The degree of general health improvement achieved by public and private health services is not as high as might be desired. Although technical knowledge for achieving better health is available, in most countries this knowledge is not being put to the best advantage of the greatest number. Health resources are allocated mainly to sophisticated medical institutions in urban areas. Rather than better health for the average person, "improvement of health" tends to be equated with the provision of medical care dispensed by growing numbers of specialists, using narrow medical technologies for the benefit of the privileged few. At the same time, access of large segments of the world's population to health services is limited or non-existent; disadvantaged groups throughout the world have no access to any permanent form of health care. These groups probably total four-fifths of the world's population, living mainly in rural areas and urban slums.
In some countries, even though health facilities are located within easy reach, inability to pay or cultural taboos put them out of bounds. To complicate matters, health systems are often devised outside the mainstream of social and economic development, frequently restricting themselves to medical care, although industrialization and deliberate alteration of the environment are creating health problems whose proper control lies far beyond the scope of medical care. Such services operate in an isolated manner, neglecting other factors contributing to human wellbeing such as education, communications, agriculture, social organization, community motivation and involvement. This ignores the fact that health cannot be attained by the health sector alone.
In developing countries in particular, economic development, anti-poverty measures, food production, water, sanitation, housing, environmental protection and education all contribute to health and have the same goal of human development. The pace of technological and economic development requires an intensified release of human energy, placing heightened importance on physical stamina as a precondition. However, although the current diet upon which people exist may appear to be ample, it lacks the nutritional balance to sustain regular participation in a modernized society. In addition, a whole complex of issues such as safe water, refrigeration and basic hygiene remain relatively undeveloped and therefore continues to perpetuate illness that drains vitality. The sheer number of people in the care of one doctor, the remoteness of proper medical facilities and the high cost of treatment prevent early detection of disease; continuation of energy-draining low-grade infections results in either long-lasting or permanently chronic defects. The care of the physical well-being of rural people when called upon to make such efforts at development is a crucial factor that cannot be neglected.
Huge inequalities characterize the current picture of global health. In the Third World, health problems are related to malnutrition, poverty and lack of access to basic needs. Health services in the developing countries have often been based on European or North American models, centering on highly technological, cost-intensive urban hospitals focused on curative rather than preventive health care. Conservative estimates of the annual cost of running a primary health care system give a figure of $12.50 per person per year. However, the current level of expenditure on health care is less than $2 per person in many of the poorest countries. About $50,000 million per year would need to be invested to develop primary health care systems in the developing countries.
In least developed countries, in spite of the high proportion of the population in the vulnerable groups of children and mothers, who are furthermore generally undernourished, public expenditure on health services is very low. The number of physicians per 100,000 population is only about 6, compared to 160 for the developed market-economy countries. The scarce medical personnel and facilities that do exist are concentrated in metropolitan areas, although only a small proportion of thee population lives there, thus exacerbating the already critical situation. A large percentage of public funds for health is spent on high technology and highly visible hospitals where less than 5% of preventable deaths are treated.
In the First World, the health problems of the ageing populations present the greatest challenge. But there is also the growing complexity of the health system and servicing organizations. Whereas scientists have developed highly effective treatments for many diseases, too many people get inadequate, outdated or even unsafe therapy instead because the health care system is a tangled maze. Today, too many patients go from doctor to doctor in search of one who will not make them wait months for a basic exam, much less one who understands and uses cutting-edge therapy. Another deficiency is the poor response time to patients' needs -- especially if they are sick at night or on the weekend.
In the developed countries, the difference between the free-on-demand system typified by the British National Health Service and the fee-for-service system typified by the USA medical care is perhaps best brought out by a comparison of children's consultation rates; children's consultations tend to be more in the nature of preventive medicine than adults. In the USA, children in families in the highest income group are approximately twice as likely to consult a doctor as children in families in the lowest income group. In the UK, the consultation rates for children in all social classes are about the same.
The collapse of the former Soviet Union has unfortunately seen the collapse of the State health system. By all accounts this was adequate, accessible, free and above corruption. The situation since in the NIS countries is much reduced.
Most conventional health care systems are becoming increasingly complex and costly and have doubtful social relevance. They have been distorted by the dictates of medical technology and by the misguided efforts of a medical industry providing medical consumer goods to society. People have become cases without personalities, and contact has been lost between those providing medical care and those receiving it. Even some of the most affluent countries have come to realize the disparity between the high care costs and low health benefits of these systems. Obviously it is out of the question for the developing countries to continue importing them.