Stronger health systems: the minimum requirements
How can the young girl in Sierra Leone be given the same chances for a healthy life as the girl born in Japan? Many factors -- such as poverty, armed conflict, institutional stability and the state of basic infrastructure -- lie beyond the direct control of the health system. Understanding the importance of these factors, the World Health Organization (WHO) advocates aggressively for improvements in the underlying determinants of health. But there is much a well-functioning health care system can do to narrow health outcome gaps, even as the work of reducing poverty and socioeconomic injustice continues.
For every child born today to have a good chance of a long and healthy life, there are minimum requirements which every health care system should meet equitably. These are: access to quality services for acute and chronic health needs; effective health promotion and disease prevention services; and appropriate responses to new threats as they emerge. New threats will include emerging infectious diseases, but also long-term shifts such as the growing burden of noncommunicable diseases and injuries and the health effects of global environmental changes. These challenges must be met simultaneously, inclusively and sustainably at the same time as underlying determinants of health are improved.
This report argues that the key to success is health systems strengthening, centred on the strategies and principles of primary health care, constructing responses that support integrated, long-term health systems development on behalf of the entire population. This requires both effective use of existing knowledge and technologies and innovation to create new health tools, along with appropriate structures and strategies to apply them. Success will demand new forms of cooperation between international health agencies, national health leaders, health workers and communities, and other relevant sectors.
The World Health Report 2003 consists of seven chapters. Key ideas and thematic connections among the chapters are briefly described here. Detailed content is summarized at greater length in a subsequent section of this overview.
The report opens with an update in Chapter One of the current state of world health. It examines both life expectancy and healthy life expectancy, and shows the global and regional gaps between the two, highlighting differences between the poor and the better-off everywhere. Among leading communicable and noncommunicable causes of death and disability, HIV/AIDS emerges as the most urgent priority. This is first reflected in Chapter Two, on the slow progress so far towards the health-related Millennium Development Goals, including action on HIV/AIDS; Chapter Three is entirely devoted to the pandemic itself and shows why a bold HIV/AIDS control effort must drive the agenda for the global health community.
Communicable diseases are one part of the double burden of ill-health. They include both old and new infectious threats. One of the great public health goals of the 20th century was the eradication of polio: Chapter Four looks at the final steps needed to achieve polio eradication within the next few years. Meanwhile, new diseases have been emerging at the rate of one per year for the last 20 years or more. The latest, which caused global alarm in 2003, is SARS, and the lessons learnt from the outbreaks are contained in Chapter Five.
Confronting the double burden is the theme of Chapter Six. A deadly overlap between communicable and noncommunicable diseases and injuries is occurring throughout the developing world, leading to a crisis of priorities for health systems already struggling with inadequate resources. This chapter is divided into three sections: the rapidly growing epidemic of cardiovascular disease; the global tobacco epidemic; and the multiple hazards -- direct and indirect -- from the growth in road traffic.
All of the topics introduced above demand stronger health systems. Chapter Seven tackles this issue in depth. It advocates strengthening health systems based on the principles and practices of primary health care and examines key dimensions of scaling up, from the health workforce crisis to pro-equity stewardship of the health system.