The past decades have witnessed a significant improvement in living standards across many areas that influence our well being. Such progress is mainly due to economic and social development and the creation of social security and healthcare systems in a number of countries.
A modern,fair society must, through universally -accessed systems offering generalcover, guarantee the right to health in an equitable manner. In a democracy,barriers that prevent citizens accessing timely and appropriate healthcarecannot be tolerated.
Success,for any health system, is dependent upon innovation and technology evolvingfrom knowledge- -generating scientific research. Indeed astounding breakthroughshave been made, namely in genetics, because of the work in highly--sophisticated technology -driven fields such as nanotechnology andpharmacogenomics.
Thetechnological revolution has thoroughly transformed global health systems andwe see a growing powerful correlation between innovation and development. Atthe same time, there’s also a profound change in disease distribution anddemographic patterns.
Theparadigm of chronic disease has progressively replaced that of acute illness.Some of the more communicable diseases, such as HIV -AIDS, have gone throughsignificant changes in their epidemiological profile, turning them into controllablechronic diseases, and there are breakthroughs in the prognoses for othercommunicable diseases with high morbidity and mortality, such as Hepatitis C.
Over thepast few years, developed countries have witnessed demographic changes, slowlymoving to an aged population with a growing number of dependent citizens.Health systems must now consider factors outside their organisational structureand response models. The costs associated with therapeutic and technologicalinnovation, for example, challenge the sustainability of health systems, makingit increasingly difficult to define health policy priorities.
Demographicchanges (populations ageing at a notable pace) will have significant social andeconomic consequences. In 2020, the number of people over 60 will exceedchildren aged under five, and between 2015 and 2050, the worldwide percentage ofpeople over 60 will almost double, from 12% to 22%.
Since theearly nineties in Portugal, people aged over 65 grew to 35% and the number ofyoung people and children under 25 dropped by more than 20%. In 2060 Portugal,the resident population will go from its current 10 million to 8.6 million andthe proportion of senior citizens to young people, now at 131/100, will rise to307/100. During the next 50 years, it’s predicted the number of people over 65will double, with inevitable consequences for healthcare and social securitysystems.
The worldhas changed over the past four decades; society has transformed. Health needshave become more complex and there’s fiercer competition for resources. Thesustainability of health systems is more and more dependent on how nationaleconomies perform and, as a consequence, what services can be offered.
It’stherefore essential to debate mid tolong -term funding and sustainability for national health services (SNS inPortugal). This presents us with a complex challenge: how do we guaranteesustainable and long -term funding for public health systems, ensure theydeliver and continue to change with the times, reward and value their staff andenable access to technologicalinnovation?
Healthpolicies concern all of us and impact generations over time. This new dilemma pits ethical and human needsagainst budgetary limitations. In themain, we have to raise awareness with all stakeholders that if resource- -sharingis the single goal, the choices made must be carefully prioritised. As we moveto integrated care in this way, we need to ‘think globally, act locally’ andput our citizens at the heart of the system.
A sustainable future requires considerableinfrastructure, equipment and human resources’ planning taking intoconsideration demographic changes, the burdens of chronic illness, access totherapeutic and technological innovation, public health actions and theindispensable participation of people.
