Comparing Health Systems: A Cause for Controversy

The Controversy: WHO v. U.S.

When in 2000, the World Health Organization published its report entitled, “Health Systems: Improving Performance,” it was met with significant controversy due to its findings that the United States rated 24th place for disability-adjusted life expectancy and 33rd for equality of child survival (as cited by Coyne & Hilsenrath, 2002). Much controversy is due to the fact that the United States continues to spend exorbitant funds on a health care system that seems to be ineffective as compared to others internationally and continues to brag about its success (Hussey, et al., 2004). While the United States, has indicators to improve upon; it is only fair to evaluate how these comparative reports evaluate their data.

The Challenge of Evaluating Health Systems

Organizations are posed with significant challenges, as they begin to compare health systems. World Health Organization’s (WHO) was subject to this significant criticism largely due to the fact that they assumed that, “healthcare is the primary force responsible for the decline of mortality and morbidity (Navarro, 2002).” This assumption neglected to consider key building blocks, often absent in health systems evaluation, including social and political interventions, and adequate transportation.

The WHO, as its own organization also indulges its on biases towards systems, including the United States, that promote, “competition and privatization,” as a way to encourage a more responsive health care system (Navarro, 2002, p. 33).  This is reflected by the much higher rating the United States and Argentina received for responsiveness despite opposing negative reports on American’s perceptions of health care (Navarro, 2002).

Changing Focus

Criticism and setbacks, however, are not limited to the highly controversial World Health Report. It is difficult and challenging for organizations to know where to begin, how to measure health, and how to compile and evaluate a comprehensive list of indicators (Hussey, et al., 2004). Understandably it is easier to focus on specific indicators within a health system, then to evaluate how each health systems has differing social, political, and infrastructure needs.

The most important take away for all countries, including the U.S., is that every health system can be improved upon. In comparing five health systems, Hussey, et al. (2004), found that no health system was consistently above the rest and that “each country could improve the quality of care (Hussey et al., 2004, p. 96).” For the U.S. however, the lower ranking may have been a lesson in humility that it didn’t appreciate. For things to improve, the U.S. needs to change its focus from being reportedly “the best” to making distinct steps in decreasing behavioral risk factors, specifically smoking and obesity (Schroeder, 2007). Despite the fact that comparing health systems internationally is challenging, it is a helpful catalyst to begin a conversation on what factors affect health and which to focus on.

~Maya Genovesi


Coyne, J., Hilsenrath, P. (2002) The world health report 2000. American Journal of Public Health, 92(1), 30-34.

Hussey, P., Anderson, G., Osborn, R., Feek, C., McLaughlin, V., Millar, J., Epstein, J. (2004) How does the quality of care compare in five countries? Health Affairs, 23 (3), 89-99

Navarro, V. (2002) Can health systems be compared using a single measure of performance. American Journal of Public Health, 92 (1), 30-34.

Schroeder, S. (2007) We can do better–improving health of the American people. The New England Journal of Medicine, 357. 1221-1228.


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