WHO urges “coverage for all, not coverage of everything”

BMJ 1999; 318 doi: (Published 15 May 1999) Cite this as: BMJ 1999;318:1305
  1. Phyllida Brown
  1. London

    Governments must ensure that good health care is accessible to everyone, but they should not attempt to provide all possible treatments, according to the World Health Organisation's annual report. The report was launched this week as the UN agency's member states gather for their annual assembly on 17 May.

    The report suggests that governments must provide cost effective services to prevent and treat their nation's most pressing health problems, and so reduce the disproportionate burden of disease on the poor and help economic growth. But it marks a significant shift in the WHO's stance from its declaration in 1978 that health was “a state of complete physical, mental, and social wellbeing and not merely the absence of disease” towards a realistic acceptance of the need to set priorities to make the best use of resources for all within society. “Choices have to be made, and they must be made in a way that involves the people,” said David Nabarro, head of the WHO's roll back malaria project, at a launch of the report in London.

    Nabarro, who previously advised the UK government's Department for International Development on health, said that rationing was often described pejoratively but that its use was a reality. “I, personally, have always taken the view that you cannot think about health care without also thinking about the available resources,” he said. In its emphasis on the economics of health, the WHO is echoing the agenda first set out in the World Bank's 1993 World Development Report, Investing in Health.

    The WHO is calling for a concept of a “new universalism” in providing access to health care. “Universal coverage means coverage for all, not coverage of everything,” states the report. Priorities should be set on the basis of the resources available to each government, and the cost of “top priority health interventions” such as childhood immunisations, safe motherhood, and tobacco control.

    The report rejects the market approach to health care. Health systems are best financed from central government taxes and by prepayment, and not by charging fees at the point of service, which is unfair and inefficient, it says.

    As their populations age, nations face a dual burden of the new “epidemics” of non-communicable diseases and injuries as well as the “unfinished agenda” of infection, malnutrition, and maternal and perinatal conditions. The report identifies four challenges for governments and international agencies: firstly, to focus health systems on delivering those interventions that will have the greatest impact on the poor; secondly, countering major threats to health, such as tobacco and antibiotic resistance; thirdly, developing health systems that offer universal access to services; and fourthly, encouraging health systems to invest in research and development.

    The World Health Report 1999: Making a Difference is available from the WHO at bookorders{at}

    Embedded Image

    David Nabarro from the WHO warned that choices must be made

    (Credit: ULRIKE PREUSS)

    View Abstract

    Sign in

    Log in through your institution

    Free trial

    Register for a free trial to to receive unlimited access to all content on for 14 days.
    Sign up for a free trial