As indicated by
archeological evidence, medicine has had its role in all cultures and
civilisations (for example, in ancient Mesopotamia and Egypt). The Romans built
hospitals for domestic slaves and soldiers in permanent forts in occupied
territories such as England. However, the real development of the hospital
derived from the spread of Christianity and the ideas of Christian charity and
caring for all who might be in need for conversion. Hospitals developed in the
main cities of the Islamic world also developed hospitals and by the 11th
century, there were large hospitals in every major Muslim town. Hospitals were
for the sick who lacked families, or servants who care for them – the poor, travelers
and those working away from home (Abel-Smith, 1994).
archeological evidence, medicine has had its role in all cultures and
civilisations (for example, in ancient Mesopotamia and Egypt). The Romans built
hospitals for domestic slaves and soldiers in permanent forts in occupied
territories such as England. However, the real development of the hospital
derived from the spread of Christianity and the ideas of Christian charity and
caring for all who might be in need for conversion. Hospitals developed in the
main cities of the Islamic world also developed hospitals and by the 11th
century, there were large hospitals in every major Muslim town. Hospitals were
for the sick who lacked families, or servants who care for them – the poor, travelers
and those working away from home (Abel-Smith, 1994).
In Europe, by the middle
Ages, a multiplicity of institutions and organisations had developed with
pretensions to authority over medicine: the church, guilds, medical colleges,
town councils and powerful individuals. In Brussels, for example, a board of
clergy, doctors and midwives licensed midwives in the 15th century. The arrival
of the plague-the Black Death-which in its first wave killed about 25% of
Europe’s population stimulated growing state involvement to protect health
through measures such as imposing quarantine and isolating the sick
(Abel-Smith, 1994).
Ages, a multiplicity of institutions and organisations had developed with
pretensions to authority over medicine: the church, guilds, medical colleges,
town councils and powerful individuals. In Brussels, for example, a board of
clergy, doctors and midwives licensed midwives in the 15th century. The arrival
of the plague-the Black Death-which in its first wave killed about 25% of
Europe’s population stimulated growing state involvement to protect health
through measures such as imposing quarantine and isolating the sick
(Abel-Smith, 1994).
From the early 19th
century, the scientific basis of medicine was increasingly established, with
scientific training becoming essential for the practice of medicine (Porter,
1996b). The strong development of discipline of public health in the 19th
century was also a response to the disease hazards of the urban environment.
Over the 18th and 19th centuries, modern forms of medical regulation
developed. Countries in which medicine was dominated by free market (such as
USA) converged with countries in Europe with strong state control (such as Germany)
to produce closely regulated medical markets that exist today.
century, the scientific basis of medicine was increasingly established, with
scientific training becoming essential for the practice of medicine (Porter,
1996b). The strong development of discipline of public health in the 19th
century was also a response to the disease hazards of the urban environment.
Over the 18th and 19th centuries, modern forms of medical regulation
developed. Countries in which medicine was dominated by free market (such as
USA) converged with countries in Europe with strong state control (such as Germany)
to produce closely regulated medical markets that exist today.
However, the degree of
state involvement in the provision of health services varied enormously between
countries, as it still does (Merson et al, 2001). A key development was
the increase in collective arrangement for funding health services. State
services developed in all Western countries to provide health services for
those who could not afford to purchase it themselves. In addition, mutual
insurance schemes developed in Europe and United States to protect workers
against financial losses, and this often included medical care (Abel-Smith, 1994).
state involvement in the provision of health services varied enormously between
countries, as it still does (Merson et al, 2001). A key development was
the increase in collective arrangement for funding health services. State
services developed in all Western countries to provide health services for
those who could not afford to purchase it themselves. In addition, mutual
insurance schemes developed in Europe and United States to protect workers
against financial losses, and this often included medical care (Abel-Smith, 1994).
Another key development in
the creation of modern health system was the development of organised systems
of medical care, as opposed to fragmented and competing individual doctors and
hospitals. World War 1 marked a turning point in Europe, when the need to
organise medical care on a massive scale, highlighted the advantages of a
large, coordinated system (WHO, 1999).
the creation of modern health system was the development of organised systems
of medical care, as opposed to fragmented and competing individual doctors and
hospitals. World War 1 marked a turning point in Europe, when the need to
organise medical care on a massive scale, highlighted the advantages of a
large, coordinated system (WHO, 1999).
In the late 19th century,
Western medicine spread around the world, often as part of colonial expansion
(Zwi & Mills, 1995). Medicine acted in part as agency of Western
imperialism, and organised health services were a component of British, French,
German and Belgian colonisation. These were initially intended for the
military, settler and civil service communities, but it rapidly became apparent
that protecting the health of expatriates required addressing health needs
among the colonized (Merson, et al. 2001).
Western medicine spread around the world, often as part of colonial expansion
(Zwi & Mills, 1995). Medicine acted in part as agency of Western
imperialism, and organised health services were a component of British, French,
German and Belgian colonisation. These were initially intended for the
military, settler and civil service communities, but it rapidly became apparent
that protecting the health of expatriates required addressing health needs
among the colonized (Merson, et al. 2001).
As in Africa, the earliest
Western health services were developed by the colonists, especially for the
armed forces and the police. Major employers provided health services
especially where enterprises were remote from urban centres. Some religious
hospitals were built to care for the poor (Abel-Smith, 2001). These hospitals
were later supplemented by government hospitals and clinics, especially in
areas without charitable hospitals. A key difference with most of Africa and Asia
was the development of compulsory insurance arrangement for workers in the
formal sector. Since medical infrastructure was lacking, the insurance agencies
often built and ran their services, thus contributing to parallel health
systems.
Western health services were developed by the colonists, especially for the
armed forces and the police. Major employers provided health services
especially where enterprises were remote from urban centres. Some religious
hospitals were built to care for the poor (Abel-Smith, 2001). These hospitals
were later supplemented by government hospitals and clinics, especially in
areas without charitable hospitals. A key difference with most of Africa and Asia
was the development of compulsory insurance arrangement for workers in the
formal sector. Since medical infrastructure was lacking, the insurance agencies
often built and ran their services, thus contributing to parallel health
systems.
The historical development of health services in many
countries resulted in a health infrastructure that was biased towards
hospitals. Attempts to re-orientate services culminated in 1978, in the Alma
Ata Declaration, which emphasized the importance of primary health care. However,
a marked development in recent years is that low and middle income countries
have increasingly questioned government’s role in health care. In countries
where market forces are allowed to influence health services, governments are
advised to step in and cushion the cost and effect of health care for a better
living condition and well-being of the citizens.
countries resulted in a health infrastructure that was biased towards
hospitals. Attempts to re-orientate services culminated in 1978, in the Alma
Ata Declaration, which emphasized the importance of primary health care. However,
a marked development in recent years is that low and middle income countries
have increasingly questioned government’s role in health care. In countries
where market forces are allowed to influence health services, governments are
advised to step in and cushion the cost and effect of health care for a better
living condition and well-being of the citizens.
