The World Health Report sets the agenda, but there's still a long way to go

Papers p 307

In June 2000 the World Health Organization provided a long awaited answer to the question beloved of politicians and journalists: “How does the health system in country X compare with that in country Y?” The results, published in the World Health Report 2000,1 delighted some governments, such as that of France, which came first, but infuriated others, such as Brazil, at 125. The rankings are based on measures of achievement of five health system goals. The achievement of health is seen as a core objective of a health system, so goals are a high level of health and a fair distribution. A health system should also be responsive to popular expectations. This includes respect for individuals (autonomy and confidentiality) and client orientation (prompt service and quality of facilities). As with health, the resulting goals relate to the absolute level of responsiveness and its distribution. The fifth goal is fair financing, with expenditure reflecting ability to pay rather than risk of illness.

In this week's BMJ some of the authors of …