PHA-Exch> Margaret Chan: Primary health care as a route to health security

[Claudio Schuftan]

From: Wendy Julias pazvakavambwab at zw.afro.who.int

The Lancet, Early Online Publication, 15 January 2009
doi:10.1016/S0140-6736(09)60003-9Cite or Link Using DOI
Primary health care as a route to health security
Margaret Chan

Health security must be addressed with great urgency, and health-system
strengthening is one of the surest routes to health security. We are not
secure when the difference in life expectancy between the poorest and the
richest countries exceeds 40 years, or when annual governmental expenditure
on health ranges from US$20 per person to well over $6000.1 We are not
secure when more than 40% of the population in sub-Saharan Africa is living
on less than a dollar a day.2 Medicine has never before possessed such
sophisticated treatments and procedures for curing disease and prolonging
life. Yet, each year, nearly 10 million young children and pregnant women
have their lives cut short, largely by preventable causes.3, 4 Economic
development will not automatically protect people who are poor or guarantee
universal access to health care. Health systems will not automatically
gravitate toward greater fairness and efficiency. International trade and
economic agreements will not automatically consider effects on health.
Deliberate policy decisions are needed in all these areas.

Poor households spend up to 80% of disposable income on food.5 The first
things that drop out of the diet when prices increase are usually healthy
foods, and the health consequences are well documented.6 When a commodity so
fundamental to life as food is priced beyond the reach of poor people, we
know that something in our world has gone terribly wrong.

All the experts tell us that developing countries will be the first and
hardest hit by climate change.7, 8 They also tell us that countries with
robust and equitable health systems will be best able to cope with the
shocks of climate change and a drastic increase in extreme weather events.8
Protection from the social factors that place poor and deprived populations
at special risk is thus far more important than structural protection.8 Many
people suggest that single-disease initiatives have weakened health systems
or distorted health priorities,9 but this is not a valid conclusion. AIDS,
malaria, and tuberculosis are high-mortality emergencies that require
targeted responses to bring the disease burden down. Increasingly, they are
doing so in ways that strengthen fundamental components of the health
system. Health systems are weak because of decades of failure to invest in
basic health infrastructures, services, and staff.10 These weaknesses have
become more visible because of the unprecedented drive to improve health. We
have powerful interventions, from excellent vaccines and medicines to
long-lasting insecticidal bednets, for reaching the health-related
Millennium Development Goals (MDGs). What we lack are the systems for
delivering these interventions to those in greatest need.

We will not be able to reach the health-related MDGs unless we return to the
values, principles, and approaches of primary health care. A recent WHO
report1 found striking inequities in health outcomes, access to care, and
what people pay for care. Many health systems have lost their focus on fair
access to care, their ability to invest resources wisely, and their capacity
to meet people's needs and expectations. To steer health systems toward
better performance, the report called for a return to primary health care.
When countries at the same level of economic development are compared, those
where health care is organised around the tenets of primary health care
produce a higher level of health for the same investment.

This approach to health is people-centred, with prevention considered as
important as cure. As part of this preventive approach, primary health care
tackles the root causes of ill health, including in non-health sectors, and
offers an upstream attack on threats to health. As the report1 noted, better
use of existing interventions could prevent 70% of the global disease
burden.

The financial crisis comes at a time when commitment to global health has
never been higher. It comes in the midst of the most ambitious drive in
history to tackle the root causes of poverty, reduce the gaps in health
outcomes, and ensure that the benefits of social and economic progress are
more evenly distributed. A fair, efficient, and affordable system of health
care is our best insurance policy, our best route to health security.

Investment in health systems and services is investment in human capital.
Healthy human capital is the foundation for productivity and prosperity.
Equitable distribution of health care and equity in the health status of
populations is the foundation for social cohesion, which is our best
protection against social unrest.

At the end of 2007, nearly 3 million people in low-income and middle-income
countries were receiving antiretroviral therapy for AIDS,11 and we should
thank the G8 for its contribution to this achievement. But, if funding dries
up in this or other areas, the health sector can produce fairly precise
estimates of what will happen, measured by the number of lives lost. Human
suffering and misery are not as easily calculated, but our common humanity
should make us care on this count as well. I believe that when the G8 takes
on a health issue, they give a human face to the political leadership that
our world so greatly needs.

The net result of all our international policies should be to improve the
quality of life for as many of the world's people as possible. Greater
equity in the health status of populations, within and among countries,
should be regarded as a key measure of how we, as a civilised society, are
making progress. Strengthened health systems, ideally based on primary
health care, are indeed the route to greater efficiency and fairness in
health care and greater security in the health sector and beyond.

I am the Director-General of WHO.

References
1 WHO. The world health report 2008—primary health care: now more than ever.
http://www.who.int/whr/2008/en/index.html.(accessed Dec 17, 2008).
2 African Development Bank. Gender, poverty and environmental indicators on
African Countries, vol 9.
http://www.afdb.org/pls/portal/docs/PAGE/ADB_ADMIN_PG/DOCUMENTS/STATISTICS/GENDER%202008_WEB.PDF.
(accessed Dec 17, 2008).
3 UNICEF. The state of the world's children 2008.
http://www.unicef.org/sowc08/docs/sowc08.pdf. (accessed Dec 17, 2008).
4 WHO. Monitoring the achievement of the health-related Millennium
Development Goals.http://www.who.int/gb/ebwha/pdf_files/EB124/B124_10-en.pdf.
(accessed Dec 17, 2008).
5 Maxwell D, Levin C, Armar-Klemesu M, et al. Urban livelihoods and food and
nutrition security in Greater Accra, Ghana.
https://www.who.int/nutrition/publications/WHO_multicountry_%20study_Ghana.pdf.
(accessed Dec 17, 2008).
6 Drewnowski A, Specter SE. Poverty and obesity: the role of energy density
and energy costs. Am J Clin Nutr 2004; 79: 6-16.PubMed
7 Stern N. The economics of climate change: the Stern review.
http://www.hm-treasury.gov.uk/stern_review_report.htm.(accessed Dec 17,
2008).
8 Cruz RV, Harasawa H, Lal M et al eds. Intergovernmental Panel on Climate
Change, 4th assessment report: impacts, adaptation and vulnerability. 2007:
469—506. http://www.ipcc.ch/ipccreports/ar4-wg2.htm (accessed Dec 17, 2008).
9 Jack A. From symptom to system. Financial Times.
http://www.ft.com/cms/s/0/2318ea9c-6d60-11dc-ab19-0000779fd2ac.html?nclick_check=1.
(accessed Dec 17, 2008).
10 Freedman LP, Waldman RJ, de Pinho H, et al. Who's got the power?
Transforming health systems for women and children.London: Earthscan, 2005.
11 WHO. Towards universal access: scaling up priority HIV/AIDS interventions
in the health sector.
http://www.who.int/hiv/mediacentre/2008progressreport/en/index.html.
(accessed Dec 17, 2008).
a WHO, CH-1211 Geneva 27, Switzerland

_______________________________________________
WOW!
Claudio
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