The World Health Report 1999 bidity also means revitalizing and extending the coverage of immunization programmes still one of the most powerful and cost-effective technologies at our disposal. The elimination of poliomyelitis in the Americas in the past decade, and great progress in control elsewhere, hold out the promise that polio will join smallpox as a disease known The new focus on reducing the burden of disease suffered by poor people is not just a call to governments alone. To make real inroads into absolute poverty will mean harnessing the energies and resources of the private sector and civil society as well. We need to be clear about what the world should be aiming to achieve and the resources needed to achieve global goals. We believe there is a good case for negotiating realistic national and international targets as a means of mobilizing resources, concentrating international attention on the most important problems, and ensuring proper monitor- ing of progress and achievement Second, there is a need to counter potential threats to health resulting from economic crises, unhealthy environments or risky behaviour. Tobacco addiction is one of the single most important threats. It is not just an issue for the north: over 80% of all smokers today live in developing countries. a global commitment to tobacco control can potentially avert scores of millions of premature deaths in the next half century, and its success can point the way for effective control of other threats Preparing effective responses to emerging infections and countering the spread of resistance to antimicrobials will help insure against the prospect of a significantly increased infectious disease threat Beyond countering specific threats, promotion of healthy lifestyles underpins a proactive strategy for risk reduction: cleaner air and water, adequate sanitation, healthy diets and safer transportation-all are important. And all are facilitated by stable economic growth and by ensuring that females as well as males have opportunities to increase their educational attainment Third, there is a need to develop more effective health systems. In many parts of the world, health systems are ill-equipped to cope with present demands, let alone those they will face in the future. The institutional problems which limit health sector performance are have been relatively neglected by governments and development agencies alike often common to all public services in a country. But, despite their importance, We now recognize that dealing with issues such as pay and incentives in the oublic sector, priority setting and rationing, and unregulated growth in the private se tor constitute some of the most challenging items on the international health agenda. The report's chapter on health systems development points to change taking place in all parts of the world-change that responds to different problems in different ways. The pressure for change provides the opportunity for reform. But reform requires a sense of direction. In my view, the broad goal of better health for all should guide reform. Beyond this, however there is a need to be clear about the desirable characteristics of health systems. The goal must be to create health systems that can mprove health status; enhance responsiveness to legitimate expectation increase efficiency: .protect individuals, families and communities from financial loss, nhance fairness in the financing and delivery of health care.x The World Health Report 1999 bidity also means revitalizing and extending the coverage of immunization programmes – still one of the most powerful and cost-effective technologies at our disposal. The elimination of poliomyelitis in the Americas in the past decade, and great progress in control elsewhere, hold out the promise that polio will join smallpox as a disease known only to history. The new focus on reducing the burden of disease suffered by poor people is not just a call to governments alone. To make real inroads into absolute poverty will mean harnessing the energies and resources of the private sector and civil society as well. We need to be clear about what the world should be aiming to achieve and the resources needed to achieve global goals. We believe there is a good case for negotiating realistic national and international targets as a means of mobilizing resources, concentrating international attention on the most important problems, and ensuring proper monitor￾ing of progress and achievement. • Second, there is a need to counter potential threats to health resulting from economic crises, unhealthy environments or risky behaviour. Tobacco addiction is one of the single most important threats. It is not just an issue for the north: over 80% of all smokers today live in developing countries. A global commitment to tobacco control can potentially avert scores of millions of premature deaths in the next half century, and its success can point the way for effective control of other threats. Preparing effective responses to emerging infections and countering the spread of resistance to antimicrobials will help insure against the prospect of a significantly increased infectious disease threat. Beyond countering specific threats, promotion of healthy lifestyles underpins a proactive strategy for risk reduction: cleaner air and water, adequate sanitation, healthy diets and safer transportation – all are important. And all are facilitated by stable economic growth and by ensuring that females as well as males have opportunities to increase their educational attainment. • Third, there is a need to develop more effective health systems. In many parts of the world, health systems are ill-equipped to cope with present demands, let alone those they will face in the future. The institutional problems which limit health sector performance are often common to all public services in a country. But, despite their importance, they have been relatively neglected by governments and development agencies alike. We now recognize that dealing with issues such as pay and incentives in the public sector, priority setting and rationing, and unregulated growth in the private sec￾tor constitute some of the most challenging items on the international health agenda. The report’s chapter on health systems development points to change taking place in all parts of the world – change that responds to different problems in different ways. The pressure for change provides the opportunity for reform. But reform requires a sense of direction. In my view, the broad goal of better health for all should guide reform. Beyond this, however, there is a need to be clear about the desirable characteristics of health systems. The goal must be to create health systems that can: • improve health status; • reduce health inequalities; • enhance responsiveness to legitimate expectations; • increase efficiency; • protect individuals, families and communities from financial loss; • enhance fairness in the financing and delivery of health care