TOWARD A SUSTAINABLE US HEALTH POLICY: LOCAL CONGRUITIES AND GLOBAL INCONGRUITIES

The United States health care system is congruous with the US economy and with prevailing local values: it is resource intensive, technology-focused, consumer-oriented, individualistic, and unequally available. However, the US health system is incongruous not only with other health care systems around the world, but also with the increasingly global nature of health care concerns. Indeed the US system, according to the World Bank, stands out as strikingly expensive and ineffective in its public health impact. The article first identifies several significant incongruities, and then argues that there is an increasing obligation for the US health system to become more ethically responsive in light of global concerns. Sustainable health should be sought as a significant goal of US health services. Health services need to be fully and accurately assessed for their environmental costs, which need to be made explicit. Actual, universal access to basic health care services needs to take priority over scarce high-tech therapies when resource allocations are made. Traditional health values such as individualism, autonomy and privacy must be placed within a context of global interdependence and responsibilities to community. Public health fundamentals such as adequate nutrition, clear water, and a biologically intact ecosystem must be emphasized. Innovations in health technology need to be made with attention to their potential international use and impact. Finally, a longer time horizon for planning is needed, taking into account environmentally caused health problems arising fifty years or more in the future.