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 heal th care systems around the world, but also with the increasingly globa l nature of health care concerns. Indeed the US system, according to t he World Bank, stands out as strikingly expensive and ineffective in i ts public health impact. The article first identifies several signific ant incongruities, and then argues that there is an increasing obligat ion for the US health system to become more ethically responsive in li ght of global concerns. Sustainable health should be sought as a signi ficant goal of US health services. Health services need to be fully an d 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 a llocations are made. Traditional health values such as individualism,a utonomy and privacy must be placed within a context of global interdep endence and responsibilities to community. Public health fundamentals such as adequate nutrition, clear water, and a biologically intact eco system 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 acc ount environmentally caused health problems arising fifty years or mor e in the future.