My career in healthcare started almost 30 years ago after I left university, where I’d been studying Modern History. It’s an unusual degree with which to embark on the career path I’ve taken but, though I’ve since done a Masters of Management and Health Policy, I still think history has its place. Thinking about where we have been can often provide a great perspective on the current challenges we face.
On his recent visit to the Ko Awatea colloquium, Sir Muir Gray did just that. He reflected on the history of healthcare, specifically three revolutions which have changed and are changing the face of healthcare delivery. The first took place in the middle of the 19th century and made common sense advances in public health such as separating sewage from drinking water, improving housing and food, and immunisation. The second revolution was driven by science and saw a shift to hospitals and hospital-based services such as MRI and CT scanning, antibiotics and hip replacements – all of which extended quality and length of life. In some ways we are now the victims of our own success. These two revolutions saw massive increases in life expectancy, from under 50 at the beginning of the 20th century to now closer to about 80 years.
And now we are in the middle of the third revolution.
While a focus on public health and hospitals remains absolutely necessary, it’s time for some change. The public hospital system was set up in New Zealand in the middle of the Great Depression in 1938. Undoubtedly the environment in which we work, and the challenges which we face, have changed significantly since that time.
The third revolution will encompass how we effectively manage chronic disease in an aging population that will increasingly want to be much more in charge of its own healthcare. Working through this and designing what the future delivery of healthcare will look like is a big challenge. At the moment, the health system is perfectly geared towards high-end, high-cost hospital services when what we also need to be doing is developing primary and community care.
It’s a big task. We have to link public health and disease prevention with the need to upgrade hospital services while also developing community-based, primary care capacity. There’s a lot to consider.
But we also undoubtedly have in front of us a once-in-a-lifetime opportunity – to design what healthcare in future will look like, to have a significant and positive impact on people’s lives and wellbeing, and to design the system that will make the next big advances in health.
Responding to that challenge will require vision and bravery. It’s an opportunity which comes with a great deal of responsibility. But we will be pioneers. I hope you find that potential, and the opportunity to be involved, as exciting as I do.