Mark Small

Second, factors chosen are not accurate gauges. Response: WHO used 5 indicators: overall level of pop’n health; health inequalities; overall health sys responsiveness; distribution w/in pop’n; & distribution of sys financial burden (who pays the costs). 6/23

1: WHO states: on overall level of population health: good health system contributes to good health. WHO uses measure of disability- adjusted life expectancy (DALE); directly comparable to life expectancy & readily compared across populations. 7/23

2: Health inequalities: (1) not sufficient to protect or improve avg health of population, if at same time inequality worsens or remains high because the gain accrues disproportionately to those already enjoying better health. 8/23

Health inequalities: (2) sys also has responsibility to try to reduce inequalities by prioritizing actions to improve the health of worse-off, wherever these inequalities are caused by conditions amenable to intervention. 9/23

Health inequalities: (3) objective of good health is 2-fold: best attainable avg level (goodness) & smallest feasible differences among individuals & groups (fairness) Gain in either w/no change in the other = improvement. 10/23

3: Responsiveness: 2 major components. (a) respect for persons (dignity, confidentiality & autonomy of individuals & families to decide own health); (b) client orientation (incl prompt attention, access to support networks, quality of basic amenities & choice of provider). 11/23

4: Distribution of Financing: objectives of the health system do not include any particular level of total spending because, at all levels of spending there are other possible uses for the resources devoted to health with no correct answer. 12/23

Distribution of financing: report suggests that countries spending less than around 60 dollars per person per year on health find that their populations are unable to access health services from an adequately performing health system. 13/23