Health care frames – from Virchow to Obama and beyond The changing frames in health care and their implications for patient care Joachim P. Sturmberg MBBS, DORACOG, MFM, FRACGP, PhD, 1 Di O’Halloran MBBS FRACGP MHPEd FAICD, 2 Ruth Colagiuri BEd, Grad Cert Health Policy & Management, 3 Ana Fernandez PhD, 4 Sue Lukersmith M. Ergonomics, B.App.Sc (OT), 5 Ghazal Torkfar B Health Care Services Management, MPH 6 and Luis Salvador-Carulla MD, PhD 7 1 Professor of General Practice, Department of General Practice, Newcastle University, Newcastle, Australia 2 Professor of General Practice, Department of General Practice, Sydney University, Sydney, Australia 3 Professor of Public Health, Menzies Centre for Health Policy, Sydney University, Sydney, Australia 4 Postdoctoral Research Associate, 5 PhD Candidate, Centre for Disability Research and Policy, Sydney University, Sydney, Australia 6 PhD Candidate, School of Public Health, Sydney University, Sydney, Australia 7 Professor of Disability and Mental Health, Centre for Disability Research and Policy, Faculty of Health Sciences, Sydney University, Sydney, Australia Keywords frames, health care vortex, health economics, health systems, health systems reform, person-centred care, social determinants of health, somato-psycho-socio-semiotic model of health Correspondence Associate Professor Joachim Sturmberg Department of General Practice Newcastle University PO Box 3010, Wamberal, NSW 2260 Australia E-mail: jp.sturmberg@gmail.com Accepted for publication 25 August 2014 doi:10.1111/jep.12266 Abstract Rationale, aims, objectives and Methods Framing allows us to highlight some aspects of an issue, thereby bringing them to the forefront of our thinking, talking and acting. As a consequence, framing also distracts our attention away from other issues. Over time, health care has used various frames to explain its activities. This paper traces the emergence of various health care frames since the 1850s to better understand how we reached current ways of thinking and practicing. Results and Conclusions The succession of the most prominent frames can be summa- rized as: medicine as a social science; the germ theory of disease; health care as a battleground (or the war metaphor); managing health care resources (or the market meta- phor); Health for All (the social justice model); evidence-based medicine; and Obama Care. The focus of these frames is causal, instrumental, political/economic or social in nature. All remain relevant; however, recycling individual past frames in response to current problems will not achieve the outcomes we seek. Placing the individual and his/her needs at the centre (the attractor for the health system) of our thinking, as emphasized by the World Health Organization’s International Classification of Function framework and the Euro- pean Society of Person Centered Health Care, may provide the frame to refocus health and health care as interdependent experiences across individual, community and societal domains. Shifting beyond the entrenched instrumental and economic thinking will be challenging but necessary for the sake of patients, health professionals, society and the economy. Introduction Thought and endeavour always occur in a particular context. It is this context that provides the boundaries of the frames for think- ing, talking and acting. As such, framing essentially involves ‘selection and salience. To frame is to [sic] select some aspects of a perceived reality and make them more salient in a communicat- ing text, in such a way as to promote a particular problem defini- tion, causal interpretation, moral evaluation, and/or treatment recommendation’ for the item described [1]. Frames work by highlighting some aspects of an issue, thereby bringing them to the forefront of our thinking, talking and acting. Logically, this also means frames detract our attention away from other issues. Frames ‘organise everyday reality by provid- ing meaning to an unfolding strip of events and promoting par- ticular definitions and interpretations’ [2]. Of note, framing the same issue through positive or negative reference points [3] provides differing contexts that influence our perception and decision making, that is, advances different cognitive and motivational consequences [4]. Lakoff [5] described in detail Journal of Evaluation in Clinical Practice ISSN 1365-2753 Journal of Evaluation in Clinical Practice 20 (2014) 1036–1044 © 2014 John Wiley & Sons, Ltd. 1036