Title: Paradigms lost? COVID-19 and the challenges of health care provision


Thomas Kuhn in his book, The Structure of Scientific Revolutions, defines paradigm “as a philosophical and theoretical framework of a scientific school or discipline within which theories, laws and generalizations and experiments performed in support of them is formulated”. The health paradigm for the last two and half centuries has been a bio-medical paradigm that pursues the search for good health as mainly the absence of disease. The criteria for interventions are that they are reliable, replicable and valid. Thus, health improvements are based on interventions that are linear, predictable and generalizable. Challenges to this view were catalyzed in 1978 at Alma Ata by member states of the World Health Organization adopting Primary Health Care (PHC). PHC was based on the principles of equity and community participation, approaches that revolutionized the ideas of how health improves. This approach has rapidly gained traction during the COVID-19 pandemic where the bio-medical paradigm has failed to halt the still spreading virus. More information and publications are giving evidence that a new approach is needed focusing on equity, community participation, governance, and social justice. Is a new paradigm for health improvements able to replace the old one? This presentation reviews the main attributes and values of both paradigms and examines whether a paradigm based on social determinants and rights base approaches can and will replace the bio-medical paradigm. It will highlight the strengths and weaknesses of a new paradigm and the challenges for change.


Susan Rifkin is an Adjunct Professor at the Colorado School of Public Health, a Senior Associate at the Bloomberg School of Public Health, Johns Hopkins University and on the faculty of the London School of Hygiene and Tropical Medicine. She has helped to establish two Masters degree Programs in Public Health --one at the University of Heidelberg and one in Kisumu Kenya. She has done consultancy work for WHO, UNICEF, World Bank and the European Union. Her research interests are focused on health policy, Primary Health Care, community participation and empowerment, in low and middle- income countries. She has published widely in The Lancet, Health Policy and Planning, BMJ Global Health, and Social Science and Medicine.

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