Elsevier

The Lancet

Volume 357, Issue 9269, 26 May 2001, Pages 1698-1700
The Lancet

World Health Report 2000
World Health Report 2000: a step towards evidence-based health policy

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Social systems and goals

In his critique, Navarro repeatedly refers to the “medical care system”, but in the WHO framework, used in the World Health Report 2000, the health system is defined broadly to include all individuals, groups, organisations, and associated resources whose primary intent is to improve health. For example, our definition includes efforts to reduce road traffic fatalities by making roads safer, policies to change the national diet, as well as personal health services and health interventions

Attainment and efficiency

Differentiation between attainment and efficiency in health systems is crucial. Every society should be concerned about attainment of standards of health, responsiveness, inequalities in both of these, and fairness in financial contribution. What explains variation in these five key outcomes is an important scientific issue. Table 9 in the World Health Report 2000,9 contained the best available evidence on attainment of these outcomes. But, what was the contribution of the health system to

Assessment of health system goals

Navarro also questions our specific measures of health, responsiveness, and fairness in financial contribution. In the World Health Report 2000, healthy life expectancy was used to gauge average population health. This measure includes the mortality of a population and the prevalence of individuals in less than full health. We intend, as detailed in the WHO Framework, to assess inequalities in health expectancy; but methods and datasets have restricted us to measurement of inequalities in child

Accountability and transparency

At the heart of the debate on the achievement and efficiency of health systems is accountability. Some might argue that the health system should not be held accountable for factors that are outside its direct managerial control. Take, for example, tobacco consumption. Should the health consequences of tobacco consumption be excluded from assessment of the efficiency of a health system? We strongly believe that would be wrong. An efficient health system is one that uses the ethical and effective

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