WHO urges change for ailing health systems

News release

"Personal expenditures on health now push more than 100 million people below the poverty line each year."

"Inequitable access, impoverishing costs, and erosion of trust in health care constitute a threat to social stability."

"WHO estimates that better use of existing preventive measures could reduce the global burden of disease by as much as 70%."

Manila, 14 October 2008— The World Health Report 2008, which is being launched today, critically assesses the way that health care is organized, financed, and delivered in rich and poor countries around the world. The World Health Organization (WHO) report documents a number of failures and shortcomings that have left the health status of different populations, both within and between countries, dangerously out of balance.

"The World Health Report sets out a way to tackle inequities and inefficiencies in health care, and its recommendations need to be heeded," said WHO Director-General Margaret Chan at the launch of the report in Almaty, Kazakhstan. "A world that is greatly out of balance in matters of health is neither stable nor secure."

The report, Primary health care – now more than ever, commemorates the 30th anniversary of the Alma-Ata International Conference on Primary Health Care held in 1978. That event was the first to put health equity on the international political agenda.

In a wide-ranging review, the new report found striking inequities in health outcomes, in access to care, and in what people have to pay for care. Differences in life expectancy between the richest and poorest countries now exceed 40 years. Of the estimated 136 million women who will give birth this year, around 58 million will receive no medical assistance whatsoever during childbirth and the postpartum period, endangering their lives and that of their infants.

Globally, annual government expenditure on health varies from as little as $20 per person to well over $6,000. For 5.6 billion people in low- and middle-income countries, more than half of all health care expenditure is through out-of-pocket payments. With the costs of health care rising and systems for financial protection in disarray, personal expenditures on health now push more than 100 million people below the poverty line each year.

"High maternal, infant, and under-five mortality often indicates lack of access to basic services such as clean water and sanitation, immunizations and proper nutrition," said Ann M. Veneman, UNICEF Executive Director. "Primary health care including integrated services at the community level can help improve health and save lives."

Data set out in the report indicated that many health systems have lost their focus on fair access to care, their ability to invest resources wisely, and their capacity to meet the needs and expectations of people, especially in impoverished and marginalized groups. The report states that conditions of "inequitable access, impoverishing costs, and erosion of trust in health care constitute a threat to social stability."

To steer health systems towards better performance, the report calls for a return to primary health care and a holistic approach to health care formally launched 30 years ago. When countries at the same level of economic development are compared, those where health care is organized around the tenets of primary health care produce a higher level of heath for the same investment.

Such lessons take on critical importance at a time of global financial crisis. "Viewed against current trends, primary health care looks more and more like a smart way to get health development back on track," says Dr Chan.

In far too many cases, people who are well-off and generally healthier have the best access to the best care, while the poor are left to fend for themselves. Health care is often delivered according to a model that concentrates on diseases, high technology, and specialist care, with health viewed as a product of biomedical interventions and the power of prevention largely ignored.

Specialists may perform tasks that are better managed by general practitioners, family doctors, or nurses. This contributes to inefficiency, restricts access, and deprives patients of opportunities for comprehensive care. When health is skewered towards specialist care, a broad menu of protective and preventive interventions tends to be lost. WHO estimates that better use of existing preventive measures could reduce the global burden of disease by as much as 70%.

Primary health care also offers the best way of coping with three ills of life in the 21st century: the globalization of unhealthy lifestyles, rapid unplanned urbanization, and the ageing of populations. These trends contribute to a rise in chronic diseases, such as heart disease, stroke, cancer, diabetes and asthma, that create new demands for long-term care and strong community support. A multisectoral approach is central to prevention, as the main risk factors for these diseases lie outside the health sector.

"We are, in effect, encouraging countries to go back to the basics," says Dr Chan. "Thirty years of well-monitored experience tell us what works and where we need to head, in rich and poor countries alike."

For more information, please contact: Dr Hendrik Bekedam, Director, Health Sector Development, WHO Western Pacific Region
Tel: +63 2 528 9951, Mobile: +63 920 963 2532; E-mail: bekedamh@wpro.who.int Dick Thompson, News Team Leader WHO, Geneva.
Tel: + 41 22 791 2684; Mobile: + 41 79 475 55 34; E-mail: thompsond@who.int

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