Healthcare & Social Determinants of Health (From Reactive to Proactive)

Healthcare & Social Determinants of Health (From Reactive to Proactive)

Health starts in our homes, schools, workplaces, neighborhoods, and communities. We know that taking care of ourselves by eating well and staying active, not smoking, getting the recommended immunizations and screening tests, and seeing a doctor when we are sick all influence our health. Our health is also determined in part by access to social and economic opportunities; the resources and support available in our homes, neighborhoods, and communities; the quality of our schooling; the safety of our workplaces; the quality of our water, food, and air; and the nature of our social interactions and relationships. The environmental and social conditions in which we live, explains in large why some of us are healthier than others. 

It is clear that Law 100 of 1993 in Colombia has changed the incentives that individuals have when making their decisions in the labor market. Regarding affiliation to the contributive regime, estimates indicate that despite this having negative impacts on wages, people today have greater incentives to enter the labor force. This suggests that Colombians place a very high value on health. On the contrary, in the case of affiliation to the subsidized regime, it is observed that although individuals have greater incentives to participate in the labor market, they also have greater incentives to be employed as their own account and in the informal sector, which suggests that the subsidized regime is acting as a subsidy to informality.

This result is worrying if we take into account that the growth of the affiliation to the Subsidized Regime in the last five years has been more accelerated than that of the affiliation to the contributory scheme, leading to a situation where there are more people affiliated to the Subsidized Regime than to the contributory scheme. This dynamic, however, is unsustainable. The rapid increase in the population affiliated to the Subsidized Regime has demanded more subsidies from the contributory scheme, for which the Government has increased the co-pay percentage (i. E. Non-salary costs). This further promotes the growth of informality, which in turn reduces the number of people who subsidize and maintain the system.

Changing individual behavior is increasingly at the heart of healthcare. The old model of healthcare—a reactive system that treats acute illnesses after the fact—is evolving to one more centered on patients, promotion, and the ongoing management of chronic conditions. This evolution is essential. Across the globe, a fundamental shift in healthcare risk is taking place, driven by an aging population and the increasing incidence of behaviorally induced chronic conditions. Health systems are innovating on the delivery side to meet this challenge through a growing emphasis on primary care, integrated care models, and pay-for-value reimbursement. 

TheBC.lab is leading efforts for reorienting the health systems around a model focused on promotion, long-term management, and patient-centered care. This will require leadership and advocacy from all stakeholders in the health value chain. Such leadership is necessary if health systems are to meet the coming wave of healthcare challenges. If health systems are to address the shifts in healthcare risk now taking place—especially those resulting from chronic conditions— they must find ways to get individuals to adopt healthier behaviors. New behavior change programs based on a person-focused, rather than disease-focused, paradigm are proving that it is possible to achieve strong, sustained results. However, a change in mindset is required if these programs are to gain widespread use.

SDG 3.8 – Health Promotion