General theory of paradigms in health

Abstract

In Costa Rica, three sequential health paradigms have been identified over the last 50 years. The first began to develop during the 40's and has been called that of the deficiency diseases, since with a diachronic approach it placed excessive emphasis on malnutrition. The second began in 1970 and it is known as that of the infectious diseases, since through a holistic or synchronic approach, it underlined the importance of infections in high rates of morbidity and mortality. The third and last is the paradigm of the chronic diseases, it appeared in the 80's and is presently in process, doing battle with the chronic ailments, life styles, and environment, and it also utilizes a holistic approach. The recognition of these three paradigms has permitted Costa Rica a rapid advance in improving the health of its population, to the point that with a per capita outlay of $130 (US dollars), it has indices similar to those of the industrialized nations. This particular experience could be useful for other less-developed countries that are still applying the paradigm of the deficiency diseases.Costa Rica's health care experience is explained in terms of 3 sequential paradigms. The 1st malnutrition paradigm (1940-69) considers the causes of ill health as poverty, ignorance, exploitation, and food shortages. The problems are malnutrition, parasitosis, infectious diseases, high mortality, high rates of hospitalization, and requiring health and hospital based services. The strategies were to improve diet through food distribution, create nutrition departments within the Ministries of Health, increase the number of doctors and nurses, and politicize medicine. Socialism was the model and economic growth and industrialization were seen as prerequisites. Curative medicine was practiced. The attitude was hopelessness is being able to solve problems and acceptance of the status quo. The 2nd infectious disease paradigm (the 1970s) focused the causes as infectious diseases, intestinal parasitosis, unwanted pregnancy, low birth weight, artificial feeding, and limited health services supply, which were given priority. Primary health care for all and health sector reform were some of the strategies. Healthier families were thought to contribute more to economic and social development. Full health services were promoted and the politicization of medicine was reduced. The attitude changed to one of being able to solve one's own problems. The National Health System began to evolve based on a holistic approach where the environment and the life cycle were integrated. Implementation of the national framework was replicated at the regional and local levels; institutions and programs were integrated in a synchronic approach so that the effects of infection, malnutrition, and fertility on human growth and development were considered. Infant mortality dropped by 70%, and infectious diseases were eliminated or greatly reduced. The 3rd chronic disease paradigm (1980s) assumes the causes to be unwanted children, insufficient prenatal and maternity care, inadequate environmental conditions, inadequate life style, and social pathology. The approach is holistic. The philosophical base is the development of individual responsibility and efficient use of science and technology; health contributes to democracy and peace. Prevention, cure, and rehabilitation are equal. The application to other countries must consider that there are more technological options but fewer resources. Rigid and dogmatic plans will not work.