“There are countries in our Region and in the world that have managed to build health systems that effectively guarantee universal and equitable access, that are collective and participatory, and that at the same time ensure efficiency, effectiveness, and quality. All of these systems are based on primary health care.”

- Mirta Roses Periago
Director, Pan American Health Organization

The Region of the Americas has made impressive health gains over the past quarter-century, as measured by nearly every key indicator. Since the early 1980s, infant mortality has declined by more than one-half, deaths from communicable diseases are down nearly as much, and average life expectancy has gained six years.

Unfortunately, these gains reflect only averages and mask continuing, often gaping, inequities in health across and within countries of the Region. Life expectancy is 20 years longer for people from the richest countries in the Americas than for people from the poorest countries. Within some countries, the wealthiest individuals live 30 years longer than the poorest. Sixty percent of all maternal deaths in the Region occur in just the poorest one-third of countries. The current global economic downturn and newly emerging health threats-especially the rapid rise of chronic noncommunicable diseases-threaten countries’ overall health gains while exacerbating inequities, as they impact disproportionately on the poor and the vulnerable.

To address these challenges, the Pan American Health Organization’s (PAHO) Member States, with support from PAHO’s Secretariat, have undertaken major efforts to reform and restructure their health systems with the aim of making them more efficient, more effective, more accessible, and more inclusive. The best of these efforts are being guided by the principles and strategic orientations of a new vision of primary health care, which PAHO and the World Health Organization (WHO) have identified as the most effective approach for promoting equitable and sustainable improvements in health.

This report highlights PAHO Member States’ advances in implementing reforms and interventions oriented toward the new primary health care vision, as well as PAHO’s role in encouraging and supporting those advances. Through this report, PAHO hopes to further promote this new approach to primary health care and thereby strengthen efforts throughout the Region to advance the vision and the reality of “Health for All.”