ABSTRACT
Politicians are prepared to speak of the rationing of healthcare, but in reality all systems have finite resources, so planning decisions are as much about deciding what is not going to happen as what is. The challenges facing any healthcare system may therefore be represented in terms of a series of conflicts pulling the system in different directions. All governments should formulate national policies, strategies and plans of action to launch and sustain healthcare as part of a comprehensive national health system and in coordination with other sectors. The United Kingdom (UK) has one of the strongest emphases upon primary healthcare and its health promotion role. In reality, the two biggest reductions in killer diseases in the UK in the 1990s were as a direct result of healthcare interventions: reduction in cervical cancer deaths in women, due largely to systematic screening and reduction in lung cancer deaths in men, due largely to reductions in smoking.
