Acquiring the Tools to Study Health Systems Flashcards
Reductionism
When anything in the natural world or society is studied by examining its individual parts.
System
An entity that maintains its existence through the mutual interaction of its parts. A group of interacting, interrelated, or interdependent components that form a complex and unified whole. Defined as an organized collection of parts (or subsystems) that are highly integrated to accomplish an overall goal (works together as a whole, not individually).
Complex Systems’ Characteristics
1) Are self-stabilizing.
2) Are purposeful.
3) Capable of using feedback to modify their behaviour.
4) Can modify their environments.
5) Capable of replicating, maintaining, repairing, and organizing themselves.
Systems Thinking
Looks at the whole system rather than its individual parts (the philosophy that everything is connected). Assumes interconnectedness of the many parts of the system. Considers how change in one part may impact other parts. Allows us to see the complexity of health and illness and health care. Goes against the reductionist approach.
System Trap
A way of thinking that is inappropriate for the context or issue being explored.
Laws of Systems Thinking
1) Today’s problems come from yesterday’s solutions.
2) The harder you push, the harder the system pushes back.
3) The easy way out usually leads back in.
4) Faster is slower.
Asystemic Thinking
The inability to think about complex systems and their dynamics.
Deforestation
A public health concern (animals are pushed closer to human society and result in more diseases and pathogens).
WHO Definition of Health
A state of complete physical, mental, and social wellbeing, and not merely the absence of disease and infirmity.
Health
Being oblivious to one’s body (not having to worry about your body, ex. not feeling light headed, sore, tired, and etc.), feeling good, and not being sick. Physical, mental, and social wellbeing. Is socially constructed (there are cultural, social, and historical variations in how we define and understand health and illness).
Disease
A condition that was diagnosed by a licensed healthcare professional ex. physician. Symptoms that can be assigned a medical diagnosis.
Illness
Our subjective experience of feeling unwell. Not formally diagnosed.
Sickness
A combination of having a disease and feeling ill.
Wellness
A more encompassing term than health, actions the individual takes to feel well.
Sociology
A study of society. It seeks to understand how societies function and to identify patterns and underlying mechanisms of the social worlds in which people live.
Individual Agency
Our decisions on how we act (things we can do/control by ourselves).
Social Structures
Stable patterns of social relations ex. families (who works and who stays at home, different from family to family), governments (how it is organized, changes from country to country) and economy (the value and system of money).
Sociological Imagination
The ability to see the linkages between personal troubles and larger social issues.
Tools for Analyzing Health Systems
1) Structural Functionalism
2) Conflict/Critical Perspectives
3) Symbolic Interactionism
4) Systems Thinking
Theoretical Paradigm
A conceptual framework or school of thought in which interrelated ideas and concepts about an aspect of reality are formulated ex. if you hold something up high and release it, it will fall.
Types of Theories
1) Micro
2) Meso
3) Macro
Micro Theories
Focuses on the social interactions between individuals or groups.
Meso Theories
Focuses on social institutions and social organizations ex. studying how things are organized in a hospital (ex. how can the hospital system be organized to reduce wait times) or university (ex. how the university communicates with students).
Macro Theories
Focused on trying to understand the big picture, usually done by comparing classes and social institutions.
Structural Functionalism
Focuses on harmonious social system, interconnectedness, linkages between one system and another, and is deterministic (it’s determined for you, you have little say). Macro theory. Views the world in a positive lens and may neglect social inequalities. Ex. comparing the food services at Waterloo versus Laurier.
Karl Marx
Focused on class relations (bourgeoise and proletariat) and economic relations. Assumed a revolution against the bourgeoise would occur by the proletariat coming together.
Bourgeoise
The highest class, owns the means of production (the one in charge). Wants to increase profit and therefore pays workers less.
Proletariat
The working class (can only sell their labour).
Max Weber
Focused on the emergence of the working class which contains social stratification ex. the role of religion/culture status.
Critical Approaches
Can be applied to gender, race/ethnicity inequalities (not just social class and power).
Conflict/Critical Perspectives
The world is built around conflict (opposite to structural functionalism). The creation of the middle class.
Symbolic Interactionism
Focuses on the meaning-making activities of individuals, exploring how we make sense of our social interactions with others. People assign different meanings to things based on how they personally perceive it (whether it was culturally or socially ingrained in them). Focus on individuals, micro approach.
The Thomas Theorem (1928)
If the situation is defined as real, it is real in its consequences.
Systems Are…
1) Self-Organizing and Self-Stabilizing
2) Purposeful
3) Constantly Changing
4) Governed By Feedback
5) Non-Linear and Interconnected
6) Capable of Replicating, Maintaining, Repairing, and Organizing Themselves (Are Adaptable)
7) Counter Intuitive and History Dependent (Anticipated Outcomes May Not Reflect Real Life Outcomes)
Health System
All organizations, people, and actions whose primary intent is to promote, restore, or maintain health (not just healthcare).
Health System Goals
1) Improve Population Health (Different Levels and Equity)
2) Improve Responsiveness to the Population (ex. improve wait times)
3) Fair Financial Contributions
Health Systems Functions
1) Creating Resources (Inputs)
2) Delivering Services
3) Financing (Raising Resources, Pooling, and Purchasing)
4) Stewardship (Oversight)
The Importance of Stewardship
1) Health should be a national priority.
2) Free markets in health services do not deliver equitable universal health coverage.
3) Key role for the state in setting rules of the game (monitoring, performance, and improving accountability).
Measuring Health System Performance
1) Ideally use outcome indicators:
—> Health Status
—> Financial Protection
—> Responsiveness
2) Don’t focus on absolute levels but on distribution because we are concerned about equity.
3) World Health Report (2000) and others have created indices to measure overall performance.
Health System Building Blocks
1) Health Service Delivery
2) Health Workforce
3) Health Information Systems
4) Access to Essential Medicines
5) Health Systems Financing
6) Leadership and Governance
Theories
Provide useful tools to examine health systems.
