January 20, 2014
McKee “Health Systems and Health”
• Health systems being increasingly seen as a cost to society from which there is no
return, rather than an investment.
o Rather than realizing that the goal of the health system is to improve health,
frequent discussions strive to make health systems more affordable or
considering the resources they may/may not require, etc.
o Some studies have even shown that more resources may mean higher mortality
as there are higher rates of discretionary surgery—death rates have even fallen
when doctors went on strike.
• Health, health systems, and economic growth can exist together.
o The appropriate and equitable distribution of health care reduces future demands
for healthcare as well as having substantial gains for population health.
o A healthier population leads to faster economic growth, as individuals can make
a greater contribution.
o When more economic progress leads to more resources, these resources can be
invested in healthcare.
o For this, we need governments and other actors to collectively create health
systems that address the health needs of their populations and respond to them
with effective policies and practices.
• McKeown argued that simply increasing therapeutic interventions did little if anything to
healthcare but that true improvements were made by improving living standards and
o Ivan Illich argued that modern healthcare was actually harmful as it could label
variants of normality as illness, leading to unnecessary treatment and adverse
Increased medicalization could also allow an increased number of people
to feel that something was wrong.
Thus, the health system would continue expanding while the population
would continue to feel worse, whereby the health system became a form
of social control.
o Laing found that what was labelled as mental illness was often just a reaction to
Mental illness as things that society deems deviant.
• Ie. “If God talks to you, you have schizophrenia.” The Antibiotic Era
• The creation of antibiotics was a major leap for healthcare.
o Prior to them, we used Sulphonamides which were less effective with side
o With antibiotics, we could now treat previously fatal bacterial infections, and
allowed for the supplementation of new classes of drugs.
o Even with the spread of TB, death rates had fallen—this achievement was
repeated 40 years later when antiretrovirals changed the battle against HIV from
rapidly fatal to chronic.
Became clear that humans and microorganisms were in an endless
Bacteria that mutated to resist antibiotics became stronger and survived.
• Emergence of resistances in cases such as TB, which cased
physicians to employ multiple therapy regimes.
Advances in the treatment of chronic diseases
• Discovery of insulin transformed the battle against Type I Diabetes
o Before then, children died 18months roughly after contracting the disease.
o First time that a person would be on a drug for the rest of their lives.
o 1950s saw the availability of drugs that would effectively treat hypertension and
still be well-tolerated.
Advances in surgery
• Development of anesthesia in the 19 century made it possible to operate on the
abdomen and thoracic cavities.
o Development of anesthetic and post-op techniques.
o Mortality of many procedures decreased rapidly.
o Ability to recognize and treat complications.
• Advances in surgical technique has reduced trauma especially with the use of minimally-
• Discovery of X-Rays—electromagnetic radiation was being used to treat cancers, t