As we look around us in the second decade of the 21st century, what do we see when we look at the performance of national healthcare systems? Are the rich, industrialised nations using their money wisely to yield populations of vibrantly healthy citizens, whose glowing vitality is enabled and supported by rational, easily accessible healthcare systems? Have the technological marvels of medical science been safely and sensibly employed in the pursuit of widespread good health, yet tempered by a medical profession that is sensitive to the varying needs and background of each individual and is empathetic in its approach?

Tragically, the answer to all of these questions is a resounding “No” – and not by a long shot. In this week’s ANH-Intl Feature, we present what we see as the most pressing problems facing modern, universal-access healthcare systems, such as the UK’s National Health Service (NHS). Although the problems are numerous and complex, it goes without saying that the problems need to be identified first before they can be solved.  Additionally, we believe that a few simple steps would go an enormous way toward changing these systems for the better. Accordingly, the second part of the article consists of ideas and initiatives aimed at creating better, more inclusive, more efficient and more sustainable healthcare systems.  All of these ideas are the subject of active, collaborative efforts by ANH to bring them to fruition.

Please use our comments section below, or email us at [email protected], if you’d like to give us feedback. We’d especially like to hear from you if you are aware of, or responsible for, other activities that might help to get our healthcare systems on a more sustainable track.

Problems with national healthcare systems

1. The existing, mainstream health care system is broken and a health care crisis of unimaginable proportions is in the making. Key drivers for this impending crisis are the current epidemics of chronic, degenerative diseases, the high incidence of depression, anxiety and other psychological and emotional conditions – conditions that many perceive to be becoming ever more prevalent  – the lack of effectiveness of many treatments offered and an ageing population
2. Chronic diseases, namely cancer, heart disease, diabetes and chronic respiratory disease, represent an enormous societal burden both in Europe and worldwide, yet cure and prevention rates for many diseases are shockingly low
3. These diseases are viewed by the World Health Organization and other health authorities as ‘largely preventable’ and ‘related largely to inappropriate diets and lifestyles’
4. The services offered by national healthcare programmes, such as the UK’s National Health Service, aim to be largely curative rather than preventative
5. Relatively, very little effort and resources are expended by the medical establishment on disease prevention
6. Health management as taught in medical schools focuses primarily on pharmaceutical interventions of diseases, so that qualified doctors become largely dependent on prescribing drugs
7. Most consultations between a patient and their primary healthcare provider average 10 minutes or less, 50% of which time may be spent in silence by both doctor and patient while the doctor interacts with his or her computer.  Most consultations also result in drug prescription
8. As recognised by the World Health Organization, there is, “An inherent conflict of interest between the legitimate business goals of manufacturers and the social, medical and economic needs of providers and the public to select and use drugs in the most rational way”
9. Evidence-based medicine (EBM) provides the rationale for most healthcare decisions, yet the common, existing interpretation of EBM ignores clinical experience – to the frustration of EBM’s originators, such as Prof David Sackett – and relies excessively on randomised controlled trials (RCTs)
10. The evidence hierarchy used in clinical decision-making under-utilises many forms of data, such as observational and epidemiological evidence, medical records and clinicians’ expertise
11. Guidelines instigated by bodies such as the UK’s National Institute for Health and Care Excellence (NICE) are often interpreted as rules, rather than guidelines. They therefore limit more flexible, individualised approaches to healthcare delivery
12. Governments appear to believe that issuing guidelines on diet and lifestyle, some of which are scientifically faulty, is sufficient; very little effort is made to customise such advice to individuals in the primary care environment
13. Most of the existing efforts to help individuals to modify diet and lifestyle are presently undertaken by ‘complementary and alternative medicine’ (CAM) practitioners, who are in turn generally shunned by mainstream health care providers
14. Fast-track courses for various CAM modalities that are offered to medical doctors based on their prior medical expertise are often inadequate, and we uphold that they often fail to take into account the fundamental differences in background and training between conventionally trained and CAM practitioners 
15. Chronic diseases generally have a multi-factorial origin and basis; yet mainstream healthcare continues to search for elusive ‘silver bullets’, rather than accept that these conditions require multi-factorial solutions
16. Integrative medicine is acknowledged internationally as being a form of medicine or healthcare that brings together many different strands to create outcomes that are better than each individually. Europe-based integrated medicine centres, such as the UK's Royal London Hospital for Integrated Medicine, are poor reflections of their US equivalents, e.g. Memorial Sloan-Kettering Cancer Center in New York
17. The so-called 'skeptic' movement has penetrated to different degrees throughout Europe. The UK, for example, has a particularly tenacious and outspoken group of skeptics that continuously attack almost any branch of CAM, working hard both to get their arguments voiced in the mainstream media and to influence politicians
18. The European legislative system and regulatory authorities are not well disposed toward foods, food supplements and other natural healthcare products that help support health naturally with minimal or no side effects
19. There is no scientific consensus on methodologies that can be used to evaluate clinical outcomes related to multi-factorial treatments, including those that incorporate diet and lifestyle modification
20. The UK, for example, is home to numerous doctors, clinicians and other experts that have considerable expertise in the integrative medicine area. However, this expertise base is deeply fragmented and only accessible to those who: a) are sufficiently aware of its existence; and b) have the private funds to pay for these services. The College of Medicine, which effectively replaced the Prince’s Foundation for Integrated Health, is the closest to providing an umbrella for research and expertise in this field. However, its mission appears weak and it has so far had little impact
21. Mainstream medicine opinion leaders continue to shun disciplines, such as functional medicine and psychoneuroimmunology, with great relevance to the current disease burden and disease prevention strategies
22. Despite grave inadequacies in healthcare delivery, the public is rarely encouraged to take responsibility for its own health. In fact, it is frequently discouraged to do so, being typically advised that an individual’s health is best managed by his or her GP.

Some remedies for improving healthcare delivery

Rather than being exhaustive, the following list merely points to some of the most pressing needs for change in several categories. 

Education

• Reform of the medical syllabus and education is urgently needed.  The current medical syllabus and training does not sufficiently deal with causes of disease, preclinical symptoms of disease, early detection of disease, disease prevention, non-pharmaceutical/surgical strategies, diet and lifestyle modification for chronic disease risk reduction and treatment, role of physical activity, etc.
• A broad range of courses should be available to medical doctors and other healthcare professionals to allow for continuing education; these should not necessarily be cut-back, abbreviated versions of courses offered to non-medically trained doctors
• Functional medicine is a branch of medicine, developed over 20 years ago in the USA, that is being continuously adapted to the needs of the 21st century chronic disease burden.  Functional medicine employs a systems-oriented approach and a ‘therapeutic partnership’ between patient and practitioner.  Among other things, it utilises the latest developments in genomics, nutritional and lifestyle research and clinical outcomes.  The Institute of Functional Medicine offers a regular training module in the UK, Applying Functional Medicine in Clinical Practice (AFMCP).  Healthcare professionals from all backgrounds should be encouraged to participate in these and similar courses
• Another branch of medicine and medical education that has great relevance to the existing chronic disease burden, along with the rapid escalation of psychological, neurological, immunological and mental conditions, is psychoneuroimmunology (PNI).  An MSc programme in clinical PNI (cPNI) has in the past been offered by the Natura Foundation, and should be widely advertised to healthcare professionals when its future is secured.

Evaluation

• At present, inadequate efforts are being made to compare the effectiveness of different approaches to healthcare, using inadequate tools.  In this context, it is important to distinguish effectiveness from efficacy, which measures only experimental, rather than real-world, conditions.  Research in this area, known as comparative effectiveness research (CER), is presently led by Professor Claudia Witt of Charité University Medical Centre, Berlin, Germany.  European Union (EU) Member States should commission Prof Witt to help develop research and evaluation programmes relevant to them
• Evidence-based medicine relies on a hierarchy of evidence in which RCTs are given primary weight.  There is an urgent need for better objective, scientifically based methodologies that measure the ‘total effect’ experienced by the patient, as opposed to simply specific therapeutic effects.  The Scientific & Medical Collaboration (SMC) of ANH-Intl has developed an outline for a collaborative project to develop such methodologies for measuring the effectiveness of multifactorial treatments, as required for chronic disease management.  Funding is presently being sought.

Primary care

• Clinical decision-making must be made on the basis of all available evidence, and should prioritise those approaches that are likely to deliver the greatest benefits and least risks.  National databases for treatment options should include options for integrated and CAM therapies
• Health monitoring should be prioritised in primary care environments, with a view to identifying individuals predisposed to particular diseases and recommending dietary and lifestyle changes to improve outcomes, disease incidence, quality of life and healthy life-years.

Research

• Research budgets allocated to innovative, non-pharmaceutical strategies are pitifully limited in most parts of the world.  This is especially true for cancer treatments that are not reliant on chemotherapy, radiotherapy and surgery, as well as nutritional and lifestyle solutions for heart disease, type 2 diabetes and obesity
• There is an urgent requirement for comparative effectiveness research (CER) to be conducted to allow better comparison of conventional and non-conventional treatments.  Such CER should not only consider health outcomes but also the economics of health care
• Sustainability criteria need to be applied to healthcare decision-making to determine those strategies that are most efficient and sustainable
• Improved definitions of health are required.  Interesting work has been commenced in this area by the Netherlands-based TNO research organisation that aims to define health as resilience to various forms of stress – such as psychological, physical or chemical stress – rather than the simple absence of disease.

Validation

• New models, other than RCTs, are required for better validation of different therapies that take into account multiple modalities and a patient’s overall experience and clinical outcome
• Disease prevention strategies need to be evaluated and validated for them to be credible and to improve their adoption.

Professional support

• Professional associations that currently represent disparate modalities that are relevant to integrated health care approaches would greatly benefit from the formation of an umbrella body.  The result would be improved collaboration and a more united approach.

Advocacy

• Effective lobbying and advocacy is required at national, EU and international levels to ensure urgent adoption of integrated healthcare, improved self-care and individual empowerment in healthcare.  Such approaches require collaboration between a wide range of non-governmental organisations, academic institutions, elected representatives and the public
• Raising public awareness about self-care and self-empowerment is critical to healthcare sustainability, efficiency and effectiveness.

Have your say!

Based on your own experience or knowledge, please let us know if you have suggestions for additional problems or solutions that could be added to the above.  Please supply us with evidence if you can, preferably by way of online links.  We’d love to hear from you!  Email [email protected] or use the comments section beneath this article.

We will be using this and related information in our advocacy campaign with EU and national regulators, as well as in the European Parliament.

ANH Europe sustainable healthcare campaign page

ANH-Intl homepage