Primary health care - now more than ever

Dr Margaret Chan
Director-General of the World Health Organization

Almaty, Kazakhstan

Ladies and gentlemen,

I believe that the world, as it stands now, is out of balance in matters of health as never before. This year’s World Health Report supports my conviction.

Thirty years ago, in this city, the Declaration of Alma-Ata launched primary health care as the route to health for all. This was a deliberate effort to tackle huge, and largely avoidable, differences in the health status of populations. The declaration put health equity on the international political agenda for the first time.

Why was this so important? What does health equity mean? It means that people should not be denied access to life-saving and health-promoting interventions for unfair reasons, including those with economic or social causes. Simply stated: equity in health is of life-and-death importance.

Globally, health has progressed remarkably over the past three decades. On average, people are now living seven years longer. But if you look at individual countries or populations within countries, you get a very different picture.

Today, gaps in health outcomes, both within and between countries, are vastly greater than in 1978. Differences in life expectancy between the richest and poorest countries exceed 40 years. Annual government expenditure on health ranges from as little as US$ 20 per person to more than US$ 6000.

Never before has our world possessed such a sophisticated arsenal of tools and technologies for curing disease and prolonging life. Yet each year, nearly 10 million young children and pregnant women have their lives cut short by largely preventable causes.

Something is wrong.

A world that is greatly out of balance in matters of health is neither stable nor secure.

Ladies and gentlemen,

The World Health Report looks at the way health care is organized, financed, managed, and delivered in countries around the world. It finds striking inequalities in health outcomes, access to care, and what people pay for care. It also looks at the causes. Many problems arise from the way health systems are organized and how resources for health are managed. The report documents these problems in detail.

All too often, people who are well-off and generally healthier have the best access to the best care, while the poor are left to fend for themselves.

Some of the greatest waste and inefficiency occurs when health is treated as a commercial commodity, to be bought and sold, assuming that market forces will somehow self-adjust to iron out any problems. This seldom happens. What you see instead is unnecessary tests and procedures, more and longer hospital stays, higher costs, and the exclusion of people who cannot pay.

When the emphasis is placed on specialized or commercialized care, providers have no incentive to invest in prevention. This is a failure with huge consequences. WHO estimates that better use of existing measures could prevent as much as 70% of the global disease burden.

Ladies and gentlemen,

The World Health Report sets out a better way to manage and deliver health care. Primary health care is a people-centred approach to health that makes prevention as important as cure. As part of this preventive approach, it tackles the root causes of ill health, also in non-health sectors, thus offering an upstream attack on threats to health.

A primary health care approach is the most efficient, fair, and cost-effective way to organize a health system. It can prevent much of the disease burden, and it can also prevent people with minor complaints from flooding the emergency wards of hospitals. Decades of experience tell us that primary health care produces better outcomes, at lower costs, and with higher user satisfaction.

Let me stress this last point: higher user satisfaction. I personally find this one of the most striking findings in the report. Social expectations for health are rising all around the world. People want care that is fair as well as efficient and affordable.

Studies show wide agreement. People surveyed in a range of countries believe that all members of society should have access to care and receive treatment when ill or injured, without going bankrupt as a result. When people are asked to name the top problems that they and their families face, financial worries usually head the list, closely followed by health.

Political leaders would be wise to heed these findings.

Ladies and gentlemen,

The visionary thinkers who gathered in this city thirty years ago could not have foreseen an oil crisis, a global economic recession, or the emergence of a world-transforming disease like AIDS.

Today, we know where we stand. We face a fuel crisis, a food crisis, and a financial crisis. The effects of climate change, another global crisis, are already being felt. All of these crises have profound implications for health.

We must face these events with resolve. This is not the time to back away or buckle under. The bill for failing to protect and promote health always comes, and this is especially true at a time when chronic diseases, like heart disease, cancer, diabetes, and mental disorders, are on the rise worldwide.

In the recession that followed the Declaration of Alma-Ata, major mistakes were made in restructuring national budgets, with reductions in health and other fundamental social services. Health care has still not recovered from these mistakes, and the bill has been extremely high. This is especially true in sub-Saharan Africa, but also in large parts of Latin America and Asia.

If history tends to repeat itself, can we not at least learn from the past and avoid repeating mistakes?

Health is the very foundation of productivity and prosperity. Cutting investments in health is not a viable option. We have made that mistake before and are still paying the price.

Every health system in the world has inefficiencies. Well-documented ways of reducing these inefficiencies, through better management, through incentives, through primary health care, exist.

But health systems will not automatically gravitate towards greater fairness and efficiency. This world will not become a fair place for health all by itself. Deliberate policy decisions are needed.

The World Health Report documents the problems, but it also shows what needs to be done. At a time of crisis on so many fronts, with so much at stake for health, let us all hope that the report has the impact it deserves.

Thank you.