dynamics that are responsible for the marginalization of certain groups. Therefore, at the global level, it is important to hold organizations that wield an unfair amount of power accountable for their actions. This can include, but is not limited to, private health corporations and policymakers.
Additionally, global health can benefit from strengthening the relationship between health and education. By increasing health literacy, more people will be able to be self-sufficient regarding healthcare, as well as have a greater understanding of the variety of health practices and a stronger sense of prevention and preparedness in the face of various health threats, whether it be the common cold or HIV infections.