In June, fourteen Ukranian government health officials visited Philadelphia as part of a project called Public Health System Recovery & Resilience in Ukraine, funded by USAID and supported by the Drexel and Temple University Schools of Public Health and the Health Federation of Philadelphia. The group was in Philadelphia to learn about our country’s mental health system at the national, state and local levels.

Our CEO, Kathleen Noonan, was asked to provide the group with an overview of the legal and institutional framework for healthcare in the United States with a focus on mental health. The Camden Coalition’s Senior Director of Care Management & Clinical Redesign Initiatives Natasha Dravid and our Board Chair Lou Bezich, Senior Vice President & Chief Administrative Officer at Cooper University Health Care, joined Kathleen to share examples of our mental health work in Camden City and South Jersey.

We caught up with Kathleen about the visit afterward.

What struck you about the group?

Of course, their resilience. The group included people from all over Ukraine — including places like Chernobyl — that have been ravaged by war, and yet they traveled all the way to Philadelphia to learn together and build a better mental health system for the people of Ukraine.

What are some of the relevant policy differences between the US and Ukraine?

In the US, we decided almost 250 years ago that healthcare was a state and local issue. That’s at least one reason why we have neither universal healthcare nor universal health coverage. Ukraine, on the other hand, created a right to healthcare in their constitution which we do not have. They also view health as a responsibility of their national government.

What were some of the questions they had for you as they considered how to design a mental health system?

As a lawyer and policy person, discussions about governance models interest me. What was particularly fascinating was listening to them discuss how much their mental health system should be centralized or if it should be left to regions to design —a question that we have struggled with as a nation since our founding.

How has our lack of a centralized healthcare system affected how care is delivered in the US?

As I shared with the group, there are costs and benefits to decentralization. While it creates flexibility that allows for a lot of innovation, it also creates great complexity that is hard for people to manage, especially people with fewer resources, as we know firsthand from our work here in Camden. It is also hard on providers — from CHWs to doctors — who are burned out from having to navigate so many different systems.

The Camden Coalition and its National Center for Complex Health and Social Needs exist in response to this deep fragmentation and complexity of our health and social care systems. At the Coalition, we are trying to make care more seamless for people with multiple, overlapping health and social needs, and also working to identify how organizations can create better ecosystems of care. Ultimately, however, it would be great if there wasn’t a need for an organization like ours to exist.

What advice did you have for the group as they return to the Ukraine and begin putting what they learned into practice?

I think polling shows that most Americans think that we are all entitled to some basic health coverage which Ukrainians have now through their national health system. I suggested to the group that it is worth building on that foundation, allowing for regional differences and customization with much more investment in integrated primary care and prevention.