The World Health Report 1999 question No central point has existed for accumulating the experience of what does and does not work - or for mobilizing political, legal and financial resources to assist govern ments or elements of civil society that are committed to tobacco control. It was to fill these gaps-to provide the requisite leadership-that we launched the global Tobacco Free Initia tive on 21 July 1998. A major milestone for the initiative will be the adoption of a"Frame work Convention on Tobacco Control "by 2003, and initial efforts towards this are well under way. SUPPORTING HEALTH SECTOR DEVELOPMENT WHO has always been strong at responding to specific requests. The Organization is good at fielding highly qualified technical experts. But often individual experts tend to see the world through their own expert lenses. WHO has, however, been less good at helping senior decision-makers deal with the big picture We know that senior policy-makers in ministries of health do not have the luxury of focusing on single issues. Health is one of the most politically and institutionally difficult sectors in any country. If WHO is to earn a leadership role in health, we cannot deny the responsibility of helping our colleagues to deal with complexity. In many countries, national governments have tended to look to other agencies fo advice on issues that affect the sector as a whole. who has to be a more reliable and effective supporter of countries as they reform and restructure their health sectors. We also have to be clear that reform is not an end in itself. It is a way of making sure that people particularly poor people- get a better deal from their health system Many determinants of better health lie outside the health system altogether: they lie in better education(and in ensuring that girls have the same educational opportunities boys). They lie in cleaner environments, and in sustained reductions in poverty. We must understand these linkages. One path to better health for all is for those of us within the health sector to serve as active and informed advocates of health-friendly policies outside the sector The second path is through reform of health systems themselves. Reform today, in much of the world, will take place in a context of increased reliance on the market forces which have increased productivity in many sectors of the world economy. But markets have failed to achieve similar success in health services or health insurance. At the same time, many of the new products critical to improving health originate in the private sector. Active govern ment involvement in providing universal health care has contributed to the great gains of recent years-but many governments have overextended themselves. Efforts to provide all services to all people have led to arbitrary rationing, inequities, nonresponsiveness and inadequate finance for essential services. Where, then, do the values of who lead when combined with the available evidence finance everything for everybody. This"classical "universalism, although seldom advanced extreme form, shaped the formation of many well-established health systems. It achieved aportant successes. But the old universalism fails to recognize both resource limits and the limits of government Our values cannot support market-oriented approaches that ration health services to those with the ability to pay. Not only do market-oriented approaches lead to intolerable inequity with respect to a fundamental human right, but growing bodies of theory and evidence indicate markets in health to be inefficient as well. market mechanisms have enormous utility in many sectors and have underpinned rapid economic growth for over a century inxiv The World Health Report 1999 question. No central point has existed for accumulating the experience of what does and does not work – or for mobilizing political, legal and financial resources to assist govern￾ments or elements of civil society that are committed to tobacco control. It was to fill these gaps – to provide the requisite leadership – that we launched the global Tobacco Free Initia￾tive on 21 July 1998. A major milestone for the initiative will be the adoption of a “Frame￾work Convention on Tobacco Control” by 2003, and initial efforts towards this are well under way. SUPPORTING HEALTH SECTOR DEVELOPMENT WHO has always been strong at responding to specific requests. The Organization is good at fielding highly qualified technical experts. But often individual experts tend to see the world through their own expert lenses. WHO has, however, been less good at helping senior decision-makers deal with the big picture. We know that senior policy-makers in ministries of health do not have the luxury of focusing on single issues. Health is one of the most politically and institutionally difficult sectors in any country. If WHO is to earn a leadership role in health, we cannot deny the responsibility of helping our colleagues to deal with complexity. In many countries, national governments have tended to look to other agencies for advice on issues that affect the sector as a whole. WHO has to be a more reliable and effective supporter of countries as they reform and restructure their health sectors. We also have to be clear that reform is not an end in itself. It is a way of making sure that people – particularly poor people – get a better deal from their health system. Many determinants of better health lie outside the health system altogether: they lie in better education (and in ensuring that girls have the same educational opportunities as boys). They lie in cleaner environments, and in sustained reductions in poverty. We must understand these linkages. One path to better health for all is for those of us within the health sector to serve as active and informed advocates of health-friendly policies outside the sector. The second path is through reform of health systems themselves. Reform today, in much of the world, will take place in a context of increased reliance on the market forces which have increased productivity in many sectors of the world economy. But markets have failed to achieve similar success in health services or health insurance. At the same time, many of the new products critical to improving health originate in the private sector. Active govern￾ment involvement in providing universal health care has contributed to the great gains of recent years – but many governments have overextended themselves. Efforts to provide all services to all people have led to arbitrary rationing, inequities, nonresponsiveness and inadequate finance for essential services. Where, then, do the values of WHO lead when combined with the available evidence? They cannot lead to a form of public intervention that has governments attempting to provide and finance everything for everybody. This “classical” universalism, although seldom advanced in extreme form, shaped the formation of many well-established health systems. It achieved important successes. But the old universalism fails to recognize both resource limits and the limits of government. Our values cannot support market-oriented approaches that ration health services to those with the ability to pay. Not only do market-oriented approaches lead to intolerable inequity with respect to a fundamental human right, but growing bodies of theory and evidence indicate markets in health to be inefficient as well. Market mechanisms have enormous utility in many sectors and have underpinned rapid economic growth for over a century in