The World Healtb Report 2008 Primary Healtb Care-Nouo More Tban Ever There is today a recognition that populations are I and reform of the ways health systems operate left behind and a sense of lost opportunities that in society today: those reforms constitute the are reminiscent of what gave rise, thirty years agenda of the renewal of PHC ago, to Alma-Ata's paradigm shift in think- ing about health. The Alma-Ata Conference Responding to the challenges of a mobilized a"Primary Health Care movement of professionals and institutions, governments/ changing world and civil society organizations, researchers and On the whole, people are healthier, wealthier and grassroots organizations that undertook to tackle live longer today than 30 years ago. If children the"politically, socially and economically unac- were still dying at 1978 rates, there would have ceptable"health inequalities in all countries. been 16.2 million deaths globally in 2006. In fact, The Declaration of Alma-Ata was clear about the there were only 9.5 million such deaths. This values pursued: social justice and the right to difference of 6.7 million is equivalent to 18329 better health for all, participation and solidarity. children's lives being saved every day. The once There was a sense that progress towards these revolutionary notion of essential drugs has values required fundamental changes in the way become commonplace. There have been signifi- health-care systems operated and harnessed the cant improvements in access to water, sanitation potential of other sectors and antenatal care This shows that progress is possible. It can reforms has been uneven. Nevertheless, today, also be accelerated. There have never been more health equity enjoys increased prominence in resources available for health than now.The glo- the discourse of political leaders and ministri bal health economy is growing faster than gross of health, as well as of local government struc- domestic product (GDP), having increased its share from 8%to 8. 6% of the world's gDP between tures,professional organizations and civil society 2000 and 2005.In absolute terms,adjusted for organizations The PHC values to achieve health for all inflation, this represents a 35% growth in the require health systems that "Put people at the I worlds expenditure on health over a five-year centre of health care".What people consider period. Knowledge and understanding of health desirable ways of living as individuals and what are growing rapidly. The accelerated techno- they expect for their societies -i.e. what peo. logical revolution is multiplying the potential ple value-constitute important parameters for for improving health and transforming health governing the health sector. PHC has remained literacy in a better-educated and modernizing the benchmark for most countries' discourse on global society. A global stewardship is emerging health precisely because the PHC movement tried from intensified exchanges between countries to provide rational, evidence-based and antici- often in recognition of shared threats, challenges patory responses to health needs and to these or opportunities: from growing solidarity; and social expectations*..6. 7. Achieving this requires from the global commitment to eliminate poverty trade-offs that must start by taking into account xemplified in the Millennium Development Goals citizens'"expectations about health and health(MDGs care"and ensuring " that their/ voice and choice However there are other trends that must decisively infuence the way in which health serv. not be ignored. First, the substantial progress ices are designed and operate".A recent PHC in health over recent decades has been deeply review echoes this perspective as the"right to unequal, with convergence towards improved the highest attainable levelof health", "maximiz. health in a large part of the world, but at the same ing equity and solidarity "while being guided ne. with a considerable number of countries by responsiveness to people's needs".Moving increasingly lagging behind or losing ground towards health for all requires that health sys- Furthermore, there is now ample documenta tems respond to the challenges of a changing tion-not available 30 years ago -of consider world and growing expectations for better per- able and often growing health inequalities within formance. This involves substantialreorientation countriesPrimary Health Care – Now More Than Ever xii The World Health Report 2008 There is today a recognition that populations are left behind and a sense of lost opportunities that are reminiscent of what gave rise, thirty years ago, to Alma-Ata’s paradigm shift in think￾ing about health. The Alma-Ata Conference mobilized a “Primary Health Care movement” of professionals and institutions, governments and civil society organizations, researchers and grassroots organizations that undertook to tackle the “politically, socially and economically unac￾ceptable”1 health inequalities in all countries. The Declaration of Alma-Ata was clear about the values pursued: social justice and the right to better health for all, participation and solidarity1 . There was a sense that progress towards these values required fundamental changes in the way health-care systems operated and harnessed the potential of other sectors. The translation of these values into tangible reforms has been uneven. Nevertheless, today, health equity enjoys increased prominence in the discourse of political leaders and ministries of health2 , as well as of local government struc￾tures, professional organizations and civil society organizations. The PHC values to achieve health for all require health systems that “Put people at the centre of health care”3 . What people consider desirable ways of living as individuals and what they expect for their societies – i.e. what peo￾ple value – constitute important parameters for governing the health sector. PHC has remained the benchmark for most countries’ discourse on health precisely because the PHC movement tried to provide rational, evidence-based and antici￾patory responses to health needs and to these social expectations4,5,6,7. Achieving this requires trade-offs that must start by taking into account citizens’ “expectations about health and health care” and ensuring “that [their] voice and choice decisively infl uence the way in which health serv￾ices are designed and operate”8 . A recent PHC review echoes this perspective as the “right to the highest attainable level of health”, “maximiz￾ing equity and solidarity” while being guided by “responsiveness to people’s needs”4 . Moving towards health for all requires that health sys￾tems respond to the challenges of a changing world and growing expectations for better per￾formance. This involves substantial reorientation and reform of the ways health systems operate in society today: those reforms constitute the agenda of the renewal of PHC. Responding to the challenges of a changing world On the whole, people are healthier, wealthier and live longer today than 30 years ago. If children were still dying at 1978 rates, there would have been 16.2 million deaths globally in 2006. In fact, there were only 9.5 million such deaths9 . This difference of 6.7 million is equivalent to 18 329 children’s lives being saved every day. The once revolutionary notion of essential drugs has become commonplace. There have been signifi - cant improvements in access to water, sanitation and antenatal care. This shows that progress is possible. It can also be accelerated. There have never been more resources available for health than now. The glo￾bal health economy is growing faster than gross domestic product (GDP), having increased its share from 8% to 8.6% of the world’s GDP between 2000 and 2005. In absolute terms, adjusted for infl ation, this represents a 35% growth in the world’s expenditure on health over a fi ve-year period. Knowledge and understanding of health are growing rapidly. The accelerated techno￾logical revolution is multiplying the potential for improving health and transforming health literacy in a better-educated and modernizing global society. A global stewardship is emerging: from intensifi ed exchanges between countries, often in recognition of shared threats, challenges or opportunities; from growing solidarity; and from the global commitment to eliminate poverty exemplifi ed in the Millennium Development Goals (MDGs). However, there are other trends that must not be ignored. First, the substantial progress in health over recent decades has been deeply unequal, with convergence towards improved health in a large part of the world, but at the same time, with a considerable number of countries increasingly lagging behind or losing ground. Furthermore, there is now ample documenta￾tion – not available 30 years ago – of consider￾able and often growing health inequalities within countries