Health Systems and the Challenge of Communicable Diseases: Experiences from Europe and Latin America

Richard Coker, Rifat Atun, Martin McKee, editors Health Systems and the Challenge of Communicable Diseases: Experiences from Europe and Latin America Open University Press, 2008 ©World Health Organization 2008 on behalf of the European Observatory on Health System and Policies It is well known that evolutionary patterns of communicable diseases are a part of our lives. Some are a result of how today's society is organised - or disorganised - and some are re-emerging. In turn, health systems are challenged to tackle and adapt themselves to these new and old diseases. The study of health, particularly communicable diseases, in our own, and neighbouring countries, is increasingly important. Population growth and demographic change, climate change, economic development, globalization, war and poverty all have consequences on disease patterns. Travelling or population movements, as noted in the first chapter, have become a necessity in many ways as well as an unavoidable phenomenon. Many of us have become modern nomads, though not always by choice. Health Systems and the Challenge of Communicable diseases in European and Latin American countries, recently published by the Open University Press on behalf of the European Observatory on Health Systems and Policies, studies the discourse on health and security and its influence on national and international politics. Fifteen chapters and over 30 tables and figures written by experts and researchers from Europe and Latin America, Canada, the USA, the European Centre for Disease Prevention and Control (ECDC), the World Health Organization and the World Bank, describe the current situation in terms of communicable diseases and the performance of healthcare systems. It is one ofthe first such major recountings of experiences through the health systems lens. Following the introductory chapter, two chapters look into the transitional societies in their contextual environment from socio-demographic changes to the responsibility of governments in controlling communicable diseases. Chapters 4, 5 and 6 provide detailed information on the changing patterns of communicable diseases in a historical perspective, and describe the epidemiological situations in Latin America and eastern Europe, and in particular the 1 5 countries of the former Soviet Union. Chapter 7, the central chapter, depicts the mechanisms of a system's approach to communicable diseases. The authors, Atun and Menabde, approach communicable diseases from the health systems perspective, emphasizing the importance of all the elements of a system's functioning as an integrated whole in order to provide the best possible care. They provide a framework for analyzing health systems and the context in which communicable diseases occur. They further emphasize that technical solutions for reforming health systems must be analyzed and dealt with together with the containment and cure of diseases. In order to provide effective responses to communicable diseases, it is of paramount importance to bring together or at least ensure the balanced interaction of all the functions of a healthcare system - employing a multidisciplinary approach to responding to communicable diseases. Chapter 8 provides examples of the roles of international agencies and their tools to respond to threats of communicable diseases. Chapter 9 supports the notion of health systems and systems thinking in a communicable disease context. Schwalbe, Lazarus and Adeyi present how HIV/AIDS and tuberculosis control in post-Soviet Union countries should ideally be tackled by the interdependent principal components of health systems in an integral fashion: service delivery, financing, management and surveillance. They conclude that any attempts to control these epidemics must be placed into the overall context of the health system, political support for integrating care, the adoption of international standards of care and their adaptation to local contexts, with an emphasis on the achievement of sustained improvements in outcomes. …

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