World health report

Executive summary

Achieving health for all

In 1977, the World Health Assembly decided that the main social target of governments and of WHO should be the attainment by all the people of the world by the year 2000 of a level of health that would permit them to lead a socially and economically productive life. In other worlds, as a minimum, all people in all countries should have at least such a level of health that they are capable of working productively and of participating actively in the social life of the community in which they live. The third evaluation of progress in implementing the Global Strategy for Health for All by the year 2000 (carried out in 1997) has shown significant improvements worldwide both in health status and in access to health care. Increasing numbers of Member States are carrying out monitoring and evaluation of their health-for-all strategies at specified intervals; for the first evaluation in 1985, 147 out of 166 Member States reported, at least with respect to the global indicators. In 1997, 158 out of 191 Member States did so, although some indicators were more widely covered than others - e.g. 90% of countries reported on immunization, but only 30% on access to local health services.

Overall there has been strong political commitment to achieving the health-for-all goals, and most countries have endorsed at the highest level the necessary policies and strategies. Existing health services are being reoriented to a health system based on primary health care, taking into account the role of the individual, the family, the community and local nongovernmental organizations, as well as health personnel. Substantial attention has been given to the health of women and their role in development.

Globally there have been significant increases in the following elements of primary health care since the first evaluation in 1985: immunization against the eight EPI target diseases; trained attendance at childbirth; local health services; and water supply and excreta-disposal facilities. Gaps between the developing and developed countries have been significantly reduced, although improvements in the least developed countries have been less satisfactory.

Coverage levels for the various elements of primary health care have improved in the developing countries. In these countries, 65% of pregnant women have access to antenatal care services and 53% to skilled attendance at delivery. In rural areas, 75% of the population have access to a safe water supply, and about 34% to adequate sanitation.

The rapid increase in coverage of immunization programmes from 5% in the 1970s to over 80% in 1996, has had a big impact on the health status of children. These improvements, however, are less significant in the LDCs than in other developing countries.

It is estimated that by 1997, 106 countries representing 64% of the global population had an average life expectancy at birth above 60 years; an infant mortality rate below 50 per 1000 live births, and an under-5 mortality below 70 per 1000 live births. In 1975, 69 countries representing 30% of the global population met these targets.

There was inevitably concern about resources for health in view of the growing costs of health services. Countries use various methods to finance their health systems, but few countries, even the most prosperous, are satisfied with the distribution of financial resources between promotive and curative services. There are also many problems associated with the provision of human resources for health - problems relating to education and training and to distribution.

As health systems become more complex and costly, and as the application of new and existing technologies becomes more refined, making the right decisions about the allocation of often scarce resources has become more difficult. Reproducibility and comparability of results are essential to the success of health laboratories. The concept of quality assurance - comprising external quality assessment and internal quality control - has been promoted by WHO and accepted worldwide. The Organization has also emphasized the provision and improvement of the quality of radiological services for diagnosis and therapy, areas that have seen spectacular progress.