Research and Health Systems Advisor, School of Public Health, Ridgeway Campus, University of Zambia, Lusaka, Zambia.
Institute of Development Studies, University of Dar Es Salaam, Tanzania.
Health Policy Plan. 2019 Nov 1;34(9):635-645. doi: 10.1093/heapol/czz042.
Priority setting within health systems has not led to accountable, fair and sustainable solutions to improving population health. Providers, users and other stakeholders each have their own health and service priorities based on selected evidence, own values, expertise and preferences. Based on a historical account, this article analyses if contemporary health systems are appropriate to optimize population health within the framework of cross cutting targets of the Sustainable Development Goals (SDGs). We applied a scoping review approach to identify and review literature of scientific databases and other programmatic web and library-based documents on historical and contemporary health systems policies and strategies at the global level. Early literature supported the 1977 launching of the global target of Health for All by the year 2000. Reviewed literature was used to provide a historical overview of systems components of global health strategies through describing the conceptualizations of health determinants, user involvement and mechanisms of priority setting over time, and analysing the importance of historical developments on barriers and opportunities to accomplish the SDGs. Definitions, scope and application of health systems-associated priority setting fluctuated and main health determinants and user influence on global health systems and priority setting remained limited. In exploring reasons for the identified lack of SDG-associated health systems and priority setting processes, we discuss issues of accountability, vested interests, ethics and democratic legitimacy as conditional for future sustainability of population health. To accomplish the SDGs health systems must engage beyond their own sector boundary. New approaches to Health in All Policies and One Health may be conducive for scaling up more democratic and inclusive priority setting processes based on proper process guidelines from successful pilots. Sustainable development depends on population preferences supported by technical and managerial expertise.
优先考虑卫生系统并没有为改善人口健康带来负责任、公平和可持续的解决方案。提供者、用户和其他利益攸关方根据选定的证据、自身价值观、专业知识和偏好，各自都有自己的健康和服务重点。本文基于历史叙述，分析当代卫生系统是否适合在可持续发展目标（SDGs）的跨领域目标框架内优化人口健康。我们采用了范围综述方法，以确定和审查全球层面卫生系统政策和战略的科学数据库和其他基于网络和图书馆的计划文献，并对其进行了回顾。早期文献支持了 1977 年发起的到 2000 年实现人人享有卫生保健的全球目标。所审查的文献用于通过描述健康决定因素、用户参与以及随着时间推移的优先排序机制的概念化，提供全球卫生战略系统组成部分的历史概述，并分析历史发展对实现可持续发展目标的障碍和机遇的重要性。与卫生系统相关的优先排序的定义、范围和应用不断变化，主要健康决定因素和用户对全球卫生系统和优先排序的影响仍然有限。在探讨确定的与可持续发展目标相关的卫生系统和优先排序过程缺乏的原因时，我们讨论了问责制、既得利益、伦理和民主合法性等问题，这些问题是人口健康未来可持续性的条件。为了实现可持续发展目标，卫生系统必须超越自身部门的界限。新的全健康和所有政策中的健康方法可能有利于根据成功试点的适当程序准则，扩大更民主和包容的优先排序过程。可持续发展取决于得到技术和管理专业知识支持的人口偏好。
