The world health report

Chapter 1

The challenges of a changing world

This chapter describes the context in which the contemporary renewal of primary health care is unfolding. The chapter reviews current challenges to health and health systems and describes a set of broadly shared social expectations that set the agenda for health systems change in today’s world. It shows how many countries have registered significant health progress over recent decades and how gains have been unevenly shared. Health gaps between countries and among social groups within countries have widened. Social, demographic and epidemiological transformations fed by globalization, urbanization and ageing populations, pose challenges of a magnitude that was not anticipated three decades ago.

In this chapter

  • Unequal growth, unequal outcomes
  • Adapting to new health challenges
  • Trends that undermine the health systems’ response
  • Changing values and rising expectations
  • PHC reforms: driven by demand