Why we need to integrate health systems with other sectors

For years, I worked tirelessly in infectious disease control, specifically HIV. It often felt like a treadmill. We’d make progress, but it never seemed to be enough. Treatment wasn’t optimal - not enough access, improper prescriptions, or patients not adhering to instructions. On the prevention side, we weren’t faring much better. Containing outbreaks, promoting healthy behaviors - all fronts felt suboptimal.

Our health systems need more: more trained professionals (doctors, nurses, public health workers), better treatments and programs (effective, safe), and supportive infrastructure. And above all, these systems need to be accessible and equitable across all geographies and demographics. “No one left behind,” they say.  

But this requires strong governance and joint commitment. Alas, this is often the bane of progress. I’ve seen firsthand how a lack of commitment can impede even the most promising initiatives. We have the evidence, but policy strays to a different path. The root of the problem: other matter prioritized over health of citizens. Like the ’economy’ during COVID-19 containment.

Health issues, especially those like HIV, often aren’t a priority. Countries like mine (Indonesia) rely heavily on external aid, and the conversation always seems to center on financial sustainability. Then there goes the same chorus: NGOs pitch for local funding, trying to convince the government that we’re close - “we’re at 90%,” or “this is the last mile.” But within a decade, I realized we were still on that treadmill.  

The Interconnections of Health and Socioeconomic Factors

The truth is, health issues are deeply intertwined with socioeconomic factors. Poverty, lack of education, poor nutrition, climate change - these all play a significant role in determining the health of a person and a community.

Even with good TB drugs and infrastructure, patients living in poverty keep getting sick. Lack of ventilated homes and poor nutrition contribute to their illness, and in dense areas, they infect families and neighbors. Risky health behaviors, often driven by poor education and lack of access to good jobs, perpetuate the cycle.  

It’s clear that we need more than just “health interventions” like treatments, drugs, doctors, hospitals, and healthy behavior campaigns. These are all essential, but they’re a subject of socioeconomic determinants.  

For example, to solve the nutrition problem of poor TB patients, we can target them with a more holistic program to ensure they have access to healthy foods. For dengue control, enhancing the sanitation system can mitigate the vector mosquito. Thus, authorities needs to extend its scope beyond the health sector. Health authorities need to collaborate with other sectors to address the root causes of poor health.  

It is a nice idea. Honestly, if there are such project or initiatives, I would drop everything I am doing and jump on board.

A Holistic Health Initiatives? Where to start?

We need to move beyond band-aid solutions and address the interconnectedness of health and socioeconomic factors. A holistic approach is essential to achieve truly sustainable and equitable health outcomes. These are often overlooked due to our tendency to prioritize industrialized medical solutions over prevention and health promotion / empowerment.  

Throughout my career, I’ve worked at all levels of the health system, from improving Puskesmas (community health centers), clinics, and hospitals to engaging with city, provincial, and national governments. The higher I climb, the more compartmentalized things become. However, integration is much more feasible at the lower level such as primary care. The sectors are seamless at the community level; or even non existent.

I’m still searching for the best framework and practices to implement this holistic approach. If only One Health framework also include food security elements and practices at community level.

But I’ve begun experimenting with grounded initiatives that integrate health promotion with the “grow your own food” movement, clean environment campaigns, and social enterprise. See my next entry.