Transcript of WHO podcast - 15 October 2008

World Health Report launched, calls for return to primary health care approach

Veronica Riemer: You’re listening to the WHO podcast. My name is Veronica Riemer and this is our special 60th anniversary episode number 50.

2008 is not only the World Health Organization's 60th anniversary, but it also marks the 30th anniversary of the Alma-Ata Declaration. Back in 1978, the declaration identified primary health care as the key to the attainment of the goal of Health for All and emerged as a major milestone of the twentieth century in the field of public health. This year, WHO has chosen primary health care as the theme for its annual report, which is launched in Almaty -- this is present-day Alma-Ata -- in Kazakhstan on 14 October.

Dr Halfdan Mahler, Former Director-General of WHO from 1973 to 1988, addressed the 61st World Health Assembly in May this year. He explained the consensus concept of primary health care in the declaration.

Dr Halfdan Mahler: Primary Health Care is essential health care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It forms an integral part of the country's health system of which it is the central function and main focus, and of the overall social and economic development of the community.

It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process. Alma-Ata was, in my biased opinion, one of the rare occasions where a sublime consensus between the haves and the have-nots in local and global health emerged in the spirit of a famous definition of consensus.

The Alma-Ata primary health care consensus also reflects a famous truism: "The Health Universe is only complete for those who see it in a complete light, it remains fragmented for those who see it in a fragmented light!"

Veronica Riemer: The 2008 World Health Report is entitled Primary health care - now more than ever. The aim of primary health care is to ensure that everyone, both rich and poor, has access to the services and the conditions necessary for realizing the highest level of health. It includes organizing health systems to provide quality and comprehensive health care to all, particularly the poor and other disadvantaged people.

Today, health systems are falling short in many countries. To address this, the 2008 World Health Report proposes four inter-linked goals for strengthening health systems based on a revitalized primary health care approach. Dr Wim Van Lerberghe, from the WHO Health System and Services Department came into the studio to explain further.

Dr Wim Van Lerberghe: If you take a long-term view, what happened in the last 30 years, the world is much better off now than it was 30 years ago. On average, people live seven years longer. But the world could have been a lot better off than it is also. What we are seeing is that health systems are not performing as well as they could. People expect to have access to health care and access to health care where they are not treated as either a number or a target for a programme but where they are treated as persons and where they receive care that goes from what they need to prevent disease, what they need to promote health but also what they need to treat them when they are sick and also what they need to relieve their suffering. So they want person-centred care.

People don't just want access to health services: they also want to live in communities where they know their health is being protected against drugs, against unsafe food, against environmental threats. They want to do this in a way that they don't have to sell their farm to pay for their health services. This is what happens in a number of countries: half of the sales of farms are in order to pay the doctor's bill. There is a third area of change that is needed in health systems: we need to move towards universal coverage where services are available for people, where they are accessible, that there are no financial hurdles to access services and where they are protected against the financial consequences of getting health care.

These expectations of people put unprecedented pressure on health policy makers but also on the political world to start to respond to these expectations. People want to be able to trust their health authorities that are going to take care of them and that means that we need to reinvest in leadership capacity to steer the health sector in the right direction. And primary health care is the smartest way we know at this moment to work to use our money well.

Veronica Riemer: Now, more than ever, there are opportunities to start changing health systems towards primary health care in all countries. The challenges are different for countries with different income levels, but they have much in common. There is more money being spent on health than ever before and more knowledge to address global health challenges, including better medical technology. WHO Director-General Dr Margaret Chan shares her view on the role of primary health care.

Dr Margaret Chan: The World Health Report sets out a better way to manage and deliver health care. Primary health care is a people-centred approach to health that makes prevention as important as cure. As part of this preventive approach, it tackles the root causes of ill health, also in non-health sectors, thus offering an upstream attack on threats to health.

A primary health care approach is the most efficient, fair, and cost-effective way to organize a health system. It can prevent much of the disease burden, and it can also prevent people with minor complaints from flooding the emergency wards of hospitals. Decades of experience tell us that primary health care produces better outcomes, at lower costs, and with higher patient or user satisfaction.

Veronica Riemer: That's all for this episode. Thanks for listening to the WHO 60th anniversary podcast.

If you have any comments on our podcast or have any suggestions for future health topics do drop us a line. Our email address is Podcast@who.int.

For the World Health Organization, this is Veronica Riemer in Geneva.