Epidemiological Transition and the Crisis of the Treatment Model: The Need for a Shift Toward Preventive and Integrative Healthcare

Alexander Dmitriev

doi:10.20944/preprints202604.0564.v1

Submitted:

06 April 2026

Posted:

08 April 2026

You are already at the latest version

Abstract

Background: Non-communicable diseases (NCDs) account for the majority of global mortality, yet healthcare systems remain largely oriented toward the treatment of acute conditions. This study examines the structural mismatch between contemporary disease patterns and healthcare system organization. Methods: A narrative analytical review was conducted using secondary data from the Global Burden of Disease (GBD) study and World Health Organization (WHO) reports, supplemented by literature from PubMed, Scopus, and Google Scholar (2000–2026). Findings were interpreted using epidemiological transition theory, health systems analysis, and political economy frameworks. Results: The analysis identifies multiple structural drivers of treatment-oriented healthcare systems, including economic incentives favoring curative services, short-term political decision-making cycles, and the historical dominance of the biomedical model. These factors contribute to systematic underinvestment in prevention, rising healthcare expenditures, and persistent global inequalities in access to medical technologies, as demonstrated during the COVID-19 pandemic. The current model is associated with increasing economic burden and projected losses in global productivity by 2030–2050. Conclusions: The findings indicate that the current healthcare model is structurally misaligned with population health needs. Improving health outcomes and system sustainability requires a reorientation toward prevention, long-term health metrics, and the evidence-based integration of complementary approaches within healthcare systems.

Keywords:

non-communicable diseases (NCDs)

;

epidemiological transition

;

health system organization

;

preventive healthcare

;

health inequality

Subject:

Public Health and Healthcare - Health Policy and Services

Introduction

At present, the modern healthcare system is facing a deep systemic crisis affecting its fundamental principles and sustainability. Despite significant technological progress and advances in precision medicine, artificial intelligence, and gene therapy, the overall health status of the global population is deteriorating. The central contradiction lies in the fact that increased healthcare funding and improved diagnostics are not accompanied by a substantial reduction in the prevalence of chronic non-communicable diseases such as cardiovascular diseases, diabetes, cancer, and chronic respiratory conditions. (1)

This crisis is structurally determined and rooted in the historical and systemic characteristics of healthcare development. The modern healthcare system was formed in the first half of the 20th century, when the primary threats to health were infectious diseases and injuries. An approach focused on treating already manifested diseases proved effective against infections and led to a rapid and significant increase in life expectancy. Today, however, the disease structure has changed: instead of acute infections, chronic diseases now predominate, requiring not one-time treatment but long-term management, including modifications in lifestyle, environment, and the social determinants of health for each individual. (1,2)

The gap between the excessive focus on high technologies and the real needs of the population is becoming increasingly evident. Healthcare systems often prioritize expensive treatments at advanced stages of disease while underestimating simple and effective preventive measures. As a result, a model emerges in which financial interests, insurance structures, and pharmaceutical industry profits tend to outweigh the actual improvement of population health. (3)

The central question of this article is as follows: why does the modern healthcare system, despite its immense technological potential, fail to effectively address the burden of non-communicable diseases and global inequality?

This study contributes to the existing literature by integrating epidemiological transition theory with a political economy perspective to explain the persistence of treatment-oriented healthcare systems despite the dominance of non-communicable diseases. It further provides a structured synthesis linking global disease patterns, institutional incentives, and health system outcomes within a single analytical framework.

Methods

This study was conducted as a narrative analytical review aimed at examining the structural mismatch between contemporary disease patterns and the organization of modern healthcare systems. No primary data were collected. The analysis is based on secondary data derived from publicly available sources, primarily the Global Burden of Disease (GBD) study and reports from the World Health Organization (WHO), which provide standardized estimates of mortality, morbidity, and risk factors across populations. These sources were selected due to their methodological rigor, global scope, and relevance to population-level health trends.

Additional evidence was obtained through targeted searches of PubMed, Scopus, and Google Scholar for publications in English from approximately 2000 to 2026, using combinations of terms related to non-communicable diseases, epidemiological transition, health system organization, prevention, and global health inequality. Sources were selected based on relevance to the research question and citation prominence. Priority was given to peer-reviewed publications, including systematic reviews, large observational studies, and high-impact journal articles. Policy reports and institutional publications were also included to capture economic and governance dimensions that are not fully represented in clinical or epidemiological literature.

The study follows a narrative synthesis approach in which findings from non-uniform data sources are examined together rather than quantitatively pooled. This analysis is structured through the combined use of epidemiological transition theory, health systems and economic analysis, and political economy perspectives. These frameworks were used to interpret patterns in disease burden, healthcare financing, and global inequalities, and to identify structural relationships between institutional incentives and health outcomes.

Sources were included if they provided quantitative data on disease burden, examined healthcare system structure or policy, or addressed prevention and integrative approaches within a population health context. Non-analytical opinion pieces and non-indexed sources were excluded unless required for historical or conceptual background.

This methodological approach has inherent limitations. As a narrative review, it does not follow a formal systematic protocol and may therefore be subject to selection bias. The integration of diverse types of evidence introduces interpretive subjectivity, and causal inferences are based on existing literature rather than primary empirical analysis.

Epidemiological Transition as a Structural Change

The concept of the epidemiological transition, proposed by Abdel Omran, explains how the causes of disease and mortality change over time as societies develop. According to this theory, humanity passes through several stages: from a period dominated by famine and infectious diseases, to a stage of their decline, and further to a period in which chronic and lifestyle-related diseases prevail. (4) At present, most countries are in this final stage, which requires the restructuring of healthcare systems to address new types of diseases.

Statistical Indicators of the Global Burden of Disease

Data from the Global Burden of Disease (GBD) study for the period from 2000 to 2021 confirm that non-communicable diseases (NCDs) have become the leading cause of mortality in all regions except for the poorest countries with a low Socio-Demographic Index (SDI). In 2021, non-communicable diseases accounted for approximately 43.8 million deaths, representing about 64.5% of all deaths worldwide. (1)

The main groups of NCDs and their contribution to global mortality are presented in the table below:

Disease Category	Mortality in 2021 (number)	Share of Total Mortality (%)	*Trend (AAPC)**
Cardiovascular diseases (CVDs)	19,400,000	28.6%	+0.21%
Neoplasms (Oncology)	9,880,000	14.6%	Steady increase
Chronic respiratory diseases (CRDs)	4,410,000	6.5%	Regionally variable
Diabetes mellitus (DM)	1,650,000	2.4%	+2.41%
Total for 4 major NCDs	37,600,000	~55%	Upward
Sources: (1) *Average Annual Percent Change

Diabetes mellitus demonstrates the fastest growth rate in incidence among all major NCDs. This indicates a profound crisis in population metabolic health, associated with changes in diet and decreased physical activity. (1,5)

Regional Specificity and the Phenomenon of the Double Burden

The epidemiological transition is occurring unevenly across the world. In high-income countries (High SDI), the peak incidence of diabetes is observed (461 cases per 100,000 population), while in low-income countries high mortality from infectious, maternal, and perinatal conditions persists. (1) The most concerning situation today is observed in low- and middle-income countries (LMICs), which face the so-called “double burden of disease.” In these regions, healthcare systems are forced to simultaneously combat classical infectious diseases (tuberculosis, HIV, malaria) and a rapidly emerging epidemic of NCDs driven by urbanization and Western lifestyles. (6,7) Under such conditions, the traditional division of medicine into “infectious” and “chronic” domains becomes ineffective, as the same populations (for example, residents of slums in India or Ghana) are exposed to both types of risks simultaneously. (2)

Projections to 2050: An Approaching Collapse

If current trends persist, by 2050 global mortality from NCDs may reach 75.5 million deaths annually. Cardiovascular diseases will continue to account for the largest share, comprising up to 86% of all NCD-related deaths. The projected number of disability-adjusted life years (DALYs) lost will reach 2.44 billion, delivering a severe blow to global labor productivity and the sustainability of social systems. (1)

These data indicate that the modern healthcare system is operating within a new biological reality while continuing to apply a “firefighting” logic designed for acute episodes, rendering it incapable of preventing the impending crisis of chronic diseases.

Structural Inequality in Global Healthcare

One of the key reasons for the low effectiveness of the modern healthcare system is systemic inequality embedded in its structure and mechanisms of operation. The global healthcare system does not constitute a unified space; rather, it is stratified into levels with unequal access to resources, technologies, and knowledge. Countries of the Global North occupy a dominant position, while countries of the Global South remain in a dependent position. This is reflected in the unequal distribution of medical technologies, funding, workforce, and scientific influence, as well as in the fact that healthcare models and treatment standards are often developed in high-income countries and subsequently transferred to less developed contexts without consideration of local conditions and needs.

Concentration of R&D and the Patent Barrier

More than 90% of global investment in medical research and development (R&D) is concentrated in developed countries, limiting the participation and priority-setting capacity of the rest of the world. The pharmaceutical industry, driven by profit maximization, focuses on developing drugs for “effective demand.” As a result, diseases prevalent in poorer regions (“neglected tropical diseases”) receive minimal funding. (8–10)

The patent system, enshrined through the TRIPS agreement, effectively restricts access to medical technologies. It allows monopolistic companies to set prices that are unaffordable for the majority of the global population. Even during crises, the use of compulsory licensing mechanisms is often constrained by political pressure from developed countries, further reducing access to treatment. (8,11)

The COVID-19 Case as a Reflection of Systemic Failure

The COVID-19 pandemic demonstrated that rapid technological advances, including the accelerated development of vaccines, do not in themselves guarantee equitable public outcomes. As early as 2021, more than 70% of produced vaccine doses were allocated to high-income countries, while vaccination coverage in low-income countries remained at only 1–4%. (8,12) This highlights a substantial gap between the capabilities of science and the mechanisms for distributing its results.

Vaccine distribution was markedly unequal. The Gini coefficient, used to assess inequality on a scale from 0 (perfect equality) to 1 (maximum concentration of resources), reached approximately 0.88. This level is close to the upper bound and comparable to global income inequality, reflecting the concentration of vaccine resources in a limited number of countries. In practice, this meant that a significant proportion of populations in low-income countries remained without access to vaccination, despite its critical role in reducing mortality.

An additional factor was the mismatch between public investment and the accessibility of the final product. Vaccine development was largely financed through public funds, including in the United States and the United Kingdom, where investments reached approximately $14 billion. However, the resulting technologies and economic benefits largely remained within the private sector, limiting the scale and speed of global access.

As a result, a situation emerged that has been described in a number of sources as “vaccine apartheid.”(13,14) This was driven not only by production constraints but also by the lack of broad technology transfer and the dependence of low-income countries on external supplies and humanitarian mechanisms. The COVAX initiative, developed by the World Health Organization to ensure more equitable vaccine distribution, failed to achieve its stated goals, as high-income countries prioritized direct procurement and securing their own needs, thereby significantly restricting access for less affluent states. This situation underscores that, within the current political-economic framework, global solidarity remains largely illusory.

Shift Toward Treatment: Economic and Institutional Drivers

The question of why healthcare systems systematically underinvest in prevention requires an analysis of institutional incentives. The observed model is not the result of inefficiency or error, but rather reflects rational behavior within existing economic and political constraints, where priority is given to interventions that produce measurable and short-term outcomes.

Historical Foundation: The Flexner Report and the Institutionalization of the Biomedical Model

A key stage in the formation of modern Western medicine was the publication of the Flexner Report in 1910. (15,16) Supported by the Carnegie and Rockefeller foundations, the document standardized medical education along the lines of German university science, establishing the primacy of the laboratory approach and clinical practice grounded in the biomedical paradigm.

The consequences of the reform were extensive: more than half of medical schools in the United States were closed, including institutions teaching herbal medicine, homeopathy, and naturopathy. This led to a sharp reduction in the institutional diversity of medical practices and the dominance of a single model of knowledge.

At the same time, there was a shift in the professional focus of physicians. Issues of hygiene, prevention, and public health were largely removed from the domain of clinical competence, while primary attention was directed toward pathophysiology and the treatment of already manifested diseases within hospital settings. This contributed to the formation of a model oriented toward intervention rather than prevention.

In parallel, the linkage between medicine and the pharmaceutical industry intensified. The physician increasingly came to be viewed as a specialist applying standardized therapeutic and surgical solutions, which objectively created favorable conditions for the expansion of the market for pharmaceuticals and medical technologies. (17,18)

Thus, the institutional consolidation of medicine in the early twentieth century established the primacy of treatment over prevention and set the trajectory for a system in which the maintenance of health became secondary to the management of disease.

The Political Economy of Prevention and Treatment

Within the existing system, treatment functions as a “commodity of immediate consumption,” providing rapid, measurable, and politically demonstrable outcomes. Prevention, by contrast, represents a form of long-term investment with delayed effects and high uncertainty within the evaluation horizon. (19)

First, political cycles prioritize short-term interventions. Governments, constrained by terms of office lasting 4–5 years, tend to favor solutions that produce quick and visible results, such as the construction of specialized medical centers or the expansion of access to treatment. In contrast, the outcomes of preventive programs aimed at reducing obesity, tobacco use, or metabolic disorders become evident only over decades, often beyond the current political cycle. (3,20)

Second, the structure of economic incentives reinforces the orientation toward treatment. Chronic diseases generate sustained demand for pharmaceutical and medical services, effectively turning the patient into a long-term consumer. In contrast, effective prevention and lifestyle modification reduce the consumption of medical products and therefore do not generate comparable economic returns for the industry. (21,22)

Third, informational and perceptual asymmetry plays a significant role. Patients and society as a whole tend to assign greater value to high-technology interventions than to gradual changes in behaviour and environment. As a result, a technology-centered orientation is reinforced, and complex health problems are framed as solvable through drugs, devices, or algorithms, while their social determinants are overlooked. (23,24)

Overreliance on Technology and the Role of Digital Factors in Healthcare

The use of artificial intelligence and big data is often presented as a universal solution to healthcare challenges. However, research indicates that such technologies can divert attention from deeper and more systemic issues. (23) Instead of addressing problems such as poverty, air pollution, or food quality, resources are directed toward the development of “smart applications” for monitoring blood glucose levels.

This approach is based on the assumption that providing individuals with more information about their condition will lead to rational behaviour. In practice, this fails to account for real constraints, such as time scarcity and financial pressure, which limit people’s ability to follow recommendations. (24–26) As a result, technologies tend to reinforce inequality: they primarily benefit more affluent and relatively healthy populations, while vulnerable groups receive little meaningful advantage. (27,28)

The Burden of Non-Communicable Diseases and the Limits of the Current Model

The current approach to healthcare is becoming economically unsustainable. Even in the wealthiest countries, healthcare expenditures are growing faster than GDP, while the quality of life of the population is stagnating or even deteriorating.

Economic Inefficiency of the Reactive Healthcare Model

According to the World Health Organization, non-communicable diseases impose annual global economic losses measured in trillions of dollars. In the European region alone, NCDs account for 1.8 million preventable deaths and cost approximately $514 billion each year. (29) In the United States, healthcare expenditures have reached 18% of GDP, twice the global average, yet the country lags behind many developed nations in life expectancy. (30,31)

Cost Type	Projection / Estimate	Consequences
Total global economic burden (by 2030)	$47 trillion	Reduction in global economic growth
Effectiveness of investment in prevention	1:14 (every €1 returns €14)	Massive unrealized gains
Share of spending on prevention in OECD countries	< 0.5% of GDP	Chronic underfunding
Productivity losses in Europe	> $514.5 billion annually	Impact on social sustainability
Sources:(19,30,32–34)

The core problem is that modern medicine is primarily oriented toward managing late-stage disease. Treating stage IV cancer or performing complex cardiac surgeries is orders of magnitude more expensive than controlling blood pressure or modifying diet at early stages. However, insurance and public financing models continue to incentivize the volume of procedures rather than outcomes in terms of health preservation. (10,31)

Declining Quality of Life and Multimorbidity

Chronic non-communicable diseases rarely occur in isolation. In low- and middle-income countries, there is a growing prevalence of multimorbidity, with patients simultaneously suffering from hypertension, diabetes, and chronic respiratory diseases. (6,35) The current system, divided into narrow specialties (cardiology, endocrinology, etc.), is unable to effectively manage such patients. This leads to polypharmacy (the prescription of excessive numbers of medications), increased side effects, and a decline in quality of life. (6,22)

An approach based on treating already developed diseases turns individuals into “chronic patients” for decades, creating a substantial burden not only on healthcare budgets but also on family structures, where the responsibility for care is often borne by relatives. (3,30)

Shift Toward a Holistic and Preventive Healthcare Model

The limitations of the existing healthcare model necessitate a reconsideration of its fundamental principles and the search for alternative approaches. One such direction is the transition to a holistic and preventive paradigm. This does not imply a rejection of evidence-based medicine, but rather an expansion of its methodological and practical frameworks.

What Is a Holistic Approach?

In contrast to the reductionist model, where the human being is viewed as a collection of organs, the holistic approach defines health as a dynamic equilibrium within a complex system. (36)

First, it assumes a systemic understanding of disease: illness is interpreted not as a localized malfunction, but as a manifestation of a broader imbalance involving the body, psyche, and environment. (37,38) This approach is oriented toward personalization, including analysis of the patient’s individual context, it being lifestyle characteristics, diet, stress levels, and social factors. (39,40)

A key element is the preventive dimension: the primary objective shifts from treating already established disease to preventing its development and progression, particularly at the pre-disease stage. (41)

To a large extent, this logic aligns with the concept of Primary Health Care, consistently promoted by the World Health Organization. However, in practice, this area remains chronically underfunded compared to high-technology specialized medicine. (31,35)

The Role of Traditional Medicine and the WHO Strategy 2025–2034

In recent years, there has been increasing attention at the level of global health policy to integrative approaches. In this context, the World Health Organization has developed the Global Strategy on Traditional Medicine for 2025–2034, aimed at institutionalizing and integrating scientifically validated traditional practices into national healthcare systems. (42,43)

The key directions of the strategy include several interrelated components. First, emphasis is placed on the scientific validation of traditional methods using modern biomedical tools, including genomic and proteomic technologies, to clarify their mechanisms of action. Second, the strategy suggests strengthening regulation through the development of quality standards for herbal medicines, as well as the implementation of certification and oversight systems for practitioners. Third, it envisions the gradual integration of specific methods such as yoga, acupuncture, and naturopathy into clinical practice as complementary to conventional treatment, including for reducing side effects and improving rehabilitation outcomes.

This shift is grounded in the fact that traditional medical systems have historically been oriented toward maintaining health and preventing disease, rather than solely treating it. In conditions of limited resources, particularly in low- and middle-income countries, traditional, complementary, and integrative medicine (TCIM) is regarded as a significant tool for expanding access to healthcare and achieving universal health coverage. (42,43)

Limitations and Risks of the Integrative Approach

Any systemic transformation entails risks. Without critical analysis, the integrative approach may turn into an instrument of misinformation or commercial exploitation.

Risk of Pseudoscience and Erosion of Standards

The key problem lies in the blurring of boundaries between evidence-based medicine and practices that lack a reliable empirical foundation. In conditions of insufficient standardization, methods whose effectiveness and safety are unproven may be promoted under the rhetoric of “holistic health.”

An additional complication is related to evaluation methodology: many traditional interventions are difficult to accommodate within the classical design of randomized double-blind placebo-controlled trials, as they act on a combination of factors rather than on an isolated biological mechanism. (42) This creates space for interpretative distortions.

A separate risk concerns safety. The widespread assumption that “natural” is inherently safe may lead the patient to refuse the necessary treatment, as well as to uncontrolled interactions between herbal remedies and pharmacotherapy. (22,44)

Commercialization and “Health Reductionism”

The expansion of the wellness and dietary supplement market has led to the formation of a large commercial sector in which the ideas of the holistic approach are often used for marketing purposes. Instead of systemic lifestyle changes, consumers are offered isolated products promising rapid effects, effectively reproducing the same reductionist logic in a different form. (21,44)

Additionally, narratives opposing “natural” and “chemical” are employed, promoting expensive products with limited evidence while simultaneously undermining trust in scientific medicine. (21)

Ethical Challenges and Equity

There is a real risk that integrative medicine will become “medicine for the wealthy.” While affluent populations can afford high-quality nutrition, yoga, and organic products, lower-income groups remain constrained to inexpensive ultra-processed foods and reactive treatment within overcrowded public healthcare systems. (44) Without state support and the inclusion of preventive measures in mandatory insurance packages, the holistic approach may further reinforce social stratification.

Economic Rationale for Prevention: Models and Interpretations

Analysis of economic models based on OECD country data indicates a nonlinear relationship between the structure of healthcare expenditure and macroeconomic outcomes. Estimates suggest that the optimal allocation of resources for maximizing economic welfare involves approximately 0.44% of GDP devoted to prevention and 10.96% to curative care. Actual figures deviate substantially from these values: preventive spending accounts for around 0.25% of GDP, compared to 8.26% for treatment. (19) This indicates systematic underinvestment in preventive measures and, consequently, a loss of potential economic growth.

An additional argument is provided by estimates of return on investment in public health: preventive programs demonstrate a high efficiency ratio (ROI ≈ 14:1). In other words, investments in immunization, reduction of smoking prevalence, and improvement of nutrition yield multiple returns through reduced social expenditures, increased labour productivity, and longer healthy life expectancy. (33)

Discussion

The findings of this study indicate a fundamental structural mismatch between the current global burden of disease and the organization of modern healthcare systems. While non-communicable diseases dominate mortality and morbidity worldwide, healthcare systems remain primarily oriented toward the treatment of acute conditions rather than the long-term prevention and management required by chronic diseases.

This mismatch is not the result of inefficiency or lack of knowledge, but rather reflects the underlying incentive structures that shape healthcare systems. Economic mechanisms favor interventions that generate immediate and measurable outcomes, while political cycles prioritize short-term results over long-term population health gains. At the same time, the historical dominance of the biomedical model has reinforced a focus on disease-specific interventions rather than systemic approaches to health. Together, these factors create a system that is functionally optimized for the management of disease rather than its prevention.

These findings are consistent with existing literature on the epidemiological transition and the economics of prevention, but extend them by integrating institutional and political dimensions into a single analytical framework. Previous studies have documented the rise of non-communicable diseases and the high return on investment associated with preventive interventions; however, less attention has been paid to the structural reasons why such interventions remain underprioritized despite their demonstrated effectiveness.

At the same time, alternative explanations must be considered. Preventive interventions are inherently more difficult to implement and evaluate, as their outcomes are delayed and influenced by behavioural, social, and environmental factors. In addition, advances in biomedical technology have led to significant improvements in survival and quality of life for many conditions, particularly in high-income settings. These factors indicate that the persistence of treatment-oriented systems cannot be attributed solely to structural incentives, but also reflects the complexity of prevention itself.

Nevertheless, the present analysis suggests that these factors operate within, rather than independently of, broader systemic constraints. The difficulty of implementing prevention does not negate its importance, but rather underscores the need for institutional arrangements that support long-term investment and cross-sectoral action. Similarly, while technological advances have improved outcomes in specific domains, they do not address the underlying drivers of non-communicable diseases and may contribute to rising costs and inequality when implemented without systemic reform.

From a policy perspective, these findings imply that meaningful improvement in population health requires changes at the level of system design rather than isolated interventions. This includes the reorientation of financing mechanisms toward outcomes rather than service volume, increased investment in preventive measures at both population and individual levels, and the development of regulatory frameworks for the safe and evidence-based integration of complementary approaches. In addition, addressing global health inequality requires structural reforms in areas such as intellectual property, technology transfer, and the distribution of research capacity.

Taken together, the results support the view that the current healthcare model is not failing due to a lack of technological capability, but because it is aligned with incentives that do not correspond to contemporary health needs. Addressing this misalignment represents a central challenge for the sustainability of healthcare systems and the improvement of global population health.

Limitations

This study has several limitations. As a narrative review, it does not follow a fully systematic methodology and may be subject to selection bias in the choice of sources. The analysis relies on secondary data and does not include primary empirical research. Interpretations are inherently influenced by the chosen theoretical frameworks, particularly the political economy perspective, which may emphasize structural and economic explanations over alternative viewpoints. Finally, the global scope of the study may obscure important regional differences, as healthcare systems operate within highly diverse political, cultural, and economic contexts.

Conclusion

The findings of this study indicate that the modern healthcare system is structurally misaligned with the current global burden of disease. While non-communicable diseases require long-term prevention and systemic management, healthcare systems remain oriented toward the treatment of already developed conditions.

This misalignment is not the result of technological limitations, but of the incentive structures embedded within healthcare systems, including economic, political, and institutional factors that prioritize short-term and intervention-based outcomes. As a result, increasing investment in healthcare does not necessarily translate into improved population health or system sustainability.

Addressing this contradiction requires a shift in the underlying logic of healthcare systems toward prevention, long-term health outcomes, and more equitable access to medical knowledge and technologies. Without such structural changes, continued technological advancement is likely to be accompanied by rising costs, persistent inequality, and limited improvements in population health.

Author Contributions

The author is solely responsible for conceptualization, methodology, analysis, and writing of the manuscript.

Funding

This research received no external funding.

Conflicts of Interest

The author declares no conflict of interest.

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