Background

Political debate about health and illness tends to focus on health systems. These may be defined as “ the combination of health care institutions, supporting human resources, financing mechanisms,
information systems, organizational structures that link institutions and resources, and management structures that collectively culminate in the delivery of health services” (Lassey, Lassey, Jinks, 1997, p. 3). Although national health systems differ in design and function, five criteria suggested by Victor Fuchs (1992) can be used to evaluate a national health system. These include technology, public health, service, efficiency, and distributional equity.

The American health system is considered one of the best in the world when evaluated by one of these measures. Through the quick and efficient application of new knowledge, technologies are created resulting in dramatic advances in medical care. The performance of the American health care system on a day-to-day basis, however, is much less spectacular. The system is characterized by uncertainty of purpose, inequities, inefficiencies and variability in quality reflected in fragmented financing and delivery mechanisms. Today’s American health system may best be characterized as the most expensive in the world with projected expenditures to grow to 18 percent of GDP by 2012 and the
least equitable when measured by the 43 million people currently without insurance.

Since the middle of the twentieth century, health care equity, financing and service related issues have repeatedly moved to the top of the national public policy agenda as incremental responses to these issues, defined as problems at the times of the responses, failed to produce lasting remedies. Over the last thirty-five years, the growth rate in expenditures has been the primary factor regularly escalating health care from a societal concern to a perceived crisis.

A recent resurgence in the increase of medical prices and insurance premiums primarily resulting from the backlash to the most recent health care fix – managed care – has again thrust the subject to the top of the policy agenda. As expressed by Jonathan Cohn (2001), the United States is again poised to enter the policy equivalent of “the perfect storm”. The three elements fueling the storm include: increases in medical costs; increases in the number of uninsured and under insured; and, the
limited ability of the government, particularly state governments, to assume greater financial responsibility for health related services.

The United States is not alone in attempting to reconcile competing health access, quality and cost issues. These issues highlight the inequalities in health and health care that exist both within and across
nations. Thus, while the comparative study of health, illness, and health care systems is important in its own right, it is also a way to better understand social and political relations more generally. Such
work provides a social context for our understanding of health and illness and helps us to realize that health care issues cannot be understood in a vacuum. Health care managers and policy makers
throughout the world are faced with these same health care challenges. And with limited success, each nation continues to seek solutions through the application of one or more of four often tried reform
strategies – cost containment efforts, quality and efficiency improvements, cost shifting efforts, and the employment of market related mechanisms.

Now more than ever there is a need to develop and implement innovative and sustainable solutions to these issues of health and illness. Health care financing and service challenges exist both nationally and internationally, especially in light of newly anticipated system demands arising from rapid medical advances, globalization, environmental degradation, and lifestyle and demographic changes.

The intent of the Health Studies Initiative is to better enable Dickinson College and its faculty and students to enter this forum in a focused manner for the purpose of contributing to these solutions. We believe that the liberal arts focus at Dickinson College will allow us to contribute to the political and social contextualization of understandings of health care – a process that will help to democratize
discussions of health and illness by opening up debate so that it includes more than just medical experts and health care managers. Health can only be understood in the context of the ways in which people live their lives. The Health Studies Initiative recognizes this and strives to make it a fundamental component of any health Developing such an interdisciplinary program in health studies will also allow Dickinson to connect with, and contribute to, the burgeoning nation-wide development of interdisciplinary programs in medical humanities (most often based in medical schools) and in health, illness, and disability studies (based in undergraduate and graduate schools). These are "exploding" interdisciplinary fields, accompanied by a plethora of conferences, fellowships, new journals, and research centers. (Penn State Hershey's Medical Humanities Department is a leader here.) The kind of creative interplay that will occur between a health certificate studies program and these growing fields and programs will benefit both faculty and students at Dickinson