To derive a set of weights for the different achievements that compose
overall attainment, WHO conducted a survey of 1006 respondents from 125
countries, half from among its own staff. The questions were designed to
elicit not only views about how important each goal is relative to the others
(for example, responsiveness compared to health status), but also opinions
about what kind of inequality matters most. The responses were
checked for consistency and bias, and yielded nearly identical values in each
of many different groups – poorer versus richer countries, men versus
women, WHO staff versus other respondents. The final weights are shown
in the table.
As expected, health is regarded as the most important
of the objectives, clearly the primary or defining
goal of a system. But fully half of the concern
for health is a concern for equality, not simply for a
high average. Taking “health” apart into two goals
emphasizes the great value of fairness, and not only
of goodness. This is fully consistent with WHO’s concentration
on the poor, the least healthy, the worstoff
in society. Equal weights also result from the
survey for the overall level and for distribution or
equality where responsiveness is concerned. In total,
how the system treats people in non-health aspects
is as important as either health level or health equality. And fairness in how health is paid for, which is not a major traditional
concern of WHO or the ministries of health it deals with and supports,
receives the relatively large weight of one-fourth, equal to that for
responsiveness. Both in this case and in that of responsiveness, the weight
assigned by respondents probably reflects the direct or intrinsic importance
of the objective, and also the indirect or instrumental contribution it
makes to achieving good health; it is difficult to separate these two aspects.
There is clear agreement that a well-functioning health system
should do much more than simply promote the best possible level of overall
health.
The exercise of weighting the five objectives also
provides values for the relative importance of
goodness and fairness. Together, the levels of
health and of responsiveness receive a weight of
three-eighths of the total. The three distributional
measures, which together describe the equity of
the system, account for the remaining five-eighths.
Countries which have achieved only rather short
life expectancies and cannot adequately meet
their peoples’ expectations for prompt attention
or amenities may nonetheless be regarded as having
health systems which perform well with respect
to fairness on one or more dimensions.