In everyday conversations about health, we tend to focus on diagnoses, treatments, and the latest medical innovations. But have we ever stopped to consider the rationality of the entire system that underpins them?
Rationality, in general terms, is the ability to act according to logic and reason. In the health field, it has traditionally focused on professionals: the ability to systematically apply scientific knowledge to weigh the benefits and risks of an intervention (a medication, a surgery, a piece of advice), what we know as evidence-based medicine.
However, in a health system facing growing challenges such as primary care overburden, overmedicalization, and persistent inequities, this definition falls short.
An over-individualistic focus
Paradoxically, even though we know that social, economic, and environmental factors have the greatest impact on our health (postal code is often more important than genetic code), the vast majority of health actions focus on individual solutions.
Let’s think for a moment about the long waiting list at our health center, or when we hear that someone has been prescribed medication for a problem that, in all fairness, it’s rooted in loneliness, unemployment, or a lack of safe green spaces in their neighborhood. This approach, although necessary for acute illness, often results in care:
- Less effective in the long term: It doesn’t address the root of the problem.
- Generates medicalization: It turns social or existential problems into “illnesses” that require a pill.
- Unfair (inequitable): It doesn’t help those who need it most, whose health is profoundly influenced by these social variables.
This is where the concept of Rationality in Healthcare comes into play.
Towards a more rational health system
Our project was born precisely to contribute to this goal. True rationality in the health system is not only the logical application of individual treatment, but the logical and effective application of resources to improve population health and equity by addressing the root causes.
The formula we want to promote is:
Rationality in Healthcare = Clinical Evidence + Addressing Social Determinants + Equity
To achieve this, the key element is co-creation.
The power of community co-creation
At CAIR, we seek to demonstrate how community-based initiatives can ease the burden on primary care services, reduce medicalization, and, above all, increase health equity.
Co-creation is the method to achieve this. It’s not about authorities or professionals “doing things for the community,” but rather about different actors (professionals, authorities, social organizations, and, most importantly, citizens) working together to:
- Identify health problems that have a social origin.
- Design and implement solutions that affect the environment (e.g., a neighborhood support program to reduce loneliness, the creation of an urban garden to promote activity and healthy eating).
- Evaluate the impact of these actions on the system and on people’s lives.
Rationality in Healthcare is not limited to using a drug appropriately. It is a commitment by the health system to use its resources (and those of the community) wisely to generate the greatest possible amount of health with the greatest possible equity.
We are not simply investigating this potential; we are gathering evidence that will demonstrate how investment in the community and citizen participation are, in fact, the most logical, rational, and, ultimately, the most humane action our health system can take.