As this century draws to a close, The World Health Report 1999 challenges the international community to examine the difference health can make in humanity's continuing progress. Issued by WHO Director-General Dr Gro Harlem Brundtland as WHO itself undergoes comprehensive reform, the report shows how the pursuit of lasting improvements in health, when supported by vision and leadership, can also secure considerable social and economic gains. It gathers the arguments and evidence that give health messages their persuasive power in the formulation of national policies and the direction of international aid. The report explains how lessons learned from past successes and failures can guide a more targeted and pragmatic approach to current and emerging health challenges. It warns of the unprecedented complexity of these challenges, and offers strategic directions for tackling them in the next decade. Clear conclusions emerge. Despite recent spectacular progress in disease control and extended life expectancy, more than 1 billion people today have not shared in these gains. Meanwhile, the threat posed by infectious diseases is being accompanied by the growing prominence of noncommunicable diseases, which are far more complex and costly to manage. Consequently, health systems can no longer afford to allocate resources to interventions of low quality or low efficacy related to cost. Spontaneous, unmanaged growth in any country's health system cannot reliably ensure that the greatest health needs are met. In defining priorities and selecting interventions, decision-makers must focus their efforts on areas where the return in health gains is demonstrably greatest. In contrast to a classic "universalism" that advocated government finance and provision of all services for everyone, the report – and WHO – argue for a "new universalism". This would maintain government responsibility for financing and leadership, while recognising government's own limits. Public finance for all entails that not all things can be publicly financed. Private sector provision of publicly financed services is compatible with government responsibility for health for all, but requires a clear regulatory role of governments. (A)
Abstract