Comparing population health (original) (raw)

The 2000 World Health Report (WHR2000) identifi ed three fundamental goals for a health system: improving the health of the population it serves; responding to the reasonable expectations of that population; and collecting funds to do so in a way that is fair (WHO, 2000). In this chapter, we focus on the fi rst of these: improving population health. Before doing so, however, we summarize briefl y the work that has taken place on this issue so far. The authors of the WHR2000 faced a challenge. They were required to estimate performance for all 191 of the WHO Member States, of which only about 60 had any data on causes of death. Consequently, the only measure of population health outcomes available to them was mortality, and even then it was necessary to produce estimates for many countries, based on empirical relationships with other measures, such as economic status (McKee, 2010). This determined their chosen defi nition of the health system, which they decided would include "all activities, whose primary purpose is to promote, restore and maintain health". The actual indicator used was disability-adjusted life years, which incorporated a measure of morbidity, but again this was estimated for most countries. This approach was the only one possible given the need to include so many countries. Although controversial, it has served as a basis for many of the subsequent developments in assessing health systems performance. It was also consistent with a considerable body of previous research on the performance of countries worldwide that had also used mortality-based measures of health outcome (although more often infant and under-fi ve mortality), which are available from Demographic and Health Surveys for many countries without vital registration systems.