As nations seek to strengthen their health systems, they are increasingly looking to primary health care (PHC) to provide a clear and comprehensive sense of direction. The World Health Report 2008 analyses how primary health care reforms, that embody the principles of universal access, equity and social justice, are an essential response to the health challenges of a rapidly changing world and the growing expectations of countries and their citizens for health and health care. The Report identifies four interlocking sets of PHC reforms that aim to: achieve universal access and social protection, so as to improve health equity; re-organize service delivery around people's needs and expectations; secure healthier communities through better public policies; and remodel leadership for health around more effective government and the active participation of key stakeholders. This Report comes 30 years after the Alma-Ata Conference of 1978 on primary health care, which agreed to tackle the "politically, socially and economically unacceptable" health inequalities in all countries. Much has been accomplished in this regard: if children were still dying at 1978 rates, there would have been 16.2 million child deaths globally in 2006 instead of the actual 9.5 million. Yet, progress in health has been deeply and unacceptably unequal, with many disadvantaged populations increasingly lagging behind or even losing ground. Meanwhile, the nature of health problems is changing dramatically. Urbanization, globalization and other factors speed the worldwide transmission of communicable diseases, and increase the burden of chronic disorders. Climate change and food insecurity will have major implications for health in the years ahead thereby creating enormous challenges for an effective and equitable response. In the face of all this, business as usual for health

systems is not a viable option. Many systems seem to be drifting from one short-term priority to another, increasingly fragmented and without a strong sense of preparedness for what lies ahead. Fortunately, the current international environment is favourable to a renewal of PHC. Global health is receiving unprecedented attention. There is growing interest in united action, with greater calls for comprehensive, universal care and health in all policies. Expectations have never been so high. By capitalizing on this momentum, investment in primary health care reforms can transform health systems and improve the health of individuals, families and communities everywhere. For everyone interested in how progress in health can be made in the 21st century, the World Health Report 2008 is indispensable reading.