Health Systems: Are We Making the Grade?

            As a public school teacher I think about things in grades, passing and failing, A’s, B’s, C’s, D’s, F’s.  As I was reading Murray and Frenk’s article on assessing the performance of healthcare systems I couldn’t get a visual out of my head.

Teaching in East Harlem I can remember a number of times that I accompanied a student to a clinic for a variety of health issues.  As a teacher in a low-income community, I became a makeshift parent for many of my kids.  Sitting in the waiting rooms of these clinics made me feel sick.  The chairs, hard plastic, were covered in a layer of dirt that hadn’t been touched in some time.  The waiting rooms were over-crowded and loud.  Many times there were one or two doctors on staff along with a handful of RNs for a waiting room of forty people or more.  I remember waiting for hours with students while people came and went.  On one particular occasion a doctor saw one of my students and when the doctor finished our conversation he began yelling the personal information across the clinic to one of his colleagues.  Because we were in a clinic in the neighborhood it was likely that my student knew many of the people in the clinic at the same time.  Those people, who were not strangers, had personal details about her health issues due to the behavior of the doctor.  All I could think about was that “this would never happen in my neighborhood!!”

As I was reading Murray and Frenk’s article the ideas they discussed about the responsiveness of healthcare systems in terms of respect for persons and client orientation kept popping up.  The visual of the clinic in East Harlem would never happen in a wealthy neighborhood, and if it did I am confident it would be addressed immediately.  So the question I have is, how much is responsiveness of healthcare systems within one country related to the relative socio-economics of the population it serves? Is this a downfall of healthcare systems just in poor neighborhoods in the US or is it just more evident there? Is the US doing enough in terms of healthcare responsiveness? What should be done to fix this problem and is this where our focus should be or is this just a small factor in a much bigger sea of problems within the US healthcare system?  If we were being graded where would fall—honor roll or failing?



Murray, Christopher and Julio Frenk. “A Framework for Assessing the Performance of Health Systems”. Bulletin of the World Health Organization. Vol 78, Issue 6. 2000. 717-729.


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