Global health is a study in contrasts. While a baby girl born in Japan today can expect to live for about 85 years, a girl born at the same moment in Sierra Leone has a life expectancy of 36 years. The Japanese child will receive vaccinations, adequate nutrition and good schooling. If she becomes a mother she will benefit from high-quality maternity care. Growing older, she may eventually develop chronic diseases, but excellent treatment and rehabilitation services will be available; she can expect to receive, on average, medications worth about US$ 550 per year and much more if needed.
Meanwhile, the girl in Sierra Leone has little chance of receiving immunizations and a high probability of being underweight throughout childhood. She will probably marry in adolescence and go on to give birth to six or more children without the assistance of a trained birth attendant. One or more of her babies will die in infancy, and she herself will be at high risk of death in childbirth. If she falls ill, she can expect, on average, medicines worth about US$ 3 per year. If she survives middle age she, too, will develop chronic diseases but, without access to adequate treatment, she will die prematurely.
These contrasting stories reveal much about what medicine and public health can achieve, and about unmet needs in a world of vast and growing health inequalities. The World Health Report 2003 affirms that the key task of the global health community is to close the gap between such contrasting lives. Building on past experience and achievements, the report proposes solid strategies to shape a healthier, more equitable future.
A key message of this report is that real progress in health depends vitally on stronger health systems based on primary health care. In most countries, there will be only limited advances towards the United Nations Millennium Development Goals and other national health priorities without the development of health care systems that respond to the complexity of current health challenges. Systems should integrate health promotion and disease prevention on the one hand and treatment for acute illness and chronic care on the other. This should be done across all levels of the health care system, with the aim of delivering quality services equitably and efficiently to the whole population. The lessons from SARS and poliomyelitis eradication programmes shape strategies for an urgent health system response to HIV/AIDS; in turn, scaling up the attack on HIV/AIDS will do much to strengthen health care systems.