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From lifespan to healthspan: A paradigm shift to achieve health for all
Critically, the health system of the future must invest in digital health technologies and infrastructure for more efficient data and information sharing among key stakeholders.
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A health officer from the Indonesian Air Force (TNI-AU) administers a COVID-19 vaccine to a local resident at the Sultan Iskandar Muda Airport in Blang Bintang, Aceh on Oct. 15. (Antara/Ampelsa)
L
ife expectancy, or the determination of lifespan and the age at which death occurs, has been used as a standard measurement of health status and health trends for many decades. Life expectancy declined dramatically in many Sub-Saharan countries in during the early days of the HIV/AIDS epidemic in the 1980s and, more recently, it fell even in developed countries during the COVID-19 pandemic.
However, and given the pervasive, diverse and multidimensional aspects of health more broadly, starkly illustrated during the COVID-19 pandemic, does lifespan remain the most useful and appropriate measure of health status and attainment in the future?
In the aftermath of the pandemic, healthcare-delivery systems are under tremendous stress in rich and poor countries alike. Indonesia, for example, will continue to struggle with the longer-term sequelae of COVID-19 infections, stunting in children, infectious diseases (e.g. dengue, malaria) and chronic-disease complications and deaths, which arise from high levels of smoking in the country. These conditions pose a high burden and huge economic costs on the healthcare-delivery system amid continuing shortfalls of funding for Indonesia’s national health insurance program (JKN). In this regard, it highlights, for example, the importance of government policy and strong public awareness of reducing harm from smoking so as to maximize reduction in healthcare spending.
In light of these challenges, perhaps what countries need is a more holistic, inclusive and integrated view of health, a move from the concept of lifespan to one of health-span, from “health care for all” to “health for all” to ensure sustainable and equitable health gains across nations, especially in the developing world.
A recent report from The Economist Impact series outlined three key characteristics of an inclusive and integrated approach to healthcare.
First, emphasis should be placed on healthy societies, not just the health of individuals. Within this domain, health should be given a high priority by governments and be seen as an investment and not as an expenditure. To reflect this high priority, health should be included in all policies (e.g. tobacco control, marketing of foods to children, dietary guidelines for healthy eating, national alcohol policy, etc.), and progress monitored within the framework of the Sustainable Development Goals (SDGs), specifically SDG3, to “ensure healthy lives and promote wellbeing for all at all ages”. The cornerstone of SDG3, which should also be a key value in the health-span paradigm, is an emphasis on primary healthcare and preventive strategies (e.g. vaccination, nutrition, early screening, lifestyle changes, etc.) rather than costlier curative approaches to treat disease.
Importantly, a healthy society must place strong emphasis on equity and social justice and ensure that vulnerable, marginalized and stigmatized elements of society (e.g. the poor, elderly, women, migrant workers, etc.) are not left out from accessing quality healthcare.
