Health transition in middle-income countries: new challenges for health care

Concepts behind current health systems are no longer adequate for dealing with the growing complexity of the health arena, both internationally and nationally. It is now too simplistic to classify world health in bipolar terms, such as East versus West, or North versus South. Conversely, epidemiologic differentiation within each country is now producing internal polarization: diminishing health care budgets may increase competition for scarce resources between two different groups of health problems —the left-over ills, caused mainly by common infectious diseases and malnutrition; and the emerging threats of chronic ailments, accidents, mental disorders, and now AIDS. In this situation, the former group is likely to lose out. It is imperative to avoid this pernicious competition by developing new health care models that assume a population-based responsibility. Unless comprehensive and cost-effective solutions to the two groups of health problems are provided simultaneously we risk an unacceptable paradox: instead of being an instrument for equity, health services may serve to increase social inequality.