International Perspectives On Setting Up Health Systems

( Pulling on her experiences working with global health systems, Professor Radhika Bhavsar, MPH discusses ways we can improve the health of our communities. She describes how often we look to the systems in developed nations to inform how we can build or improve the systems in developing nations. However, she stresses that often we should look to developing nations and apply their successes to help improve the health of communities in the US.

Professor Bhavasar discusses that when thinking of health care in communities, it is important to emphasize creating a Culture of Health. With her work in Rwanda, focus was paid to community health workers to reach rural communities, sustainable agricultural practices to improve nutrition, and improving social determinants of health, including transportation, safe roads and walkways, proximity of clinics to communities, etc.

Within her Culture of Health model, emphasis is put on our collective social responsibility to lift our communities. Community health workers can connect with communities in ways that clinicians may not be able, they have the ability to enter homes as peers.

The United States similarly has invested in improving similar services, such as social workers, case managers, and patient advocates. These individuals aid our patients in navigating an ever complicated system in order to improve their health.

Even further, within Rwanda there is a shared collective responsibility that is facilitated by the federal government. Once a month, there are days of community service, called Umuganda, where individuals across the entire country are expected (and federally mandated) to contribute to community projects, such as building walkways, picking up trash, taking care of communal spaces, etc. Further, the government mandates a “Sports Day” once a month where roads are closed and individuals are encouraged to run, cycle, or use the streets for activities that improve health. Can our government foster a culture that puts health and community at the forefront?

This idea of shared social responsibility for community is deeply entrenched in many of the communities of developing nations, and is a concept that can and should be brought the United States. Professor Bhavsar conveys that this idea of shared social responsibility allows us to not only care for others, but also allow others to care for us. Community heals community and ultimately, we are all in this together.

She ends with a pungent question for the group: “How would you create a culture of health for humanity and what will you do to make that happen?”


Presented by: Radhika Bhavsar, MPH, UCSD’s School of Social Science, Global Health

Written by: Michelle Leach, MD, PGY3 Urology Resident Physician at UC San Diego, during the 2023 Urology for Social Responsibility Meeting January 14-15, 2023


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