Should nurses, rather than doctors, be leading the health systems of the future?
The question is asked in this provocative article published by Lives, a partner publication of Scientific American that focuses on global health.
It has generated something of an international stir, not to mention a deal of vitriol.
Interestingly, not all of the authors were nurses, and they include Dr Richard Smith, former editor of the BMJ and a well known provocateur who is now Director of UnitedHealth Chronic Disease Initiative.
The article says:
Until now, healthcare systems have generally been dominated by hospitals and concerns with the “four Ds”—doctors, disease, drugs and death. Discussions on health have been led by what Nigel Crisp, once chief executive of Britain’s National Health Service (the world’s largest employer of health workers), has called “medico-academic-commercial-governmental” interests. These interests have combined to convince the rich world that it needs more doctors, hospitals, and technical treatments. This strategy worked well in the 19th century.
That was then. This is now. In the rich as well as the poor nations of the world, chronic, non-communicable disease is taking over from infectious disease, and health systems are failing to adapt. Health systems in poorer countries cannot afford to copy the systems that exist in rich countries, and it would be wise not to do so. Organizations like the world’s biggest non-governmental agency, BRAC in Bangladesh, for example, emphasizes the importance of community, family, lifestyles, culture, and behavioral and social factors in health, factors that are the foundation of nursing care. And Ethiopia is trying to build a system based on health, not disease.
The advancement of non-communicable diseases in developed and developing countries and the need for professionals who can implement health promotion and intervention strategies lead us to believe that there is a strong case for building health delivery systems led by nurses rather than doctors.
One reason for arguing this, the authors say, is the presence of nurses in underserved regions (that’s certainly the case in remote parts of Australia). The authors note that most people in low –and middle–income countries live in rural areas; the WHO reports that more than three quarters of doctors are concentrated in cities.
The article generated such a heated response that the authors posted a response saying they were “not arguing that doctors do not have a role in global health, rather that nurses are fully capable of playing a more prominent role and that these nursing resources should be more broadly used”.
The article – and the responses – are worth a read.
For those who might have been tempted to think of professional wars as a peculiarly Australian problem, clearly they are not.