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Health System Man

By Kristof Decoster
on April 20, 2015

This morning, as we were gathering for one of our (nowadays rather common) “strategic meetings” at the public health department of  this institute, to “boldly go where synergies can be found and preferably costs can be cut”, at some point my colleague Bruno Marchal made an intervention, in trademark Autobahn way. Bruno has just been appointed as a professor, and deservedly so.  One of my colleagues joked this now officially makes him a ‘Health System Man’.  A strategic meeting, I told you.

But hey, it does sound like a nice concept.

What would a ‘Health System Man’ look like, if you started thinking about it? What would draw the crowds to movie theatres all over the world to watch the unlikely hero  ‘Health System Man’? Put differently, will there ever be a Health System Man my teenage son, who just can’t get enough of Iron Man (and Iron Man 2, and Iron Man 3 etc), wants to see?

True, the health systems research and global health community does have its superstars and philantro-capitalist billionaires, but a superhero “who has it all” and appeals to the masses we still  lack. And let’s face it, in the crisis-prone post-2015 era,  a superhero to implement UHC and build resilient health systems all around the world, would come in more than handy.

Enter Health System Man (HSM) ! (now you need to imagine some sort of Jason Bourne style hyperkinetic electronic beat to get your adrenaline up)

The HSR Tony Stark would not just have his own three-letter acronym (HSM), he would obviously be super smart, have dazzlingly resilient HSR armor, methodological skills beyond comparison, as well as his very own think tank with resources as deep as the ocean. Filthy rich, he wouldn’t need to bother about being cost-effective, and his performance would invariably be top-notch without ever having to be incentivized. As this is meant to be standard Hollywood fare, Health System Man is naturally also a slick wisecracking playboy, albeit one with good manners and always making use of the latest ‘state of the art’ contraception devices. Still, the reproductive health community doesn’t like him  much.

Clearly, Health System Man needs some powerful allies to achieve health system reform in countries as backward as the US or find his way in settings as complex and tricky as Geneva and Seattle. As you might have guessed, they are  the UHC Avengers.

Clearly, Rob “UHC” Yates would have to be one of the “UHC Avengers”, but HSM’s dream team would also comprise a Chinese UHC Avenger (for the many Chinese viewers), and as in all Hollywood superhero blockbusters, we also need a (very) good looking female heroine for the squad, Health System Woman (HSW)  with incredible superpowers as well.  (this is a tricky oneperhaps we need to ask Ilona Kickbusch to start a list on Twitter for some inspiration)

Unfortunately,  Health System Man and the rest of the UHC Avengers would have plenty of enemies. You’d have the evil billionaire – plenty of choice there – hell-bent on techno-fixing health care (there’s no room for complexity in a Hollywood comic blockbuster, so you only need black and white characters), but there’s also  the wicked health system researcher/policy maker with global clout but also a thinly veiled UHC agenda.  While on the road, trying to get UHC off the ground somewhere in the world, Health System Man would also be seduced by stunning women you just can’t trust.  For some reason they’d all be called Amanda.

Typically, Health System Man has huge trouble to make Disease Control Man understand what he’s all about, even in his own institute. Disease Control Man has ancient Neanderthal roots and tends to be somewhat less sophisticated than Health System Man.  The former is usually rather bad news for a ‘learning organization’, by the way.  (conversely, Disease Control Man thinks Health System Man is full of pomp and jargon, just having to mention ‘paradigm’ or ‘complexity’ in every other sentence.)

While trying to establish UHC in countries, Health System Man would also “embed” himself in the mythical Decision Making Land to push his paradigm in a sneaky but incredibly effective way, changing mindsets of decision makers without them even noticing.

All in all, as this is supposed to be an action movie, Health Systems Man would be known for actually doing UHC (rather than just talking about it). And to make it really a dazzling action picture, Health Systems Man first read the ‘Doing development differently’ manifesto, before embarking on his global struggle for UHC.

What would ‘doing UHC differently’ entail?

Well, he’d start by bombing one tax haven, and after finding out just how successful that is to secure health financing, he’d rapidly scale up and bomb all the other ones on earth. Then he’d rob (or rather take back) all remaining assets in secret  money hide-outs in the Netherlands, Ireland and other places with a bit more collateral damage if you start bombing them, from the likes of Bono, Starbucks and Apple.

He wouldn’t hesitate though to draw on slick Apple technology to set up his superfast global health information system.  As a supposedly super smart hero, a systems and complexity approach would be his thing, but at various tipping points in the movie, he’d just drop all pretense of complexity and evidence-based action and instead send Rob Yates “to clean up” things and more in general go berserk  for the good cause.  As any Health System Man fan knows,  Rob is always UHC value for money. It’s a bulldozer, the Vin Diesel of HSM movies.

That wouldn’t be all, though. In addition to Rob’s wrecking ball work, Health  System Man would also train somewhere in the Saharan desert  a daunting army of health workers, ready to be deployed anywhere in the world. Not health staff, but UHC robots, of course –  as task-shifting is Health System Man’s device. While treating one needy patient with one hand, the robots would butcher UHC enemies with the other one – so not just a task-shifting health force but also a multi-tasking army, so to speak. Treating patients and chopping off heads of enemies, all in one go. Super -efficient. UHC done differently, and obviously more than fit for the 21st century.

Last but not least, Health System Man doesn’t feel bothered by global health governance, and even less so by global governance for health. Going through reports and top notch publications, or mapping key stakeholders and seeking strategic alliances,  is just not his thing, let alone following up how often WHO statements are being revised online. As for SDG Christmas trees, he often gets a bit lost in them. No, as far as HSM governance goes, he just walks into the corridors of power and then tells Davos men & women to either pay or die: “Either you ‘re with me, or against me, in this global fight for UHC! “ ( he usually says this with a smirk on his face)  ( the quote will sound strangely familiar to the high net worth individuals in the room).

And then HSM finishes the job: “I can always ask my dear friend Richard Horton to dedicate an Offline piece to your multiple sins.”     (That’s the catchphrase of the HSM blockbusters – just like ‘I’ll be back’ for the Terminator movies, or ‘Yippee-Ki-Yay’ for the Diehard movies. )

As a viewer, you know that by then the high-net worth individuals are reaching mechanically for their wallets.

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