blog Chairs & Fellows Symposium Recap - Joep Lange Institute

Chairs & Fellows Symposium Recap

Access to Care: How to make health markets work for the poor

On 8 October, four leading experts on health and data came together in Amsterdam for the JLI Chairs and Fellows Symposium to present their latest research findings. Profs. Dan Ariely (behavior economics), Mark Dybul (former executive director of Global Fund), Anna Vassal (health economics) and Catherine Kyobutungi (epidemiologist) shared and discussed different solutions on how to make health markets work for everyone, everywhere.

The four JLI chairs made convincing pleas for renewing the world of global health. All speakers addressed that most care is currently supply driven and this is harming the quality of care patients have access (or in the worst case no access) too. “Right now the health sector is too top down. The starting point should be the patients”, executive director of African Population and Health Research Centre Catherina Kyobotungi emphasized that the way forward is to better listen to the needs of the public.

Not only does the public know better what they need, they also come up with the best solutions, we heard in the opening speech by former United States Global Aids coordinator Mark Dybul. He started his talk with a convincing complaint about the paternalistic and hierarchic way of doing things in the global health community. Dybul: “Too often global solutions are being rammed down top down, while many times the best ideas come from the patients or people in need. We have to link local innovation with global impact.” Dybul blamed the global health world’s reluctances to include the public to its slowly diminishing embedded racism: ‘’Since 2000 things started to change philosophically. But the paternalistic past has never really left.’’

As Dybul believed that this type of paternalism has been a major barricade for better solutions to emerge, renowned Duke University Professor of Psychology and Behavioral Economics Dan Ariely stressed that, to create healthier behavior a bit of paternalism is needed. The question is how much paternalism is needed? Ariely: “Just supplying people with the correct information doesn’t per se result in better behavior. Overall humans are not as rational as we often like to believe. We have to tweak the feedback and present it in a way that makes people change their lifestyles to healthier ones. That is being paternalistic with positive results.”

Next speaker Anna Vassall, Professor in Health Economics at the London School of Hygiene and Tropical Medicine, criticized governments for working in silo’s en therefor they often don’t look at ‘the broader impact’ when doing health interventions. She spoke out for a more holistic approach. Vassall: “Look for example at the health benefits poverty reduction has. And what are the poverty benefits for tuberculosis interventions?”

According to Catherina Kyobotungi health care systems are currently mainly reactive and cure orientated, while these times demand a more proactive and prevention focused approach. Kyobotungi: “In Africa there is an increase of chronic diseases (NCD’s). We focus mostly on treating people (only) when things get critical. It would be better if we also help them to stay healthy by, for example, informing a person with heart problems about alcohol use and on how to eat healthier.” The two-hour event left the audience with many new ideas and visions for change. A quick summary so you can’t miss the most important ones:

  • Include the public in decision making and scale up local innovations
  • Paternalism has caused health care systems to not work in the benefit of patients, but a bit of paternalism is needed to direct people into healthier behavior
  • Transform the healthcare system from reactive and cure based to pro active and prevention
  • Health interventions also need to focus on other effects on targeted people’s lives – such as the consequences on poverty reduction

We support our chairs in their strive for changing the global health world. The poor across this world have too often been the victim of dysfunctional and bureaucratic systems. These systems should work in the benefit of the people more. Although barely mentioned on the symposium, we think the mobile phone offers a unique opportunity to get good healthcare services available to more people.


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