London School of Hygiene & Tropical Medicine

Martin McKee, Professor of European Health at the London School of Hygiene & Tropical Medicine has contributed one of three commentaries appearing today in the journal Health Policy and Planning, each of which take a different perspective on the World Health Report 2000 on health systems (WHR2000).

It is ten years since the publication of WHR2000, a controversial document which many at the time believed had been published prematurely, and which introduced a new system of performance rankings applied to the health systems of each country. McKee recalls how few observers believed that the World Health Organisation would sanction such a system, given its sensitivity to complaints from health ministers in member states and the lengths its legal department go to in order to avoid appearing critical. Yet, in what he calls 'an act of remarkable courage', it did, leading to predictable responses from the winners and losers.

The tenth anniversary, and the forthcoming publication in November of the World Health Report 2010 on health systems financing, provide an ideal opportunity to reflect on the report's significance, and the changes it brought about.

McKee recalls the criticisms levelled at the report at the time, which ranged from accusations of being 'pro-market' to a claim by one US commentator, in an early taste of the arguments that President Obama would have to address almost a decade later, that the WHO was adopting a Marxist stance by arguing for any more than a token role for the state in providing health care. He also considers the difficulties compiling information on all 192 WHO Member States, some of whom barely functioned and many of which lacked control over all their territory and even the most basic information.

He argues that far from being premature, and despite its limitations, the report succeeded in placing the assessment of health system performance firmly on the political and research agendas. It emphasised that providing money for health care is not enough unless consideration is also given as how to supply those things that make it possible to deliver health care, such as trained staff, pharmaceuticals and appropriate facilities. Crucially, he says, the report stimulated a major programme of research and analysis, and considerable improvements in the availability of data, although there is still much to be done.

'Perhaps the greatest achievement of the 2000 World Health Report was to place health systems performance on the political agenda', says McKee. 'It is now much more difficult for a politician to dismiss comparative data on performance; perhaps this is the report's greatest legacy'.

The two other commentaries have been produced by Dr Julio Frenk, Dean of Harvard School of Public Health, who was involved in the design and execution of the report during his time as Executive Director of Evidence and Information for Policy at WHO, and Di McIntyre, Professor and South African Research Chair in 'Health and Wealth' at the University of Cape Town. Dr Frenk focuses on the context and content of the Report, discussing its important conceptual contributions and the concerns raised by some governments regarding the measurement of health system performance, while Professor McIntyre focuses on how the report contributed to health system financing, and led to more equitable financing and access to health care.