“Decent Care” — The Key Values for Health Care Reform?
A recent World Health Organization (WHO) and Ford Foundation-sponsored Global Consultation on Decent Care Values in Palliative Care Services sought to bring together people living with HIV/AIDS, palliative care experts and specialists, and global health leaders to explore the conceptual alignment between the concepts of decent care and the practice of palliative care.
The Consultation aimed to document how the values of decent care resonated with people worldwide and whether those values might influence new approaches to primary care and palliative care. Through its internal research and development program, Altarum Institute participated in the conceptualization and design of the Consultation and will be working on the final report and follow-up activities.
“Decent care” offers a new approach to health care that seeks to acknowledge and apply universal human values of decency. Just as the concept of “decent work” sought to name and redefine the conditions of work in the industrial age, decent care seeks no less than to redefine and describe values that are essential to primary health worldwide.
Decent care begins with three questions that patients should ask of themselves and that providers should bear in mind as they work with patients, families, and communities to develop treatment plans:
- What do I/we need now?
- How do I/we live in the face of disease?
- How might I/we flourish?
Decent care values have been described as agency and dignity, interdependence and solidarity, and sustainability and subsidiarity. A WHO white paper on decent care explains, “Decent care … posits an approach to health services which is holistic (meaning comprehensive), inclusive, and responsive to the community and which enrolls the community in the problem-solving and support for care.” A new book, Restoring Hope: Decent Care in the Midst of HIV/AIDS, describes decent care values extensively.
With this first Global Consultation on decent care, WHO focused on palliative care because it is an area of medical practice that already embraces and promotes decent care values, particularly in terms of agency and dignity. Palliative care presented a clear medical discipline in which WHO could begin to talk about and describe real-world, on-the-ground applications of decent care. As a result of the Consultation, several WHO regions are now looking at ways to develop regional consultations of their own and create strategies that will include decent care values as a way to conceptualize the framework needed to develop palliative care services in places where none now exist.
In seeking to find ways in which the two concepts of decent care and palliative care converge, the Consultation also pointed to directions that decent care might take to inform and drive the current debates about the very structure of health care systems in general. As countries – including our own – look to restructure their health care services, they also might look to the ideas and values of decent care to help consider what the health care system is and does, and how that system might be reconfigured to better serve the needs of patients and families.
Decent care values suggest that health care services are best planned and developed with the collaboration not only of care providers, but with the people who are affected by that system. This values proposition should be a powerful warning to policymakers when considering sweeping health care reforms. Where too often debates on health care reform seem to be driven largely by large special interests, we cannot forget that the true end of health care is to serve the needs of the people who must live within that system.
All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Read more.
Zack Cooper
Serena Vinter
Joanne Kenen