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

[Claudio Schuftan]

YOU RECEIVED THIS, ALISON, NO?  OF ANY HELP TO YOUR WRITING?
CLAU


On 1/21/09, Claudio Schuftan <cschuftan at phmovement.org> wrote:
>
>
> 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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