Angela Hill

Here is a question from my EdX SW25x class this week – Biosocial approach to Global Health.

There has been a long discussion about the strengths and weaknesses between vertical approaches and horizontal approaches. Please provide an example of each. What do you see as the trade-offs between these two approaches? Can you suggest why or for what goals one approach would be more effective than the other?

Here are some of my thoughts, am I right? wrong? What do others think?

The vertical approach to primary health care focuses on fighting one disease at time, whereas the horizontal approach focuses on a number of activities to promote and maintain health.

Medical staff might like to use vertical approaches because there is a tangible result that can be seen, ex. There is no more small pox. Or we don’t see a lot of measles because a majority of people have been vaccinated for it. Those are some positives, however there are negatives as well, for example vertical approaches tend to make the use of funds and resources too narrow, to specific. For example, in the effort to eliminate guinea worm, are we ignoring those who are getting diarrhea from their local water source?

It can be harder to see instant results from horizontal health, but a broad-approach to primary health care is increasingly more effective and puts fewer burdens on health budgets, especially in places like Canada.

Type two diabetes as an example, a vertical approach to that might be to treat with insulin and have people take care of their sugar intake. If that doesn’t happen it could lead to expensive hospitalization treatments for cardiovascular disease, stroke, lower limb amputations and kidney failure.

With a horizontal approach people seen as at risk of type two diabetes (genetics or poor lifestyle) can be reached out to early. Along with education and diet changes, there can be lifestyle changes also, proper foot care etc. Not only does this early primary care intervention possibly delay or prevent the onset of type two diabetes, the changes have positive outcomes for the possibility of obesity, heart disease, stroke and a number of other diseases.

Within the existing Canadian health structure I think there is room for both approaches, with vertical more focused on infectious disease (with childhood and adult immunizations etc.) and horizontal for the growing population/lifestyle health epidemics we are facing.