Imagining a Justice-Based Health System
April 3, 2020 at 11:35 AM - Views: 9 #297157
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We have seen a lot of countries already ravaged by this pandemic. Some have health care that is at least relatively equitable—at least compared to most countries on earth—such as Italy, and others, like the United States, do not. Are there things that you’re noticing from this pandemic about why it’s so important to build as much equity into the system as possible?
Yes, I am noticing some real differences. What we have here is we have a set of natural experiments unfolding before us, right? You have a very good display of different kinds of approaches to public health domestically. And it’s within the context of a global public-health system, or lack of a system. So, for example, we have the contrast between what we would call two typologies. The first is a more centralized public-health policy that has more of a focus on equity and health, and looking across the population, as opposed to a more decentralized public-health policy.
There are real differences between the two, generally speaking. Centralized public-health policy is more planned. It’s more deliberate. It’s more intentional. There are several steps along the way. Centralized governance and authority tends to be federally located in terms of decisional latitude and authoritative standards with national guidelines and triggers. The decentralized public-health policy tends to be very ad hoc, more patchwork, unscripted. It tends to be spontaneous and reactive, and there tends to be a lot of voluntary actors in the mix. And we’re seeing in general a difference in, for example, the United States approach, which tends to be very decentralized, and countries like Taiwan or Singapore, which tend to be more centralized. Other differences are that under a centralized public-health policy you tend to have more uniform standards and uniformity in policies and practices.
So we had this huge variation in the decentralized standards with respect to testing, for example. In a decentralized approach, we have a lot of variations, considerable disorder, more disarray. It’s a little bit messier. And so these are very different approaches to the way we look at public-health policies at the domestic leve
Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction
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