Published: 06/01/2005, Volume II5, No. 5937 Page 25
We can learn a lot from other healthcare systems. Sometimes we find we have more in common than in variance - even with situations that appear to be the polar opposite of the NHS.
A case in point is a US summit I attended in Boston recently on quality improvement for public health. It was hosted by Don Berwick of the Institute for Healthcare Improvement and Sue Hassmiller of the Robert Wood Johnson Foundation.
The participants described themselves as public health 'mavericks and mavens'; pioneering leaders from local government health departments and state and federal agencies. Their uniting cause was a profound desire to promote and preserve health and wellbeing across the US.
The US leads the world in healthcarerelated expenditure but lags behind many of its peers in terms of health status. Ninety-five per cent of US health spend goes on medical care and biomedical research.
Yet in terms of avoidable mortality, healthcare is a minor issue compared to lifestyle, environment and economic status. This is particularly pertinent in the US where the benefits of healthcare investment are denied to millions of people.
Public health US-style is not a 'system' in the sense that I understand the word. There are 3,000 local government health departments. There is no agreed definition of public health.
There is a national vision, Healthy People 2010, but few measures of success or performance-management systems that connect with achievement of the vision.
Following 9/11, the US federal government has invested $4.1bn in public health to improve preparedness for bioterrorism, creating fears about competing priorities.
Does it enhance or undermine the ability to tackle obesity, smoking or long-term conditions? State-level financial deficits have led to reductions in core public health programmes such as child immunisation.
You get a sense of two unconnected universes: the well-resourced, largely privately run healthcare delivery system and the poorly funded, underprioritised local public health system.
You might ask what we can learn when our public health strategy is so much more well-developed.
The answer is plenty. The summit was an exemplar in terms of organising to change the world. The activist-leaders are working within the mainstream system yet are willing to challenge the status quo, working together collectively with some impressive expert advisers and supporters.
They want to translate powerful, evidence-based tools for innovation and improvement from healthcare delivery to health. They seek a new model of local leadership for health, building public coalitions around radical aims for improvement.
They talk about the need to motivate through compelling stories. They understand the need to create early tangible change 'because mavericks do not get anywhere unless they can show results'.
I believe I witnessed the birth of an important movement for US public health at the summit. I saw local leaders starting to mobilise to change an entire nation.
Here we have the vision and blueprint of the Choosing Health white paper, but if we are going to orchestrate transformational change in health and well-being, we need to think about local leadership action that enables broader collective action to take hold. We can definitely learn something from these groundbreaking public health leaders across the pond.
Helen Bevan is director of the Modernisation Agency's innovation and knowledge group.