A global "return to primary healthcare" is needed to steer world health systems towards better performance.
This was the message of the World Health Report 2008, launched today (14 October 2008), which documents failures that have left the health status of different populations, both within and between countries, "dangerously out of balance".
The report, titled Primary health care – now more than ever, champions the "holistic approach" of primary care, as opposed to a more narrow focus on specialist care to treat certain diseases.
When countries at the same level of economic development are compared, says the report, "those where healthcare is organised around the tenets of primary healthcare produce a higher level of health for the same investment."
In particular, the report praises primary care for an approach that "makes prevention equally important as cure in a continuum of care that extends throughout the lifespan."
The World Health Organization (WHO) estimates that better use of existing preventive measures could reduce the global burden of disease by as much as 70%.
"Viewed against current trends, primary healthcare looks more and more like a smart way to get health development back on track," said WHO Director-General Dr Margaret Chan.
In a wide-ranging review, the World Health Report found striking inequities in health outcomes, in access to care, and in what people have to pay for care.
It says that personal expenditures on health now push more than 100 million people below the poverty line each year. And differences in life expectancy between the richest and poorest countries now exceed 40 years.
In rural parts of the developing world, the report says, care tends to be fragmented into discrete initiatives focused on individual diseases or projects, with little attention to coherence and little investment in basic infrastructures, services, and staff.
"A primary healthcare approach, when properly implemented, protects against many of these problems," it argues.
Conversely, it says: "When health is skewered towards specialist care, a broad menu of protective and preventive interventions tends to be lost."
By putting families and communities at the hub of the health system, primary care "honours the resilience and ingenuity of the human spirit and makes space for solutions created by communities, owned by them, and sustained by them."
"Primary healthcare, including integrated services at the community level, can help improve health and save lives," said Ann Veneman, Executive Director of UNICEF.
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