The future has always been an unknown that is difficult to unravel and has generated different feelings depending on the present state of those who wonder about it.
By Jorge Pompei
Thus, with regard to health, some see an irreversible process of deterioration in the face of the increase in the age of the population associated with illness and disability.
Others, on the other hand, believe that advances in knowledge will allow a growing understanding that will lead to overcoming illness, reducing risks and improving the health of the years gained in life expectancy.
One way or the other, the future of health is presented to us as something new and changing that will confront us with new challenges that we will have to face.
To do this, we will start by developing a hypothesis based on a study of current trends in the field of health.
Thus, we will choose three aspects of the health universe and study the possible scenarios that could be presented to us.
These three aspects concern the concept of health, the treatment of illness and health in its community dimension.
The concept of health
Let us begin by asking what is health?
The first thing we see is that, in order to answer this question, we must place ourselves in time and space, since the idea of health changes with cultures and over time.
In other words, what we think about health is socially, culturally and historically determined.
The history of health and what is believed about it is as long as human history and it could not be otherwise because health has always been one of the most cherished values in any society.
Thus, in broad strokes, we can imagine different approaches to health at different times and places.
The first approach corresponds to a magical paradigm, where health was the result of the action of supernatural forces that “rewarded” or “punished” the actions of mortals. The response to this approach was the ritual treatment of illness, which sought to appease the “punishment”.
Some peoples developed a less ritualistic approach that emphasised the use of natural plant, mineral or animal products which, through trial and error, proved their efficacy over time and allowed each community to build up its own pharmacopoeia.
As Europe entered the modern age, we saw new visions that sought other explanations. In the 19th century, many scientists of the time defended miasmatic theories that found the origin of diseases in putrefactive substances in the environment.
This view changed with the experiments of Pasteur who, in the second half of the 19th century, successfully demonstrated that there was no such thing as spontaneous generation and thus opened the door to the discovery of the microbial agents causing the prevalent diseases of the time.
Let us recall the health impact at the time of tuberculosis, leprosy, cholera and so many other diseases that originated from bacterial infection.
This discovery, in turn, led to the development of antibiotics which, together with the change in living conditions, modified the epidemiological profile of European populations.
The idea of health associated with infectious diseases, which were caused by a single causative agent, became more complex as the role of the environment in which the agent-host relationship took place was understood.
Thus, improved living conditions and the use of antibiotics allowed for effective treatment of infectious and parasitic diseases.
From then on, the main determinants of illness and death were no longer infectious and contagious diseases, but the new protagonists, chronic degenerative diseases.
Today, the focus is on high blood pressure, diabetes and tumours, with heart attacks and strokes being the main causes of death.
To this must be added the deaths and disabilities resulting from accidents, violence and a series of causes that have their origin in environmental and social deterioration.
All of this makes the concept of health more complex and comprehensive.
From the single-causal view of the late 19th century, progress was made towards an ecological view that involves the environment. Later, in the mid-20th century, the WHO defined health as a state of equilibrium in which the biological, psychological and social aspects are involved, and not just the absence of disease.
This definition, which was a step forward at the time, must now necessarily incorporate the environment as a determinant of the utmost importance and must move on from a static view, placing it in process and considering how health changes and improves through the conquest of better living conditions.
In this sense, we believe that in the future, health will have to stop being an aspiration for improvement and become a fundamental human right.
Treatment of illness
With regard to the treatment of illness, in its clinical aspect, it is clear that care has changed significantly since the last century.
From general practitioners, often family doctors, there has been a shift to specialists.
This change came about as a result of the so-called Flexner report of 1910, which was promoted by the Rockefeller Foundation.
Abraham Flexner, an educator, carried out an investigation of US medical schools and concluded that teaching was very deficient and proposed changes that would end up being implemented by all Western countries and that transformed the way medicine was studied and practiced.
From then on, care was organized into specialties with a biological approach and a strong pharmacological component, oriented towards treating symptoms.
This gradually led to the diversification of consultations, requiring the care of several specialists for each patient and the chronic use of medication to treat the disease.
At the same time, the specialties and later subspecialties required increasingly sophisticated equipment for more precise diagnosis and therapy.
This was widely accepted by providers and patients who saw in this deployment a better quality of care.
If we add to this the ageing population with its burden of disease, we find that an important part of the life of the elderly is devoted to medical visits and the purchase of drugs.
At the same time, from the second half of the 20th century onwards, new concepts were developed that went beyond the field of illness and studied the risks of people who, although healthy, present conditions or situations that make them more prone to suffering harm and which must be attended to.
Thus, Leavell and Clark in 1953 described, based on what they called the natural history of the disease, the levels of prevention to be considered at the different stages of the health-disease process.
This led to the development of tools to anticipate the disease by treating the risks.
Finally, along with the prevention of disease, the idea of health promotion was developed, a fact that proposes a different concept to that of disease. An important concept is that of treating healthy people to strengthen their own capacity to stay healthy.
People are now looking for solutions that involve less investment of resources and time, so new specialties such as general practitioners and family doctors are being developed to solve most of the health problems that arise in the doctor’s office.
At the same time, the growing access to the internet, today strongly driven by the COVID 19 pandemic, spreads care strategies that are little recognized by academia and little known by the general population, such as Traditional Chinese Medicine, Ayurveda, Tibetan Medicine, Orthomolecular Medicine, Neural Therapy, Anthroposophical Medicine and several others that have a holistic view that differs from that of the specialist.
All this leads to the challenge of creating new modalities of care that satisfy the needs and expectations of the patients, generating a first level of continent-wide care and a body of specialists for those who require it, but who are not the entry point to the system.
This will require the formation of a health team trained in a vision that integrates biological, psychological, environmental, community and spiritual aspects and the different strategies of different cultures.
Population health
It was in the 20th century, and especially after the Second World War, that a number of significant events took place in the field of health.
On the one hand, we witnessed an unprecedented demographic phenomenon. The world population, which by 1950 had slowly reached 2.5 billion inhabitants, had risen to 8 billion in 70 years.
On the other hand, life expectancy, which in Europe at the beginning of the 20th century was around 40 years, is now approaching 80 years, and we are already beginning to see the appearance of a generation of centenarians.
Today, living conditions for the general population are not improving. The environment is rapidly deteriorating as a result, among other causes, of the uncontrolled action of industries that depredate the seas, forests, soils and the use of hydrocarbons as a source of energy.
At the same time, community life is also suffering from the fragmentation of the times, and although the world’s population is moving towards urbanization, which brings people physically closer together, personal conflicts and the feeling of loneliness are increasingly deteriorating human life in cities.
In summary, we can see that, although the life expectancy of populations is tending to increase, reaching situations that were unimaginable until recently, the deterioration of the natural and social environment is endangering the lives of large sectors of the population.
Health care involves allocating more and more economic resources, without which it is impossible for the health care system to function and for living conditions to improve. But the costs of the care model and the deterioration of the environment are increasing and threaten its sustainability.
Although in today’s society the right to health care and health is increasingly being taken into account and the population’s demands are being heard more loudly, there are still major problems with access to services.
To summarize. The concept of health must necessarily move towards a model that favors the maintenance of health rather than the treatment of illness.
The care of consultations should be resolved by health teams trained in a holistic view of the person and who can resolve the majority of consultations, leaving only a small percentage for specialist care.
It will be necessary to implement the incorporation of other practices and other non-traditional knowledge (such as traditional medicines) that are recognized and requested by the population.
We note finally that, despite all the existing impediments, progress will be made to the extent that health becomes a fundamental and effective human right that guarantees for all people universal coverage in equity with quality and opportunity and without any kind of discrimination.
